CCO Public Domain/Free for Commerical Use
Source: CCO Public Domain/Free for Commerical Use

By Julie Jarrett Marcuse, Ph.D.

Literature on dieting suggests that, in the long run, most diets don’t work. Weight loss is followed by weight gain, often more than the pre-diet weight. This “yo-yo” experience is familiar and frustrating! Let’s take a deeper look at this problem.

To begin with, using the term "dieting" dooms it to failure. The dieter abruptly shifts into a mode of restriction with the goal of rapid weight loss. The more draconian the diet, the more the body becomes its own worst enemy.

Why Is this Happening?

When the body is starved, our Darwinian wiring for survival kicks into place. The fewer calories consumed, the more metabolism slows. The body releases the hormone leptin, thus increasing appetite and hunger. So people eat more. And they get discouraged, which tends to prompt emotional eating, that is, eating for the purpose of self-soothing rather than a response to physical hunger.

The desire for rapid weight loss can be great enough to temporarily override the body’s craving for food. Indulgence followed by restriction involves a fantasy that by force of will bingeing can be controlled.  This is not true. Studies show that radical restriction can permanently slow down the body’s metabolism. Success is far more likely if done with optimism, awareness, and patience.

The Myth of Willpower

Dieting has a punitive quality that makes it extremely difficult to sustain. At some point self-deprivation becomes tedious and unpleasant. Punishment frequently generates a sense of entitlement to some reward. This leads to cheating. How many times have you heard someone exclaim, “I’ve been so good; I’ll just have this one cookie!” People may describe this experience as “losing their willpower.” They may be overestimating the mind’s capacity to rule the body.

A Hopeful Strategy

I would like to suggest a strategy for weight loss developed for a patient in my practice. She was a thoughtful and appealing 28-year-old obese woman. She had “failed” to lose weight following many different diet plans over the prior decade.  She came to me with feelings of numbness alternating with periods of depression. She felt completely disconnected from her body. She refused to get on a scale, look in the mirror or consult a physician. The only way she knew she was gaining weight was that she needed to replace her clothes with larger and larger sizes. She rarely mentioned her weight in our sessions. More than a year went by. I realized that I would need to initiate the conversation that she was avoiding.

I needed a strategy before I could ask her to delve into such painful territory and wanted to “reframe” dieting as a path to achievement, rather than a futile struggle. Most diets are passive, depriving and intrinsically shaming. For my patient, they were humiliating, unsuccessful experiments. How might I empower her?

Not surprisingly, her weight was a deep source of shame and despair. We came to understand that by binging she was attacking herself. But the layers of fat were also protection against closeness and vulnerability. She was terrified of rejection and disappointment.

Going Back To Square One

We talked about the years before she left home. At that time, without much conscious effort, she was slim. We started to work on a model of returning to, or redeveloping, her inherent capacity for self-regulation. I was not convinced my approach would work, but the stakes were high. I was worried about her. I explained that words and attitudes were powerful and could alter behavior. My patient was intrigued. I felt encouraged!

Hope

My patient had never thought of losing weight as a process of reclaiming a lost capacity. There was never an optimistic spin. Given her experience with diets and dieting, she had an extensive knowledge of nutrition and calories. Like most obese people, she knew precisely how to lose weight, but she could not sustain her motivation. She often felt discouraged and even hopeless. We needed to develop a slow, gentle and sustainable plan, initially no more than 1 pound each week.

Each pound lost was conceptualized as a gift to herself, a restoration, a return to her inherent capacity to self-regulate. She gradually set “health goals” for the week, for the month and for the year.

This encouraging stance is a strategy worth considering. My patient has lost 40 pounds and feels her motivation and resolve deepening. She is becoming more attuned to her body, developing a sense of when she is hungry for food and when she is hungry for acceptance, validation and love.

Feeling Empowered

If obesity has been an issue since childhood, there is no self-regulation to reestablish. But whenever the onset, it is essential to reframe dieting as an empowering process, rather than a depriving one. It can only be sustained in a health oriented, upbeat context. In the words of my patient, ”I used to feel so ashamed of myself. But each month I hang in there, I feel proud.”

Julie Jarett Marcuse, Ph.D., is a psychologist/psychoanalyst in private practice in Manhattan. She works with adults using an eclectic psychodynamic approach. Her clinical specialties are anxiety, depression, relationship issues, gender issues, eating disorders, and emotional trauma. She just completed an 11-year tenure as Head of the Sexual Abuse Service at the William Alanson White Institute.

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