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Judith J. Wurtman, PhD

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The Recovering Overeater

Posted: 05/21/2012 12:34 pm

There are certain changes in behavior that seem unlikely to last without continuous vigilance. People who once were alcoholics, and are now abstinent, do not consider their recovery complete. Rather, they call themselves "recovering alcoholics" and are constantly aware of the temptation to go back to drinking. Ex-smokers will tell you the number of years, months, weeks, and days they have been without a cigarette, and many admit that they still crave the feeling of nicotine in their system. But the ex-smoker, or ex-alcoholic, will not allow himself to take one drink or smoke one cigarette for fear that he will not be able to stop. For him, recovery is an ongoing process with constant temptations to revert to old behavior.

But this vigilance to maintain abstinence from alcohol or nicotine does not seem to extend to many who have completed a weight-loss program. Perhaps this is the fault of diet programs that proclaim permanent weight loss or, "You will never have to diet again." Whatever the reason, many who have completed a diet will allow themselves to go back to eating high-fat meals, snack foods and desserts, as well as the calorie-laden drinks they consumed prior to their diet. And, unfortunately, the first bite of the cookie, potato chip, bacon cheeseburger or other foods whose calorie content is incompatible with maintaining weight loss wipes out any control over subsequent bites.

Many years ago I witnessed someone who had just ended a successful 50-pound weight-loss diet take the first bite into weight gain. She announced, as we were handed menus, that this was her first post-diet restaurant meal, and she was planning to eat everything she couldn't eat on the diet. Her dessert was three scoops of gourmet ice cream and two small pitchers of hot fudge sauce, a specialty of the restaurant. She lovingly spooned up every melted bit of ice cream and sauce, telling me how much she had looked forward to this meal. The end of the story is predictable. Within that year she gained more than 75 pounds and has not lost the weight again.

My friend was like many dieters who stop setting limits on the kinds and amounts of food they eat once a diet is over. As soon as she allowed herself to eat what she wanted, and paid no attention to how much she was eating, a chain reaction of overeating was set off. In a sense, she was like a recovering alcoholic, or ex-smoker, whose previous behavior returns because vigilance and self-discipline were relaxed.

Might her weight have stayed off if she understood that the end of the diet did not mean the end of self-discipline, willpower and mindful eating? Would she have avoided her subsequent weight gain if she accepted herself as an overeater in recovery but not recovered?

Researchers at the National Institute of Diabetes and Digestive and Kidney Diseases have given mathematical proof to the need for this post-dieting caloric vigilance.[1] Carson Chow, an MIT-trained mathematician and physicist, and Kevin Hall, a mathematical physiologist, developed a formula that would predict how many calories a person should consume to lose weight and subsequently keep it off. The factors that were plugged into this model included height, weight, exercise, food intake, and the changes in how the body uses energy during and after weight loss. They found mathematically what physiologists have known for decades. Weight loss slows metabolism so the body needs considerably less food than it did at a higher weight. The frustratingly slow pace of weight loss that occurs as a dieter nears his or her goal is due to the body's need for fewer calories than required at the start of the diet. According to their figures, it may take as long as three years for weight to stabilize at a lower level, and this is, of course, only if the diet or maintenance program is followed.

Should this mathematical model of weight loss and maintenance lead to a new behavioral model? Should dieters, like abstinent alcoholics, consider themselves permanently in recovery rather than recovered? Indeed, if we scrutinize the way those who successfully maintain a lower weight do it, the answer is yes. People who have struggled with weight loss and finally make it to the weight they wish to maintain are models of caloric vigilance.

Those who maintain successful weight loss watch their portion size, fat and sugar intake and daily calorie consumption. They rarely indulge in highly caloric food or beverages. If they do give into temptation, they compensate by increased restraint during subsequent meals. Weight is monitored weekly, if not daily. Exercise is as constant in their routine as brushing their teeth. Like the ex-smoker who still craves the cigarette or the ex-drinker who longs for a glass of wine, these slim, healthy eaters drool over sky-high chocolate cake or crispy fried chicken. But, like the ex-smoker and ex-drinker, they won't allow themselves to eat these foods. As a friend just told me yesterday at a reception where luscious-looking canapés were being passed, "If I take one, I will take 20, so I never take one."

This regimen probably sounds dreadful, and a typical response when presented with such a routine of edible deprivation is, "Life is too short to deny myself what I want to eat." But the unfortunate truth is that life is going to be even shorter for those who do not pay attention to what they can and cannot eat. If the mathematicians are right, our post-dieting bodies are primed to defeat our efforts at maintaining weight loss. But we can win this battle of weight maintenance by admitting that our desire to overeat never goes away. As long as our desire to control never goes away as well, we will win. And, by the way, it is 12 years, three months and two weeks since I ate fried chicken.

References:

[1] The Lancet, Volume 378, Issue 9793, Pages 826 - 837, 27 August 2011
"Quantification of the effect of energy imbalance on bodyweight." Dr. Kevin D. Hall, Ph.D., et. al. The Lancet. Vol. 378, Issue 9793, Pages 826-837. 27 Aug 2011. DOI: 10.1016/S0140-6736(11)60812-X

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