Social custom—This may over-ride physiological hunger. Celebrations held for recreational or spiritual reasons invariably centre around food and drink. In some societies the obligation to eat can go beyond feasting. In the South Pacific in earlier times, for example, women were fattened up with chicken fat to make them more desirable for prospective husbands.

Time of the day—Most Western societies tend to have set family breakfast, lunch and dinner times, perhaps reinforced by the school bell. One classic study has shown that the time on the dock may easily over-ride the natural hunger mechanism When one group of people were kept in a room with a dock running faster than normal, they became hungry and ate their meals before another group kept in a room with a dock operating on normal speed.

Food availability—Individuals have specific food preferences. Increasing the number of available food items will increase the probability that all individuals find more of their favourite foods.

Controlled experiments demonstrate that people, like rats, consume larger meals when given multiple foods than when offered a single food (you can do your own research at a buffet restaurant). Whereas in the past, limited food choices may have led to monotony and discouraged intake, this is no longer the case with our vast variety of foods.

food palatability—Palatability is largely determined by the flavour of food—taste, aroma, texture and temperature. Fat is highly palatable due to its creamy texture, and much of the flavour of food comes from volatile fatty acids.

Other factors—Restrained eaters, due to their constant dieting vigilance, may have periods of increased appetite, especially when their control or ‘willpower’ is compromised, such as during periods of stress and grief.7 This helps explain why some people eat despite not being hungry and also refrain from eating despite being hungry.

*111\186\4*

Well, if we could somehow level out the hill so it was no longer as steep, the car would eventually roll to a stop. Perhaps, too, a mechanic could leap aboard and fix the brakes. At the same time we could broadcast a quick course in driver education over the car radio, teaching the driver how to relax and ease up on the gas. And by setting up a giant canopy, we could keep off the rain and reduce the slipperiness of the road surface.

As a biopsychiatrist, I see parallels between this scenario and the treatment of eating disorders.

The slope of the hill represents the physical, or biological, component. If I can “level off” the peaks and valleys (reducing the chemical imbalances, or decreasing the starvation or the bingeing and purging), I can return the patient to a more even course of eating. Medical therapy-the use of everything from controlled nutrition to certain medications-comes into play here.

Behavioral and cognitive therapies work to fix the way a patient behaves and thinks by showing her how to apply the brakes and bring her disordered habits under control.

By teaching her about the dangers of starvation or self-induced vomiting, educational therapy equips her with the strategies she needs to make sensible eating choices.

Individual and group therapies that address her feelings help her to ease up on the gas and stop supplying the emotional fuel that propels her erratic behavior.

Last, by improving her relationships with significant people in her life, for example, through family therapy, we might provide her with a dry surface, a road through life on which she can maneuver with greater confidence and stability.

Lisa’s story shows this principle in action. Medications helped her deal with the biological issues, including her depression. Behavioral therapy showed her how to change bad habits. Cognitive therapy helped her learn new ways to handle stress. Through individual and group therapy she explored her feelings and improved her relationships, and the “twelve-step” approach of Alcoholics Anonymous and Overeaters Anonymous reduced her dependencies on alcohol and food. Though family therapy wasn’t an option in her case, many patients do benefit from this approach.

Treatment that focuses on one element and ignores others may be ineffective. For example, “talking” therapy in which disordered eating behavior is not addressed may lack a crucial ingredient for success. The twelve-step approach of Overeaters Anonymous may be doomed to fail if the patient has a biologically caused depression. For an anorexic, restoring weight without altering distorted attitudes may merely be a “quick fix” whose results won’t last over time. Similarly, fad diets or the megavitamin and food-allergy approaches may seem to work, at least temporarily, but their results are only a placebo effect that provides the passing illusion of a successful cure.

*49/35/5*

As a flight officer in the U.S. Navy, Robert bounced from one military base to another, spending between 3 and 6 months in places as far-flung as Alaska and Japan. “We’d fly for 12 hours a day, and by the time we’d get back to base, the restaurants would be closed,” he recalls. “I’d eat whatever I had stashed in my room. And it was usually junk.” His hectic schedule made a regular exercise routine difficult, too.

In 1996, Robert left the Navy to attend law school. Every day, on his drive between home and campus, he’d pass the YMCA. Eventually, he decided to join. “I didn’t like the way I felt or looked,” he says. “I had to get back to a weight that I was comfortable with.” He made a promise to himself to work out 5 days a week, whether on his way to school or on his way home. Since he didn’t have to drive out of his way, he had no excuse for not exercising.

This strategy worked so well that Robert, now age 35, was able to take off 23 pounds. And when he relocated to Reno in 1998 to enjoy the mild climate, he made sure to join a gym that was located along his commuting route. “I go almost every day on my way home from work,” he says. “Sometimes I play basketball, sometimes I ride a stationary bike. Best of all, I’ve maintained my weight.”

WINNING ACTION

Find a gym that’s on your way. With a gym, as with any piece of real estate, the important thing is location, location, location. If you have to drive 30 minutes across | town to work out, chances are, you won’t do it. Follow

Robert’s lead and look for a gym somewhere along your commute to and-from work. If you pass by the place every day, you’ll be more likely to go.

*103\89\8*

Yet, the truth is that eating high-calorie sugary foods in small amounts won’t affect your health in the long run provided you don’t also overindulge on a consistent basis in eating fat. The key is to eat the foods you love, cutting down on them as much as you can, while taking your Chitosan to make sure you keep your fat intake low. Since you are now eating a large proportion of what you want when you want it, your desire to splurge will be greatly reduced.

Guidelines for the Fat Blocker Eating Program: The Fat Blocker Eating Program is really not a diet. Instead, it’s a guide to lifelong good eating. In fact, if every American adopted this eating plan and followed it scrupulously, the national rates of cancer, heart disease, and diabetes would come crashing down. Immune systems would get a tremendous boost, so that infections and illnesses would carry less of a punch. Everyday health problems that drain us of energy, patience, and joy, like chronic headaches, allergies, and certain skin conditions, might become things of the past. So don’t think that you’ll be depriving your family once you start planning your meals according to the Fat Blocker guidelines. Actually, you’ll be doing them a big favor.

*73\29\2*

Eating Disorders Questionnaire:
Put a check (/) by any of the items that apply to you.

1. My friends tell me that I’m thin but I don’t believe them
because I feel fat.

2. I frequently eat when I’m not hungry.

3. I have had an out-of-control eating binge in the past year.

4. Food is usually the first thing I think of when I wake up in
the morning.

5. I seem to be constantly on a diet.

6. I have become obsessed with food to the point that I
cannot go through a day without worrying about what I will or will not eat.

7. I have dieted to an abnormally low weight because it
makes me feel that I’m in control.

8. My menstrual periods have stopped or become irregular for
no known medical reason.

9. I frequently eat to the point of being uncomfortably full.

10. I panic if I cannot exercise to compensate for food I have eaten or plan to eat.

11. After a binge, I have done at least one of the following in
the past year: forced myself to vomit; used laxatives,
enemas, or colonies; fasted; exercised in an unusually
vigorous way.

12. I would be very upset if I got on the scale tomorrow and
found that I had gained two pounds.

13. I play with the food on my plate so people will think I have
eaten more than I really have.

14. I feel uneasy about eating in general.

15. I often eat to make myself feel better emotionally, and
afterward I feel guilty about it.

16. I restrict my eating in public and then binge secretly in
private.

17. I use laxatives, enemas, or colonies at least twice weekly.

18. I find myself talking at length about food, weight, recipes,
restaurants, diets, and other food-related topics.

19. People around me seem very interested in what I do or
don’t eat and I get angry at them for pushing food on me.

If you’ve checked off more than 2 items, you may have a problem with your eating. Checking even one item can be a sign of danger. In addition, if you or others in your immediate family have had an alcohol or drug abuse problem, this may predispose you to developing an eating disorder. Obviously, it doesn’t mean you have one, but should warn you to beware of the possibility. In any case, if you are in any doubt or see any danger signs, see your physician or registered dietitian, and take this questionnaire with you.

*56\29\2*

Additionally, dietary fat plays an important role in the development of cancer. You’ve already learned this by the example of several generations of families moving from one country to another and watching their children develop cancers of affluence. As you learned in Chapter 2, the cancers of affluence-cancers of the prostate and pancreas for men; colon/rectum cancer for men and women; and cancers of the breast, ovaries, and uterus for women-strike with greater fury in wealthier countries. Here in America, we eat a richer and fattier diet than do our counterparts in poorer countries. It’s a well-established fact: Cancer and fat are intimately linked. Therefore,, anything that can lower the level of fat in our diets can be a lifesaver.