At a dinner with friends a few days ago, someone commented that his parents would not even recognize some of the foods we were consuming. “My father insisted on red meat at least six times a week,” he said. “If he saw this seaweed salad and brown rice, he would assume it was for our pet bird.” Indeed, if one compares the way people ate 50 to 60 years ago with the food choices today, it is obvious that our options have changed immensely. We know much more about what is healthy and unhealthy to eat. In the middle of the last century, few were concerned about calories, cholesterol, transfat, anti-oxidants, high fiber or omega-3 fatty acids. Foods found in supermarkets today, like bok choy, tofu, oat bran, fat-free Greek yogurt and sushi, were almost unknown. Back then, only a few so-called health-nuts made any connection between food and the quality and longevity of lives. Food was eaten to take away hunger and prevent malnutrition; that was all.

However, our current focus on the impact of food on our physical and mental health did not occur overnight. We did not wake up one morning, throw out the cold cuts and start eating soy products. It took decades to recognize that we should use canola oil rather than solid white shortening and eat more fish and less red meat. Our healthier food habits developed very slowly, and many of us are still struggling to make them a habit.

The story is entirely different for dieters. When they go on a diet, they are asked to make radical and instantaneous changes in their food choices. They are told to stop preparing meals with butter, cheese, cream, bacon and eggs and start using low-calorie ingredients instead. Familiar, comforting foods like macaroni and cheese and meat loaf must be abandoned, and steamed spinach with poached salmon eaten instead. 

Most important, instead of making these changes over years, the dieter must make these modifications in a New York minute. The diet plan is presented, the guidelines reviewed, and diet foods put in the refrigerator. Fattening foods are thrown out and the diet begins.

For dieters, making these changes is like moving to “Thin Country,” where everything is new and disorienting. This place, with its restrictions, forbidden foods, portion control, demands to exercise, and insistence on making food choices based on nutrient and caloric content, rather than taste alone, feels strange and uncomfortable. Anyone who has traveled to a place where the language and customs are hard to decipher is familiar with the bewilderment and even helplessness that comes from not knowing how to communicate. The dieter staring at a bunch of kale in the supermarket or trying to figure out what to order at a restaurant where every item is coated with batter and fried may feel the same confusion and helplessness.

Keeping the weight off after the diet is over is even harder. It is the difference between staying in a strange country with the knowledge that you will go back home in a few weeks and emigrating to a new land. Losing weight is like being a tourist with an extended visa. Keeping it off means applying for citizenship.

Obesity experts have failed to recognize that the dieter who has reached the end of his diet and taken up residence in “thin country” needs as much support to survive as any new immigrant.  If the dieter is to keep his weight off permanently, then he needs help in dealing with the issues that caused the weight to be gained, strategies for resisting the temptation to go back to his old ways of eating, aid in making him feel comfortable in his newly thin body, and ways of dealing with those around him who don’t believe he will succeed in staying slim.  

Compare the absence of group support for successful dieters to the presence of support for people who stopped drinking. Recovering alcoholics can find meetings everywhere, every day, to help them maintain sobriety. Where are the comparable support groups for the formerly fat who are now thin? Except for some weight-maintenance programs that deal mainly with modifying food intake to keep weight stable, there really are no groups to help the dieter who has reached his goal adjust to a life of being permanently thin. 

For example, many newly thin people feel that they are being treated differently than when they were obese and don’t know how to deal with this. I have had weight-loss clients who complained that they were always the same inside so why were they being treated better now that they are thin? Why were they now getting attention from the other gender when they were ignored while fat? The newly thin need to form new friendships with people who speak the language of healthy eating, rather than returning to old friends who speak the language of overeating and poor food choices. That decision, and the action that it requires, only adds to the difficulty of maintaining new lifestyle choices.

Many of us who are now thin after years of being obese should reach out to those who have just crossed the border into this country. Like any new immigrant, they need our help and support to stay on the road to better health and long term happiness. Isn’t that what all newcomers seek, after all?    

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