What You Can Change _. And What You Can't - Martin E. Seligman [95]
The dieting theory cannot fully explain bulimia. Many people who diet don’t become bulimic; some can avoid it because their natural weight is close to their “ideal” weight, and therefore the diet they adopt does not starve them.24 In addition, bulimics are often depressed, since binging-purging leads to self-loathing. Depression may worsen bulimia by making it easier to give in to temptation. Further, dieting may just be another symptom of bulimia, not a cause. Other factors aside, I can speculate that dieting below your natural weight is a necessary condition for bulimia, and that returning to your natural weight and accepting that weight will cure bulimia.
There is a new and disheartening development in “eating disorders.”Dr. Robert Spitzer, a New York City psychiatrist who organized the writing of that useful document the Diagnostic and Statistical Manual of the American Psychiatric Association (DSM-3 and DSM-3-R), is now trying to have “binge-eating disorder” added to DSM-4. He discovers this new malady in as many as 30 percent of those dieting in hospital weight-loss programs. They binge occasionally, but they don’t purge, so they gain weight. From my point of view, many of these poor people are trying to slim down to weights far below their natural weight. Their bodies, like bulimics’, are screaming for food. Perhaps their disorder is not binge eating but inappropriate dieting.25
The Right Treatment
BULIMIA NERVOSA SUMMARY TABLE
In fact, we should consider a new category for DSM-4, “dieting disorder,” defined as being within 20 percent of your “ideal” weight and ruining your life and health by dieting.
The idea of natural weight has another huge practical implication. Right now I’m drinking my morning coffee with three packets of artificial sweetener in it. I love sweet coffee, but I hate the nearly 50 calories in a tablespoon of sugar in each cup. I have been assuming—until now—that for each dose of artificial sweetener I consume, I will take in that many fewer calories each day. I am also afraid that if I stop drinking artificially sweetened beverages, I will gain weight. This is the hidden logic of the army of consumers that supports the $10 billion diet-soft-drink industry. With artificial sweetener in three cups of coffee, the savings is about 150 calories; two diet soft drinks means another 400 or so calories saved: That’s around 550 calories a day I avoid; almost 4,000 calories a week, more than the equivalent of one pound of weight. But why haven’t I lost a pound a week since I started using artificial sweeteners? (I calculate that I should now weigh less than zero and go floating off like a helium balloon.)
The answer, I suspect, is natural weight. I probably eat an extra 550 calories elsewhere each day to make up for the sugar I avoid. Those calories aren’t in sugar, so my teeth aren’t rotting out, but they might be in fat. I don’t know if this is so, but I’m going to find out.26
Diet Pills
Diet pills suppress appetite, and they have one virtue: Unlike diets, taking pills requires no discipline. But pills create the same problem as dieting—rapid regaining of weight—and are more dangerous: In 1973, the Federal Drug Administration severely limited their use because the weight loss they produce (about two pounds per week) is small, and the health risks, including psychosis, addiction, heart attack, and death, are substantial.27
New drugs are developed every so often. The latest ones, fenfluramine and phentermine, show more promise. They produce substantial weight loss, and unlike their predecessors, they