Medsarticles. Medical Weblog

All of the effects of the influencing and moderating factors on body fat stores are mediated through the final common pathway of food, or energy expenditure. In particular, the intake of energy through dietary fat, and the utilisation of fat as energy through physical activity are now known to be the major influences on fat stores. However, as we have stressed the importance of fat in determining total energy, we now concentrate more on the two components of the energy balance equation as fat/energy intake (F/EI), and/or fat/energy expenditure (F/EE).

The most appropriate aspects of physical activity, which is the major modifiable component of EE for fat loss. The important point is the change in thinking about the components of energy

balance from energy intake, to fat intake, and from energy expenditure to fat utilization.

The implications of this on the energy intake side, are that it is much more realistic to aim for a change in the quality of the diet (reducing the fat-carbohydrate ratio) than by asking people to eat less. On the energy expenditure side, the approach places a much greater emphasis on ‘physical activity’, in contrast to ‘exercise’ for fat loss, and is in line with recent research which supports the use of lower duration, moderate intensity activity to achieve metabolic fitness and promote fat loss. It redirects priorities for fat loss and obesity reduction away from a physical fitness orientation towards a strategy based on increasing low-moderate intensity activity (such as walking and ‘incidental’ exercise).

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The Family Perspective

I would be hard pressed to think of a patient whose family life had no direct bearing on the way her disorder developed. Volumes have been written on the role of family dynamics in anorexia and bulimia.

Some patterns that have been identified in certain eating-disordered families include an overemphasis on appearance, social isolation, emotional rigidity, and the inability to resolve conflicts. However, there is no such thing as a “typical” eating-disordered family. The same dynamic that triggers an eating disorder in one person may allow another to thrive. In Chapter Eleven we’ll learn more about the family’s influence on eating disorders, and how family therapy can be a vital component of treatment.

The Sociocultural Perspective

To sociologists, eating disorders result from the extreme value our culture places on thinness. Through advertisements, TV programs, and magazines, thinness has become a kind of social currency, a means of exchange between people. The hidden message: Thin wins.

The other side of the coin: Fat is failure. Chubby children suffer cruel teasing by their schoolmates-teasing that can become the trigger for an eating disorder. Fat people are the targets of jokes and whispered comments. Some find the doors to advancement closed. The cultural pressure to be thin can make feelings of insecurity, self-doubt, or unworthiness much worse.

Other trends stoke the fire. The modern changes in women’s place in society and the lack of models showing how to fulfill those roles add to the problem. A girl whose mother was “just a housewife” may suddenly find herself, at adolescence, expected to become a “superwoman,” adept at juggling career, family, and personal needs. Some women may lack the skills to cope with-or resist-these demands, including the demand that one must be thin. By submitting to these pressures, they hope to show they are worthy, that they can set and reach goals, and that they deserve respect.

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Devoutly religious, Theresa Giffin says that her relationship with God has been her salvation from a lifetime of weight problems.

“I had tried everything available to lose weight,” she notes. “I took pills. I fasted. I got a tummy tuck. I did it all. And each time, I’d regain what I lost—and more.”

But for Theresa, prayer succeeded where pills, fasts, and surgery had failed. It happened one day when a coworker left a 2-pound box of chocolates on her desk.

Theresa took one piece, but she knew that wouldn’t be enough. “It was my very favorite candy, and I thought I wouldn’t be able to stop,” recalls the 51-year-old nurse from Fall Creek, Oregon. “So I whispered a little prayer: ‘God, you know that I want to eat this whole box of candy. You have to help me!’”

In an instant, Theresa’s desire for chocolate vanished. “It had no smell, no taste,” she says. “It was like a piece of cardboard to me.”

Theresa joined Weigh Down Workshops, an international program that advocates weight loss through prayer. She credits this approach with her weight-loss success.

Now, every time temptation hits, Theresa says a little prayer. In little more than a year, she lost 87 pounds. j pi

WINNING ACTION

Create your own intervention. When you feel that overwhelming surge of emotions sending you off on a binge, stop it in its tracks. Like Theresa, you can pray. Or you can do what I do: Before I start stuffing myself with food, I say to myself (or sometimes out loud), “Stop, slow down, and think!” Usually, that’s enough to help me switch gears, so I can do something—anything—else.

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