Rather than using control to stop herself from eating, Sasha learned to say to herself: "I'm reaching for food and I'm not hungry. I wonder what I would think about or feel if I didn't eat right now?" In the past, the moment she'd reached for food, she'd lost access to what was really bothering her, but she'd now gained a window into her feelings. She began to identify more of the conflicts in her relationship with her husband and to talk directly with him about her concerns. As a result, the couple elected to go to marital counseling to address long-standing issues.
As the relationships among dieting, overeating, and emotions become clear, therapy helps clients develop their ability to regulate affect without automatically reaching for food. Clients who integrate attuned eating into their lives will find that their relationships to food, themselves, and the world change in profound ways.
Attuned Eating vs. Weight Management
Mounting research on intuitive eating shows positive outcomes, from improved cardiovascular health, increased pleasure and enjoyment of food to fewer dieting behaviors and food anxieties, greater body satisfaction, and better coping skills. In a well-controlled study in 2002 reported in the International Journal of Obesity, Linda Bacon and her colleagues compared a traditional weight-management program with a nondietary approach. Both groups showed similar improvements in metabolic fitness, psychological factors, and eating behaviors; however, the dropout rate for the diet group was 41 percent, compared to 8 percent in the nondiet group. The diet group showed short-term weight loss and improved self-esteem, but these results weren't maintained after one year; conversely, members of the nondiet group showed improved outcomes over the same time period.
In 2005, a two-year follow-up to Bacon's study appeared in The Journal
of the American Dietetic Association. Participants in the nondiet group had maintained their weight and sustained their initial improvements, while members of the weight-management group had regained their weight and showed little sustained improvement. The researchers concluded that the approach based on intuitive eating "enabled participants to maintain long-term behavior change; the diet approach did not. Encouraging size acceptance, reduction in diet behavior, and heightened awareness and response to body signals resulted in improvements in health risk indicators."
Weighing Our Attitudes
It's ironic that with two-thirds of us moving into the "overweight" or "obese" categories, fat-bashing remains a common occurrence, and weightism (or weight stigma) arguably remains one of the last socially acceptable prejudices. Unfortunately, psychotherapists aren't immune from this bias. In his book Love's Executioner and Other Tales of Psychotherapy, Irvin Yalom acknowledges this prejudice. In the chapter titled "The Fat Lady," he writes, "I have always been repulsed by fat women. I find them disgusting: their absurd sideways waddle, their absence of body contour—breast, laps, buttocks, shoulders, jaw lines, cheekbones, everything, everything I like to see in a woman, obscured in an avalanche of flesh. . . . How dare they impose that body on the rest of us?"
Yalom's honesty is admirable, but his observations raise a topic not often discussed in our profession. Most of us agree that the cultural ideals of thinness are unrealistic and harmful, but how do we really feel about people who are fat—or "large," or "oversized"? At workshops, I ask therapists to brainstorm the qualities they associate with "thin" and "fat." Like most others in the general population, they tend to regard thin people as healthy, successful, attractive, active, and sexy, and to regard fat people as lazy, stupid, ugly, and unhealthy.