Traditional thinking: The physics model. It has always been thought that the main causes of excess body fat are simply too little exercise and/or too much food. The traditional model for defining this has been encompassed by the formula:

Change in energy stores = Energy intake (EI) – Energy Expenditure (EE)

Where EI = calories from food, EE = resting metabolic rate (MR) + thermogenesis + daily physicalactivity.

There are now a number of reports that have established this is clearly inadequate for describing weight gains and losses in living organisms. According to the above calculation, for example, it has been estimated that a 75kg man who is in energy balance and who then adds an extra slice of toast and butter (100kcal) a day to his diet for 40 years would gain around 189kg over that time—a prediction which is clearly not sensible. The discrepancy results because energy is more closely balanced in free living organisms than was once thought. This comes about because there are changes in EE and EI with changing weight (e.g. changes in metabolic rate and the energy cost of activity, or changes in food intake with changes in physical activity). The above formula then needs to be modified to reflect rates of change, thereby allowing for the effects of changing energy stores on energy expenditure. It is now clear that initial differences between EI and EE (such as a modest increase in total calorie intake) do not lead to unbounded changes in body mass, hence the insufficiency of the physics approach.

*75\186\4*

Are eating disorders all in the mind?

No. There may be a physical malfunction in the way the body regulates hunger. And the longer a disorder persists, the greater the damage it does to the body. The impact of starvation on the brain can lead to worsening mental and emotional problems.

Is an eating disorder a sign that some other psychiatric illness exists, such as a personality disorder?

Eating disorders are illnesses in and of themselves. They are not necessarily the product of some other illness. Of course, an eating disorder arising in a young person can affect the way her personality develops.

Do eating disorders cause depression?

Depression is a separate problem. A woman can be depressed and have an eating disorder; the former doesn’t necessarily cause the latter. Some patients feel depressed because they are struggling with a chronic illness. However, there does seem to be a connection between a family history of mood disorder and the risk that a member may develop an eating disorder.

Will a teenage girl who worries about her figure develop an eating disorder?

Unfortunately, over-concern about one’s body is normal in our culture. But when other emotional pressures bear down on a vulnerable person, the risk rises that she’ll develop an eating disorder.

Does dieting lead to eating disorders?

Many patients did diet before their disorder arose, but others who diet never develop an eating abnormality.

Do food allergies, vitamin deficiencies, or improper diet cause eating disorders?

We need more research before we can answer this conclusively. Improper diet is destructive to a person’s health, as are vitamin deficiencies and untreated food allergies, but there’s not enough evidence to show that these in themselves can cause an eating disorder. However, there is evidence that imbalances in some vitamins or minerals may cause certain problems. Too much vitamin A, for example, can cause menstrual problems, while too little zinc can affect one’s mood, appetite, and sense of taste.

Is it true that anorexics have no appetite?

No. Anorexics do experience hunger much of the time and need considerable willpower to conquer these feelings. The more they starve, the more their bodies crave food.

Do anorexics hate sex?

Better to say that most anorexics would rather avoid sex. Starving uses up all the patient’s energy, leaving her none for any other activity, including but not limited to sex.

Are anorexics lying when they say they are fat but are obviously starving?

No-they mean it very sincerely, because the disorder has warped their ability to think and see accurately. The longer the illness persists, the more the patient misjudges her appearance and the more she feels compelled to keep starving herself.

Do an anorexic’s psychological problems have to be cured before she can gain weight?

Absolutely not. This would be like trying to fix a broken leg by analyzing the hidden motivations behind someone’s decision to go skiing. It won’t work and it only delays therapy that might do some good. An anorexic is in danger of dying. Job One is to restore weight so that her body-and her ability to think clearly- can return to normal. Only at that point will psychotherapy have some chance of succeeding.

Do anorexics starve themselves so they can look good?

Looking “good” has a different meaning for anorexics than for normal people. Many anorexics know they look skeletal and emaciated. For them, starvation is a compulsion they can’t control, not a plan to become more attractive.

Do laxatives and diuretics help control weight?

Not really. By the time food passes in a bowel movement, the body has absorbed most of its calories anyway. Any weight lost is probably just temporary “water weight” loss.

*14/35/5*

Dina Jachens lost 40 pounds without giving up any of the foods that she craves. Instead, she learned to enjoy them one piece at a time. Dina, a 31-year-old full-time mom from Midland, Michigan,

had her three children within 4 years. Each pregnancy left her a little bit heavier, and she had an increasingly difficult time getting rid of the extra pounds. “I was busy every minute, but not doing the things I could have done to keep in shape,” she says. “And I tended to eat whatever I could grab, which included lots of chips and other salty snacks.”

Even as her weight climbed toward 175 pounds during those 4 years, Dina didn’t think much about slimming down. Then, one day, as she sorted through some size 10 and 12 clothes that no longer fit, she began thinking about a family reunion that she had recentiy attended. At past reunions, she had always received lots of compliments about her appearance. But not this time.

Dina looked in the mirror and took a good long look at herself. She didn’t like what she saw. She vowed that she would get back into the size 8 that she had worn before having her kids.

“I realized that my eating habits had gotten out of control,” Dina says. “I was eating whatever I wanted to, as much as I wanted to. I’m a salt freak, so I’d eat chips by the handful. And before my periods, I’d crave chocolate, so I’d eat a good part of a bag of M8cM’s.”

Dina knew that she couldn’t completely give up the foods that she loved. But she learned how to control how much of them she ate by savoring them one piece at a time. Take those M&M’s. Dina stopped tossing them in her mouth a fistful at a time. Rather, she put one on her tongue and allowed it to completely melt before starting another. “It usually takes only about 10 M8cM’s until I feel satisfied,” she says. “That’s a lot better than a whole bag.”

The same rule applied to chips. Instead of eating them by the handful, Dina crunched one at a time, giving herself a chance to really savor the taste.

Dina made other changes in her eating habits, like giving up most desserts as well as high-fat, high-calorie foods that she didn’t really care for. “If there was something that I simply couldn’t pass up, I’d eat only a bite or two, just to get the taste,” she says. She also launched an exercise program, walking 6 days a week.

In 12 months, Dina managed to take off 40 pounds. She’s maintaining her weight at a healthy 135 pounds—and she’s back into her ^ size 8 clothing.

WINNING ACTION

Indulge yourself one bite at a time. Dina has found a terrific way to deal with her cravings for high-fat, high-calorie foods: by eating treats one piece at a time. It sounds like she’s enjoying them more, too! Do the same, and I bet you’ll find out how much you really enjoy every bite. Another suggestion is to look for your favorite treats in single-serving packages. If you crave chocolate, for example, buy a box of Fudgsicles instead of a half-gallon of ice cream. It will give you built-in portion control.

*68\89\8*