Breaking Free From Bulimia’s Cycle of Bingeing and Purging

by Dr. Rodriguez on May 8, 2012

Bulimia is an eating disorder, but it has little to do with eating. In reality, bulimia has more to do with low self-esteem, perfectionism, unrealistic expectations, anxiety, fear of losing control, depression and other psychological barriers.

Unfortunately, parents, spouses and others who become aware of a bulimic’s problem have a tendency to focus on eating and weight, just as the bulimic does.

The symptoms of bulimia include:

• Recurring episodes of binge eating. Binge eating is characterized by eating large amounts of food in a short period of time. While the exact amount of food eaten may vary, it’s not unusual for someone with bulimia to consume whole cartons of ice cream, a whole pizza or an entire bag of chips or cookies in one sitting.

• Lack of control over eating during a binge. Someone with bulimia may feel they cannot stop eating during a binge until either all the food is gone, they literally can’t fit more food into their body or someone walks in and disrupts what they consider their shameful behavior.

• Compensatory behavior. Bulimics are extremely afraid of gaining weight. Therefore, they try to compensate for the binge by misusing laxatives or diuretics, fasting or extreme dieting, excessive exercising and self-induced vomiting. Many people think that all bulimics vomit after eating. But that’s not every bulimic’s chosen “purge.” For example, a former patient would ingest more than 50 laxatives per day. Another would fast for three days after a binge, while another would exercise five hours straight to compensate for a single binge.

TV and movie comedies sometimes poke fun at bulimic behavior, but it’s no laughing matter. Medical complications that can accompany bulimia include dental problems, stomach rupturing, heart problems, inflamed esophagus, swelling of the glands behind the cheeks that can become chronic, irregular menstrual periods and death.

In addition, bulimics often lead lives filled with anxiety, fear, depression, addictions, obsessive-compulsive disorders and feeling helpless and out of control.

Bulimia usually is not obvious. The typical sufferer is neither emaciated nor overweight (although they think they’re fat). This leads other people either to assume that they don’t have a problem or to inadvertently reinforce their behavior by praising them for their thinness and apparent self-discipline with food.

Bulimics are ashamed, so they hide their bingeing and purging. Shameful as it may be, they feel purging is the only way they can keep in control.

For many, bulimia began simply with attempts to lose weight that became more rigid over time, leading to the first binge. The desire to regain control and erase the apparent failure then led to compensating for the huge number of calories consumed. The cycle of bingeing and purging quickly takes over.

Not realizing the connection between the rigid, depriving behavior and the loss of control, the bulimic continues the same behavior.

Bulimics think they just need to stop bingeing. But as long as purging is an option, the next binge isn’t far away.

To recover, the individual must acknowledge and accept that food and eating are not the problem. Fears must be confronted, usually with the help of an expert guide. And the bulimic must accept that recovery is a process that requires dedication and hard work. The person must want to be free of the disorder, seek professional help and put recovery first.

Fortunately, recovery is possible and can be complete. It may go just as unnoticed by most of the world as the bulimia did, but those who have taken the journey say it was well worthwhile.

As one recovered patient once said, “I feel like I was stuck in hell for many years. Now I feel I’m finally really living.”

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Middle-aged Men and Their Weight

by Dr. Rodriguez on April 23, 2012

Most of what is said and written about diets and weight seems to be directed at women. But in truth, weight is even more of a problem for men.

In 2010, 71 percent of American men were overweight or obese, compared with 57 percent of women, according to the U.S. Centers for Disease Control and Prevention.

Men often wait until they are at least 50 pounds overweight before becoming concerned about it. Add to that a cultural bias that puts more pressure on women to be slim and one can see why some men might “let themselves go.”

This is unfortunate. While we know that being overly preoccupied with weight isn’t healthy, neither is ignoring seriously escalating weight.

But as the story of my patient Jon shows, men and women face many of the same reasons for gaining weight.

“It seems that my weight problems started after we had children,” he told me. “I was focusing on my career and making money to provide for my family. I lost sight of myself and before I knew it, I was 60 pounds heavier.”

We all tend to become more sedentary through the years. However, the pattern with men is a bit different. Men tend to be more active in their youth, and remain active longer than women. But once they slow down — often when they’re preoccupied with career, marriage and children — they become significantly less active than women.

Numerous male patients have told me that once they married, their eating habits changed. They report coming home to a sit-down dinner with more food than they needed after a long day of mostly sitting, followed by hours of TV watching or computer work (more sitting) and snacking. Add to all that the stress of work and family life, plus no formal exercise, and you have the perfect recipe for eventual obesity.

The middle-aged male who finds himself stressed, overweight, lacking energy and sleep-deprived has to change his priorities to regain his health. But everyone has an excuse for putting it off. How many of these sound familiar to you?

“I don’t have time.” If you wait passively for the time to appear, it will never happen because the real issue is that you have to give your health your top priority. It may be difficult rearranging and getting rid of other things that fill up your life, but it has to be done to accomplish a real change. Make yourself important and time will appear.

“I need to focus on making money now. I’ll take care of myself later.” This is a mistake many men make. Postponing your health is extremely risky. Too often, after each monetary goal is reached, another is put in its place. Secondly, you may just end up too old, too sick — and perhaps too dead — to enjoy the money you worked so hard to make. Work hard at your profession, but also leave time to work hard on your health. What you do with your health today will determine your future.

“I want to give my family all the things they want.” What your family wants most is for you to be healthy and happy as long as possible. They don’t want the “things” without you.

“I’m fine.” Denial is a dangerous psychological defense mechanism when it comes to your health. We’ve all heard of sudden heart attack or stroke cases occur in people whose ill health was obvious to everyone but themselves. It’s best to give up denial and replace it with sound concern that motivates healthy behaviors.

If these sound like you, it’s time to stop procrastinating, rationalizing and fooling yourself. Time is passing. You’re the only person that can take care of you properly, so take on the job and live well. You’ll be proud of yourself and your loved ones will thank you for it. You might even inspire them to do the same.

Previously published in the Tampa Bay Times

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When dieting, scale is a tool, not an enemy

by Dr. Rodriguez on April 12, 2012

Should you weigh yourself every day? Maybe once a week?

Or not at all?

Advice about weighing can be confusing.

Some experts say weighing should be kept to a minimum so that we don’t get obsessed about it; others say weighing daily can keep us from losing awareness so that we don’t cheat; and still others tell us to judge our weight by how our clothes fit, not the scale.

Most dieters believe that the more you weigh yourself, the more motivated you’ll be and the faster you’ll lose weight. But when the number on the scale is our primary focus, there’s less attention paid to the behaviors that result in weight loss.

With so much focus on weight, a bad day on the scale can make us want to give up and avoid weighing in — and even the diet and exercise behaviors that promote weight loss — altogether.

The truth is that less rigidity about weighing in leads to more success with weight management.

Viewing weighing in as a time to find out whether you’re a success or a failure, no matter how frequently, will be a problem. Weighing in is only an opportunity to get information. It’s not even the most important information that you need.

If it were possible to get reliable and accurate information about the amount of fat you’ve lost, that would be useful. But household scales aren’t sophisticated enough to provide this level of detail.

The good news is that it’s possible to use a household scale in ways that make weighing in a productive exercise.

Your weight can vary due to what or how much you’ve eaten, the time of day when you weigh, how much water you may be retaining or how much muscle mass you may have gained or lost.

There are several factors that can help determine your best weighing schedule.

• Objective attitude: The mind isn’t going to want to do anything that’s uncomfortable. So if you see the scale as your personal judge, the mind will resist. It’s important to approach the scale unemotionally. Weighing in is simply a tool, not a test. If you approach the scale with rules such as “I must lose weight today,” then you’re setting yourself up to fail.

You might say, “My weight is the same as yesterday. I’ve been losing, and I’m doing well with activity and nutrition. I’m going in the right direction.” Or, “The scale shows my weight as 2 pounds higher than yesterday. I’m still doing well with my behaviors, so it must be something other than fat gain. I’ll keep doing my job and let my body do its job.”

This may also be true: “I’ve been gaining weight consistently the past couple of weeks. I’m still exercising, and my nutrition is good. However, I’ve been eating out more. My body’s reflecting what I’m doing. I’ll cut back on eating out.”

All three examples show how weigh-ins can be used as tools, rather than as determiners of success or failure.

• Realistic expectations: However fast or slow your weight loss is, there’s a logical reason. Rather than getting frustrated at the number on the scale, use that number to help figure out whether your behaviors are on the right track.

Instead of continuing to think that you can decide how quickly to lose weight, consider yourself to be your body’s teammate. As long as you’re doing your part, your body will do its part, too — but on its schedule, not yours. Weight-loss deadlines make little sense. Relax and do the work. The rewards will come.

• Sensible goals: Your goals should be about behaviors, not numbers on the scale. Goals dealing with activity level, nutrition and portion control deal more directly with fat loss than any number. Besides, it’s best to stay away from trying to guess what your “right” weight should be. Everyone is different physiologically, and it’s next to impossible to forecast what the best weight is for someone.

How often should you weigh? Once you have a realistic attitude about the scale, you can choose to weigh daily, weekly, monthly or not at all. Discover what works for you.

Previously published in The Tampa Bay Times

If you wish more information on this subject, read Dr. Rodriguez’s book Mind Over Fat Matters: Conquering Psychological Barriers to Weight Management which includes a chapter on The Psychology of Weighing

 

 

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