188 Obesity Treatment
their energy balance by eating less than they usually do. But both styles of
treatment emphasize imposing cognitive restraint upon eating behavior. And
by encouraging avoiding food, people are put into a state of denial which
brings with it the potential psychological and physical consequences of
dieting described earlier, in chapter 7. Furthermore, this underestimates
the many roles that food can play in a person’s life and can leave people
lacking a way to regulate their emotions or engage socially (see chapter 4).
In addition, how and what we eat are habits engrained from an early age
which cannot be changed just because we are told that it would benefit
our long-term health (see chapter 3).
Psychological problems and obesity treatment
Wadden, Stunkard, and Smoller (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 psycho-
logical disturbance. In addition, results from a study by Loro and Orleans
(1981) indicated that obese dieters reported 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 nonobese,
with lowered mood and episodes of overeating, both of which are detri-
mental 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 common response to such limits – overeating. Conse-
quently, any weight loss may be precluded by episodes of overeating which
are a response to the many cognitive and emotional changes which occur
due to dieting.
Physical problems and obesity treatment
In addition to psychological consequences are the physiological changes which
accompany attempts at food restriction. In particular, research suggests that
shifts in weight, in addition to weight per se, may be an important pre-
dictor of the health of the individual, and that treating obesity with dieting
may result in weight variability. For example, research examining men indi-
cates that a single weight cycle of weight gain and weight loss is a risk factor
for coronary heart disease, but not for death from all causes (Hamm, Shekelle,
and Stamler, 1989). Lissner et al. (1989) reported that weight variability
(which is the standard deviation/mean) calculated at three time points pre-
dicted coronary heart disease in men (not women) and all-cause mortality
in both men and women. Furthermore, Lissner and colleagues (1991)