Ellyn Satter

Treating the Dieting Casualty

TREATING THE DIETING CASUALTY

Ellyn Satter, MS, RD, LCSW, BCD

Eating well is one of life's great pleasures. However, for many people, the pleasure of eating is spoiled by conflict and anxiety. Taking pleasure in eating, particularly for people of size, is not socially acceptable. The trend in recent years has been toward punitive, self-negating over-control of eating in general and toward weight management by restricted eating.

Almost everybody undereats in an effort to lose weight at some point in life. For some people, it is an odious task that can be picked up and put down at will, with little conflict and anxiety attached. Others, however, get caught in the process. The Dieting Casualty is one such person. Having dieted many times and suffered the negative physical, emotional and social consequences of food restriction, the Dieting Casualty can no longer tolerate undereating. However, after all the years of external control of food intake, she has lost touch with her internal regulators of hunger, appetite and satiety. As a consequence, lacking either external or internal controls, her eating becomes chaotic.

The Dieting Casualty functions adequately emotionally, but has lost control of eating. Despite repeated failures with weight reduction, she remains committed to the idea that somehow she should be able to restrict food intake and lose weight. Like Sisyphus, the Greek mortal condemned to a lifetime of pushing a boulder up a hill only to have it roll back down again, the Dieting Casualty can neither succeed at the task nor let go of it. Typically, dieting casualties begin weight reduction efforts at an early age (or have them begun for them by their parents) and continue those efforts throughout their lives. They buy the weight management books, participate in the medical and commercial programs, and lose weight, again and again, only to regain to a higher level.

Treating the Dieting Casualty and the How to Eat program offer secondary intervention for the person who experiences her eating as being chaotic and out of control. The intent is to help the patient set aside attempts to externally regulate food intake and body weight, rediscover internal regulation, resolve conflict and anxiety about eating, build competent eating and accept the body weight that evolves from self-nurturing, stable, internally regulated eating. Secondary intervention depends on a thorough evaluation, development of a behavioral treatment plan and progressive institution of the plan over several sessions.