Eating for fat loss is essentially little different to that for eating for health, as described in the Healthy Eating Pyramid. Food selection should focus on generous quantities of breads, cereals, fruits and vegetables; moderate amounts of protein such as meat, fish and dairy products; and only small amounts of fats, sugars and salt.

The emphasis in both fat loss and healthy eating plans is a reduction in dietary fat and an increase in complex carbohydrates and fibre. For more information on other aspects of eating for health, the reader is encouraged to consult other texts.

The emphasis on a reduction in dietary fat does not disregard total energy. As we have described, fat intake is the main determinant of total energy intake. However, minor reductions in total fat and significant increases in other calories will lead to an overall increase in total energy and thus weight gain. This often happens when a person has been ingrained with the thinking that sugars, bread, potatoes and pasta are fattening. Those previously ‘blacklisted’ foods suddenly become good ‘fat-free’ foods and are over-eaten in large quantities.

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The same principle-the crossover of symptoms-applies to eating disorders. In fact, one expert referred to anorexia nervosa as one of the “great pretenders.”

An endocrinologist might conclude that weight loss results from hyperthyroidism or Addison’s disease (a malfunction of the adrenal glands that results in inadequate supplies of hormones). A gastroenterologist might suspect a disease of the bowels that prevents adequate absorption of nutrients, a neurologist might wonder about a defect in the hypothalamus or the possibility of epilepsy, and so on.

As a biopsychiatrist, I look for signs that some organic illness or abnormality is causing the patient’s eating problem. A physical examination and lab tests will usually reveal whether some underlying illness, perhaps a tumor or some other condition, is causing the weight loss, the swelling of the ankles, the low blood pressure, and the extreme sensitivity to cold.

Many psychiatric and physical illnesses cause weight loss. With other illnesses, however, the patient usually complains about the problem, or is at least indifferent to it. In contrast, the anorexic takes inordinate pride in her thinness.

Depression-a symptom of anorexia in a certain number of patients-is also widespread. Depression can exist as a disorder of its own, with its own defined set of features, or it can arise from many organic illnesses. Sometimes feelings of depression are a natural, even healthy response to a troubling situation, such as the loss of a loved one.

Prolonged depression can lead to weight loss. But depressed individuals do not usually experience disturbance of body image or fear of fatness. Such attitudes signal the presence of anorexia.

People with schizophrenia often experience warped beliefs and behaviors related to food and eating. Typically, schizophrenics might maintain that their meal has been poisoned, or that “Martians have put aphrodisiacs in the water supply.” They might also eat in weird ways that resemble the bizarre habits of an anorexic. But a schizophrenic usually will not meet the full set of criteria for anorexia. In rare cases, however, both disorders can be found in the same individual.

The behavior of the anorexic often suggests the presence of an obsessive-compulsive disorder. To illustrate, let me tell you about an anorexic patient named Sonya.

The day Sonya arrived at the hospital, I stopped by her room and saw her unpacking her suitcase. I saw that she had wrapped everything she had brought-toothbrush, underwear, books, a favorite cuddly toy-in aluminum foil. She had then placed each foil ball in a separate plastic bag.

Sonya noticed the somewhat startled look on my face. “Germs,” she said tersely.

In my years of experience with eating disorders, I had never seen anything like it. She seemed to be laying in a year’s supply of foil-wrapped baked potatoes. It’s possible that even before her anorexia struck, Sonya, like some other eating disorder patients, may have had an obsessive-compulsive disorder. This is a very hot area of current research, and there seems to be more of an overlap than was previously thought between anorexia nervosa and an obsessive-compulsive disorder (OCD). Medications that are useful in OCD, such as Prozac (fluoxetine), may prove quite helpful in treating anorexia nervosa. It is important to remember, however, that starvation itself will increase obsessional thinking.

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LisaKay, of Romulus, Michigan, watched her weight climb to 325 pounds through two tumultuous marriages. The combination of personal upheaval and unhealthy weigh gain left her an emotional wreck. “I had no self-esteem left,” she says.

But LisaKay believed in an old but true cliche. When things get that bad, there’s only one way to go: back up.

“I wasn’t emotionally prepared to tackle the problem with my marriage, but I believed that I could improve myself,” LisaKay says. So she went out and bought a low-impact aerobics tape, slipped it into the VCR, and started following the instructor. “After just 2 minutes, I was sweaty, beet red, and breathless,” she says. “I thought I was going to die.”

Convinced that she was having a heart attack, LisaKay called

911. “When I got to the hospital, the emergency room doctor tersely told me that I was merely out of breath,” she recalls. “And he told me to warm up next time.”

Too embarrassed to try aerobics again, LisaKay switched to a seemingly simpler activity: walking. Her first time out, she walked one-quarter mile so slowly that it took 40 minutes. Three months later, she could do 1 mile in an hour.

Six months later, LisaKay was ready for a more intense challenge: a “fat-burner” aerobics video. With her legs kicking high in the air and her arms moving nonstop, she was unaccustomed to such high oxygen demands—and that heart attack scare returned. Back to the hospital she went.

This time, a different doctor told her that she was breathing incorrectly. “He told me to breathe in through my nose and out through my mouth while exercising,” she says. “He said to exhale harder to force a deeper inhale, since this sends more oxygen to muscles.”

That simple tip did the trick. LisaKay continued exercising, gradually adding light weight training and toning and stretching exercises to her workout routine. She made some dietary changes as well, trading in fatty fried foods for salads, steamed cauliflower, and water-packed tuna. Within 1 year, she had lost 75 pounds. Two years later, she had shed a total of 215 pounds.

Today, at age 33, LisaKay is holding steady at 110 pounds. She has joined a fitness club, where she works out on the treadmill and weight machines. At home, she does lots of marching in place, along with exercises to strengthen and tone her body.

Determined to use her life lessons to inspire other overweight women to improve their lives, LisaKay has become a motivational speaker and counselor. “I learned that I matter,” she says. “My message to others is that they matter, too.”

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