She realized:
"I was as heavy as I"ve ever been in all my life…"
It was then when she decided to consult with me as an eating disorder specialist.
"Frankly — Elisa stated — until now I never saw myself as being a fat person.
"At home, my three sisters and my mom had to fight the battle of the bulge, but I always managed to control myself maintaining a reasonable weight.
"But it seems as if lately I"ve lost it."
The process began
The initial — didactic — phase:
During this stage our patients are instructed on the phenomenology of weight and its regulation and how the organism accumulates and/or disposes of the energy it consumes. (See my articles about The role of education in treating eating and its disorders).
Me, fat?
Old, time-honored notions and beliefs are analyzed, scrutinized, and discarded as the person begins to appreciate in depth the enormity of her dilemma and the uphill battle she will face in order to achieve permanent results.
It"s also during this period that the patient is familiarized with the Eating Adaptive Strategy of our species. (See pertinent articles)
Repeat:
In order to succeed knowledge is essential…
Not a diet but a plan to fit the person
Not a diet but an eating plan is developed to adjust with flexibility to each individual, her personal needs, life stage, and lifestyle.
This phase lasts until the patient feels comfortable enough to enter the next stage.
The active weight losing phase:
During this period the patient confronts (often during therapy) the emotional aspects of eating and its protean symbolisms.
The dietary plan becomes more structured at this point — without having to endure feelings of hunger or deprivation.
Here is when the patient learns how to deal with the frequent obstacles erected by closely related persons (so-called "well meaning friends") who — witnessing her progress — challenge the patient, her chosen method, and her convictions.
Despite the efforts of the "saboteurs", techniques designed to counteract these common obstacles, result in Elisa"s self-confidence remaining unthreatened and her will to succeed survives intact.
Relapse prevention and the maintenance phase:
This is the most important aspect of the Program, as it aims at preparing the individual to resist relapses or falling into the vicious circle of the yo-yo dieting that, for physiological reasons, is usually the sequel of all forms of dieting.
You lose it, but you must gain it back! (Often with a bonus).
Not for us…
There are some important fundamental principles to apply during this relapse-prevention phase.
Here are some:
Understanding that losing weight is easier to achieve than keeping it down.
That food is not only nutrition but an often habit forming and handy palliative for dealing with angst and stress.
That suffering the pain of hunger in order to lose weight is self defeating.
That certain foods are unnatural and do not constitute part of the eating strategy of our species. That such foods are senseless to eat and detrimental to everyone"s health and figure.
That for those, in any plan to lose weight, the last few pounds are the hardest to go.
That learning how to lose weight is like learning another language.
That losing weight without reconstructive psychotherapy is wasteful at best, since it seldom yields permanent results.
That a "permanent cure" is always an individualized, elusive goal, and that it takes time to achieve.
That the Plan is a lifelong change in eating strategies.
Discussion
During a conference at Northwestern University in Evanston once I heard one of the leading experts on eating disorders say:
"In a fat person there is always a schizophrenic [individual] waiting to get out".
In making this particular observation Hilde Bruch (its author) was wrong.
But, if one works around the semantics it can be recast this way:
"A fat person is an unhappy individual eating her way through adversity in order to cope with stress and feel better".
Realities
Today we are confronted with a perplexing and enormous obesity pandemic ("Globesity", some call it)..
To confront it, academia has offered very little hope, unless one decides to accept as being serious, their often confounding and confused, recurrent press releases and investigation reports.
Besides endless repetitions of the obvious magnitude of the obesity situation, academicians often dabble in absurdities:
Gut flora, babyhood infections, different types of fat, genetics, and other unlikely causes are "suggested" (never proven) as causes for the obesity epidemic while, in the process, sidestepping obvious considerations.
For example, ignoring the deleterious impact of fast foods and sugary beverages on the individuals" weight, or their dogged persistence in the arbitrary and improper use of the BMI.
About the BMI
The BMI is a useless research tool that, despite its futility, maintains itself as the yardstick, in academic circles, to measure the presence and severity of obesity as a clinical condition, something that it was not designed to do. (See my articles to this effect).
But who cares, when the purpose is to impress?
Diets and pills
Diets have failed us miserably and medications for their part run a second, not distant and yet a hazardous, place on this race.
The Gym
It"s a proven fact, that it"s not what you do at the gym, but — what and how you eat what you eat — what really matters.
Bariatric surgery as a remedy, is no remedy
It"s a surgical procedure; it entails risks, does not address the individual dynamics and often — quite often — fails. (See my articles to this effect).
So that the proverbial Emperor is found in the end, to be naked.
In summary
This brings us full circle to where we began, when we I said that losing weight is a balancing act.
Let"s see why
Let"s observe Nature and what it communicate to us.
We live by the sea. When we swim we see the great variety of birds that glide through the skies searching for their food.
They are lithe, graceful and never fat.
It"s so because they maintain an instinctive and programmed homeostatic balance between what they ingest, utilize, and store.
Their eating strategy is circumscribed and specific.
For us is different
As a omnivorous species — for countless reasons — we"ve long lost the ability to keep this equilibrium which we managed to maintain, as the birds and other animals do, in times remote.
Now we find ourselves in the conundrum that an equilibrist would find herself if she were fat.
We eat too much of tasty and calorie laden foods.
We eat for pleasure and not to aliment our bodies.
We eat for pleasure and often as a "sport".
See my point?
References
Larocca, F: (1984) The Psychiatric Clinic of North America issue on Eating Disorders W. B. Saunders & Co.
Larocca, F. E. F. (2007) Las dificultades inherentes con el control del sobrepeso en monografías.com
Larocca, F. E. F: (2007) Del por qué el perder de peso es asunto tan elusivo en monografías.com
Larocca, F. E, F.: (2007) De por que el perder y el controlar el sobrepeso es como aprender otro idioma en monografías.com
Larocca, F. E. F: (2007) El Sistema Fiduciario en monografías.com
Dwyer, J and Larocca, F. E. F: (1974) When a Child is too fat. Patient Care VIII-6- 158-76
Cassell, D, and Larocca, F. E. F: (1994) The Encyclopedia of Obesity and Eating Disorders. Facts On File
Larocca, F. E. F: (1991) A Public Primer on Eating and Mood Disorders Midwestern Medical
Larocca, F. E. F: (1986) Eating Disorders: Effective Care and Treatment Ishiyaku Euroamerica
Larocca, F. E. F: (1986) Eating Disorders: The Facts in New Directions for Mental Health Services # 31 Jossey-Bass
Larocca, F. E. F: (1986) Una Introducción a las Disorexias en Médico Interamericano 5:12 27-30
Larocca, F. E. F: (2007) Los Trastornos Malignos del Comer en Psikis.com y en monografías.com
Microsoft Encarta 2007 (CD/DVD) List of recommended reading
Larocca, F. E. F: (2010) Hobson"s: The only viable Option in the treatment of fatness Sistema Límbico Blog
Autor:
Felix Larocca
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