Many years ago, an eminent obesity researcher was explaining why weight-loss drugs or diets rarely produced permanent weight loss. Dr. George Bray compared weight gain to emotional disorders like depression, panic attacks or anxiety. "No one," he said, "would treat a patient only once with an antidepressant or anti-anxiety drug, and then, if the mood disorder returned, tell the patient that he or she was to blame for not staying mentally healthy. But," he went on to say, "that is the attitude we have toward the obese patient. When weight is regained after a diet or weight-loss drug treatment, we blame the patient for not staying thin rather than diagnosing the behavioral, brain or hormonal changes that might have caused the weight to return."
No one wants weight to be regained after a successful weight-loss treatment, least of all the dieter. But it is time to be realistic about the likelihood that it will occur. The statistics on what is called recidivism, i.e. sliding back into old eating and exercise patterns, are clear. Most everyone regains weight. Even those who have had surgery to limit food intake often start to overeat eventually, halting their weight loss and even causing weight gain. We have stopped being surprised at these statistics. Yet we continue to blame the overeater for his or her lack of will power. They are told to "just eat less and start going to the gym." What we should be doing instead is pinpointing the reasons the eating cannot be controlled and developing therapies to help the individual regain a healthy eating pattern.
Common causes of repetitive weight gain are overwork, lack of sleep, sickness, travel and urgent social and family obligations. As John Tierney points out in a recent New York Times article, when life goes out of control, willpower may be insufficient to keep eating, and an exercise schedule, in control. He cites the example of an obese businessman who hired personal trainers to supply him with diet-appropriate meals and maintain his exercise program when business forced him to live in a hotel for many weeks. This dieter succeeded in continuing to lose weight, but most dieters would have given up their attempts and resigned themselves to not losing or even gaining weight under similar circumstances.
Dieters who keep losing and gaining weight may be doing so because of reoccurring work situations that cause them to overeat and under-exercise (think accountants and tax season, political staff during reelection campaigns, and holiday retail sales for a store owner). They are experiencing overeating "flare-ups" because during these periods, they are simply unable to eat and exercise as they should.
Flare-ups are common for many chronic conditions. Imagine someone who gets asthma when exposed to cats. This person keeps his asthma under control with appropriate medication and avoidance of felines. But when he visits his in-laws, who have a house full of cats, he suffers a severe asthma attack. A doctor would never tell the asthma sufferer that he was a failure at asthma control because he wheezed through a weekend with his wife's parents. Rather, the patient would be treated for the asthma attack and perhaps advised as to how to deal with the in-laws' cats in the future.
Is a weight-loss therapist or physician as understanding when her patient abandons his diet and gains weight? Is the response to weight gain that he is not a failure at eating control and that it is obvious that intense work, too little sleep and no time to exercise caused the weight gain? I suspect that compassion and understanding toward the fat patient is not as forthcoming.
Rather than blaming dieters for yet another diet failure, they must be reassured that once the period of overeating is over (like the tax season or political campaigns) they should resume their weight-loss food plan and exercise program. And, just as the asthmatic patient is helped to avoid another feline-induced attack, dieters should be helped to plan a better eating and exercise strategy during the next anticipated overeating flare-up.
Overeating flare-ups due to emotional upheavals are less predictable, but also damage or destroy a diet. And since much overeating is tightly linked to stress, then these flare-ups might reoccur often during the lifetime of the dieter.
Willpower is irrelevant when someone is fighting the urge to eat in order to diminish emotional pain. Blaming someone for not being able to get eating under control when anxiety, depression, tension and anger are overwhelming is as cruel as telling someone who is suicidal that he should stop feeling sorry for himself.
The emotional overeater must be helped so that eating provides adequate nutrition, encouraged to use exercise to rid the body of the physical tension caused by the stress and told how to eat to diminish the emotional pain. Although diets will usually be abandoned for the duration of the crisis, the dieter should be encouraged to follow a food plan that will diminish her stress and minimize overeating. These foods are low-fat carbohydrates that promote serotonin synthesis and serotonin's ability to increase calmness and satiety.
Ultimately, dieters who are plagued by chronic overeating flare-ups may be able to diminish their severity because they learn from past experience how to handle the situations that are causing them to stop following a calorie-conscious food plan. Just as with a medical flare-up, professionals such as therapists, life coaches, trainers or nutritionists should scrutinize overeating episodes and strategies developed to minimize weight gain. Most important, the expectation of the dieter must be realistic. Just as the asthma sufferer knows that he is always going to be vulnerable to cats, the chronic weight gainer and loser knows that there will always be situations that provoke a flare-up of overeating. The goal is to make such flare-ups short and to return to normal eating as quickly as possible.
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