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 physio-
logical 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.
OBESITY AND CORONARY HEART DISEASE 367