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The Thin You Within You
Winning The Weight Game with Self-Esteem
By Abraham J. Twerski
St. Martin's PressCopyright © 1997 Abraham J. Twerski, M.D.
All rights reserved.
Why Do We Let People Insult Our Intelligence?
Every month, without fail, someone advertises a miracle diet guaranteed to reduce your weight quickly and dramatically and, as an added bonus, without starving yourself.
Let's think for a moment. If any of these phenomenal diets really worked, why would there constantly be a need for new and different ones? Why not just stick with the one that works? You might argue that people don't know which one is really effective, and that might be a valid argument — if the notion of dieting was recent. You could say the right diet hadn't been developed yet. However, dieting has been going on for years, month in and month out: diets, pills, exercises. Hundreds of gimmicks have been advanced over the years, and if any of these was really good, certainly it would have persisted.
It is not really accurate to say that these diets don't work. In fact, they do work, and that's part of the problem. Almost any diet will cause you to take off weight fairly quickly, but as most people have sadly found out, it is only a matter of time before the weight returns, and then some. The result is a yo-yo syndrome, and as some people have said, they have lost more than a thousand pounds over the years — and are still overweight.
If we were honest with ourselves, we would understand that these quick, surefire methods work for the short term, but none results in a long-term weight reduction.
Of course, if you are marooned on an island with nothing to eat but fish, you could indeed lose all the weight you wanted. But as soon as you returned to civilization, the weight would come right back. This is equally true of pills, diets, spas, surgery, and other gimmicks. None of these is sustainable over the long haul, and consequently the weight loss is short-lived.
Hope lives eternal, and each time a new promise of some magical method appears, we are vulnerable. "This time things will be different! The effects of the previous seventy-four diets didn't work, but this time I'll take the weight off and keep it off."
We know why we allow our intelligence to be insulted. We wish to deceive ourselves.
The only way to maintain a reduced weight is by a lifestyle change. We are always reluctant to make long-term changes because they can be uncomfortable. We are essentially creatures of habit. We do things a certain way, and our habits become integrated into our behavior. If you have any question about this, just transfer your wristwatch to the other hand. Even though it should not make the slightest difference on which hand it is worn, you will soon find that you are very aware of the change, and it may even feel cumbersome or awkward. Returning the watch to its usual place brings back a feeling of comfort. If feelings of discomfort accompany so minor an alteration, how much more so with significant behavior changes? It's easy to imagine why some people consider change virtually intolerable.
Another factor in our resistance to change is an intolerance for delay. Thanks to technological advances, most tasks can be accomplished with unprecedented speed. Distances that required weeks if not months of travel can now be traversed in hours. Cooking that used to take hours can be done in minutes. Written communications that took days to arrive at a destination appear in seconds, and calculations that required laborious, time-consuming effort can be done in a fraction of a second. We have come to expect things to happen fast. However, a lifestyle cannot change at a rapid rate; it may take years. Little wonder that people who are accustomed to microwaves, fax machines, and computers are impatient with a process that takes years and are susceptible to promises of methods that take only a few weeks.
If you are one of those who have tried umpteen diets and have come to the realization that your next diet is not likely to produce any more durable results than its predecessors, this book is for you.
Much of my work as a psychiatrist has involved treatment of alcoholism. When I began working with alcoholics, a very wise and seasoned therapist told me that the only word I should avoid using with my patients was "alcohol." Recovery from alcoholism requires a lifestyle change, and as long as the focus remains on alcohol, the real problem will remain unattended. This is equally true of food, and this is one reason why preoccupation with food and diet is counterproductive: It evades the real problem.
You will therefore not find in this book much mention of foods to eat or not to eat. Also, there is still no universal agreement on which foods to avoid or to emphasize: fat, proteins, carbohydrates. Each one has been championed or vilified throughout the years. Indeed, new and sometimes conflicting ideas about nutrition appear in the news every few weeks. How can we avoid being confused?
Obviously, we can use only the information we have, since we have no access to discoveries of the future. Furthermore, it is important to take a reasonable approach toward nutrition and not go overboard. For example, a recent finding that broccoli and spinach contain a cancer retardant does not mean that you must eat huge amounts of broccoli and spinach at every meal, but rather that these should have a place in the menu. Similarly, if it is found that a certain food may be harmful, this does not mean that it must be totally avoided. Usually the findings are based on foods fed to laboratory animals in amounts much larger than any sane person would eat.
There will always be people who champion dietary extremes, and there are many anecdotal claims for certain diets. Medical research has not confirmed any of these claims, and the reasonable approach is to have a well-balanced diet, based on the most reliable scientific information. The appendix at the end of this book contains current nutritional guidelines.
Eating problems involve two components: the person and the food. The various diets that have been unsuccessful in the long term have sought changes in the food. My approach is to deemphasize the food by avoiding fads and adhering to the general guidelines in the appendix and focusing instead on the necessary changes in the person. Let us now look at what some of these are.CHAPTER 2
Just What Is an Eating Problem?
When does eating become an "eating problem"?
The primary function of eating is to provide the body with its necessary nutrients. This function, in its purest form, is best observed in animals in their natural habitat. Animals in the wild are not obese or bulimic. When their nutritional needs are satisfied, they stop eating.
This situation in human beings is not as simple. Over and above its nutrient value, food has social and ritual values. Various religious services include eating or drinking, and many social activities center around food. "Breaking bread" together has symbolized friendship since ancient times. Although we may have met all our daily nutrition requirements, partaking of hors d'oeuvres at an evening reception can hardly be considered an "eating problem."
Eating that results in overweight can be both a physical and emotional problem. Ideal body weight cannot be calculated to the ounce. If the normal range for a person is 140-145 pounds, we hardly consider her obese if she weighs, say, 147 pounds. Although there is no precise demarcation between healthy and unhealthy weight, bear in mind that the heart was designed to serve the ideal weight efficiently, and that each additional pound adds almost a mile of blood vessels, which places an additional workload on the heart. It is also known that overweight contributes to high blood pressure and to metabolic diseases, such as diabetes. From a health perspective, maintaining the ideal weight is desirable, and if eating results in excess weight, it may be considered a "problem."
Eating can be an emotional problem when it is "compulsive," when you feel compelled to eat even though you intellectually understand that you should not be eating and aren't even hungry. You may think you are hungry, but you know that this desire for food is not in your body's best interest and yet you feel driven to eat.
Bulimia is a compulsive condition in which one feels compelled to eat and then compelled to lose weight. Some people consider being slender as attractive and think themselves overweight even though they are well within or even below the normal range. Their preoccupation with food, in quest of an idealized image rather than the physiologically ideal weight, results in their eating habits becoming a "problem."
Elsie is a thirty-year-old woman who is representative of many others. At 5'3", and given her frame, her ideal weight should be plus or minus 116 pounds. However, at 115 pounds Elsie considered herself to be fat. She periodically dieted and exercised to lose weight and fluctuated between 110 and 118 pounds. Her moods varied with her weight, but it was difficult to determine which was cause and which was effect. Much of her waking time was occupied with ruminating about food, about her weight, and about her wardrobe. This preoccupation had far more to do with her self-image than with health considerations. While there was nothing grossly abnormal about Elsie's behavior, she was generally unhappy, except for those days when she weighed 110 pounds, and her unhappiness could certainly be considered to be a "problem."
Some people have an "average" ideal weight if calculated over an extended period of time, but the average is a result of a yo-yo pattern, alternately gaining and losing weight. This apparently healthy "average" is misleading. For example, a room at a steady seventy-degree temperature is comfortable. Wide temperature fluctuations between sixty degrees and eighty degrees yield an average of seventy degrees, but we would hardly say that the room was generally comfortable.
There are several studies that demonstrate that compulsive eating and especially bulimia are more prevalent among women than men, and that there has been a significant increase in bulimia since the 1980s. It cannot be mere coincidence that this period coincides with some fairly radical changes to the female role in society.
Several writers have pointed out that for all the gains achieved by the feminist movement, there have also been some severe stresses. Stereotyping has its limitations and may indeed be oppressive, but broadening horizons and increasing one's options is not without cost.
In 1968 I was asked to develop a counseling service for Catholic nuns, some of whom were thrown into turmoil by the liberal changes of Vatican II. One thirty-five-year-old nun who had served as a teacher since entering the convent came for a psychiatric consultation, bringing with her a questionnaire she had received that asked about her interests and what she would like to do in the next several years. In addition to the traditional roles of the nuns as teachers or nurses, there were now opportunities for a variety of positions in community services. The nun threw the questionnaire on my desk and stated angrily, "If I wanted to have a choice of careers, I would not have entered the convent. I used to receive a little card telling me where I was assigned to do the Lord's work. I don't want to make choices."
To some people, being dictated to may appear tyrannical, but to someone who does not want the responsibilities of decision making, this is a desirable arrangement.
The "traditional" female roles of homemaker, teacher, secretary, nurse, or social worker may indeed have been stifling to women whose creativity was suppressed, but there was relatively little stress in choosing a lifestyle. A woman who chose the role of wife and mother had no reason to feel that she was performing a less than optimum role. Today, however, with the opening of professions and business opportunities to women, the choices are much wider, and the demands of some of the available roles are much greater. To add to this, women in the workplace often feel that they have to prove that they are equal to or superior to their male counterparts. A woman may feel that she has to choose between being a wife and mother or being a doctor, lawyer, or executive. Choosing the former may result in her feeling that she is not fulfilling herself and that resigning herself to the traditional role is a regression, whereas choosing the latter frustrates her maternal instincts. She may therefore decide to do both, which results in what Dr. Harriett Braiker has termed the "type E woman," the "E" meaning "everything to everybody."
Men are generally not subject to being type E, and although a man may have a type A personality — being time-driven, constantly under pressure to meet deadlines, relentlessly striving for success, intolerant of delay, and overassertive — he does not have as much need to vindicate himself as the woman does, nor is he expected to perform full time at home. The type A professional or executive may indeed have a harrowing day at the office, but when he comes home, it is perfectly acceptable for him to kick off his shoes and recline in the lounge chair.
Not so for the woman, who may end the "workday" with feelings of guilt that she has abandoned her children to a latchkey existence, and who, rather than recline in an easy chair, must prepare dinner, review the children's school activities, and prepare the children's clothes for the following morning, to name just a few of her duties as a homemaker. Furthermore, it is not enough that she meets the "minimum daily requirements" that might be adequate for the traditional homemaker. This woman must prove that her homemaker's duties are not being adversely affected by her career, and vice versa. One career woman said, "Being type A would be like a vacation."
A thoughtful, considerate husband may ease the woman's conflict and help her fulfill both roles, but not all husbands understand the wife's dilemma, and not are all up to providing the necessary support.
Time may eventually clarify the roles and ease the challenges for the woman of the future, but today's woman is caught in the period of transition. To further complicate things, many women who seek to compete with their male counterparts have been brought up with concepts of femininity that conflict with the aggressive behavior they must adopt to make their place in professional or commercial circles. In short, today's woman may find herself subject to contradictory demands.
Some psychologists claim that compulsive eating symbolizes the conflicting roles that confront the modern woman, with eating representing the passive, nurturing mother, and the slimming representing the aggressive, competitive masculine identity. Others say that the slimming represents compliance with society's standards of what is sexually attractive, while excessive eating represents a rejection of the social norms. While there may be some truths in these formulations, both are simplistic.
There is no denying, however, that the modern woman is caught in an identity conflict, which in itself can depress self-esteem or aggravate preexisting low self-esteem. While men are also subject to various stresses and conflicts, there is a preponderance of self-concept stress in the modern woman, which may explain the much higher incidence of eating disorders in women as well as the rise in the incidence of these conditions in the past few decades.
What choice should a woman make, and how should she go about making her choices? When a woman behaves according to other people's expectations, instead of fulfilling her own needs or desires, the result is often stressful. What is needed, then, is for a woman to identify what her own needs are and to feel that it is permissible for her to satisfy them. But before a woman can identify her needs, it is important to understand the compulsion behind her eating habits, whether they are consistent overeating, yo-yoing, or bingeing and purging.
Excerpted from The Thin You Within You by Abraham J. Twerski. Copyright © 1997 Abraham J. Twerski, M.D.. Excerpted by permission of St. Martin's Press.
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