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What This Book Is and How to Use It When I began researching treatment strategies for obesity three years ago, I never, in my wildest dreams, thought that a book would be the end result. Explaining to you how this self-help book evolved may shed further light on the complexities of treating obesity. This book is based on a therapy group that I developed a few years ago. The therapy group is heavily grounded in cognitive-behavioral therapy, but also utilizes interventions from more recent developments in Interpersonal Therapy, Personality Disorders, and Health Psychology. These therapies conceptualize behavior as being a result of thinking patterns, which can be shaped and molded by interpersonal relationships and previous experiences. The lessons in this book are derived from strategies that have been productive in treating eating-disordered patients. The interventions, however, have been tailored to treat compulsive overeating. Although I am implying that similar interventions are also effective with eating disordered patients, I am in no way implying that obesity carries with it psychopathology. These strategies are only a tip of the iceberg when treating Anorexia and Bulimia. Groups consisted of 10-23 obese men and women. I administered the material in a "classroom" format for the first half of the session. I reviewed the numerous handouts and readings given to patients for that session. The second half of the session was the supportive group therapy part. It remains striking to me that my patients had difficulty "holding on to" new ways of thinking. My patients would be working on material in session six and at the same time, forget the information from session two. One very assertive woman politely asked me to "write out more of the material," which was a daunting task to say the least and took me the good part of a year. Here are the reasons why her request, now, makes a lot of sense to me. Obesity is a chronic problem requiring lifelong attention. You know the saying, once an alcoholic . . . always an alcoholic. A self-help book will help the reader easily refresh themselves for the rest of their lives. You can review personal notes you made as a result of reading this book. You can review information that you highlighted. You can summarize the rationale behind the behavioral suggestions. You can reread sections that you found particularly motivating. Having a book continuously available will help the reader to repeatedly review material that will make cognitive changes stronger and more permanent. When I treat a person with an eating disorder, the goal is not necessarily to cure the illness. More realistically, treatment is considered successful if the person can learn how to manage their illness over the course of their entire life. The unhealthy impulse to overeat is likely to be a fact of life and never completely be "cured." Habitually controlling these behaviors and predicting when the impulse is likely to worsen is essential. Second, the diet industry breeds confusion and reinforces the idea of a "quick fix," and these beliefs are extremely stubborn to change. The ten-session group that I run in my practice is hardly sufficient for some folks to "undo" the beliefs that they have been fed for decades. Sometimes, within months after the group ends, some people briefly revert to their old habits. In this case, a few "booster" sessions can get them back on track. The groups that I run help people remain immune to the barrage of new diet ads and promises. This book will help remind you of the irrationality behind the empty promises of fad diets. Third, losing weight successfully may require the help of numerous healthcare professionals and friends, yet, there remains some degree of prejudice when it comes to a person being obese. Throughout this book you are recommended to seek help from another professional. Your physician, a physical therapist, a nutritionist, or a behavioral scientist are just a few examples. Presenting these professionals with your ideas about what you need in order to be successful can get the wheels in motion for you to develop your treatment team who can support your efforts. The suggestions in this book will hopefully empower you to be assertive so you can get what you need from your "treatment team". We have made great strides in overcoming racial oppression and sexism, but ignorance about weight loss had been described by some as the "last modern-day prejudice." This may even be true for some professional people you seek help from. All professionals need to better understand why weight loss may be stalled. Conveying empathy and understanding to you will carry you a lot further than making prejudicial and critical comments. Helping you analyze your overeating triggers will lead to success, not criticizing you for overeating. Fourth, changing life skills requires practice, patience, and persistence. So many people have said to me, "I know what to do . . . I just don't do it." Or people are afraid to stop their "program" or not attend their meetings. These people may have difficulty gaining confidence in themselves that they are responsible for the changes; not the special supplement, the pre-cooked meals, the group meetings, or a membership. Don't get me wrong, these programs have their place and are effective. In the end, however, you need to take full responsibility for making good choices. You need to be commended for your progress and persistent effort. So don't just read this book, make it a part of your life and live by it piece by piece. Remember, it's not just a book, it's a journey. This book is designed to help overweight or obese people help themselves, but the importance of having significant other(s) to support you through this process is essential. Have your partner(s) read this book along with you or show them excerpts which you think they need to know. Have someone grocery shop for you if you're finding it hard to get to the store. Ask a friend to be your "workout buddy." Ask for help if you are in a bad spot. You are going to need as much support as you can get. This book is also designed to assist any professional or significant other who is trying to help an obese or overweight person. Therapists, physicians, nutritionists, and physical therapists are in powerful positions. An obese person may present to your office and choose you to coordinate their treatment team. Operating from a platform of mutual respect and choosing colleagues who are able to work as a team player will only benefit your patient. On the other hand, some patients do not have the desire, resources, or time to see all of the people who could be helpful to them. This may require the chosen professionals to be flexible and work from other schools of thought and/or consult with other professionals from other disciplines. Fighting obesity takes a community effort and we all need to accept that not just one person has all the right answers. We all have something to contribute, yet patients sometimes feel comfortable working closely with only a few. The tools within these pages are an attempt to get professionals from different disciplines to work together and understand each other's contribution. Some of these topics are complex in that they offer a very different way to think and behave around food. Consequently, it may take you some time to fully "digest" these lessons. It is a different way of thinking about eating, which runs counter to many diets you may have tried over the years. When trying to make changes, you may need weeks before you feel completely at ease and comfortable with the new approach. The worst thing you can do is rush through this book. I know you feel desperate and want a "quick fix," but it is my belief that all of these "quick fixes" landed you where you are right now. If you move too fast, you may miss something that may sabotage your efforts later. Please take your time. These eating behaviors have gradually developed over many years; they are going to take months or years (not days) to change. Your eventual weight change will illuminate your effort. I encourage many overweight people to first stop gaining weight. A pound never gained, is a pound always lost. Especially for people with Binge Eating Disorder, you may struggle with actually losing any weight while making that essential step to stop binge eating. If you are a binge eater, weight loss will come if you take your time. One of the main points of this book is that fad dieting makes people binge eat, so please try to make more permanent life changes this time; don't stay stuck in this terrible cycle. If your weight continues to go up within the first two months of starting this program, it does not mean that you are a "failure" or "have no willpower." Be honest with yourself. Figure out why your weight went up and search for what you may have skipped or misinterpreted. This will be one more piece of the puzzle you are struggling with. Ask for help from a friend, review your checklists, or contact a dieting "buddy." The only way you can fail at this book is to keep gaining weight. |
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