Underwater, hydrostatic weighing, or densiometry as it is sometimes called, has been the ‘gold standard’ of fat measurement for many years. This is carried out by immersing the subject totally in water and corrrecting for air trapped in the lungs. The person’s weight in air and their weight underwater are then calculated to determine body density, body volume and body fat percentage. The fatter a person is, the heavier he or she weighs in air and the lighter he or she weighs in water. Because it requires a lot of equipment and delicate measuring techniques, underwater weighing is generally reserved for research purposes or for measuring body fat changes in elite athletes. Validity is high, as is the reliability and sensitivity of the measure. The practicality of this measure, however, limits it to research and teaching facilities, with little prospect for use in the practical counselling situation.

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Anorexia-self-starvation-was first described as a clinical syndrome three hundred years ago. Yet only within the past few decades have eating disorders been widely recognized, not just by the public but by physicians themselves. Even as I write, controversy rages, here and abroad, over the exact nature of these disorders. This debate is more than mere medical hairsplitting; a precise understanding is crucial so that therapy can be developed and applied.

Anorexia and bulimia may appear to be different illnesses with different symptoms. Anorexia is characterized by starvation; bulimia is notorious for its cycle of bingeing and purging. While there are distinctions between the two conditions, it is also true that they have certain features in common.

Both anorexics and bulimics overvalue bodily thinness. The flip side of this attitude, and of equal importance, is an exaggerated fear of fatness. These highly prized but basically unhealthy concepts are constantly reinforced by social pressures and cultural signals.

Both disorders also involve an obsession with food. As the disease progresses, patients get caught up in the rituals of acquiring, preparing, and consuming meals. In time, thoughts of food come to dominate every aspect of their lives, at the expense of family, friends, careers, and, of course, health.

Eating disorders are “spectrum” disorders. Like the spectrum of light in a rainbow, anorexia and bulimia appear in a range of intensities. Think of anorexics as occupying the red end of the spectrum, with bulimics at the violet end. Both “colors” are highly intense but are of different hues. In between are many variations of the illness, each with a distinctive “color,” or pattern of symptoms. There are several types of patients with eating disorders, especially among those with bulimia. The main difference between them may be simply the severity of their symptoms.

Looking at a rainbow, it is difficult to tell exactly where one color ends and another one begins. The colors seem to slide into each other, overlapping at certain critical points.

The same can be said of eating disorders. Women who start off with anorexia find it difficult to maintain constant starvation. So they eat. They then often adopt such measures as self-induced vomiting in order to keep their weight down. Conversely, patients who begin by bingeing and purging may eventually try starvation as their only means of restricting food intake. This passage from one kind of eating strategy to another affects the treatment they require. Anorexic patients, for example, fear that learning how to eat normally may result in urges to binge.

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Shortly after the birth of her son, Noah, Sandra got serious about shaping up, determined to return to her prepregnancy weight of 100 pounds. She started using her cross-country ski machine four times a week. She also went on a strict diet, allowing herself no more than 1,300 calories a day and denying herself a lot of her favorite foods, especially pizza and french fries. As a result, she found herself on the brink of a full-scale binge more than once.

When a sympathetic friend learned of Sandra’s efforts—and her list of forbidden foods—she made a suggestion: “Why not give yourself a break from your eating program once a week? You’ll tame those cravings before they permanently undo your diet.”

The next Monday through Thursday, Sandra was a model of gastronomic self-control, amazing even herself. Then came Friday, and with it, her old favorites: pizza, ice cream, and a hearty dessert.

As radical as it sounds, indulgence was just what she needed. The next day, Sandra resumed her stricter eating plan with greater enthusiasm. Soon after, her husband got into the act by taking her to dinner on Friday nights, which only served to make her splurges seem even more special. “I looked forward to them,” she says. “They made my diet easier to stick with.”

Four months later, Sandra stepped on a scale and discovered that she had lost all 40 pounds without guilt or giving up the foods that she loved. As a gift to herself, she hired a personal trainer to help her get in the best shape ever. “She brought me to a new level of fitness,” Sandra says.

WINNING ACTION

Give yourself a break. As we all know, dieting is hard work, and temptation is everywhere. Instead of trying to fight the urge to splurge all the time, allow yourself a chance to indulge those fat fantasies every now and then. Just remember that you have to be on the wagon 6 days out of 7.

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