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exercise for life, have social support, understand behavioral self-
control methods, and confront their personal-emotional-interpersonal
problems directly.
The strength and tenacity of bad eating habits is shown by Perri's
(1998) review of the effectiveness of weight loss programs with obese
patients. Most programs take off some weight and some programs
continue the maintenance of weight loss by extending the treatment
and using phone calls as follow up. But, as Perri says, maintenance
effectiveness tends to dissolve after termination. That means that you
have to pay as much attention to relapse prevention as to
weight loss. See Relapse Prevention in chapter 11 to control your
impulse eating and re-start the weight loss plan as soon as you regain
two pounds!
Opinions differ about dieting. The professionals who work with
anorexics and bulimics caution against diets because severe dieting is
seen so often in their clients' history (they favor exercise rather than
diets). To prove their point a recent study found that the 8%-10% of
teenage girls who dieted severely were eighteen times more likely to
develop an eating disorder than girls who had not dieted. (It shouldn't
surprise anyone that diets are the first step but the study underscores
that severe dieting may serve as a warning sign.) Another group of
professionals simply say all diets are bad because they don't work in
the long run. On the other hand, professionals dealing with very
overweight clients consider diets to be a main solution to serious
health problems. The facts are: obesity is certainly a health risk;
weight loss is usually beneficial but can increase certain risks, e.g. yo-
yo dieting year after year is associated with certain chronic diseases;
diets do work (maintenance often fails); learning how to maintain
weight loss is badly needed (Brownell & Rodin, 1994).
Many diet centers and hospitals offer classes for extremely
overweight people which provide detailed knowledge about how the
body uses food, the role of fiber and fat, how to prepare better meals,
and how much exercise is needed. Many (indeed, most) people don't
know these things about nutrition, but once they know exactly how
their diet and exercise program needs to be changed, they will often
do it. I urge you to get that knowledge. Two of the better current
books about fat and nutrition are by Bailey (1991, 1999) and Ornish
(1993). Bailey also has four PBS videos (1-800-645-4PBS). It is
commonly thought that very strict diets will be so unpleasant that
people will not stick with them, but research has shown that stricter
diets are actually more effective. Strict diets tend to be simpler and
easier to follow.
Losing weight may require attention to your feelings and
interpersonal relationships. Obviously, if overeating is a misguided
attempt to handle some emotional pain, the emotions need to be dealt
with. See Abramson (1993) for ordinary "emotional eating" and
Sandbeck (1993) for the shame, guilt and low self-esteem that often
underlie bulimia or anorexia. Virtue (1989) and LeBlanc (1992) also
