Getting Ready

I read the program from beginning to end and knew immediately that it made so much sense. I underlined point after point. It didn’t simply say “Eat this” and “Avoid that.” Rather, it explained how to get on the right track in a realistic step-by-step way. I felt inspired because it understood my problem. It was exactly what I was looking for and exactly what I needed.

No self-help program will be successful unless the person undertaking it genuinely wants to change. So this is where we should start. And even if you are certain you want to change, I suggest you read this section because it will encourage you still further.

WHY CHANGE?

As I grow into middle age I realize with great sadness how much energy I have directed toward controlling my weight and eating, and the misery of the regular and consequent binges. I could be doing something productive with my energy—building relationships, reading, writing. I don’t know what I might do, but I don’t want my epitaph to be “Jane wished she was thin.” It was this, in the end, that made me decide to change.

By this point in the book you should be sure, if you were not already, whether you binge. If you do binge, the key issue is whether you want to change. Do you want to stop binge eating? It is certainly possible to change: It is possible to start eating normally again; possible to enjoy eating rather than eating with regret and guilt; possible to be happy eating with others.

As we discussed in Part I, how severely, if at all, binge eating affects a person’s life varies greatly from person to person. Only you can decide how pressing the need is for change. Because your motivation is likely to wax and wane, it often helps to have a stable set of guidelines by which you can judge the benefits of change, unaffected by fluctuations in the severity of your eating problem. Furthermore, if you have a long history of binge eating, it is possible that you have adjusted your life to accommodate the problem. If so, you need to consider whether this is the right thing to be doing.

The Advantages of Attempting to Change

One of my difficulties in deciding to change was that it seemed self-indulgent. After all, lots of people have problems with their eating and weight. But the truth I had to face was that the problem was so much more invasive than it seemed—it affected everything. I couldn’t be me while I still had the problem.

Start by drawing up a list of the potential advantages of change. To help you do so, ask yourself the following questions:

If I stop binge eating . . .

• Will I feel better about myself?

• Will it improve my quality of life?

• Will my physical health be enhanced?

• Will others benefit?

People are often surprised at how much better they feel once they stop binge eating. Even minor binge eating problems can have subtle adverse effects on many aspects of life. You may be unnecessarily irritable at times, your concentration may not be as good as it could be, you may avoid social events that you would like to attend (see Chapter 4), and your physical health may be impaired (see Chapter 5). Perhaps you don’t realize that these are direct results of your binge eating problem and will resolve as it improves. Another benefit of change is the effect it has on morale and self-image: many people find it restores their sense of self-respect and self-worth. As I mentioned in Chapter 4, one of the most gratifying aspects of helping people overcome binge eating problems is seeing the person underneath emerge as the problem recedes. The depression, tension, and irritability fade, concentration improves, and old interests (perhaps forgotten) return.

It is also important to take a longer term perspective. I suggest you look again at the quote near the beginning of this chapter. Basically, Jane didn’t want to waste her life. With this in mind, ask yourself the following four questions:

How many years have I spent binge eating?

How much time has it taken up?

How much money have I unnecessarily spent?

Have I been adjusting my life around my binge eating?

And, of course, you would be in a better position to control your weight if you had control over your eating.

For some people one of the most compelling reasons to stop binge eating is to put a halt to the harm that self-induced vomiting and laxative abuse may be doing to their health. When you stop doing these things, you can expect a gradual return of normal sensations of fullness and hunger, an increase in energy, and an improvement in your overall sense of wellbeing.

The other people in your life—friends, family, and coworkers—will also benefit if you regain control over your eating. You will stop being unpredictably irritable and moody; you will be less touchy about eating and less sensitive about your shape and weight; and you will be happier being with others. And you will have more time—for yourself, for work, and for other people. As a result, your relationships and your work performance will improve.

The Disadvantages of Attempting to Change

Having compiled your list of reasons to change, you should think of possible disadvantages. There may be some, and it is worth balancing these against the advantages. How would you feel if you did not succeed? Perhaps you are tempted to do nothing rather than risk failure. While this stance is understandable, it is best resisted. There is every reason to expect that, with the right sort of help, your binge eating problem will improve, if not resolve altogether. Furthermore, if you decide to use this self-help program and make a determined effort to do so, there can be no question of failure. If things do not improve, the program simply was not right for you; it will have failed, not you. And if that is the case, there are many other options available, as we are about to discuss.

One other point to note is that a good way of assessing the seriousness of a problem is to see how easy it is to overcome. If you discover that you can readily stop binge eating, then at least you have learned that the problem is surmountable. On the other hand, if you discover that it is not easy to change, you will have learned that it is a significant problem, perhaps more so than you thought. In this case you should perhaps consider taking it more seriously than you have been doing.

HOW TO CHANGE: THE VARIOUS OPTIONS

Assuming you have decided to tackle your binge eating problem, what should you do? We considered the main options in Chapter 8. In principle, there are four.

1. Seek professional help. There are many professionals who help people who have binge eating problems. They include psychologists, psychiatrists, general physicians, dietitians, social workers, nurses, and others. Some specialize in the area. Guidance on how to find a local specialist is given in Appendix I.

2. Join a self-help group. Many such groups are excellent, but unfortunately some are not. Some have questionable views on binge eating problems and how they should be tackled. Also, some are focused more on helping people live with their problem than overcoming it. Before committing yourself to a self-help group, find out as much as you can about it. If you do decide to join one, see if it suits you. Remember, you can always leave if the group isn’t right for you.

3. Use this self-help program. Whether you are male or female, single or married, living alone or with others, you can use this self-help program. You should reject this program only if one of the exclusion criteria mentioned later applies.

4. Combine professional help and self-help. There are two ways to do this. You can use this program on your own while at the same time receiving therapy of some other sort—therapy directed at, for example, self-esteem or relationships. This is a good plan so long as you have discussed it with your therapist. He or she must be fully informed in case there is a clash between this program and the help being provided.

Deciding Which Option Is Best for You

If you think you need professional help, it is important that you take steps to obtain it. This self-help program must not divert you from doing so.

However, this program, used with or without professional help, is likely to be appropriate for most people with a binge eating problem. Having said this, I must stress that overcoming a binge eating problem is not easy; it generally requires a lot of effort. Half-hearted attempts tend not to succeed. I therefore urge you to suspend any doubts about the program—after all, it is strongly evidence-based—and do your very best to follow it.

WHEN TO START

If you have decided to change but hesitate to commit yourself, the best advice is to take the plunge and get started. There is one point to note, however, and it applies to most forms of help but especially to this program: if you can foresee that major distractions are likely to get in the way, it is best to delay starting. If you are about to relocate, change jobs, get married, have a baby, or go on vacation, postpone starting until the distraction has passed or at least its influence has waned.

To get the most out of the program you will need at least a couple of months free from significant distractions. Anything less will not be enough.

WHEN SELF-HELP MAY NOT BE APPROPRIATE

You should not use this program if any of the following circumstances apply.

If you are underweight. If your BMI (see Box 3) is below 18.5, your weight is low. Table 8 shows what weights in pounds (for different heights) are equivalent to a BMI 18.5. If you weigh less than the weight shown for your height, you should not follow this program unless advised to do so by a therapist who is knowledgeable about eating problems (see Appendix I). On its own, the program is unlikely to help if you are underweight.

If you have a serious physical illness. If you have a physical illness that might be affected by a change in your eating habits, you should use this program only under the supervision of a physician. This advice applies particularly to those with diabetes.

If you are pregnant. Women who are pregnant should not use the program without first discussing the matter with their obstetrician.

If you suspect that your physical health is being affected by the binge eating problem (see Chapter 5). If this applies, you should consult a physician to have your health checked before embarking on the program. Once you have done so and have informed the physician of your plan, it may well be appropriate to embark upon the program.

If you are significantly depressed or demoralized. If you are feeling this way, you may not be able to summon up enough mental energy and optimism to make good use of the program. Under these circumstances seek the advice of a health professional and when doing so mention your binge eating problem. Once your mood has improved, you might well benefit from the program.

If you have a significant problem with alcohol, drugs, or repeated self-harm. If this is the case, it is best to seek professional help since this program on its own is unlikely to be sufficient.

WHAT WILL HAPPEN TO MY WEIGHT?

As we discussed in Chapter 4, most people with binge eating problems are highly concerned about their appearance and weight. It is therefore likely that you want to know what will happen to your weight if you follow the program. The answer is that there is generally little or no change. The reasons for this were explained earlier, in Chapter 5. However, some people lose weight and others gain, and it is impossible to predict what will happen in any individual case. If your weight is low as a result of your own efforts, you are likely to need to gain some weight because continuing to diet is rarely compatible with overcoming a binge eating problem. On the other hand, if you are medically overweight (see Box 3 and Appendix II), it is less easy to predict what will happen, although you are most unlikely to gain weight.

At this stage I suggest that you concentrate your efforts on overcoming your binge eating problem and accept for the meantime whatever change in weight that occurs. If this seems too difficult, try putting aside the question of your weight for, say, a month while embarking on the program. Then, after the month has passed, take stock and evaluate your progress in terms of your eating and your weight. By this point you will be in a much better position to decide whether to focus on your binge eating problem or your weight.

It is, of course, entirely appropriate to monitor your weight as you progress through the program. Advice on how to do this is given in Step 1.

HOW TO USE THE PROGRAM

The program is comprised of a series of “steps” and, as in the cognitive behavioral treatment on which it is based, the steps are additive, that is, each step builds upon the previous one. It is therefore not a good idea to dip around in the program, doing bits of this and bits of that. Instead, you should start at the beginning and work your way through to the end, following the guidelines provided . . . but before doing that it is most important that you read Chapters 1, 4, and 5 of Part I of this book. The program assumes that you have read these chapters.

This said, it is likely that some elements of the program will not be relevant to you. The program has been designed for all those who binge eat and, as explained in Part I, binge eating problems vary in their nature and severity. Most people who binge also diet, often strictly, but some do not diet at all. Similarly, some are highly concerned about their appearance and weight, while others are not. Some are perfectionists, and meticulously organized, whereas others are on the chaotic side. And some vomit, or take laxatives or diuretics, whereas others do not. As explained in Chapter 4, all these characteristics contribute in their own way to the persistence of the binge eating problem and therefore need to be addressed by the program. For this reason, the program has multiple components, and some may not apply to you. For the most part it will be obvious what applies and what does not. But if you are in doubt, the best policy is to assume that the advice does apply and follow it.

Some Tips to Help You Succeed

Persevere, especially when the advice is difficult to follow. In general, the harder you find it to follow the advice, the more important it is that you do so. When things are difficult it is often because you are now directly tackling the most powerful processes maintaining your binge eating problem.

Keep in mind that you will not need to follow the program forever. You will need to do many things to break out of your binge eating problem but only some will need to be kept up over the long term. These differ from person to person and will be identified toward the end of the program.

Do not rush through the program. Instead, proceed at the pace suggested since experience indicates that this rate works best. Sometimes it is a good idea to stay at a step for an extra week or so to see if there is more that you can do. And if you have a setback, it is often wise to go back a step in the program.

In general, it takes people between 4 and 6 months to work through the program and get the most out of it. Some people are able to change rapidly; for others it is a slow process. The key issue is whether you are making progress. If you are moving in the right direction, then it is reasonable to carry on. However, if you have not benefited by the time you have reached Step 5, you should seek outside help. The same applies if you get stuck on a step.

Do not expect overnight success. Do not be disappointed by less-than-dramatic results. Change takes time, and binge eating problems are not likely to resolve within just a few weeks.

Do not expect to make smooth and steady progress. It is normal for progress to occur in fits and starts. There are likely to be times when things go well, times when you get stuck, and times when you have setbacks and the problem seems to worsen. In the course of the program, you will be monitoring your progress. This will allow you to identify, and tackle, any obstacles that are getting in the way.

Do not expect the urge to binge to disappear as soon as you stop binge eating. Even after you have completely stopped binge eating, you will intermittently experience urges to binge. These urges will persist for some months. Don’t be discouraged by this. These urges will be triggered by the same circumstances that used to trigger actual binges. The program will help you resist these urges, and gradually they will fade away.

Be sure to hold weekly review sessions. Integral to the program are regular “review sessions” in which you assess your progress. Until your binge eating is well under control, have two of these review sessions a week. Thereafter they can be weekly. It is a good idea to book them in advance and view them as equivalent to an appointment with a therapist, but in this case you are your own therapist. Try to set aside 15 to 30 minutes for these sessions. They are important, and you should not allow other activities to take precedence over them. (Guidelines for conducting the review sessions are provided at the end of each step.)

Consider enlisting someone to help you. While many people use the program on their own, others enlist outside help. Helpers are of two types, and their roles differ. You might choose a friend or relative. In this case their main role is to provide support and encouragement at times of difficulty. Helpers of this type need to remain in the background unless their assistance is requested. Alternatively, you may seek the help of a therapist with whom you have a professional rather than a personal relationship. Therapists can take a more active role than friends or relatives. Indeed, they can oversee your use of the program along the lines outlined earlier, in Chapter 8. Both types of helper need to familiarize themselves with the program if they are to support your use of it. (Appendix V provides guidelines for relatives and friends, and Appendix VI is for therapists.)