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Losing weight: the mind game
Why is it that every time you shed a few pounds, you gain them back (and then some)? Because most dieters have it all wrong: They focus on what goes into their stomachs instead of what's going on in their stomachs instead of what's going on in their heads. AIMEE LEE BALL reports on four unconventional approaches to weight loss that work because they recognize that it's not the food--it's you. EVERY WOMAN who's ever tried to lose weight probably has a stationary bike turned into a clothing rack, not to mention the exact calorie count of a half cup of cottage cheese etched on her brain. And that's a lot of women: The most recent government statistics show that more than a third of American adults are trying to lose weight. Yet with two-thirds of this country's adults either overweight or obese, it's reasonable to surmise that all this dieting isn't working. The good news is, it's possible to break free of traditional--and counterproductive--dieting habits. Compelling evidence suggests that the secret is changing your relationship to food. Body Wisdom The idea of a nondiet diet has been around for at least 20 years. The premise of books such as Diets Don't Work and Overcoming Overeating was that you don't need Jenny Craig or anybody else telling you how many fat grams or net carbs you can eat. In 1995 a book called Intuitive Eating argued that we enter the world programmed to feed ourselves without getting fat. "If you give babies milk and they're done, you can't get any more milk into them," says the book's coauthor, Elyse Resch, a registered dietitian and nutrition therapist in Beverly Hills. "Toddlers can leave a cookie on their plate and not even think about it. But adults have all this debris from media, dietitians, doctors, peer groups. I wanted people to learn to trust themselves." Now a professor of health science at Brigham Young University is trying to prove that intuitive eating works. He has a personal interest: Steven Hawks, EdD, struggled with weight all his life until he embraced the principles of what he calls body wisdom and lost 50 pounds in one year. In a study reported in the American Journal of Health Education in 2005, Hawks asked female college students to agree or disagree with statements such as "After eating I often realize that I am fuller than I would like to be" and "When I feel especially good or happy, I like to celebrate by eating." The results provided tentative evidence that intuitive eating may be a healthy alternative to dieting: Women who ate in response to hunger (as opposed to social cues or emotional needs)--and stopped eating when their bodies were satisfied--had lower body mass indexes and significantly reduced risk for cardiovascular disease. "Research says hunger has two aspects: the need for sustenance and the desire for palatability," Hawks says. "You must find ways to honor both but not use food to manage stress or cope with life. One strategy that has lots of promise is mindfulness meditation: recognizing the relationship between eating and what you're feeling, and learning how to identify why you eat what you eat and how it makes you feel." Being mindful of eating just enough to satisfy hunger requires being hyperconscious until you know your own foibles. "It's not good for me to eat with the TV on," says Lara Berman, 26, a graduate student at the University of Southern California. "I look down and the plate is empty, and I don't even know what the food tasted like." Berman shares such insights with an intuitive eating support group every week. "The trap is thinking that anything said in the group is the 'right' way," she cautions. "Intuitive eating is, by definition, personal." Berman's system includes keeping a chart to identify what different levels of hunger feel like. "I used to eat because it was mealtime," she says. "It could have been a small portion or everything that wasn't nailed down. Now I take a moment before I eat and ask: What am I hungry for? Something crunchy, salty, warm, cold, fresh, light? I really tune in and listen to my body." But tuning in isn't only about what you cat; it's also about when you eat it. "Most of us get hungry three to four hours after our last meal, but not everyone has the same symptoms," Resch says. "It's not always an empty stomach. Sometimes it's a headache or getting cranky." Paying attention to these symptoms--and heeding their call--can prevent what Resch calls primal hunger, a scenario in which the brain senses the threat of semi-starvation and releases a chain of amino acids that strongly stimulate appetite. Hawks, who uses a scale of 1 (starving) to 10 (stuffed) to track his hunger, knows that such constant monitoring might seem like drudgery. Yet intuitive eating, in one important regard, is hugely freeing: No foods are off-limits, so long as you stay in touch with hunger. Hawks is now conducting two long-term studies: one with a local community of overweight people, the other with eating disorder patients, using intuitive eating as a recovery tool. "The theory I'm trying to test is that dieting triggers an abnormal, unhealthy relationship with food," he says. "I want to get away from good and bad, acceptable and unacceptable. Exposure and allowance reduce the urge to binge. Without them, you will constantly be a victim of the food environment we live in." "You Are Getting Thinner ..." A trance that takes off weight sounds too good to be true, but hypnosis has been embraced by scientists. Because the hypnotic state is characterized by heightened concentration and responsiveness to instructions, proponents say it can help break routines, separate a desire to eat from the impulse to act on it, and imprint new eating patterns on the subconscious mind. In a 1996 analysis of several studies, Irving Kirsch, PhD, of the University of Connecticut, found that the addition of hypnosis to psychotherapy appeared to have a significant effect on weight loss: Those using it lost an average of nearly 15 pounds; those not using it, only six. "What hypnosis does is get around having to wait for change," says Deirdre Barrett, PhD, assistant clinical professor of psychology at Harvard Medical School and president of the American Psychological Association's Division 30, a.k.a. the Society of Psychological Hypnosis. "For some things, the minute you make the change, you get the result. If you quit smoking, you're a nonsmoker the next day. But the day after you decide to lose weight, you don't necessarily look thinner. Hypnosis can let you experience in vivid fantasy the results you want." The hypnotist comes up with suggestions based on the subject's goals. "Someone might want to have more energy and not get winded from walking," explains Barrett. "Someone else might mention seeing grandchildren grow up. I might talk them through looking in a mirror and seeing themselves swimming laps. It's vivid imagery, and for some people it's completely hallucinatory. 'Experiencing' the change can be very motivating." David Spiegel, MD, associate chair of psychiatry and behavioral sciences at Stanford University School of Medicine, plants the idea that the body is an innocent creature and needs to be saved from harm. In a study he coauthored, reported in the International Journal of Eating Disorders, patients under hypnosis were asked to repeat phrases such as "For my body, overeating is a poison" and "I owe my body this respect and protection." The impulse to eat certain foods is not denied but rather weighed against the commitment to protect the body. "You can think of traditional hypnosis as an external power pack for your superego," says Jeffrey K. Zeig, PhD, director of the Milton H. Erickson Foundation in Phoenix (named for a psychiatrist who was a leading 20th-century proponent of hypnotherapy). The suggestions might be positive ("You'll put down your fork between each bite") or negative ("You won't eat any white food"). But Zeig goes further by combining hypnosis with experiential tasks. For Debbie Competello, he came up with the idea of "divorcing" bad eating habits and "marrying" healthier ones--he actually had her sign a contract and go through a ceremony. "I had allowed food to be the controlling element of my life. Nothing else mattered," says 54-year-old Competello, a management trainer in Phoenix. "Hypnosis was important in getting to some of the underlying issues. Under hypnosis we went to what we called an archive, and I pulled out all the things that were bothering me that I didn't want to keep anymore." Competello describes hypnosis as a surrendering of her body--"but not where somebody says words and suddenly you're quacking like a duck. You might imagine yourself at a table in a fancy restaurant with beautiful china. You sit down, pick up a fork, put food in your mouth, chew, swallow, have a conversation. You feel what that's like, and you have an assignment to carry out that task. The power of suggestion under hypnosis penetrates better." It seems to have penetrated for Competello: After a lifetime of pursuing "every diet that ever came on the market," she lost 163 pounds over two years. It's the Thoughts That Count There's a talking pizza (or hot fudge sundae or bacon cheeseburger) in the life of every dieter--a particular food that woos with an irresistible siren call. A branch of psychology known as cognitive behavioral therapy might help you talk back. CBT teaches that unwanted feelings and behaviors (obsessions, phobias, addictions) come from a certain kind of thinking, which can be replaced with thoughts that lead to more desirable reactions. "CBT teaches self-counseling skills," says Aldo Pucci, president of the National Association of Cognitive Behavioral Therapists, whose clinical practice in Weirton, West Virginia, is called the Rational Living Therapy Institute. In the case of weight management, these skills are meant to help identify thoughts that make it difficult to adhere to a diet plan. "What are you thinking as you're unintentionally self-sabotaging?" Pucci asks. "Often a low tolerance for frustration plays a role. People want to lose a hundred pounds in a week, and if they don't have rapid weight loss, they either starve themselves or eat everything in sight. We try to get them to develop frustration tolerance and patience so that they have an approach that's reasonable for them." Every emotion and behavior is caused by an attitude or thought, Pucci says. Some thoughts are so well learned that they're stored and automatically triggered, like reacting with your foot when you see the red brake lights on the car ahead of you. "The more you know about the thoughts that go with different kinds of emotions," Pucci says, "the better you are at uncovering them." And when you uncover them, you can dispute and replace them. In a group seminar called Rational Eating, Pucci instructs participants to look at what they're thinking when they feel something they don't want to feel or do something that isn't productive or healthy. When one overweight woman admits that she thinks of herself as a freak, Pucci responds with his ABC's: awareness, belief, and (emotional) consequence. A is awareness of her size. B is her belief that she's grotesque and worthless. C is a feeling of depression. Yet if she changes her thought to I'm not a freak but a person who is unhappy with her size, she feels calmer and more in control. A 2004 study at University Hospital in Geneva, Switzerland, showed the most significant weight loss when CBT was combined with nutritional education and a physical activity program. CBT is one of the most effective treatments for binge eaters and yo-yo dieters, according to Rene D. Zweig, PhD, director of the Eating Disorders and Weight Management Program at the American Institute for Cognitive Therapy in New York City "The idea is to break the cycle of being obsessed with weight and food and dieting that leads to feelings of deprivation and hunger and overeating," she says. "People become rigid in their thinking and sometimes in their behavior; they feel trapped, like they need to exert more control. It's counterintuitive, but the more they let go, the more they are able to eat moderately, relax around food, and stop being so critical based on weight and appearance." Zweig tries to counter what she calls all-or-nothing thoughts, such as I ate a few cookies, so I've blown my diet. A better thinking pattern would be: Oops, I made a mistake. Let me turn it into a learning experience, and not beat myself up or count this day as a waste. This is one bad choice. Clients plan meals ahead of time and eat every three to four hours. "Structuring eating breaks some of the thinking that willpower is good, that dieting equals control," says Zweig. "And when they practice not eating between meals, it helps them ride out urges to eat and get their hunger signals back. In time they learn to recognize when they're hungry versus when they see tempting food." She also has clients keep an eating record to identify emotional eating triggers. "We challenge the thought that they can't be safe around certain foods, like potato chips. I'll have them plan to eat some chips when they're not going to be around an infinite supply--a small bag instead of a big bowl at a party. There's a balance between easing up on some of the rules and at the same time holding yourself accountable." The Spiritual Solution A group leader for the weight loss program called First Place posed a question: "Why do you want to lose weight?" One woman called out, "To bring God glory," and the leader replied, "C'mon, get real." Sheepishly, the heavyset woman changed her answer: "I want to be able to cross my legs," she said, to which another woman added, "... under a table." But a divine presence is very much on the minds of those in First Place, whose tagline is "the Bible's way to weight loss." The group began at Houston's First Baptist megachurch and now has more than half a million members across the country, who make a series of "commitments" including Bible study, Scripture memorization, and prayer. "We started out believing that God was interested in the whole of our being," says Carole Lewis, who was part of the original group and is now national director. "If we could pray about our finances or our marriages, we realized we could pray about our weight. The Bible clearly says that our bodies are on loan," Lewis notes. "First Corinthians says: 'Your body is a temple of the Holy Spirit, who is in you, whom you have received from God. You are not your own; you were bought at a price. Therefore honor God with your body. " TAMARA FISHER, A 31-YEAR-old mother of four in Rock-wall, Texas, had tried many diet plans before losing 140 pounds with First Place over the past two years. "A lot of times when you're overweight, you live in denial," she says. "But I couldn't hide from God--I couldn't sneak a candy bar in the pantry without God knowing." One of the First Place commitments involves keeping a written record of food intake, which reminds Fisher of her responsibility to have a strong and nourished body. Verses of Scripture that strike a meaningful chord become a kind of mantra. "It's not like I see an apple pie and get down on my knees to pray that I don't eat it," she says. "I do my Bible studies in the morning, and I feel refreshed for the rest of the day. I can think of them and refer to them. People who are not Christians would probably say that I had an inner voice before this program and now I can hear it." A nonspecific "higher power" is substituted for willpower in Overeaters Anonymous, an international "fellowship" of people who are recovering from compulsive eating. There is no weigh-in or recipe sharing at meetings (about 6,500 OA groups meet each week in more than 60 countries). There's no religious imprimatur, either--the organization has a plurality of religions, as well as atheists and agnostics, in its midst. What OA offers is group support and, like its older sibling Alcoholics Anonymous, a set of spiritual principles called the 12 steps and the 12 traditions that are said to promote inner change. God--often with the qualifying phrase "as we understand him"--is referenced in half of the 12 steps. "I had stopped eating for physical nourishment, instead using food the way an addict uses drugs--to satisfy difficult feelings, emotional hungers, and a spiritual void," says Michael, a midwestern member (anonymity is prized in the organization). "OA looks upon compulsive overeating as a physical symptom of an emotional problem with a spiritual solution." The spiritual aspect of another faith-based program called Pathways, administered by trained lay health educators at seven Chicago churches, helped lead to a clinically significant weight loss for women who had failed at typical diets. "A lot of diets oversimplify, dummy it up," says Michael T Quinn, PhD, a researcher in the University of Chicago's department of medicine. "They teach people that there are bad foods and good foods. So rather than just saying fried foods are bad, our program taught people to monitor energy expenditure and energy intake--calories in, calories out." Weekly meetings followed scripts, starting with self-assessment: Why do I want to lose weight? How confident am I that I can? What skills do I need to acquire? (If it sounds odd to characterize losing weight as a matter of skill, Quinn points out that in a supersize culture, "simply identifying a normal serving size has to be learned.") On average, Pathways participants lost ten pounds over the 14 weeks of the program and kept the weight off for eight months of follow-ups. The spiritual common ground provided a different environment from, say, a Weight Watchers meeting, according to Quinn. "I was struck by the amount of palpable social support. These were connected people. They not only attended church together on Sundays but had choir practice on Thursdays, church suppers on Fridays." The very nature of those suppers changed with Pathways. As Quinn says, "You'd be surprised about the healthy modifications you can make to macaroni and cheese." Though there's a big difference between reading scripture and keeping a hunger chart, or between limiting potato chip intake and going into a trance, all four of these approaches to weight loss aim to help people get beyond what Hawks calls extrinsic eating: eating in response to emotional or social cues, or because there's a box of doughnuts on your coworker's desk. "People treat their emotions and behaviors as if they're approaching a patch of ice on the road, where it doesn't matter how you turn the steering wheel--you're out of control," Pucci says. "But unless you're pickled with alcohol or drugged or there's something wrong with your body, you're always in control of your behavior. Sometimes you just control yourself in ways that you later wish you hadn't." As the "nondiet" diets show, the key to adjusting the controls may be found in any number of places. So whether you're more comfortable in a church pew or on a therapist's couch, the goal is to find the support system that will encourage you not to give up. In weight loss as in everything else, one insight doesn't fit all.
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