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Rethinking Thin To Diet ort Not to Diet? That is One Tough Question

THE BALTIMORE SUN

Every diet story starts with a success story, and why should this one be different? So here is the success story of nurse Jean Antonello of Minneapolis:

Jean Antonello's moment of truth came the summer she realized she'd gained back every one of the 20 pounds she'd lost by dieting the six months before her wedding. She was not pleased by the knowledge. In fact, it made her depressed. It made her desperate. In her opinion at the time, anybody who weighed more than 120 pounds was fat, and here she was, checking in at 155 big ones.

So she did what she thought she was supposed to. She went on a diet -- a rigorous diet. She also worked out, running several miles a day, sometimes twice a day.

And, at the end of two months, she had lost nothing. Zip. Zilch. She was still checking in at 155 big ones, though she looked like a wrestler from all that working out.

"I went into a real crisis," says Ms. Antonello. "I thought, 'My God, how can my body do this? If this didn't work, then my body is just hell-bent on making me fat.' I said to myself, 'I can't go on living like this.' "

And "like this" didn't mean weighing 155 pounds, she says; it meant "dieting." Jean Antonello had had it with dieting.

"I began to search for a cure, a solution. I had two problems. One was my weight problem, and one was my relationship with dieting. And my second problem was by far my biggest problem."

Next to that, she says, being 35 pounds over what she wanted to weigh was nothing. Nothing.

WAIT A MINUTE, YOU'RE SAYING, wait a minute.

Wasn't this supposed to be a diet success story? So, where's the success? This Antonello woman is left out there floating in porkland, 35 pounds from the border. Aren't diet success stories all supposed to end with "and she lost every one of those pounds plus a few more and lived happily ever after in a size 6 dress, just like Julia Roberts in 'Pretty Woman' "? And where are the before-and-after photos, with the one showing a blimp and the other a babe? What is this?

Well, this is a story about alternative ways of thinking about dieting.

It's a story about how maybe it's not a good idea to diet.

It's a story about how maybe dieting can make you gain weight as well as lose it.

It's a story about how many of the people who do diet don't really need to diet.

It's a story about how maybe your objective should be not so much a lower weight as making peace with your body and yourself.

Which brings us back to Ms. Antonello, who is now the author of a book called "How to Become Naturally Thin by Eating More." The story of her hungry summer is a success story, not because she lost weight but because she began to realize that for her dieting wasn't the solution, it was the problem. And that next to it her weight problem was no problem at all.

THESE ARE TWO OF THE MAJOR ASsumptions of the alternative thinking about dieting: Dieting itself can be the problem, and sometimes weight isn't.

This is exactly the reverse of the way just about everybody -- just about everybody female -- thinks about it. Ms. Everybody thinks about it this way: "The problem is that I don't wear a size 6 like Julia Roberts. The solution is Optifast."

So Ms. Everybody goes on a diet -- OK, in the wake of Oprah's return to plumpness maybe it's not necessarily a liquid diet, but it will be some form or another of caloric deprivation -- and everything is fine, except for one little detail.

Which is, according to the alternative thinking about dieting, that diets don't work.

That is, diets -- especially the fast and restrictive ones that are the most popular -- work for a while, but not for the long term: Just like Ms. Winfrey, dieters lose the weight, but most of them put it back on again within a year or so, if not sooner. Usually it's accompanied by a few extra pounds that weren't there the first time around. Some people stop there. They say the hell with this, and buy one-size-bigger slacks. They're the lucky ones. The others -- women, for the most part -- go back on a diet and lose again. Then they gain again, diet again, gain again, diet again -- and voila! that miserable creature, a yo-yo dieter, is born.

Often the yo-yo-er is also a binge eater: She will end a day of stringent dieting with a night of gorging, or cap a week of starving by a weekend of stuffing. When she isn't eating, she's thinking about eating, and she has probably annoyed you at many a meal with her tiresome litany of "oh, I can't" and "oh, I shouldn't" while she enviously ogles your leftover french fries.

But her predicament is not a funny one. "Society's obsession with weight and with dieting has turned millions of us into food junkies or compulsive eaters," says New York psychotherapist Carol H. Munter, co-author with Jane R. Hirschmann of "Overcoming Overeating." And in many cases, says Baltimore psychiatrist Harry A. Brandt, director of the Mercy Center for Eating Disorders at Mercy Medical Center, it has led to the dangerous and sometimes fatal extremes of anorexia nervosa and bulimia.

The conventional way of thinking about dieting and weight puts the blame for these dire consequences squarely on the dieter: It says lack of willpower or emotional problems in the dieter are to blame. The alternative view, though, points the accusing finger in quite different directions: toward society's unrealistic expectations about ideal weight, and toward the body's own adaptive mechanisms.

The normal human body, according to this way of seeing things, can't tell the difference between restrictive dieting and starvation. Both of them spell f-a-m-i-n-e, as far as the body is concerned, and it reacts in the same way that has managed to keep the human race alive over the hundreds of thousands of years when real famine was not only a possibility but a likelihood: It slows down its metabolism.

In the hungry Third World, this means that even during long durations on short rations, people can survive because their bodies adapt by needing less food. But in prosperous America the same prolonged duration on short rations -- habitual dieting -- means chronic dieters find their weight stays the same on a calorie allotment that would have a brand-new dieter dropping pounds like flakes of dandruff. The chronic dieters, in the alternative view, have "trained" their bodies to live on less.

And that's not the end of it: When the chronic dieter stops dieting, she'll find she regains weight eating less than she did before: What her dieting has done is trained her metabolism to survive on less food than a non-dieter at the same weight would need. That is the hidden penalty of successful dieting. And when she tries to take it off the next time, it will take her longer to do it, or even fewer calories than she ate before.

This is dismaying, even horrifying news for dieters, but alternative thinkers about weight point out that it is nonetheless a normal, adaptive response to starvation. So is the chronic dieter's midnight nemesis: binge eating. This kind of compulsive eating doesn't mean the dieter has a weak will, but rather that her body has a stronger one: the normal, healthy, adaptive response to starvation, which insists lost weight must be regained as soon as possible, right now, if not sooner.

So, as Ms. Antonello puts it, "the accumulation of fat is a positive adaptation to an environment where food is restricted" -- which is a fancy way of saying that weight problems can result not just from eating too much but also from eating too little.

THIS IS NOT EXACTLY NEW INFORMAtion. Much of it has been around a while, but it has not made its way yet into the public consciousness.

"We cling to the belief that we can find a way to make one [diet] work. This time will be different, we tell ourselves, and with that promise, we re-enter the diet/binge cycle -- one more time," write Ms. Hirschmann and Ms. Munter in "Overcoming Overeating."

And psychotherapist Andrea Gitter, who works with the Women's Therapy Center Institute in New York, which treats many women with eating problems from an anti-diet approach, tells about watching a long TV report explaining how diets don't work -- at the end of which the reporter concluded that everybody just has to try harder.

The alternative view is exactly the opposite: That yo-yo dieters and compulsive eaters -- often the same people -- have to stop trying so hard and start eating.

"In order to cure their problem, [they] have to first stop dieting," says Carol Munter, who is credited with starting the first anti-dieting group for women with compulsive eating problems in 1970. "And then they have to go back to the beginning of their eating lives and begin feeding themselves on demand -- when they're hungry, exactly what their bodies crave and in the amounts required."

In Jean Antonello's words, "Eat when you're hungry until you're not."

Sounds simple, but it's anything but. One problem, says Ms. Antonello, is that chronic dieters are terrifically anxious about letting go of their long-maintained controls. Ms. Munter agrees. "Compulsive eaters can't imagine life outside of a diet without envisioning themselves eating everything in sight," she has written.

But in practice they don't eat everything in sight, insist proponents of the alternative views: Once former dieters start eating enough on a regular basis to reassure their bodies that the famine is over, that familiar and terrifying desire to eat the entire contents of the cookie aisle at the Giant fades out.

Letting go of the old controls, though, isn't the only problem chronic dieters face in shifting to hunger-mediated eating: Many of them also have trouble separating emotional hunger from physiological hunger.

"The problem in compulsive eating is that people use food as a tranquilizer rather than as a fuel," says Ms. Munter. The goal, she says, "is for them to get to the point where they can think about their problems rather than eat about them."

That's why many of the specialists in this kind of thinking advise keeping food journals -- lists not just of what you eat but also what you were thinking and feeling at the time you ate it -- to learn to distinguish between physiological cues and psychological ones. Keeping such journals, notes Baltimore dietitian Colleen Pierre, spokeswoman for the American Dietetic Association, is one of the factors associated with successful weight loss -- that is, not only losing it but keeping it off. (The other factors are a slow rate of loss and a regular exercise program.)

It is important, many people in the alternative diet movement emphasize, to satisfy both kinds of hungers -- the psychological and the physiological. In this they again run counter to the conventional thinking, which says both kinds of neediness must be "controlled" (that is, suppressed) for successful weight control.

In fact, many among the alternative thinkers tend to see the emotional problems experienced by compulsive eaters and dieters as caused by their self-starvation. This view moves away from psychological explanations of eating problems and puts the blame instead on biology and society alone.

Most, though, see compulsive eating problems as caused both by physiological responses to protracted hunger and by a tendency to eat in response to non-physiological cues.

Both hungers must be fed, they say -- but only one of them by food.

LET'S SAY YOU DO IT, AND YOU TRY feeding yourself when you're hungry at the same time that you stop eating from habit, anxiety, boredom and other non-physiological cues.

Will you lose weight?

Maybe, maybe not. Jean Antonello points out that she did lose, from the 155 pounds she weighed that hungry summer to her current range of 138 to 145, and she believes most people who follow her "anti-diet" will also drop some pounds. Not everyone agrees: Janet Polivy, professor of psychology and psychiatry at the University of Toronto and co-author of "Breaking the Diet Habit," says although a minority will lose weight, a majority won't.

But, she says, losing weight's not the point.

Which brings us to another important tenet of alternative thinking about dieting: That the obsessive concern about weight should be replaced by other concerns, such as developing healthy self-esteem and respect for the body one already has.

Thus losing weight "is not the goal and it's not the result" of VTC breaking out of food and diet compulsions, says Ms. Gitter, though it may be a side effect.

"The focus of recovery [from habitual dieting] is the normalization of a person's relationship with food and her body, or his," says Jean Antonello. "So getting well is really about something much bigger than getting thin. And people who are in the recovery process know that: Six months in, they realize that it's about their whole life being liberated from something very draining, which is the constant, never-ending and compulsive fight against their own body. People who diet are at war with themselves."

Compulsive eaters and dieters have a choice, says the alternative thinking: Continue the war with themselves, or accept a limited victory in which they won't look like Julia Roberts but in which they will be free of the starve-binge cycle and its attendant miseries and costs.

Part of this limited victory is renegotiating the definition of overweight -- upward. All dieting women think they're overweight, but only half of them really are, says Washington endocrinologist Dr. C. Wayne Callaway, author of "The Callaway Diet: Successful Permanent Weight Control for Starvers, Stuffers and Skippers." Such women are suffering from the misperception that results from the "dissonance" between what American culture says women should weigh and what healthy biology says they should weigh.

This is probably why those who advocate giving up dieting don't use the term "ideal weight": Too often it refers to the cultural ideal and not the biological one. Instead they talk about "home" weight or "natural" weight -- the weight to which a body will return by itself if its owner is neither stuffing nor starving but simply eating normally in response to normal physiological hunger.

But accepting their natural weight can be very difficult for many people, Ms. Gitter says; they'd rather keep on hoping that somehow, some way, they will come out looking like Cheryl Tiegs. Adding to their difficulties is the belief that any degree of weight over the ideal -- even a few pounds -- is the source of all kinds of medical ills from diabetes to heart disease, a belief supported by many physicians.

Some in the health community, though, are moving away from such stringency. They point out that in the absence of such conditions as elevated cholesterol, high or borderline blood pressure, or diabetes or a family history of it, a few extra pounds don't hurt, and their view is finding its way into the medical literature, says Roberta Pollack Seid, author of "Never Too Thin."

This kinder, gentler way of thinking about weight has even received official recognition, in the form of the Dietary Guidelines for Americans released last year by the U.S. Departments of Agriculture and Health and Human Services. Dr. Callaway, who served on the advisory board for the guidelines, notes that they allow more generous weights than ever before for healthy people who have none of the conditions that are believed to raise the risks involved with extra pounds.

According to the new guidelines, for example, Jean Antonello's old weight of 155 was well within the suggested range for her height of 5 feet 8 inches, and her current bottom weight of 138 edges on underweight, since it is the lowest suggested for people her height who are over 35.

Her old "ideal" weight of less than 120 is pushed right off the map -- and the funny thing is, she says, when she looks at pictures of herself at 118 pounds, she sees she really didn't look any better than she does now. But, she adds feelingly, "I felt horrible."

BUT IS ANYONE OUT THERE ACTUAL- ly accepting this kind of thinking and acting on it?

Some people, but not a lot of them, suggests Roberta Pollack Seid. When she went on talk shows two years ago after her book came out, she worried about what people would say about her "blasphemy" against the "religion" of dieting. And her worry was justified:

"I would have people call up and screech at me," she says, "asking how can I tell people to stay plump."

Now, though, she's back on the talk shows again with the release of "Never Too Thin" in paperback, and she says, "The calls are totally different, they're much more sympathetic."

Still, conversion isn't absolute -- not by a long shot. "People in the field are beginning to be aware that it's very difficult to lose weight and that it's better for people to maintain their weight" than try to lose, she says, but "on the other hand, those women in magazines are as skinny as ever."

The alternative thinking is "not terribly widespread," agrees Dr. Callaway, even in the medical community. "Physicians, like lawyers or anybody who has a vested interest in the status quo, are very much a product of their culture and don't realize that what they're projecting on their patients is a cultural bias, not a medical one," he says.

It will take a while for the new evidence to sink in, he continues, but eventually "we're going to look back on this era like the era of bleeding and purging."

Until that enlightened time comes, though, he advises all those dedicated dieters who are out there trying to force their bodies to change to think about a certain geographical analogy:

"For centuries the [Army] Corps of Engineers has been trying to get the Mississippi to change its course," Dr. Callaway says, but "ultimately the Mississippi is going to win."

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