Here are some important questions to ask in terms of deciding how difficult weight loss will be:

1. Have you been overweight since childhood? If so, it may be harder for you to lose weight than someone whose weight gain began in adulthood. You have more years of habit to undo.

2. Are other people in your family overweight? If they are, you could have inherited a biological predisposition to weight gain. On the other hand, you may have a family of compulsive overeaters who have learned how to use food for comfort. Either way, it will require effort to make changes.

3. Do you have any underlying disease state like hypothyroidism or Cushing's syndrome that is the cause of weight gain? Check with your doctor and have a physical examination.

4. How overweight are you? The more you have to lose, the more discouraging it can be to stay with your plan and new habits. Support is needed.

5. Are you realistic about how much weight you have to lose and how long it may take to do it safely? Begin by setting the weight loss goal at 10 percent of your current body weight. Consider weight loss of one to two pounds a week as successful.

6. Do you binge, deny how much you eat or tend to make excuses for overeating? If you do any of the above, don't start a weight-loss program until you can be honest about your behavior. Otherwise, you'll fail, and you don't need that.

7. Do you have people who will support your efforts? Social support is critical when you make changes in eating habits. Spouses and family members can sabotage your efforts.

8. Are you willing to make lifelong changes and give up dieting? Weight loss isn't a time-limited deal. You are committing to change the way you think, feel and behave.

9. If you never dropped a pound, would you still be a worthwhile person? If your feelings of worth are tied to your weight, you are not healed. Jesus loves you unconditionally. He esteems you regardless of your weight. Get a revelation of His love for you.

10. Do you want to change? Are you ready to give up these destructive habits? Change doesn't come quickly, but if you are committed to the goal of getting control over your eating, you will be successful. You will need patience and the ability to recognize the small but important changes you make.

Weight-Loss Methods

By now, I hope you understand that gaining control over the compulsive eating is your first goal. More help to accomplish the goal is found in chapter five of my book, Breaking Free From Compulsive Overeating. Second, you must learn to eat healthy. Since so many people struggling with weight issues wonder about the plethora of weight-loss methods, let's take a look at these. I am not making recommendations. I just want you to be aware of the basic pros and cons of going these routes. These strategies should be discussed with a physician and dietitian.

Pills And Medications

We are a pill-popping society. When we feel bad, we take something to feel better. Americans are in love with drug solutions to anything. Pill popping is easy, convenient, and doesn't make us deal with the complicated issues of life. Temporary relief is the goal.

The pill-popping mentality is all around us. On the one hand we tell our children and teens not to take illegal drugs or misuse medications. On the other hand, we model the opposite by popping a pill for every ache and pain. Nowhere is the quick-fix mentality more evident than when you look at weight-loss products. The number of products on the market claiming to make you lose weight is staggering. I am amazed at what people will swallow to reach the thin ideal of American beauty. Billions of dollars are wasted on elusive promises to melt away pounds. We covet the magic pill, and we'll try anything in an effort to find it.

At present there is no magic pill. We are still searching for a better understanding of the molecular biology of obesity. If we truly understood the causes of obesity, we could do more than treat the symptoms. But until that happens, pharmacological solutions for obesity remain hopeful but not yet proven.

Science continues to bring us new treatments, but we need proof of their effectiveness. Remember the fenfluramine hydrochloride and dexfenfluramine hydrochloride fiasco. Wyeth-Ayerst Laboratories in Philadelphia, Pennsylvania, the American distributor of fenfluramine and dexfenfluramine, voluntarily withdrew these medications from the market in September 1997 at the request of the Food and Drug Administration.

Then there was phen-fen (phentermine and fenfluramine). Obese patients were flocking to physicians for phen-fen prescriptions. People were desperate to find the right combination of drugs to make those pounds drop. At the height of the phen-fen popularity, I was working with an internist who studied the research of Michael Weintraub and colleagues at the University of Rochester in New York. The results indicated these medications were less than exciting in the long run. Then national concern about possible serious side effects related to valvular heart disease surfaced. People who jumped on the phen-fen bandwagon were left wondering what damage, if any, they may have done to their physical bodies. And, over time, many patients gained back most of their weight loss.

Since that time, newer agents have been approved, including sibutramine and orlistat. Again, time and research will tell if long-term results can be maintained without significant risks. The question continues to be, what amount of sustained weight loss is considered successful and worth the risks? Is a 5 percent reduction in weight worth the long-term effects of continued drug use?

After the 1994 discovery of the ob gene and its protein product leptin, the search goes on. The hope is that pharmacology will eventually cure obesity. Even as I write the book, an exciting new hormone discovery has been made that may boost weight loss. A hormone that is naturally produced in the intestines (called PYY-36) has been shown to reduce food intake in rats.

The wish of many is that a magic pill will be discovered and our obesity problems solved. In the meantime, keep doing the sensible things we know to do: Eat healthy, exercise, and change your lifestyle. It may be awhile.

Very Low-Calorie Diets

The popularity of very low-calorie diets (VLCDs) was enormous in the 1980s. Remember Oprah strutting her thin and trim body on TV? If you've tuned in recently, you won't see the Oprah of the VLCD era. You'll see an attractive woman who struggles with her weight just like the rest of us. So what are we to think of these VLCDs as a weight-loss option for the significantly obese person?

VLCDs were defined in 1979 by a scientific panel as fewer than 800 kilocalories daily. A revision of that definition includes 10 kilocalories per kilogram of ideal body weight. The revision takes into account energy requirements related to body size.

The modern versions of VLCDs are considered generally safe if used under a physician's care. There are no increased mortality rates associated with their use. These diets are recommended for people who are at least 30 percent overweight and who undergo a thorough medical examination. Contraindications for use are recent myocardial infarction; a cardiac condition disorder; a history of cerebrovascular, renal or hepatic disease; cancer; Type I diabetes; pregnancy; bulimia nervosa; significant depression; acute psychiatric illness; and substance abuse disorders (excluding cigarette smoking). But always check with your physician when even considering something like VLCDs.

The attractions of VLCDs include rapid weight loss and the simplicity of eating. With liquid diets, there are no choices - food is avoided. The downside is that these diets are a temporary solution to weight loss. They don't teach one how to modify lifestyle despite the frequent use of a behavioral psychologist who instructs patients to modify eating habits and exercise. Many patients go off of the VLCDs and eat as they did prior to the diet. Of course, weight comes back. And when you reintroduce food back into your diet, the compulsion is often still there and not treated.

In the short term, patients on VLCDs lose weight. Any weight-loss effort, though, must take into account weight-loss maintenance. According to data compiled by obesity researcher Tom Wadden, patients on VLCDs regain 35 percent to 50 percent of their lost weight in the year following treatment. Only 10 percent to 20 percent maintain their weight losses that first year, and an equal number regain it all. Over time, patients gain increasing amounts of weight.

Considering the time (medical monitoring and groups) and expense of VLCDs ($2,500 and up for a twenty-six-week program), the benefits are questionable. The use of VLCDs needs to be re-evaluated. If the long-term results are no better than traditional reducing diets, what's the point? In fact, the sense of failure many patients feel after losing a chunk of weight only to regain it is demoralizing. Too much time, effort and money were spent on something that didn't demonstrate long-time staying power. You have to decide if it's worth it.

Surgery

Surgical treatment for obesity may be recommended for people whose obesity is refractory or who have obesity-related conditions that pose serious health consequences. Surgical intervention is usually reserved for those with a BMI (body mass index) of 40 or greater, or a BMI of at least 35 with obesity-related health conditions.

Surgery can achieve maintainable losses of 40 percent to 60 percent of pre-surgery weight. But weight loss is a complicated psychological as well as physical feat. Unfortunately, the psychological state of a patient is not always considered when recommending this option. Increasingly, more surgeons are interested in psychological screenings for medically qualified patients. Unfortunately, far too many surgeries are still performed without taking this necessary step.

Positive personality changes can accompany weight loss. Patients often report feeling less helpless, more stable, have improved mood, and so on. Other patients experience negative psychological postoperative changes.

I've had patients who experienced a rise in anxiety because of trauma histories. When pounds are dropped, they feel vulnerable and scared. If fear and anxiety were channeled through food, and food is no longer available as a coping mechanism, problems can arise.

Others have spent years fighting social discrimination, attacks on self-esteem and rejection and view surgery as a way to gain an acceptable body. When the physical body conforms to social expectation, the attention can be overwhelming and difficult to handle.

Furthermore, many obese patients do not know how to determine their internal emotional states. They often see all needs as hunger needs. Emotional-based eating does not go away with surgical weight loss.

The key, then, is to be screened for psychological issues prior to surgery and address any potential negative outcomes. It appears that those who do best with weight reduction via surgical treatment are those who are psychologically healthy and make this decision with the recommendation of their physician for medical reasons.

New developments continue to be reported in the field of obesity and weight loss. This is exciting, but the psychological issues have to be treated no matter how weight loss is achieved. Controlling the compulsive behavior is key. Emotionally, we have to learn not to use food as our nurturer. Spiritually, we must be filled with the power of the Holy Spirit.

Prayer For You

Lord, I look at all these options and feel overwhelmed. Am I hoping there will be some magical way to make the weight disappear and get my eating under control? If I am, help me see the core issues involved - that freedom is more than just a weight-loss method and that I need to address the emotional reasons for overeating as well.

Reprinted from Breaking Free From Compulsive Overeating by Dr. Linda Mintle, published by Charisma House, copyright 2002. No portion of this material may be copied or reprinted without permission of the publisher.

Dr. Mintle – author, professor, Approved Supervisor and Clinical member of the American Association for Marriage and Family Therapy – is a speaker and media personality, as well as a licensed clinical social worker with over twenty years in psychotherapy practice.

For more articles and information, visit Dr. Linda Mintle's Web site.