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By Root 989 0

top of your stomach. This is major surgery with a fair number of complications that must be corrected by more surgery. The mortality rate from the surgery is very low, below 1 percent, but do note that patients have a subsequent suicide rate of around 1 percent. The food you eat for the rest of your life must be soft, for it passes through your body less well digested. Appetite decreases, weight loss is dramatic, and, most important, the weight tends to stay off. In three-and five-year follow-ups of several hundred patients, the majority have done well. The patient who weighed three hundred pounds before surgery weighs only two hundred pounds five years later. Heart function also improves. Only about 15 to 20 percent fail completely and end up weighing close to their original weight. Gastric bypass is the only treatment of obesity with a documented satisfactory long-term outcome. The effect of this surgery on overweight people who are less than enormously obese is presently unknown, but given their desperation about overweight, I will not be surprised if moderately overweight Americans start to seek it out in the near future.40

A Word to the Professional

I intend this book for two audiences. It is primarily for the consumer. Millions of people are trying to make rational decisions about how to cope with their problems and what to do about their shortcomings. They consume self-improvement regimens, psychological treatment, and psychiatric treatment to the tune of many billions of dollars annually. There is presently no consumer’s guide, nothing comprehensive and scientifically grounded, to tell the public which treatments work and which treatments fail, which problems can be conquered and which are intractable, which shortcomings can be improved and which cannot. Creating such a guide is my primary aim.

My second audience is the professional: the clinical and counseling psychologist, the psychiatrist, the social worker, the physician, the deliverer and designer of self-improvement programs. Dieting is a special case for us. It affects about half our clients, and it dwarfs all the rest of the problems we deal with by its sheer scale. For a half century we have been advising our clients to diet. Initially, our justification was sound: The “ideal weight” tables pointed to increased health risk with overweight. The situation has changed in the last twenty years. It is now clear that

weight is almost always regained after dieting

dieting has a number of destructive side effects including repeated failure and hopelessness, bulimia, depression, and fatigue

losing and regaining weight itself presents a health risk comparable to the risk of overweight

When we encourage dieting, we are in danger of violating our oath to “do no harm.” Help-givers should change their advice. We should tell our overweight clients that unless their only concern is short-term attractiveness, dieting is unlikely to work.

Commercial weight-loss plans, diet books, and magazine diets are under a more urgent obligation: They should warn their clients and their readers emphatically that any weight lost is likely to be regained. If commercial programs will not do this voluntarily, disclosure of their long-term success (or failure) rates and of their side effects should be a matter of law.

These steps will go a long way toward making our profession a more responsible one.

13

Alcohol

Poetry is the lie that makes life bearable.

R. P. Blackmuir (from a poetry lecture,

Princeton University, spring 1959)

FIFTEEN YEARS AGO two pioneering graduate students at the University of Pennsylvania—Lauren Alloy and Lyn Abramson—conducted an experiment that yielded the most annoying results I have seen in my scientific lifetime. For a decade I kept hoping their findings would be overturned, but subsequent studies confirmed them.

Subjects were given differing degrees of control over the lighting of a light. For some, the action they took perfectly controlled the light: It went on every time they pressed a button, and it never went on if