For the most part, Jean did well in Stage 3. She loved the idea that no foods were ever out of bounds and that she could plan to have a favorite food every day. She usually planned to have a moderate portion of ice cream, but only at bedtime, so that if a craving for more hit her, she'd be in bed. Her greatest difficulty was getting herself back on track when she made a mistake, since she struggled with common sabotaging thoughts, such as: I can't believe I ate that. I'm so weak. Oh, well, I might as well eat whatever I want for the rest of the day, and start again tomorrow.
To help Jean see the irrationality of this line of thinking, I suggested an analogy:
"If you went through a red light by mistake, would you say to yourself, 'I can't believe I did that! Oh, well, I might as well keep going through red lights for the rest of the day, and start driving carefully tomorrow?'" She got the point: it makes no sense to compound one mistake with more. I also explained to her that if she ate an unplanned 300-calorie piece of cake, it probably wouldn't even show up on the scale at the end of the week, but if she used one mistake as a justification to eat whatever she wanted, she'd see the negative consequences on the scale the next morning. It took Jean almost two months to consistently get herself back on track whenever she ate something she wasn't supposed to. But the more she was able to limit her mistakes, the more her confidence grew, until she finally mastered this essential skill.
Stage 4: Planning for Special Occasions
At this stage, dieters learn how to handle special eating situations—restaurants, travel, holidays, social events, illness, and increased stress. Although problem-solving is usually beneficial, dieters most need to learn to respond to the sabotaging thoughts that give them permission to abandon their diet plan altogether. They develop "special occasion guidelines" that allow them to increase their calories temporarily, and in a controlled way.
Jean had typical sabotaging thoughts when faced with special occasions. When considering Thanksgiving, for example, she predicted that she'd probably think, I deserve to eat whatever I want. It's not fair that I have to limit myself. I want to be able to eat and drink like everyone else. So I asked Jean what her goal was: to eat whatever she wanted on special occasions or to lose weight permanently. After explaining that the two goals were incompatible, I helped her develop a reasonable rule for herself: as long as she had no more than two special occasions per week, she could eat about 300 calories more at those events. Expecting her to eat in exactly the same way as on an ordinary day just wasn't reasonable—it was more important to make sure that she didn't revert back to her old way of eating, gain weight, become demoralized, and perhaps quit the diet altogether.
Stage 5: Staying Motivated for Life
By the final stage of the dieting process, the focus is on helping clients learn to cope with declining motivation after they reach their ideal weight (which I define as the weight at which they plateau when they're eating a healthy diet they can keep up for the rest of their lives—plus about 5 to 10 pounds). Dieters need to start preparing themselves in Stage 1 for the probability that they won't lose as much weight as they'd like, and they need to work hard in Stage 5 to deal with the disappointment they feel when the number on the scale no longer goes down. The emphasis here is on practicing skills to continue to motivate themselves daily, arrest mistakes before they turn into setbacks, and recover from setbacks so they don't turn into full relapses.
From the beginning of treatment, Jean had struggled with the idea that, if she were to avoid the dieting roller coaster, she'd need to continue to eat in the same way as long as she lived. We'd spoken about this repeatedly, but it hadn't really sunk in. I explained it to her in this way: "You've lost 48 pounds and seem to have stopped losing weight. I think we should officially declare that you're in maintenance."
"Does that mean I can start to eat more?" she asked.