Beyond a Shadow of a Diet & The Diet Survivor's Handbook: Review

Beyond a Shadow of a Diet: The Therapist’s Guide to Treating Compulsive Eating by Judith Matz & Ellen Frankel (2004 Brunner-Routledge)

The Diet Survivor’s Handbook: 60 Lessons in Eating, Acceptance and Self-Care by Judith Matz, LCSW & Ellen Frankel, LCSW (2006 Sourcebooks, Inc.)

Review by Peggy Elam, Ph.D. in the Summer 2006 issue of Psychobits, the newsletter of the Nashville Psychotherapy Institute.

American women and girls (and, increasingly, men and boys) are bombarded with messages about ideal bodies and acceptable weights, “good” and “bad” foods and the health risks of “obesity.” Toss in the wealth of other stresses related to contemporary life and a recipe for disordered eating is born.

The disordered eating often takes the form of socially sanctioned and even professionally encouraged dieting and weight-loss behaviors. At the turn of the millennium about 116 million Americans (55% of the adult population) were dieting, supporting a $50 billion weight loss industry.

 “With more than half the population dieting at any given time, the cultural norm has shifted to a point where dieting behavior and body dissatisfaction have become the common experience for many,” Judith Matz and Ellen Frankel write in Beyond a Shadow of a Diet, their guide for therapists treating compulsive eating.

 “In a culture that refuses to acknowledge that healthy, beautiful bodies come in all shapes and sizes and that insists that dieting can make you permanently thin, a lot of people are walking around feeling that something is terribly wrong with their bodies and themselves,” the social workers add in their self-help book The Diet Survivor’s Handbook. “Dieters of all sizes feel their body is unacceptable because it fails to meet the societal view of perfection….The truth is we live in a shame-based culture that says that if your body differs from the coveted thin physique, something is intrinsically wrong with you and in need of fixing.”

 Matz and Frankel cite evidence that dieting is hazardous to physical and emotional health. For instance, dieting and dieting-related weight cycling (yo-yo weight loss & regain) increases risks of cardiovascular disease & Type 2 diabetes, eating disorders, depression, and shame. Meanwhile, the health risks of anything but the extremes of fatness (or thinness) have been greatly exaggerated by the diet-pharmaceutical-medical industries in a campaign to persuade the public--and funding agencies--that a dangerous epidemic exists for which the only hope for cure is expensive weight-management-oriented products, programs and research.

Most research purporting to link “obesity” with health risks and increased mortality is actually inherently flawed in its failure to control for the effects of chronic dieting and weight cycling--not to mention the stress of fat stigma, prejudice and discrimination--as well as almost always confusing correlation with causation. (Exercise physiologist Glen Gaesser, Ph.D. provides an excellent critique of the “obesity” related research in his 2002 book Big Fat Lies: The Truth About Your Weight and Your Health, published by Gurze Books.) In Beyond a Shadow of a Diet Matz and Frankel also point out that the health risks associated with being fat actually decrease with age, which is the opposite of what one would expect if “obesity” were truly a degenerative disease.

Perhaps the most valuable aspect of Matz’s and Frankel’s work is their unhooking weight (and fatness) itself from eating and emotional issues. “Compulsive eaters come in all shapes and sizes,” they write in Beyond a Shadow of a Diet.

There are large people who do not eat compulsively, and there are thin and average sized people who struggle with compulsive eating problems. The amount of food eaten can vary for compulsive eaters from small amounts of ‘too much’ food throughout the day to binges characterized by large amounts of food consumed in a short period of time. The key factor, however, is that eating has little to do with physical hunger. In fact, the person may no longer know what it feels like to be hungry.

Whether a person is actually fat or erroneously thinks she’s fat, they point out, the treatment of choice is the same: Teaching/learning attuned (or intuitive) eating in which one learns to recognize true hunger, to identify the foods one is hungry for, and to eat them when one is hungry for them…regardless of one’s body size. For people who have become alienated from their natural appetites (and appetite regulation) due to the externally focused eating of dieting/weight management practices, learning or re-learning natural eating and appetite regulation is tremendously liberating.

In both books (one intended for therapists, the other a self-help resource), Matz and Frankel document the damage dieting and other weight-focused attitudes and behaviors can do to physical and emotional health, including ways they contribute to compulsive eating. They offer strategies to help clients (or, in the self-help handbook, oneself) identify ways in which uncomfortable feelings are channeled into “bad body” (or “fat body”) thoughts and sensations, for which dieting or other forms of restrictive eating or weight-loss behavior are grasped at as possible solutions.

Again, Matz and Frankel point out that grasping at weight loss as a solution is no more a healthy (or potentially successful) strategy for truly fat women (or men) than it is for those who merely think they’re fat, or who are just a few pounds over the societal ideal. And this, I think, is an important addition to the clinical and self-help literature.

While many women (and girls) who are of average weight are encouraged to embrace and accept their bodies as they are--even with a little pudge here and there--attitudes towards body acceptance often change when a very fat (or “supersize”) man or woman walks into a therapist’s office. Even, sometimes, when the therapist is experienced with the treatment of eating disorders, he or she may erroneously assume that all fat people are compulsive eaters or that their fatness stems from emotional issues.

Dieting (or restricting what one eats) is often viewed as a solution to compulsive eating (as well as to “obesity”)—but instead is actually a significant cause of compulsive eating, in part because dieting teaches and/or reinforces tuning into external rather than internal cues and guidelines for eating. In fact, dieting and other weight-loss related behaviors reinforce bodily dissociation, as individuals override natural sensations of hunger and satiety in attempts to lose or “manage” weight. Ironically, dieting also tends to make people fatter, due to lowered metabolism and the tendency of many people to regain more weight than they lost as their bodies compensate (and protect) for the self-induced famines.

In both books Matz and Frankel challenge assumptions about body size, fear of fat, and “diets in disguise.” In the clinically oriented Beyond a Shadow of a Diet they also address therapist countertransference in working with fat clients, and the importance of identifying and addressing one’s own discomfort (or issues) with fatness (or “obesity,” as fatness has been pathologized) so as not to negatively affect the treatment of fat clients.

Beyond a Shadow of a Diet and The Diet Survivor’s Handbook provide sane and empirically sound approaches to healing compulsive eating and body shame—approaches based upon considerable clinical and empirical evidence that diets do not work and, in fact, are harmful.

Matz is the director of the Chicago Center for Overcoming Overeating and Frankel is an eating disorders specialist, consultant, and author in Massachusetts.They maintain websites at http://www.beyondashadowofadiet.com and http://www.dietsurvivors.com. Frankel's personal memoir about sizeism, Beyond Measure: A Memoir About Short Stature & Inner Growth, is being published by Pearlsong Press this month.

Sample excerpts from Beyond a Shadow of a Diet & The Diet Survivor's Handbook:

Researchers have reported that a mere 3-minute exposure to photographs of models taken from popular women's magazines led to increases in depression, stress, shame, insecurity, and body image dissatisfaction....Women are repeatedly encouraged to compare themselves to an unrealistic and unhealthy view of thinness and taught that dieting and weight loss result in happiness, success and love." (BSD)

Simply by assessing body size, we often assume that the thin person is healthy and the fat person is unhealthy. Kara is a very large woman in her early 40s. She has had a series of health problems, including diabetes. For years doctors have told her that she must lose weight to be healthy. Kara has tried diet after diet but has repeatedly gained back the lost weight. She eventually followed the suggestion of her support group to look for a doctor who would attend to her medical problems without demanding that she change her size. Her new doctor helped her by finding appropriate medications. Kara also consulted a dietician who follows a non-diet philosophy and learned techniques to address her diabetes without feeling deprived. As a result of these actions, Kara is in good health. She recently had a physical and passed with flying colors. She has not lost an ounce of weight.

Anna, on the other hand, has recently lost weight. Although she was never particularly large, she is now slimmer than ever before. People at work compliment her for her weight loss, noting that she must be doing something right. Actually, Anna is dying of cancer. (BSD)

The two major factors that lead people to reach for food when they are not physically hungry are deprivation and the use of food for affect regulation....The translating from the language of feelings to the language of food and fat occurs only because people are strongly supported in their belief that losing weight solves complex personal issues." (BSD)

Calling a person who is able to give up dieting a survivor gives credence both to the damage caused by diets and to the empowerment that results when people move from a diet mentality to a normal relationship with food. The term diet survivor encourages people to get off the diet roller coaster and get on the non-diet bandwagon of living fully and joyfully in one's body through the life-affirming action of feeding oneself based on internal cues of hunger and satiety." (DSH)