• Sustainable strategies of eating a low-fat diet and maintaining appropriate activity levels are required for long term management of fat stores.

• Fad diets are not sustainable, exploit the vulnerabilities of the overweight and are counter-productive.

• Criteria can be applied to these diets to assess their validity and sustainability.

Long term management of fat stores requires people to develop sustainable strategies in eating a low-fat diet and maintaining appropriate activity levels. The ad libitum approach to low-fat eating has been shown to be the most effective and easiest to follow over the long term. The rationale and techniques for doing this have been discussed in previous chapters. One disadvantage of this approach, however, is that it takes longer for success—even though this is likely to be more sustainable over the long run. Hence, there is still often a desire by many for a ‘quick fix’. ‘Diets’ offer this. Fad diets offer it even more convincingly. The most popular diets promise faster and seemingly effortless ways of losing ‘weight’, contributing to sporadic, and often counter-productive, efforts in weight management.

*126\186\4*

The most popular antidepressant in the United States these days is Prozac, the brand name of fluoxetine. Part of the reason for the enormous success of this medicine is that its side effects, when present, are often less troublesome than those of other antidepressants. While many antidepressants act on a variety of neurotransmitter systems, Prozac appears to work exclusively on the serotonin system. While some other antidepressants can cause weight gain, Prozac seems less likely to do so—a feature of particular interest for people with eating disorders. In fact, some people taking Prozac experience a decrease in weight.

Another interesting feature of Prozac is that it seems to reduce obsessive thinking in some patients. There is growing research on the overlap between obsessive-compulsive disorder and anorexia, and Prozac is being evaluated for its effectiveness in both or these disorders. Current evidence seems to show that Prozac is as effective in reducing bingeing in bulimia as other antidepressants. Side effects can include agitation, nausea, fatigue, and insomnia. But on the whole, it is well tolerated by most patients.

When to Use Antidepressants?

Different doctors use medications differently. Some feel confident that these drugs work and should be tried first. Doing so, they feel, is cost-effective, and produces the most benefit in the shortest time. Other doctors prefer to use the various forms of psychotherapy. Then, if those strategies fail to produce enough improvement, they’ll decide whether to step up to the use of medications.

Although I am convinced antidepressants can work, I am not so sure they result in long-term improvement once the patient stops taking them. If the patient’s psychological, social, and family pressures haven’t changed, then it’s possible that her illness will persist or return. Of course, I will usually not hesitate to use antidepressants in patients who also have a clinical depression.

Research hasn’t yet shown how long a bulimic patient should keep using antidepressants. As a rule, if the patient shows improvement during the initial six-week trial, we continue with the drug for at least six months. Doing so decreases the possibility of relapse.

Many patients fear using medications. They are afraid the drug will make them “high,” like cocaine, or that they will become addicted. I try to reassure patients that such fears are groundless. While antidepressants do help a depressed person return to a normal mood, they do not produce a “high” in someone who is already at a normal level. They are also not addictive.

*63/35/5*

“In 1993,1 finally accepted the fact that my dry cleaner wasn’t shrinking my clothes,” laughs the 41 -year-old Brandywine, Mary-land, resident. “And I admitted to myself that my zippers weren’t breaking because my clothes were poorly made.” Sandy knew that, at 150 pounds, she was heavier than she had ever been, because her eating habits were out of control. But every time she tried to lose weight, she quit as soon as she made even the most minor mistake, like choosing a “bad” food or eating too much. Embarrassed by her inability to stick with a weight-loss program, she refused to discuss her problem with her family or closest friends.

Eventually, Sandy sought help from Weight Watchers, thinking that a structured approach to weight loss might be what she needed. Through the program, she learned how emotional upsets such as boredom and stress drove her to binge on junk food and fast food. “I also became aware of my habit of ‘unconscious eating’— munching on a handful of M&M’s at work and not remembering whose candy dish I had raided,” she says.

Even more important to Sandy was the rebirth of her self-esteem. “Weight Watchers helped me see that I wasn’t a bad person because I was overweight,” she says. “I just needed to learn healthier habits.”

After 5 months in the program, Sandy lost 20 pounds. She has stayed at her goal weight of 130 pounds for more than 5 years.

Sandy admits that she has had her share of slip-ups. The difference is that she no longer views every setback as a failure. “Everyone makes mistakes,” she says. “The key to weight-loss success is turning each mistake into a learning experience.”

WINNING ACTION

Challenge all-or-nothing thinking. So you ate a half-pound of your favorite chocolates. That doesn’t mean that you failed, that you’re a bad person, or that your diet jis over. Acknowledge the blip and just pick up where you left off. Even the most successful “losers” slip up.

That’s called being human. The trick is to learn from the situation and keep trying. Every day really is a new day.

*117\89\8*

I should warn, however, that there are two potential pitfalls to splurging. One is that you have to be careful to avoid a splurge becoming an all-out binge. One piece of cheesecake is fine; an entire cheesecake is not desirable! That’s why we should approach these foods with caution. I like to figure out in advance what my treat will be, when I’m going to eat it, and how much of it I’ll eat. Then I take the appropriate amount of Chitosan before eating the splurge food. If I’m ordering my treat in a restaurant, I also decide in advance how much of it I’m going to eat. I remove the excess before I start to eat and have the waiter take it away.

The other risk with splurging is that we get to rely so much on Chitosan’s ability to negate the negative of fat that we keep splurging. Inevitably, that means we’ll gain weight. For the Chitosan never absorbs all the fat we consume. For one thing, you can’t eat enough Chitosan to eliminate all the fat you can consume if you are really overeating. The practical maximum of Chitosan you can take before a meal is about 4 grams. At most, that will eliminate 24 grams of fat. But a McDonald’s Big Mac contains about double that. So, if you eat as many cheeseburgers as before and eat your Chitosan, you’ll cut down on fat, calories, and weight. But if you splurge regularly on extra Big Macs, you’ll gain weight, and probably lots of it.

*87\29\2*

Many factors can prompt the onset of the various forms of arthritis, but it’s clear that obesity makes things worse, especially if the arthritis affects the weight-bearing joints of the spine, hips, knees, or ankles—as it usually does. Slimming down to your ideal weight with Chitosan and my Fat Blocker Program is an excellent beginning for anyone who suffers from this disease.

In fact, switching to the Chitosan-based Fat Blocker Program aids in several ways. First, it helps you to lose weight. Second, it reduces the amount of fat that remains in your body, which can help with certain forms of the disease. For example, elevated levels of saturated fatty acids in the blood and fat tissues have been associated with rheumatoid arthritis.²⁷ Third, the ability to gradually increase the amount of exercise you do is an excellent medicine for many forms of the disease. Exercises helps to increase and maintain joint stability, improve joint function, and often does much to decrease pain.

*70\29\2*

With Chitosan, you are already cutting down on your fat and calorie intake so the tendency to lose weight already exists. But you don’t want to negate that tendency by allowing yourself to slow down. Rather, by adding just a little more exercise, you will be sure the program is fully effective.

Overweight, on the other hand, means weighing more than the number of pounds recommended for your height and body build. Just being overweight doesn’t necessarily imply a health risk. What’s far more important is whether or not you’re over fat, and you can’t determine that simply by stepping on the scale. The most accurate way to determine whether you are over weight or obese (or neither of these) is to have your body fat measured.