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The role of dieting in treating obesity
Page 367 Black blue OBESITY AND CORONARY HEART DISEASE 367 The role of dieting in treating obesity With the exception of the multitude of surgical interventions now available, all obesity treatment programmes involve recommending dieting in one form or another. Traditional treatment programmes aimed to correct the obese individual’s abnormal behaviour, and recent packages suggest that the obese need to readjust their energy balance by eating less than they usually do. But both styles of treatment suggest that to lose weight the individual must impose cognitive restraint upon their eating behaviour. They recommend that the obese deny food and set cognitive limits to override physiological limits of satiety. And this brings with it all the problematic consequences of restrained eating (see Chapter 6). Psychological problems and obesity treatment Wadden et al. (1986) reported that dieting resulted in increased depression in a group of obese patients, and McReynolds (1982) reported an association between ongoing obesity treatment and psychological disturbance. In addition, results from a study by Loro and Orleans (1981) indicated that obese dieters report episodes of bingeing precipitated by ‘anxiety, frustration, depression and other unpleasant emotions’. This suggests that the obese respond to dieting in the same way as the non-obese, with lowered mood and episodes of overeating, both of which are detrimental to attempts at weight loss. The obese are encouraged to impose a cognitive limit on their food intake, which introduces a sense of denial, guilt and the inevitable response of overeating. Consequently, any weight loss is precluded by episodes of overeating, which are a response to the many cognitive and emotional changes that occur during dieting. Physiological problems and obesity treatment In addition to the psychological consequences of imposing a dieting structure on the obese, there are physiological changes which accompany attempts at food restriction. Heatherton et al. (1991) reported that restraint in the non-obese predicts weight fluctuation, which parallels the process of weight cycling or ‘yo-yo’ dieting in the obese. Research on rats suggests that repeated attempts at weight loss followed by weight regain result in further weight loss becoming increasingly difficult due to a decreased metabolic rate and an increase in the percentage of body fat (Brownell et al. 1986b). Human research has found similar results in dieters and athletes who show yo-yo dieting (Brownell et al. 1989). Research has also found that weight fluctuation may have negative effects on health, with reports suggesting an association between weight fluctuation and mortality and morbidity from coronary heart disease (Hamm et al. 1989) and all-cause mortality (Lissner et al. 1991). Repeated failed attempts at dieting, therefore, may be more detrimental to physical health than remaining statically obese. Page 367 Black blue