Nice Girls Finish Fat: Put Yourself First and Change Your Eating Forever

Nice Girls Finish Fat: Put Yourself First and Change Your Eating Forever

by Karen R. Koenig
Nice Girls Finish Fat: Put Yourself First and Change Your Eating Forever

Nice Girls Finish Fat: Put Yourself First and Change Your Eating Forever

by Karen R. Koenig


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From a therapist and expert in emotional eating, the first book to explore the link between weight gain and women who do too much, complete with proven techniques for dropping pounds.

Many women put too much on their plates, both literally and figuratively. In Nice Girls Finish Fat, psychotherapist Karen R. Koenig explains the link between the two and gives overweight women detailed advice on how to lose their extra baggage—both emotional and physical—by becoming more assertive in every aspect of life. For the millions of overweight women in America, diet and exercise just aren’t cutting it. That’s because many of these women have emotional issues buried deep beneath those stubborn pounds, issues that must be dealt with first if weight loss plans are to succeed. In this illuminating book, based on decades of professional experience, Karen Koenig offers on-the-page psychotherapy to help readers attack the roots of their food problems. With her engaging personal style, she teaches women about the biological connections between repressed emotions and eating, revealing the ways many women use food to stuff their anger, control their aggression, and assuage their feelings of guilt—all in the pursuit of being “nice.” Giving “good girls” permission to love themselves first, Koenig offers thought-provoking quizzes and questions to help readers identify and overcome the habits that have been holding them back. Empowering readers to gain the confidence they need to lose weight, Nice Girls Finish Fat not only shows women how to stop obsessing about food and develop healthy eating habits, it teaches readers skills to improve every aspect of their lives.

Product Details

ISBN-13: 9781416592648
Publisher: Atria Books
Publication date: 06/02/2009
Edition description: Original
Pages: 272
Product dimensions: 6.00(w) x 9.00(h) x 0.60(d)

About the Author

Karen R. Koenig is a cognitive-behavioral therapist and author of three books on eating and weight. A national speaker, she regularly teaches workshops on eating to groups around the country. She lives in Sarasota, Florida.

Read an Excerpt

Introduction: Nice Girls — Read This

How Is Being Nice a Vice?

Weight loss is a marathon, not a sprint — and rare is the habitual overeater who goes on a diet, loses twenty or fifty pounds, and coasts slimly through the rest of her days. If staying trim were that easy, I'd be out of my psychotherapy job as fast as you could say Nutrishake. Instead of miraculous, overnight, permanent transformation, the stream of women I've treated for eating and weight problems over the past three decades had to struggle and settle for modest successes in improving their relationship with food and the bodies their aspiring spirits inhabit.

It isn't that they aren't motivated — they are! — or that they don't work hard in therapy — they do! Their drive to eat normally and lose weight has the focus of a laser. Their diet histories could fill libraries. They've read all the weight-loss books, sat through the twelve-step meetings, swallowed the magic pills, and had their stomachs surgically sectioned and stapled. Their stories are unique yet oddly universal. These women have been there and done that and are still searching for the Holy Grail that will grant them peace with the bleeping scale.

As I sit and listen to the play-by-play of their lives, one thing becomes clear. It's not just their dysfunctional childhoods, crummy genetic loading, depression, or anxieties that hold them back from reaching their eating and weight goals. Nor is it their stressful jobs, loopy families, parched lives, or lackluster spouses or partners. What keeps them fat and stuck in the cookie jar, unable to climb out and stay out, is that they're too damned nice!

They love being nice. I do an exercise in the first session of my Quit Fighting with Food workshop in which I ask participants (who are — big surprise — mostly women) to share one thing they like about themselves. And what do most of them say? They beam and tell me they're nice, of course. Though many are highly educated and skilled, world traveled, at the peak of impressive careers, or have raised children alone with few resources except their own broad shoulders...they continue to believe that their most striking asset is "being nice." Not that there's anything wrong with it, as they say on Seinfeld, but come on. It makes me want to cry and shake some sense into them at the same time.

The women I treat are so übernice that they'd not only insist on giving you the blouse off their backs, they'd launder and press it first, wait around for you to put it on, then button it up for you! These kinds of women swell the ranks of the helping professions — teachers, nurses, secretaries, librarians, and (yup) therapists — in part because they are ultranurturing, self-effacing, unselfish, generous, and caring to a fault. The problem is that often their size grows as big as their hearts.

Now, before readers who think I'm maligning either "nice" or "fat" start to pen me hate mail, let me clear up a few things. There is nothing inherently wrong with being either fat or nice. My goal here isn't character assessment and it certainly isn't character assassination. Au contraire, I've spent the last thirty years trying to help nice, overweight women stop obsessing about food, get healthy, love their bodies whatever they weigh, and move on with life. My point is that there just might be a correlation between being nice and getting (and staying) fat. The possibility and nature of that link are what this book is about.

Naturally, not every nice woman has eating or weight issues...and every fat female isn't sweet as honey. And, yes, there are nice men who are fat, thin, and in between, along with portly gents who are dear dumplings and others who are boorish brutes. Frankly, from the limited number of overweight men I've counseled (they don't come to therapy in droves, mind you), I'd say the too-nice label fits them like an extralarge glove. In fact, they're as doggone pleasant and other-centered as the women I treat, so the correlation between chubby and caring might not be a boy-girl thing after all.

However, for the purpose of this book, gender is what it's all about — the way women are brought up and expected to be nice and how that thrust of socialization straitjackets them in their options, cookie-cutters their personalities, and catapults them headfirst into the Häagen-Dazs. In this culture, even in this day and age, there is a humongous difference between how women and men are raised and treated (never mind the scientific variance of gender genetics), which makes women win the niceness contest hands down.

I know all about it. I was once an overly nice girl turned woman myself — an overweight one, at that. It's not that I'm no longer affable and kind or that I've given up being giving. I haven't. But I work extra hard at not striving to be nice for nice's sake, as if it's the brass ring or an Olympic medal, the one defining word that sums up my entire existence. I've incorporated a sprinkling of "not nice" into my personality and — wonder of wonders — I am still standing. As I've gotten older, I've developed this crazy notion I can be anything I want to be, and that includes a giver and taker, a person who elbows herself up to the front of the line when need be and invites folks to step ahead of her just because I feel like it, a woman who finds pleasing herself one of life's underrated delights, yet who is considered by most people as caring, nurturing, generous, and, yes, downright nice.

This book is for all you women who know you're too nice, who recognize somewhere deep inside that overdoing for others leaves nothing for you, who don't get why you can't stop eating when you're not hungry, who feel the need to apologize for any particle of your being that isn't wholesome and angelic, who take care of others with love and take care of yourself with food, who work too hard on being perfect, live to please others, think no and say yes, and have to make things right for everyone.

Every chapter in this book speaks to niceness that is unhealthy in its extreme and keeps you joined at the hip with food. Think of these pages as guiding you through an annotated tour of Niceville, including the pitfalls of perfectionism, the hazards of food as self-care, the downside of doing everything yourself, the perils of having your needle permanently stuck in the yes groove, the masochism of trying to be all things to all people all the time, and the dangers of letting yourself get so stressed out that you're killing yourself because you can't stop worshipping at the altar of nice. By the time you're done reading, you'll understand how being too good and giving at your own expense encourages you to camp out in front of your refrigerator and skyrockets your risk of remaining overweight, unhealthy, and underhappy.

Along the way, you'll learn the life skills and self-care strategies needed to create a happy, fulfilling, successful life and stop abusing food. Life skills are general abilities for negotiating the world effectively, your basic tools for maximizing your potential. Self-care strategies are exactly what they sound like, the behaviors and activities you must engage in to keep yourself in good shape — physically, mentally, and emotionally. Skills and strategies are all learnable with drive, practice, and patience. No matter how young or old you are, you can learn to make choices that are always in your best interest.

Chapters include a host of activities and advice to help you pack your bag and make tracks out of Niceville:

Grab Your Thinking Cap exercises focus your attention on the psychological, interpersonal, and social aspects of your life you need to understand in order to make meaningful change.

Nice Girl Recovery Tips give you a heads-up on how to undo years of overly nice behavior and transform dysfunctional beliefs and behaviors.

No More Nice Girl Manifestos are practical dos and don'ts for every wannabe former nice girl.

Meet One of the Nice Girls vignettes tell the stories of aspiring saints like you who are learning to toss away their halos and stop abusing food and their bodies.

Think of it: You'll soon be the envy of all your Goody Two-shoes friends — basking in the warmth of people who can't do enough for you, leaving work on the dot of five heading for a well-deserved workout, and dancing the night away instead of taking care of your sister's kids while she's out on the town. By the end of this book, you'll have the wisdom and tools to give yourself a surgically safe nice-ectomy, put food in its rightful place, and get on with creating the life you've always wanted and deserve.

Copyright © 2009 by Karen R. Koenig


What's a "Nice" Girl?

Sugar and Spice and Everything...Fattening?

Since you picked up this book (and read the introduction), you probably have an inkling of what being "nice" is all about...and how it can get us into trouble. In most cases, it's what our well-intentioned parents taught us to be, what our misguided mothers and other female relatives modeled for us, and how we were told men wanted us to act if we ever planned on dating and getting married. If you need a reminder, nice equals good, pleasing, agreeable, caring, kind, and thoughtful.

There's nothing inherently wrong with any of these traits individually or collectively. In fact, they're a pretty lofty group of attributes to aspire to — as far as they go. And therein lies the rub. If you were brought up to be intelligent, assertive, autonomous, creative, self-assured, candid, honest, secure, and successful — as well as nice — it's okay to give this book to someone who needs it more than you do. But many of us were encouraged to choose only the nice crayon when shading in our personalities. We didn't get much chance to try out the rest of the gloriously screaming colors in the box and, therefore, became boringly, unhealthy, monochromatically nice.

Exactly how nice is too nice?

For the purpose of this book, let's say there's a difference between being nice and too nice, a workout that is so off the charts that it actually gives nice a bad name. So that we're all on the same page here, let's assume it's okay to be a sweetheart and an earth mother as long as you have the ability to turn off these traits and bring in the big guns of selfish, practical, confident, bold, bullish, driven, and outspoken when you need 'em. As the oracles advise, we need to be in balance.

How do you know if you're overdoing it with sweetness and light and jeopardizing your physical and emotional well-being? How do you make sure you're not so accustomed to being a dear and a darling that you fail to notice how sadly one-dimensional you've become? How do you push aside your fears about seeing yourself as you really are long enough to discover if you've got a halo welded to your head?

Here's how. Gulp a deep breath, aim for honest, take this little test, and find out what it has to say about your niceness level. (And please don't agonize over your answers. There are only twenty questions and they're all simple, declarative sentences. Hint: Not wanting to fail or make mistakes may be a big part of your problem.)


Write the number that best describes in general how you think, feel, or act:

1 = Rarely/Never 2 = Sometimes 3 = Often 4 = Always

___ 1. I jump in and take care of family members when others could but don't or won't.

___ 2. I feel guilty whenever I say no to family members or disappoint them.

___ 3. I avoid burdening family members with my problems.

___ 4. I put family members' needs before mine at my own expense.

___ 5. I take care of friends more than they take care of me.

___ 6. I feel guilty and bad whenever I say no to friends or disappoint them.

___ 7. I am there for friends even when they're not there for me.

___ 8. I put friends' needs before mine at my own expense.

___ 9. Even though it stresses me out, I push myself to give my all at work.

___ 10. I pick up coworkers'/bosses' slack and rarely get credit for it.

___ 11. People at work take advantage of my good and giving nature.

___ 12. I stress myself out by saying yes to people when I know I should say no.

___ 13. I feel in the wrong and apologize automatically even when I'm not at fault.

___ 14. I keep silent about what's on my mind rather than speak up.

___ 15. I feel that whatever I do isn't enough with friends, family, at work, and at play.

___ 16. If I don't do something perfectly, I feel like a failure.

___ 17. I'm mortified about making mistakes because of what people will think of me.

___ 18. I have an overwhelming need for people to like/love/accept/approve of me.

___ 19. I avoid making waves.

___ 20. I go out of my way not to hurt people's feelings and end up being dishonest.

Okay, now that wasn't so hard, was it? If so, not to worry; you're only at the beginning of this book. You'll feel much better about yourself by the end of it. So here's how to score this little test. Give yourself 4 points for each Always answer, 3 for Often, 2 for Sometimes, and 1 for Rarely/Never, then add up your points. Now take a gander at the scores below and see where you fall:

60-80 Go make yourself a crown of thorns. You're killing yourself with kindness!

45-59 Find some thorns and get on the waiting list for a crown-making class.

25-44 Buy yourself a niceometer and monitor yourself extremely carefully.

20-24 Being too nice is not your problem.

Not to sound too much like a therapist, but how are you feeling about your score? Are you in shock? Did your answers reinforce what you'd already guessed about yourself? Are you so depressed you're considering drowning your sorrows in a milk shake?

All kidding aside, it's tremendously hard work to view yourself honestly and accept who you are — warts and all. And let's be real, being too nice is not the worst thing in the world. It's hardly up there with being an ax murderess or a mercenary. Take a deep breath and gently pull yourself out of self-flagellation mode and start courting curiosity. Hmm, so you're too nice, and that may be why you have an eating or weight problem. That's okay — you're smart, talented, a terrific problem solver (for other people, anyway), and you'll change and grow and be a finer femme for having done so.

GRAB YOUR THINKING CAP Look objectively at how you hurt yourself by being unilaterally nice. Can you recognize that this doesn't make you bad, but that you've merely taken a good thing too far? zx

Could you be a tad more specific about what's wrong with me?

Before you can fix the problem, you have to recognize what it is and understand whence it came. Excessive niceness comes in many shapes and forms. You may have only some characteristics, or you may have the whole kit and caboodle. Because I'm a cognitive-behavioral therapist — I operate on the assumption that beliefs produce feelings and behavior and that changing beliefs transforms emotions and actions — I've divided up characteristics of the overly nice into three aspects of self: what you believe, what you feel, and how you behave. These examples will give you an idea of how too much niceness plays out; there are dozens more where they came from.


I am responsible for people's happiness.

I need to be upbeat and cheerful, and make people feel better.

People will fall apart without my help.

If I say what I feel, people will be hurt and won't like me.

If I stop being overly nice, people won't accept me.

I have to be perfect, including how I look and act and what I say.

I need praise from others to feel okay about myself.

Saying no to others' requests means I'm selfish.

Putting myself first means I'm self-centered and don't care about others.

I'm not a good person unless I'm being helpful or productive.


I can't bear when people are in distress.

I feel guilty letting people down by disappointing them or not meeting their needs.

I feel driven to keep people's spirits up and to prevent them from suffering.

I can't stand hurting people's feelings.

I'm scared people won't like me if I stop being overly nice.

I'm determined to be/look/act perfect because I hate failing or making mistakes.

I feel inadequate and insecure unless people shower me with praise and compliments, although mostly I don't believe them.

I hate the thought that I might be selfish and feel awful about myself when I think I am.

I feel guilty if I take care of myself rather than other people.

I feel lost and useless unless I'm doing something for others or being useful.


I listen endlessly to people's problems, offer solutions, and give advice.

I do favors for people even when I don't have the time or the energy and they don't reciprocate.

I'm a smiley face and cover my negative feelings to appear upbeat.

I say things I don't mean and do things I don't want to do simply to avoid hurting someone's feelings.

I avoid confronting and challenging people and am a yes-girl.

I obsess about looking/acting/saying things perfectly and would rather die than make a mistake.

I rarely stand up for myself, set and stick to clear and firm boundaries, or put myself first.

Because I don't know when enough is enough, I overdo even when it stresses me to the max.

Guilt drives most of my behavior and it's so automatic I don't even realize it.

I don't know how to stop being so damed nice to people.

Are you starting to understand how what you believe and feel causes your nice button to be stuck in overdrive? And that your current thinking isn't doing you any favors? Face it: You're going to need a mental and emotional tune-up (maybe an entire rebuild, who knows?) to get your niceness factor into the healthy range. Still not convinced? Here are some examples that might pop open your eyes. Do any of these sound familiar?

You spend so many hours on the phone at night helping your girlfriends solve their problems that you're too tired to do your laundry and go to work the next day wearing dirty clothes.

You convince yourself that you can't make it to the gym because you're the only one who can finish that special project — the one that was begun by your coworkers who are all down at Mahoney's chugalugging their way through happy hour.

Stressed out over the week from hell, you surround yourself with all your favorite foods and eat yourself into oblivion instead of calling a girlfriend and insisting that she zip her lip and let you rant and rave for five minutes.

You say, "Sure, stay as long as you like," to out-of-town friends who suddenly appear on your doorstep when you've got the flu, and you sleep on the broken futon so they can enjoy your brand-new water bed.

You constantly bolster your spouse's/partner's fragile ego so he or she won't fall into a pit of self-loathing and despair and, instead, become depressed yourself.

You spend hours searching for just the right thing for your impossible-to-please parent's/sister's birthday, overnight it to him or her, never receive a thank-you, and go out and do the same thing the following year (and the one after that).

You calculate that you've said "I'm sorry" seventeen times and it's only midday, although not one thing you apologized for was remotely your fault.

Okay, now you've got the picture and that blurry image of a too-nice person is getting clearer: Surprise, it's you! If you're feeling anxious or unsettled about this discovery, that's natural. Your mind is probably zooming ahead to how you're going to manage to get a nice-ectomy without losing too many friends — or your job. Well, stop right there. You aren't going to whip yourself into a made-over woman warrior in a week. This is not a crash diet — you already know those don't work.

Before you even start considering what to do about being too nice, you have to understand how and why you came to be the poster child for nicehood. Moreover, remember, you don't want to stop being nice completely. You just want to lop off some of that goodness and maybe bulk up other qualities — selfishness, self-confidence, limit setting, candidness, and assertiveness — to round yourself out.

GRAB YOUR THINKING CAP What is it like to reflect on specific beliefs, feelings, and behaviors that relate to niceness? Does this make you feel better or worse about yourself, or are your feelings a mixed bag? zx

Was I born with twelve extra niceness genes or what?

It should come as no surprise that there's a big parental push for one of the genders to be "nice" while the other is encouraged to be everything else. Women are expected and socialized to be agreeable, pleasant, kind, comforting, nurturing, self-sacrificing, dependent, generous, good, polite, other-oriented, helpful, well behaved, gentle, sympathetic, compassionate, gracious, and, of course, respectful. There's nothing wrong with being any of these things — and many good reasons to cultivate such esteemed qualities — but flaunting them 24/7 makes you only half a healthy human being. If your intent is to only or always sport these traits, you elbow out the other essential qualities that will help you discover life's true sweet spots.

I won't go into a long historical account of how and why women have been jammed into the niceness slot, while men get to roam about and try out lots of different options to see what fits. Sure, women have made tremendous strides in cracking our nice shells and stepping out into the world more assured and empowered. However, it's hard to peel off a label that was stuck on at the beginning of human existence. It may be too late to change history, but it's never too late to change yourself.

However, it's not just history but also current culture — not only in the United States but all over the planet — that dangles the nice ideal in front of us and wags its finger when we aren't sweetie pies. While it's no longer the fifties, the error (oops, I mean era) in which I was brought up, when women were supposed to remove their aprons only to slip into their baby doll pajamas, we still have a long way to go not to be viewed as a bitch when we're outspoken and assertive. Even in this day and age, there are men (and sadly, women as well) telling us how we should and shouldn't act, what choices are okay to make and which ones will damn our souls to hell, and trying to narrow our rightful human potential.

Culture being what it is, we have two clear choices: to jump on the bandwagon or hijack it for our own purposes. I'm not looking to make you into a revolutionary. You may not care about equality between the sexes in general, and you may rather be mistaken for an ostrich than a feminista, but the fact is, if you blindly accept the female prescription to be nice at all costs, you may not be able to rid yourself of your eating problems and establish a comfortable weight. Let's remember that this book is about how putting yourself last drives you to food, which is another way of saying that being too nice can lead you to getting your face stuck in the cookie jar.

Gender aside, being good and caring is encouraged in school, through religion, on the playground, and just about everywhere else. It's a fine and necessary long as it doesn't apply to only one half of the species and doesn't crowd out every other personality card in the deck. There's nothing wrong with the Golden Rule, "Do unto others what you would have them do unto you." There's everything wrong with, "Do unto others and keep doing it in spite of the fact you never get done unto."

So it's the ways of the world that have done me wrong, right?

Not exactly. History is the backdrop for how we got to this point, and culture is our current stage, but there's much more going on. The most likely explanation for your over-niceness is how you were brought up, especially the role modeling done by your parents and, to a lesser degree, other relatives.

In an ideal family, you would have been raised to believe that, along with being nice, sometimes you have to risk being perceived as "naughty" to get what you want and deserve, and that sometimes you have to stop asking and simply grab what's rightfully yours. In more dysfunctional families (and whose isn't?), you're given erroneous, incomplete, or conflicting messages about niceness and caring about others. These messages generally skew to one extreme or the other: In dysfunctional families, parents often are either extremely giving or extremely selfish — and either extreme can send a kid into a too-nice tailspin.

Maybe everyone who ever met her said of your mother, "Oh, Marge, she's the nicest woman you'd ever want to know. What a saint!" Or perhaps she wasn't around much because she was working two jobs and you were raised by Grandma Flori or Aunt Juanita who were shining examples of piety and politeness. If your primary female role model avoided arguments, backed off from taking risks and challenges, fed off being praised, tried to keep the peace at all costs, couldn't stand to have people mad at her, kept quiet rather than said what was on her mind, took care of everyone but herself, or stressed herself out being Supermom or Superperson, well, small wonder you followed along in her saintly footsteps.

At the other extreme, your mother may have been mean, abusive, self-centered, a taker, or a not very warm and fuzzy human being, so that you vowed early on to be her opposite. Now you're afraid that if you're not hypervigilant about keeping yourself on the nice wagon, you'll fall off and end up exactly like you know who. If you had one parent who was overly nice and one who was overly not nice, you may be wary of both options and confused about how to be. Or, maybe your parents pingponged between being nice one moment and nasty the next, so that you never learned there's an in-between. Perhaps neither of your parents treated you well, so you responded by keeping a low profile or yessing them to death. What else could you do? Rebelling would have risked more abuse, so you threw all your energy into desperately hoping that being extra good would drive away their meanness.

Just one more point about why you've spent most of your life angling to be Mother Teresa and I'll move on. When we're young, we think in the simplest terms. If we see only two positions, overly nice and not nice, with no gradient in between, we assume there are only two choices. We fear that if we pick overly nice, we'll be stepped on and run over, so we choose top dog over underdog. Or we select overly nice because it's unbearable to consider being not nice and hurting other people. A choice between a rock and a hard place if ever there was one. Who knew that there were other options? Not you.

GRAB YOUR THINKING CAP From your upbringing, how were you programmed to be the nice queen? Are you trying to be like someone or unlike him or her, or are you confused about how to be?

How can I ditch the nice girl persona and regain control of my eating?

Never fear — there's hope! By reading this book, you'll learn how putting yourself last and doing what others want rather than what you want has set you up to feel cheated and drives you to overeat. Of course, all the understanding in the world won't change you automatically, but insight leads to clearer, healthier thinking and forms the basis for making better decisions.

What you need is some balance in your life: to know when to say no and when to say yes, how to ask for help as easily as you give it, when to let other people live with the consequences of their choices, how to be honest with yourself (always) and forthright and direct with other people (most of the time), and why it's important to give up striving to be perfect and accept your perfectly imperfect self. Right about now, little voices in your head may be screaming that what I'm suggesting is too tall an order, that you'll never be able to succeed at scrubbing all that snowy whiteness out of you and allowing yourself a bit of tarnish. Or you may be terrified of uncovering some sourness or bitterness under that glossy, sugar-coated veneer.

All natural and normal reactions. Not to worry. I'm convinced that after reading this book you'll be able to reorder your priorities and reshuffle your goals, improve your relationship with food and be more comfortable in your body and, better yet, feel freer and more authentic than you've ever felt in your life.

Nice Girl Recovery Tips

Add new, forceful personality traits — don't eliminate your niceness. Kindness, caring, consideration, and generosity are stellar long as you don't go overboard with them and act in ways that are hurtful to yourself.

Recognize that women have a history of subservience and are fighting an uphill battle to be not nice and accepted in today's society. Men don't have to jump through these hoops. If the deck seems stacked against you, it's because it is!

Study women — past and present — who were courageous, outspoken, and powerful, and discover how they were able to succeed in spite of the fact that they weren't the nicest girls on the block. Use them as role models. All women need them.

Talk to other women about the pressure to be nice. Think about starting a No More Nice Girls support group of friends, neighbors, or coworkers.

Ask yourself how the roles of men and women in your family (particularly your parents) have shaped your desire to be so nice.

To do today

Catch yourself when you're about to apologize and instead say nothing!

Meet One of the Nice Girls

Mary now

Mary is a registered nurse in a large teaching hospital in Boston. Patients love her, colleagues sing her praises, and her supervisor says she can't imagine the mess her unit would be without her. Mary came to see me because a colleague had mentioned I work with women who overdo it, and this colleague kept nagging her until she made an appointment.

At forty-one, Mary continues to pour every ounce of her considerable skill and energy into being the best nurse she can be. If someone needs to switch shifts at the last minute, Mary'll do it; if there's an emergency on another floor, she's off to the rescue; if a patient or family member is especially difficult, she's by his or her side lending a hand. (I hope I have a nurse like her next time I'm in the hospital.)

Her husband is a quiet man, owner of a roofing company, who is nurturing and supportive, even more so since they lost an infant with a birth defect three years ago. The two are very close and spend much of their time outside work together, never straying far from home. Neither one likes to make waves and they're both self-confessed people pleasers. In fact, one of the reasons Mary is so well liked is that she finds it nearly impossible to say no. She knows why — "They won't like me" — but has only begun to explore the roots of her fears. Over time in therapy, on occasion, she's been able to say no to or challenge me, but when we began our work together, she agreed with everything I said or suggested no matter what her true feelings were.

Mary weighs nearly 275 pounds and recognizes that her eating problems are directly related to her inability to take better care of herself. However, she worries about keeping her job, patients being in pain and not properly cared for, making her fellow nurses spend extra time at work, "especially those with little ones." Being childless is her explanation for why she's willing to cut other nurses slack, but she admits that taking extra shifts is also her way of keeping her mind busy. Plus, she acknowledges that when she's asked to do something, even something she thinks might not be in her self-interest, it simply doesn't occur to her to refuse.

By her own admission, "My eating is abominable." She grabs food on the run, forgets about nutrition, waits until she's ravenous to eat, or goes in search of a snack when she has a minute to herself. Plan meals ahead? Never. She admits she doesn't really taste food or even care much what she's eating as long as it's easy to get, doesn't cost a fortune, and "isn't too far past the pull date." There's a definite gravitation to sweets and starchy snacks because, she insists, she needs energy to keep on trucking. Although she's tried dieting, she's never stuck to one for more than a few weeks, complaining that it's too hard. She jokes about her bad eating habits and doesn't seem to care about her weight. Because her husband is heavy and he's happy with her as she is, she lacks motivation to eat differently.

Mary as a child

She's the oldest of nine siblings, two of whom died before they reached their teens. Her mother was an LPN and her father spent most of his time and money drinking and complaining about being unemployed. She describes her mother as a "saint who did what she had to and didn't whine about it," and her father, well, the words aren't printable here! He was verbally and physically abusive when he was drunk and she and everyone else in the family steered clear of him. While her mother was at work, it was Mary's job to take care of the house and what she calls "the brood." She didn't have to be asked twice to do something and tried to be a clairvoyant and anticipate everyone else's needs and wishes. When I asked what she did in her free time, she looked at me as if I were crazy.

Rarely did she complain to her mother, whom she didn't want to burden. She just kept putting one foot in front of the other until she left home to marry after completing nursing school. She avoided challenging her father on any fronts because she was afraid he'd go after her, watching in terror as her more rebellious siblings got knocked around. If she didn't do her best with "the brood," she feared letting down her mother and angering her father. Interestingly, she was thin until she got married. "All that running around," she told me, "who had time to eat?"

De-nicing Mary

Mary has been a bit of a challenge, in part because she isn't terribly motivated to do the hard work of therapy nor is she consciously unhappy with her life. I told her right off that I saw a number of issues for her to work on: eating, an inability to say no, and a need to grieve for her deceased child. To say that Mary is not eager to work on any of these issues is an understatement, but she manages to stay engaged in therapy enough to make some inroads without ever admitting she needs and values the help.

On the eating front, I ask her to keep a food diary, something I rarely do because most of the women I see already focus too much on food. But Mary needs to stop and think about food, and when she reads over her diary, she's appalled at what she puts into her mouth. Instead of encouraging her to regulate her eating, I encourage her to pick nutritious substitutes when she wants to eat, whether from hunger or stress. This is not as hard as Mary has feared, and she's surprised she has more energy when she eats more healthily.

Much of the therapy focuses on her childhood: the burden of being a parentified child with overwhelming responsibility at too young an age and dealing with her passive mother and abusive, alcoholic father. This work takes a long time, but slowly Mary discovers that saying no to doing a double shift won't close the hospital and that leaving work on time can make her feel proud, not ashamed. Her first major step in the self-care direction is to take a weekly yoga class. We also talk a lot about the loss of her child, and this is a pivotal point in the therapy. She even brings her husband in for a few sessions so that they can grieve together, and Mary begins changing in spite of herself.

What's Next? In Chapter 2, "Using Food as Self-Care," you'll learn

About the biology of eating and weight

How stress makes you eat

How personality traits push you toward food and away from people

Copyright © 2009 by Karen R. Koenig

Table of Contents

Introduction: Nice Girls-Read This: How Is Being Nice a Vice? xi

1 What's a "Nice" Girl? Sugar and Spice and Everything . . . Fattening? 1

2 Doesn't Everyone's Best Friend Live in Her Refrigerator? Using Food as Self-Care 21

3 If It Doesn't Have Frosting, What Good Is It? Finding Substitutes to Eating 42

4 I Am Woman, Hear Me Chew! Taking Care of Family 66

5 Go Cry on Your Own Shoulders! Taking Care of Friends 90

6 Do I Look Like Santa's Helper? Taking Care at Work 111

7 What Part of "No" Don't You Understand? Saying What You Mean 132

8 Can I Be Perfectly Imperfect? Overcoming Perfectionism 152

9 Please Please Me, Oh, Yeah! People Pleasing 173

10 Me, Me, Me, Me, Me . . . Just Practicing! Learning to Be Selfish 194

11 Look at Me . . . . I'm at the Head of the Line! Finish First, Not Fat 220

References 245

Index 247

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