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MANAGEMENT & EATING BEHAVIOUR
Prepared for Australian
Nutrition Foundation Victorian Division Inc. by Dr. Rick Kausman MBBS
(Author of the book " If
not Dieting Then What? ") ... Visit website www.ifnotdieting.com.au
ARE DIETS THE ANSWER? -
IF NOT, THEN WHAT?
"In controlled settings
participants who remain in weight loss programs usually lose 10% of their weight. However,
1/3 to 2/3 of the weight is regained within one year, and almost all is regained within 5
[Annals of Internal Medicine (Oct.93)]
In fact, many people not only regain the
weight they lose, but they actually end up heavier than before they started the diet.
For many years, the word diet has been used to mean "a
way of eating'. The meaning of the word has changed so much now that for most people it
actually means the exact opposite. A way of not eating!
The word diet for most people also implies:
|D for deprivation
||- just thinking about going on a diet let alone
attempting one can make us feel deprived,
|I for impressive
||- because diets can create an impressive weight
loss in the short term,
for energy sapping
||- because they drain us of our emotional and
physical energy; and
||- which is what most people get if they go on a
diet - a temporary change.
Are Diets the Answer?
|When people decide to diet, they
are faced with a myriad of choices. Fad diets, drink mixes, meal replacements, calorie
counting - the list goes on and on. It doesn't seem to matter which one you try, the long
term results are all similar. Most people put the weight back on again. If there were no
negative effects associated with regaining weight after going on a diet, if you had the
money to spend, and it was simply a matter of bad luck, then you might think it would be
worth it to try again. Maybe it will work for you? However, there are risks for
people who diet.
There are short term physical side effects, such as impaired concentration,
with subsequent negative effects on work or study.
Studies from recent world research show that there may also be long-term physical
side effects if we have swings in our weight. Some people call this yo-yo dieting. At the
time of printing, there is no definite answer on this, but it is a possibility.
Dieting has been seen to be associated with an increased chance of depression, and
has been shown to be a risk factor for eating problems and for eating disorders. There are
also significant emotional and psychological risks that come from regaining weight lost on
a diet. Our self esteem drops and this impacts in a negative way in many areas of our
If not dieting, then what?
It is healthy for us to maintain a comfortable weight, but it is how we go
about achieving this that is the key. So if not dieting, then what?
1. Individual, sustainable behavioural goals: As
with many areas of life, having goals is essential. But it is important to have the right
goals to help you achieve what you really want. If you are over the most healthy,
comfortable weight you can be, it may be that one of your goals is to lose weight.
However, even when this is your aim, it is important to focus on individual and
sustainable behavioural goals, and allow the change in weight to come as a result of the
behaviour change. The following points include some of the important behavioural changes
many people need to focus and work on so they can achieve and maintain a healthy,
|2. A positive attitude towards
Despite what many of us think about
food, despite how many of us talk about food, and even despite what many of us have been
taught about food, there is no such thing as good food or bad food. We do need to know which foods are healthy for us to meat most of, but putting a moral tag on
food, such as calling it "junk food", or "good food" is of no benefit
in developing a healthy eating pattern. So chocolate is not bad and apples are not good.
Cake is not bad and capsicums are not good. We need to look at all food as being 'morally
neutral'. Going to the local fish and chip shop every night for a month would be a bad use
of fish and chips, but that does not mean that having an occasional meal of fish and chips
is bad for you, or that chips are bad. For most people, 10 chocolate bars a day would not
be a healthy way of eating, but it still does not make having a chocolate bar bad, or make
the chocolate bad itself. It also wouldn't make the person who ate the chocolate bad.
If we do think of certain types of food as 'bad', or 'junk'
or 'rubbish' and then we eat that food: How do we feel? Usually we feel bad about
ourselves and guilty about what we have eaten, and this makes even harder the process of
looking after ourselves and developing a healthy eating pattern. Often this guilty feeling
can make us eat more of that sort of food, even when we no longer feel
like it. It is very important that we know which foods are most healthy for us to eat, but
calling a certain food 'good' or 'bad' is of no benefit to our nutritional understanding
or education. We need to be looking at these foods and calling them what they are. For
example, we can talk about food being healthy, high fat or high sugar, or
particularly for children, we could describe food as healthy food, party food or
sometimes food. So apples would be a healthy food, and chocolate would be a high
fat or a sometimes food.
We do need to be educated as to which foods are high or low
in sugar and fat, and we certainly want to have a balance in the amounts of the different
types of food that we eat, but there is no benefit in placing a moral tag on food - it
just increases the chances of creating problems with our eating behaviour.
|3. Non-hungry eating
We can all eat food when we are not really feeling physically hungry. This sort
of eating can be called non-hungry eating. Non-hungry eating can include things like
overeating, grazing, picking, nibbling and bingeing. Non-hungry eating can occur at any
time, such as at the times we eat our main meals, in between the times we eat our main
meals and even overnight. It is quite normal to do some non-hungry eating, but when we do
too much it can tip our eating out of balance.
If we can decrease the amount of eating we do when we are really not physically
hungry for it, most of us can still enjoy a wide range of foods of different tastes,
textures, fat and sugar content and still reach and maintain a healthy, comfortable
(a) Is it hungry or not?
Over time, many people become unsure, or even forget, what being physically hungry
really feels like. This is particularly so for people who have been on many diets. Most
diets involve having a specific plan to follow, and actually tell us not to listen
to what our body is saying. It should come as no surprise then, that many people have
either partly or even completely lost the ability to recognise when they are physically
hungry. To become aware of the difference between hungry and non-hungry eating, try to
check your hunger level before and after you eat using this simple hunger/fullness scale.
||- Stuffed Full
||- Getting Empty
||- Absolutely Empty
(b) If it is non-hungry eating, why are we
putting food in our mouths?
After people become aware of the frequency of their non-hungry eating, the next
step is to try to understand why they might eat when they are not physically
hungry. For any individual person, the reasons may be many and varied. Some typical
examples might be: because the clock says it's lunch time, because people are feeling
tired or bored, or that when they were children their parents always said they had to
finish off their plate.
However, the reason we may be doing plenty of non-hungry
eating may be due to particular emotions that are difficult to deal with. In this
situation, non-hungry eating may well serve a very legitimate purpose, being used as a way
of coping. Food is relatively cheap, it can be a quick fix in the short term, and it is
legal. So it is very easy to see how food can be used to deal with many situations and to
meet many different needs.
We don't want to exclude food as a way of dealing with
certain situations, but we certainly want to try to develop some other options as well as
food to deal with different situations that arise.
4. Being active
The importance of being active cannot be stressed too highly. Unfortunately,
the word 'exercise' for many people has been associated with the 'no pain, no gain'
In other words, that it has to hurt to be worthwhile. This
is simply not true.
Always remember, whatever activity you can do is
worthwhile. The difference, for example, between taking the stairs rather than going in
the lift, or walking to the shops whenever you can, rather than taking your car, can be
very significant. This sort of unplanned generally non-sweaty activity can be called
incidental or non specific activity. Walking up and down the stairs a couple of
times in a day may not seem like very much, but if you look at it over a year, it adds up.
A number of recent studies are highlighting this point. They show that small amounts of
activity are cumulative throughout the day, and that a 'bit of activity' is significantly
better for the person than no activity.
Ways of including more activity into your day without doing a
specified planned activity are things like:
- walking the dog
- walking short distances instead of driving
- looking at gardens whilst walking
- pottering in the garden
- walking to the post box
- collecting the children after school on foot
- standing up to change the TV channel rather than using the
- getting off the tram/bus one stop early
- getting up for a stretch and a little walk around at work
- playing games with your children that involve moving
- visiting parks
|5. Body Image
Even when you feel your body is not at the most comfortable size and shape it
can be, and even when you are working on a long term plan to change it, you need to try to
be as accepting of your body as you can be. You might not like every part of your body,
but it is important to try to come to terms with this. It is okay to want to change
things, but in order to do that, you need to feel as comfortable as possible with yourself
and your body. Being more accepting of your body image can be a very challenging thing to
do if you are feeling uncomfortable about your size, weight and shape, but it is important
For a moment, think about your body
- Are you frequently self conscious about your appearance?
- Do certain body parts tend to dominate your thoughts?
- Do you often compare you looks to those of other women/men,
models in magazines, or actors in films or on TV?
Changing your body image involves work and time. Following
are three exercises to stimulate your self awareness and help you improve your body image.
(a) The family genetic tree
Draw your family tree: parents, grandparents, aunties, uncles, siblings, etc. What
physical characteristics can you observe? For example, slight or solid thighs, round face,
small or large bottom, dark or light hair? Try to see where you may have inherited certain
features of your body. You might like to use a photo album to help with this research.
(b) My body's capabilities
List positive behaviours that your body allows you to do. For example, legs for
walking, eyes for seeing and ears for hearing. This might seem very basic, but it can
highlight the remarkable things your body allows you to do that many of us simply take for
(c ) Up to five physical positives
Over and over, when people are asked to list and describe five positive aspects
about their body, they struggle to find one thing. They find it much easier to list
negative things. Try it yourself. Take a moment to write down at least five positive
things about your body.
6. Working with food
(a) Facts about Fat
A number of studies show from a population perspective that the increased
availability and consumption of high fat food is the key nutritional factor that has
contributed to the increasing level of overweight in western society this century.
Interestingly, the percentage of carbohydrates consumed has decreased, with for example,
bread consumption in Australia currently at about one half of what it was in the early
1900s. On an individual level, while the relationship is not necessarily clear cut, many
studies also show that the key nutritional factor preventing us from achieving and
maintaining a healthy weight is the fact content in the food and drink we consume. There
are several reasons why the fat content plays such a significant role.
* Fat is stored very efficiently
Excess fat intake is very efficiently stored by the body as body fat. This is
different from the way the body handles other nutrients. When for example, we eat foods
such as bread, rice, pasta and potatoes, or other foods high in complex carbohydrates,
very large amounts are required before the body will produce even small amounts of fat.
One study even suggested that 32 slices of bread would need to be consumed in a day before
any of the carbohydrate would be converted into fat! So carbohydrates are used up as fuel
and under normal circumstances, not converted into fat in the body. Similarly, protein is
readily used as fuel.
* Fat doesn't fill us up very well
Compared to other nutrients, such as carbohydrate and protein, fat seems to be
the least effective in its ability to make us feel satiated and content. This seems to be
true for both our levels of satiation and contentment during a meal and with respect to
the amount of food we eat at subsequent meals. In other words, it is very easy to eat
large amounts of high fat food, without filling up very easily.
* Fat tastes pleasurable and can be eaten quickly
High fat food is often very palatable. Fat is also very energy dense,
containing more than twice as much energy for the same weight as either protein or
carbohydrate. It tastes good and you get plenty of energy in a relatively small volume of
food, which therefore can potentially be eaten much faster.
* High fat-foods are readily available
High fat foods are very available, convenient and very well marketed. However,
it is not all one-way traffic. It is vital that you consume some fat, and imperative to
have some fat in and on your body.
|*We do need to consume some
- Fat is a required nutrient and we cannot live without it. For
example, 50% of the energy derived from breast milk is from fat.
- Fat is a carrier for the fat soluble vitamins A, D. E and K.
- Fat enhances the pleasure we get from food.
- Certain fat seems to enhance health.
Rosemary Stanton a well-known Australian Nutritionist, wrote
in an article in 'Australian Doctor', February 1996;
We have not yet unravelled all the mysteries locked in the
many different fatty acids and possible combinations of these. But the evidence is
strengthening that we should distinguish more between different fats. The best ones seem
to be found in fish and other seafood, olive oil, canola oil, nuts, seeds and avocado'.
We do need to have some fat in our body.
- Fat lines every body cell and is an integral part of each
- Fat provides insulation.
- As we get older, having some extra fat around our hips is
protective and leads to fewer bone structures. Fat also provides some protection for
certain vital organs in the body.
- Having a certain amount of fat is vital for a woman's normal
menstrual cycle, fertility, and for pregnancy.
- Fat provides a reserve of energy.
Experiment - fine tuning the fat content
So it is definitely healthy for us to consume some fat, and it is healthy to
have some fat on our bodies. However, many of us consume fat in excess of need. From a
nutritional point of view, if you consume a high fat content in food and drink (and as you
know it is an easy thing to do), you may like to change some changes. If you can find some
way of decreasing your overall fat intake, then you have lots of scope to eat a wide range
of different foods and drinks and still achieve and maintain a comfortable healthy weight.
We might call this process fine tuning the fat content in our food and drink without
Having an understanding of
nutritional information is helpful. But understanding is just the beginning. The important
thing is how we use that information. What you do is a matter of
personal preferance, but it is important to experiment to find out what best suits each of
us. Here are two examples:
* Many people really
enjoy having some butter or margarine on their toast in the morning. However it makes very
little, or no difference at all, to the pleasure they get from their sandwiches at
lunchtime whether they have butter, margarine or no spread at all. Having some spread on
toast in the morning, but leaving the butter or margarine off the lunchtime sandwich is
fine tuning the fat content in a non-deprivational way. It is a way of decreasing the fat
content without hurting, without deprivation, and without measuring or counting.
* I always smothered cooked corn on the cob with margarine. I
didn't really think about why, I just did. A few years ago I decided to see how corn
tasted without any spread at all. Instead of the soggy, sweet, fatty taste that I had
become accustomed to, it became a crunchy, sweet, fresh taste. A taste I have come to very
much enjoy. This for me was fine tuning the fat content in a non-deprivational way.
For help with fine tuning the fat content without
deprivation, and for a advice regarding food ideas to suit your own tastes and needs, it
can be beneficial to speak with a dietitian.
- Dieting Dilemma.
R. Stanton, Allen & Unwin
- Diet No More.
J. McFadden, Penguin
- Real Gorgeous
K. Cooke, Allen & Unwin
- Overcoming Overeating
J. Hirschmann and C. Munter, Cedar Books
- If Not Dieting. Then What?
R. Kausman, Allen & Unwin .. see review
© Copyright - remains with the author of this
article - 1997
All rights reserved
No part of this publication may be
reproduced without the prior permission of the copyright owner.
Produced by the
Australian Nutrition Foundation Victorian Division Inc.
Caulfield General Medical Centre, 260 Kooyong Road, CAULFIELD Vic 3162
Ph/Fax (03) 9528 2453 - Email: firstname.lastname@example.org
East Valley Division General Practice, Victoria,
Level 1, Pathology Building, Repatriation Campus, A&RMC,
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