Total fasting. Otherwise known as starvation. This is not recommended because of the excessive losses of lean body mass that occur. Many people undertake short-term fasts and actually say that they feel better for it! In the short term, it can contribute to micronutrient deficiencies and in the longer term, contribute to increased body fatness and morbidity. Fasting causes the body to lose water, potassium and sodium (as well as active metabolic tissue) which disturb the homeostasis of the body. Fasting becomes self-defeating as people become lethargic and less active, therefore metabolising less body fat People eventually stop starving themselves, which can have inherent physiological dangers depending on the severity of the fast. Fasting should be avoided.

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The therapist may need to provide reassurance and support at every step. Eating disorder patients can be highly anxious about their situation. Anorexics, for example, often feel a sense of panic when their weight begins to rise or when menstruation returns. The therapist should anticipate this panic and know how to deal with it. Some anxiety arises because the patient has lost her ability to recognize her inner feelings. One of the greatest services a therapist provides is teaching the patient what her true feelings are and showing her that they are valid.

Properly handled, the relationship between the therapist and the patient provides a context of trust. The patient is gradually able to discuss “bad” feelings more freely and with less fear or shame. In time she begins to trust herself. When she reaches that milestone, she begins to feel she can trust other people as well. Therapy becomes a sort of microcosm of the whole world, and î the patient’s process of growth and maturation within that world.

If you are in treatment, or if you are shopping for a therapist, keep the above points in mind. A health-care professional who lacks these basic skills, or who fails to earn your trust, is less likely to be helpful.

There’s no hard and fast rule stating which type of therapy should be tried first. The choice depends on many factors. In less extreme cases I might hold off using medication until I’ve given other forms of therapy a chance. However, in dealing with a patient who has binged and purged every day for fifteen years but who will only be staying in the hospital for a month, I will be inclined to use every means at my disposal – not just medications but intensive individual, group, and family therapy as well. Some might describe this as a shotgun approach – but if you only have one shot, a shotgun can be pretty effective.

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Even with her supporters, Debbie understood that there was only one way she would slim down successfully: She had to do it for herself. And she did, losing 91 pounds in 18 months.

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| Debbie, a 42-year-old marketing manager from Chesapeake, Virginia, had struggled with her weight since seventh grade. “I went i§ ; on every kind of diet known to womankind,” she says. When she reached 286 pounds, she despaired that she’d never achieve a healthy weight.

When her husband suggested they start exercising to an aerobics video every night, she reluctantly decided to join him. She admits that her heart wasn’t in it—until she noticed that her clothes were looser after just 3 weeks of working out. Inspired, she decided to give weight loss one more try.

Ever the marketing professional, Debbie wondered whether her story had any publicity potential for the newspaper that employed her. So she proposed that a reporter chronicle her quest.

Once a month, the newspaper ran an article on her progress. It also set up a special voice-mail number so that readers could leave messages for Debbie. “I heard from all kinds of people— husbands who wanted their wives to lose weight, teens, even people from outside the paper’s readership area,” she says. They offered their encouragement and asked for her suggestions on weight loss.

While grateful for the support of her husband and the strangers who followed her story in the newspaper, Debbie kept reminding herself that she was slimming down for her sake and no one else’s. “If you lose weight for another person, you start to look for feedback from that person,” she explains. “If you do it because you want to please your husband but he doesn’t seem to notice, you don’t get the reward you expected. But if you do it for yourself, the reward comes from within you. That’s when you start to succeed.”

With 91 pounds gone, Debbie is still working toward her goal weight of 175 pounds. She feels so good about herself that she’s confident of her ability to go all the way.

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