In the writing of this book, we have changed the names and occupations of all of our personal clients so that their true identities will not, in any way, be revealed, in order to maintain their anonymity. In addition, we use the pronouns we and us when referring to our work with individual clients, rather than specifying each time which of us has worked with a par tic ticu u lar client. It should be noted, howe however, ver, that each of us has a private clientele; we do not see clients together as a team. When referring to an event in the private life of either of us, we do differentiate between us by putting in parenthesis the initials of the one involved— hence, (ET) refers to Evelyn Tribole and (ER) refers to Elyse Resch. ��������� ������. Copyright © 1995, 2003, 2012 by Evelyn Tribole, M.S., R.D., and Elyse Resch, M.S., R.D., F.A.D.A., C.E.D.R.D. All rights reserved. Printed in the United States of America. Amer ica. For information, i nformation, address St. Marti Ma rtin’ n’ss Press, P ress, 175 175 Fifth Fif th Avenue, Avenue, New York, N.Y N.Y. 10010. 10010. www.stmartins www .stmartins.com .com ISBN 978-1978-1-250-0 250-0 0404 0404-8 -8 (trade paperback) paperba ck) ISBN 978-1-250-01418-4 (e-book) First Edition: August 2012 10
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Chapter 1
Hitting Diet Bottom
I just can’t can’t go on another a nother diet, d iet, you’ you’re my last resort. resor t.”” Sandra had been be en dieting all her life and knew she could no longer endure a single diet. She’d been on them all, Atkins, Dukan, The Zone, South Beach, grapefruit diet . . . diets too numerous to itemize. Sandra Sand ra was a dieting pro. At �rst dieting was fun, ev even en exhilarating. exhila rating. “I always always thought, this th is diet would be different, di fferent, this time.” And so the cycle would recharge with each new diet, each and every summer. But the weight lost would eventually rebound like an unwanted tax bill. Sandra had hit diet bottom. By now, however, she was more obsessed about food and her body than ever. She felt silly. “I should have had this dealt with and controlled long ago.” What she didn’t realize was that it was process cess of dieting that had done this to her. Dieting had made her more the pro preoccupied pre occupied with food. Dieting had made food the enemy. Dieting had made her feel guilty g uilty when she wasn’t wasn’t eating dietd iet-typ types es of foods (even (even when she wasn’t of�cially dieting). Dieting had slowed her metabolism. It took years for Sandra Sandr a to truly tr uly know dieting dieti ng doesn’t doesn’t work (yes, she was was familiar with the emerging concept that dieting doesn’t work, but she always thought she would be different dif ferent). ). While most experts and consumers accept the premise that fad diets don’t work—it’s work— it’s tough for a nation of people obsessed with their bodies to believe that even “sensible dieting” is futile. Sandra had been hooked into modern-age modern-age social mythology, the “big diet hope,” for most of her life since her �rst diet at the age of fourteen. By the age of thirt thi rty y, Sandra felt stuck—she stuck—she still wanted to lose weight weight and was uncomfortable in her body. While Sandra couldn couldn’’t bear bea r the thought t hought of another diet, she didn’t realize that most of her food issues were actually caused by by her dieting. Sandra was also frustrated and angry—“I know
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everything about diets.” Indeed, she could recite calories and fat grams like a walking nutritional database. That’s the big caveat—losing caveat— losing weight and keeping it off is not usually a know k nowledge ledge issue. issue. If all we needed to be normal weight was knowledge about food and nutrition, most Americans wouldn’t have weight problems. The information is readily available. (Pick up any women’’s magazine, women magazi ne, and you you’ll ’ll �nd diets d iets and food comparisons compar isons galore.) galore.) Also, the harder you try tr y to diet, the harder ha rder you fall (it (it really hurts hur ts not to succeed if you did everyt everything hing right r ight). ). The best description descr iption for for this th is effect is given by John Foreyt, Ph.D., a noted expert in dieting psychology. He likened it to a Chinese �nger puzzle (the hollow hollow cylindrical straw puzzle, into which you insert an index �nger on each end). end). The harder ha rder you try to get out, the more pressure you exert, exert, the t he more dif�cult dif �cult it it is to get out of the puzzle. Instead you �nd yourself locked in tighter . . . trapped . . . frustrated. SYMPTOMS OF DIET BACKLASH
Diet backlash is the cumulative side effect of dieting—it dieting— it can be short term or chronic, depending how long a person has been dieting. It may be just one side effect or several. By the time Sandra came to the of�ce, she had the classic symptoms symptoms of diet backlash. Not only diet weary wear y, she was eating less food, yet had trouble t rouble losing weight during her more recent diet attempts. Other symptoms included: • The mere contemplation of going on a diet brings on urges and cravings for “sinf “sinful” ul” foods and “fatty “fat ty favorites,” favorites,” such as ice cream, chocolate,, cookies, and so forth. chocolate • Upon ending a diet, going on a food binge and feeling guilty . One study indicated that post post--dieting binges occur in 49 percent of all people p eople who who end a diet. • Having little trust in self with food. Understandably, every diet has taught you not to trust your body or the food you put in it. Even Even though it is the process pro cess of dieting that fails you, the failure continues to undermine underm ine your relationship relationship with food. • Fe Feeling eling that you don’ don’tt deserve to eat, be because cause you you’’re overweight. • Shortened dieting duration. The life span of a diet gets shorter and shorter. (Is it no wonder that Ultra Slim-Fast’s Slim- Fast’s sales pitch is, “Give us a week . . . and we’ll . . .”
Hitting Diet Bottom
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• The Last Supper. Every diet is preceded by consuming foods you presume you won’t won’t eat again. Food consumption consu mption often goes goe s up during this time. It may occur over one meal or over a couple of days. The Last Supper seems to be the �nal step before “dietary cleansing”—almost cleansing”— almost a farewell-tofarewell-to-food food party par ty.. For one clien client, t, MariMar ilyn, every meal felt as if it were her last. She would eat each meal until she was uncomfortably stuffed, as she was terri�ed ter ri�ed she would never eat again. For good reason! She had been dieting since the sixth grade— grade—over over two-thi two-thirds rds of her life! life! She had attempted periods of fasting and a series of low calorie diets. As far as her body was concerned, a diet was only around the corner—so corner—so better eat while you can. Each meal for Marilyn Mari lyn was famine relief. relief. • Social withdrawal. Since it’s hard to stay on a diet and go to a party or out to dinner, it just becomes easier to turn down social invitations. invitati ons. At �rst, social food avoidance avoidance may seem like li ke the wise thing to do for the good of the diet, but it escalates into a bigger problem. There’s There’s often a fear of being b eing able to stay in control. It’s It’s not uncommon for this experience to be reinforced by “saving up the calories or fat grams for the party,” which usually means eating very little. But by by the time t ime the dieter arrives ar rives at the party par ty,, ravenous ravenous hunger dominates and eating feels very out of control. • Slugg Sluggish ish metabolism meta bolism. Each diet teaches the body to adapt better for the next self-imposed self-imposed famine (another diet). Metabolism slows as the body ef�ciently utilizes each calorie, as if it’s the last. The more drastic the diet, the more it pushes the body into the ca loriepinching survival mode. Fueling metabolism is like stoking a �re. Remove Remove the wood, and the �re � re diminishes. dim inishes. Similarly, Similarly, to fuel metabolism, we must eat a suf�cient amount of calories, or our bodies will compensate and slow down. • Usin Using g caffeine caf feine to survive the day. Coffee and diet dri drinks nks are often abused as management tools to feel energetic, while being underfed. disorders. Final • Eating disorders. Finally ly,, for some, repeated dieting d ieting is often the stepping-stone steppingstone to an eating disorder (ranging from anorexia nervosa or bulimia, to compulsive overeating). Although Sandra felt she could never never diet again, she still engaged in the t he Last Supper phenomenon. (We regularly encounter this when we see somesome one for the �rst time.) time.) She literally ate higher quantities qua ntities of food food than tha n usual,
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and ate plenty of her favorite foods (she thought she would never see these foods again). It’s as if she were getting ready for a long trip and was packing extra clothes. Just the thought of working on her food issues put her into the pre-diet pre-diet mentality, mentality, a common com mon occurrence. While Sandra was just beginning to understand the futility of dieting, her desire to be thin had not changed—clearly changed— clearly a dilemma. She held on to the allure of the noble American dream. THE DIETING PARADOX
In our society, the pursuit of thinness (whether for health or physique)— has become the battle cry of seemingly every American. Eating a single morsel of any high fat or nonnon-nutritionally nutritionally redeeming food is punishable by a life sentence of “guilt” by association. You may be paroled, however, for “good behavior.” Good behavior, in our society, means starting a new diet, or having good intentions to diet. And so begins the deprivation cycle of dieting—the dieting— the battle of the bulge and the indulge. Rice cakes one week, Häagen-Dazs HäagenDazs the next. “I feel guilty just letting the grocery clerk see what I buy,” lamented another client, who happened to hav havee her cart stock stocked ed with fru fruits, its, vegetabl vegetables, es, wholee grains, whol gra ins, pasta, and a small pint of real ice cream. It’s as if we live in a Food Police state run by the food ma�a. And there always always seems to be a dieting offer you can’t refuse. Exaggeration? No. There’s a good reason for Disorders— s—The The Jourthis perception. A study published in 1993 in Eating Disorder nal of Treatment and an d Prevention found that between 1973 and 1991, commercials for dieting aids a ids (diet (diet food, reducing aids, a ids, and diet d iet program foods foods)) increased nearly linearly linea rly.. The researchers also noted that there is a parallel para llel trend trend in the occurrence of eating disorders. They speculate that t hat the media med ia pressure to diet (via (via commercials) is a major in�uence in the eating disorder trend. The pressure to diet is fueled beyond televi tele visio sion n commercials. com mercials. Magazine articl ar ticles es and movi movies es contribute to the t he pressure to be slim. Ev Even en subtle cigarette billboards aim for the female Achilles’ heel—weight—with heel— weight—with names such as Ultra Slim 100, Virginia Virgin ia Slims, and so on. A Kent cigarette, “Slim Lights,” especially characterizes this tug on women’s body issues. Their ad reads more like li ke a commercial for a weight weight loss center than for a cigarette, by highlighting slender descriptions: “long,” “lean,” “light.” Of course the models in cigarette ads are especially slender. It is no surprise that the
Hitting Diet Bottom
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Total number of diet product commercials and total number of diet food commercials as a percent of total commercials, 1973–1991. Reprinted with permission from: Wiseman, Claire et al. Increasing pressure to be thin: 19 years of diet products in television commercials. Eating Disorders: The Journal of Treatment & Prevention. 1(1):55, 1993.
Center for Disease Control (CDC) attributed an increase in smoking by women to their desire to be thinner. Sadly, we have heard women contemplate in our of�ces that they too have considered taking up smoking again as a weight loss aid. But weight loss is not just a women’s women’s issue (although clearly there’ t here’ss added add ed pressure on women). The proliferation of light-beer light-beer commercials has planted the seed of body consciousness in men’s minds, as well—a well— a lean belly is better bet ter than th an a beer belly b elly.. It’s It’s no coincidence we we’’ve seen the t he launch of magazines aimed at men, such as Men Men’’s Fitness Fitness and Men Men’’s Health. Health. While Wh ile the pursuit of leanness has crossed over over the gender barrier, bar rier, sadly sadly,
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INTUITIVE EATING
we have given birth to the �rst generation of weight watchers. A disturbing new dieting trend is affecting a ffecting the health hea lth of U.S. U.S. children. Shocking studies stud ies have demonstrated that school-age school- age children are obsessing about their weight—aa re�ection of a nation obsessed with diet weight— d iet and weight. Around the country, children as young as six years old are shedding pounds, afraid of being fat, and are increasingly being treated for eating disorders that threaten th reaten their t heir health and growth. Societal Societal pressure to be thin has back�red on children. Dieting not only does not work, it is at the root of many problems. While many may diet as an a n attempt to lose weight weight or for health reasons, the parapa radox is that it may cause more harm. Here’s what our nation has to show for dieting: • Obesity is higher than ever ever in adults adults and children. • Eating disorders disorders are on the rise. • Childhood obesity has doubled doubled over over the last de decade. cade. • Ev Even en though there are more fat-free fat-free and diet foods than ever before, nearly two-thirds two-thirds of adults are ov overweigh erweightt or obese. • Over twelve twelve hund hundred red tons of fat have have been liposuctioned liposuctione d from 1982 to 1992. (A recent study showed that only one year after having a liposuction procedure the fat returned, but to a different part of the body.) • Dieting increases your your chance of gaini gaining ng even even more more weight weight than you lost! (See “Dieting Increases Your Risk for Gaining More Weight!” on page 7.) DIETING CAN’T FIGHT BIOLOGY
Dieting is a form of short-term short-term starvation. Consequently, when you are given the �rst opportunity to really eat, eating is often experienced at such intensity that it feels uncontrollable, uncontrolla ble, a desperate act. In the t he moment of biological biological hunger, all intentions to diet and the desire to be thin are �eeting and paradoxically irrelevant. In those moments, we become like the insatiable man-eating maneating plant in the movie Little Shop of Horrors, demanding to eat— “Feed me, feed me.” While Whi le intense eating may may feel out out of control, and unnatural, it is a normal norma l response to starving and dieting. Yet Yet so often, of ten, postpo st-diet diet eating is viewed as
Hitting Diet Bottom
7
having “no willpower,” or a character defect. But when you interpret postdiet eating as such, it slowly erodes trust in yourself with food, diet after diet. Every diet violation, every every eating e ating situation that t hat feels out of control lays the foundation for the “diet mentality,” brick by brick and diet by diet. The seemingly brave solution—try solution—try harder next time—becomes time—becomes as bewildering as the Chinese �nger puzzle. You can’t �ght biology. When the body is starving, it needs to be nourished. Yet so often a dieter laments, “If only I had the willpower.” Clearly, this is not an issue of willpower. (Although glowing testimonials from weight loss clinics foster this misplaced m isplaced blame on willpow wil lpower. er.)) When underfed, you will obsess about food—whether food—whether from a self-imposed self-imposed diet or starvation star vation.. Maybe you don’t diet but eat vigilantly in the name of health and �tness. This seems to be the politi po litically cally correct term for “dieting” in the nineties. But for many, it’s the same food issue—with issue—with the same symptoms. Avoiding fat or carbohy ca rbohydrates, drates, at all costs, and subs subsisting isting virtually virt ually on fat-free fat-free or carbohydrate-free carbohydratefree foods is essentially dieting, and often results in being underfed. There are many forms of dieting and many types of dieters. We will explore your your dieting personality per sonality and meet the t he Intuitive Eater in the next chapter. chapter.
DIETING INCREASES YOUR RISK FOR GAINING MORE WEIGHT!
If dieting programs had to stand up to the same scrutiny as medications, they would never be allowed for public consumption. Imagine, for example, taking an asthma medication, which improves your breathing for a few weeks, but in the long run, causes your lungs and breathing to worsen. Would you really embark on a diet (even a so-called so- called “sensible diet”), if you knew that it could cause you to gain more weight? Here are some sobering so bering studies indicating that dieting promotes weight gain: • A team of UCLA researchers reviewed thirty- one long-term long-term studies on dieting and concluded conclude d that dieting is a consistent predictor predicto r of weight gain— up to two-thirds two-thirds of the people regained more weight than they lost (Mann, et al, 2007). • Research on nearly seventeen seventeen thousand kids ages nine nine to fourteen years old concluded, “. . . in the long term, dieting to control weight is not only ineffec in effective, tive, it may actually promote weight gain” (Field et al. 2003). cont.
INTUITIVE EATING
8 Continued
• Teenage Teenage dieters had twice the risk of becoming overweight, overweight, compared to non-dieting non-dieting teens, teens, according to a fivefive year - year study (Neumark(Neumark- Sztainer et al. 2006). Notably, at baseline, the dieters did not weigh more than their non-dieting non-dieting peers. This is an important detail, because if the dieters weighed more it would be a confounding factor (which would implicate other factors, rather than t han dieting, such s uch as gene netics). tics). A novel study on over 2,000 sets of twins from Finland, aged 16 to 25 years old showed that dieting itself, inde in depen pendent dent of gene genetics, tics, is significantly associated with accelerated weight gain and increased risk of becoming overweight (Pietilaineet et al. 2011). Dieting twins, who embarked on just one intentional intention al weight loss episode, were nearly two t wo to three times more likely to become overweight over weight,, compared to their non- dietin dieting g twin counterpart. Furthermore, the risk of becoming overweight increased in a dose-dependent dose- dependent manner, with each dieting episode. Studies aside— asid e—what what have your own dieting experiences shown you? Many of our patients and workshop participants say their first diet was easy— the pounds just melted off. But that first dieting experience is the seduction trap, which launches the futile pursuit of weight loss via dieting. We say futile— because our bodies are very smart and wired for survival. Biologically,, your body experiences Biologically exp eriences the dieting pro cess as a form of starvation. Your Your cells don’ don’tt know you are voluntarily volunt arily restricting your food fo od intake. Your Your body shifts into primal survival mode—metabolism mode— metabolism slows down and food cravings escalate. And with each diet, the body learns and adapts, resulting in rebound weight gain. Consequently, many of our patients feel like they are a failure—but failure— but it is dieting that has failed them.
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