To cater for the dynamic nature of energetics in living systems, a second phase of thinking in the field incorporated rates of change, i.e:

Rate of change of energy stores= Rate of energy intake (EI) – Rate of energy expenditure (EE)

The use of ‘rates’ in this equation allows for changes with time and hence allows for the effects of changing body mass on EE and EI. This would mean that a small change in energy balance (e.g. an increase in food) would not lead to a large increase in body fat because as body mass increases, there will be an increase in EE (through increased metabolic rate and the increased energy costs of moving a bigger body around). This will then balance the increased energy intake and the individual would thus again be in energy balance, although at a slightly higher body weight. Using this approach, it has been calculated that the extra slice of toast for the man mentioned above would only add around 2.7kg of weight over 40 years, which is clearly a much more realistic figure. This approach highlights the need to look for the cause of a chronic imbalance between energy intake and expenditure, rather than small, absolute differences of either one (which is the ‘calorie counting’ approach). However, this model still offers no clues about what causes a chronic energy imbalance in the first place. For that, a further explanation became available in the 1980s.

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Typically, anorexia strikes between the ages of fourteen and eighteen; most of my patients range between ages twelve and thirty-five. Yet anyone, from a small child to a postmenopausal woman, can become a self-starver. In these cases a metabolic problem other than anorexia may be present. The onset of bulimia usually occurs later in life than anorexia: The average age is around sixteen to twenty.

Statistics can give us some idea of how widespread these illnesses are, but there are problems with the accuracy of these numbers.

For one thing the criteria doctors use to diagnose eating disorders keep changing. As these guidelines narrow, the number of people who fit them changes. People with milder cases may be grouped with severe cases and thus distort the picture. Also, the incidence among certain groups of people is changing. True, many eating-disordered people fit the stereotype of the white, upper-class teenager, but a growing number of patients do not match this description. The disorders are now more equally distributed among social classes-evidence that cultural pressure to be thin permeates all levels of society.

Over the last decade, there has been greater public awareness about eating disorders. There may simply be more victims. Or perhaps the number is the same, but more people are seeking help, inspired by media coverage of these illnesses.

Another possibility is that the number of reported cases is lower than it should be. Many people think eating disorders, like other psychiatric illnesses, are shameful or embarrassing, not just to the victim but to the family as well. Some people with these problems, particularly men, may choose not to get help.

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One of her strategies is to associate foods with special occa-

Q sions. She eats hamburgers and hot dogs only at barbecues, popcorn § only at the movies, and pasta only on nights when she goes to the “g theater. “I incorporate eating into the ambience of what I’m doing,” (§ she explains. “It gives the food officialness and meaning.” It also “g gives Rosemary license to indulge without going overboard.

On those occasions when she allows herself treats, Rosemary doesn’t settle for inferior-quality foods. If she craves chocolate, she doesn’t gobble down a cheap candy bar. She treks to a local Godiva shop, chooses six fancy chocolates, and has them wrapped, two to a box. Then, she eats only one box at a sitting. Likewise, if she wants ice cream, she doesn’t sit down with a pint container and a spoon. She heads for the local ice cream parlor and has her favorite flavor served to her in a pretty dish. “All of this reminds me that I’m being good to myself, that I’m giving myself a gift,” she says.

By turning her indulgences into events and using the portion-control skills and other tools that she learned through Weight Watchers, Rosemary lost 87 pounds in only 18 months. “This is the only thing that worked for me,” she says. “I’m an emotional eater, so I had to change my mindset toward food. Now, when I think about food and losing weight, I don’t think ‘deprivation,’ I think ‘indulgence and pleasure.’”

WINNING ACTION

Think quality, not quantity. Rosemary is really onto something here! Instead of taking a “sneaking” or “cheating” attitude toward indulging her cravings, Rosemary celebrates the pleasure of the occasional treat. Give yourself

permission to do the same. Enjoy your favorite foods— buy the absolute best quality for yourself and savor every single bite.

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