Beyond Dieting®

Chapter One: Introduction

This thesis reports on a qualitative study of the impact of a 10 session psychoeducational group treatment approach called Beyond Dieting®. The purpose of this study was to develop, implement and evaluate a non-dieting program that would address the needs of a group of overweight women who had undergone repeated attempts at dieting and were considered weight preoccupied. The research traces the experiences of the women, presents the content, and examines the process of the Beyond Dieting group.

The Problem

There is increasing evidence that the North American preoccupation with diet and body image is hazardous to our health. Concerns about weight may lead to obsessions about diet and weight control, disordered lifestyles, abnormally high or low patterns of exercise, disordered eating patterns, metabolic depression and inadequate nutrition (Wolf, 1991). Society has placed a negative value not only on the obese, but on those that are considered to be only slightly heavier than the norm.

The areas of dieting and obesity are quite complex, touching upon physiological, psychological and social issues. Social work is ideally suited as a profession to address these issues. It recognizes the need to deal with the multifaceted aspects of a problem and utilizes a framework that questions issues from both a private and public perspective. Social work looks at the person in environment and at the societal structures that create and maintain meanings of personal value based on appearance. A social work perspective enables the practitioner to understand and address the social problems arising from issues of stigma, discrimination, ideals of beauty, and acceptability (Hepworth & Larsen; McMahon, 1994; Pincus & Minahan, 1973).

Ciliska (1990) asserts that there are three important issues should be considered when looking at dieting: 1) Genetics may preclude some people from being thin; 2) Severe dieting is not healthy both physically and emotionally; and 3) Obsessing about dieting and thinness can get in the way of leading a normal life. Weight preoccupation can be described as an excessive focus on weight related issues such as weight, dieting, body image and the power of food (Thompson, 1995). Weight preoccupation occurs predominantly among women and is independent of actual body size or shape. For many women, dieting and weight preoccupation have become a "normative obsession" given international coverage that is out of proportion to the health risks associated with obesity (Wolf, 1991). Shape dissatisfaction and attempts to restrict food intake is evident in all but a small minority of women who are statistically overweight (Garner & Wooley, 1991).

Most diets fail in achieving effective weight loss or maintenance. In a review of several studies, Safer (1991) concluded that 92 to 96% of all weight reducing diets fail. Despite this, society upholds the strong belief that weight loss is relatively easy and only "weak-willed" people are overweight. I believe there is a need for those who struggle with the issues of weight preoccupation to be educated, supported, and given an opportunity to explore its impact in a safe environment. The Beyond Dieting program was developed as a psychoeducational group experience in order to meet these needs. Three general content areas were looked at during the Beyond Dieting group experience: 1) Education and awareness of weight preoccupation, 2) Self esteem and body image issues, and 3) Relationship with food. It was hoped that through increased awareness and discussion, members would come to terms with their own dieting and weight preoccupation issues. I believe that a psychoeducational group model for the treatment of this population was an ideal method for developing knowledge, awareness and resolution to these issues.

This thesis describes three processes: 1) The issues of weight preoccupation and discussions of obesity and dieting as it pertains to obese women who were repeat dieters, 2) The development of a model of intervention called Beyond Dieting, and 3) The experiences of one group of adult women who underwent 10 sessions of the psychoeducational group called Beyond Dieting. It is hoped that this study will contribute to an already growing knowledge base that looks at weight preoccupation from a non-dieting approach. There is the possibility of helping women come to terms with issues of weight preoccupation, self esteem, and their relationship with food. Education provided to a group about diet and weight information may provide health benefits despite no change in weight. As well, it is hoped that with greater information and understanding, the social need to look at issues of discrimination towards the obese may be further recognized and addressed. Using a social work perspective allows for the issues of weight preoccupation to be addressed on a multidimensional level that deal with these issues from both a personal and social viewpoint.

Rationale for Group Treatment

Issues of weight preoccupation such as food, dieting and health are often discussed openly and with great interest and enthusiasm in many informal social situations. I first developed the idea for Beyond Dieting when I ran specialized weight loss groups for an international dieting firm. The groups were smaller and therefore more intimate in nature than traditional weight loss groups. I discovered that the women composing the groups had a great deal of interest in discussing issues of weight preoccupation before weight preoccupation came into being as a recognized term. There was an enthusiastic sharing of information, mutual support, caring and empathy about these issues. Most of the groups formed cohesive units and members were enthusiastic in participating. However, no one lost weight. This was a consistent finding in most of the small groups that were run throughout North America. Since the firm's only criterion for success was weight loss, the groups were considered a failure and eventually the program was discontinued in most cities. However, most of the participants felt that a great deal of their needs had been met through the small group format despite the lack of weight loss. Many of the participants felt that they understood themselves better, felt better about themselves and had a great deal of relief in sharing and learning from one another about their own personal issues with food and dieting.

I considered these groups successful in terms of improving self esteem, helping members make peace with their relationship with food and increasing their knowledge and understanding of weight related issues. Despite the fact that they were not losing weight, most expressed a desire to continue the group process. They wanted to continue talking about these issues but no longer wanted to focus on food, dieting or weighing themselves. Once I left the firm and having regained weight myself, I felt that developing a group without the focus of weight loss could be an important and needed intervention for women.

It was hoped that the Beyond Dieting program would be able to achieve deeper levels of understanding and exploration of weight preoccupation issues. It was hoped that the goal of weight loss would be replaced with goals that were within reach, such as sensible nutrition practices, self-care and moderate exercise (Siegler, 1993). I believed that a psychoeducational format that would include both education and self exploration in a supportive environment was the ideal model for treatment.

Nothen (1988) discusses dynamic forces that are identified as applicable to the effective practice of social work with groups. The dynamic forces that were essential parts of the Beyond Dieting Group® included:

• Mutual Support: Support among others who confront similar issues with regard to weight preoccupation was an essential part of the group process. The group leader and members provided support which helped reduce anxiety and encouraged participation and willingness to hear new ideas.
• Cohesiveness: Mutual acceptance lent itself to group commitment and enjoyment. When mutual support, acceptance and empathy were provided, cohesiveness and a sense of belonging were achieved.
• Quality of Relationships: The relationships among the members provided support and caring in an environment of trust and intimacy.
• Universalization: It was important and reassuring for others to learn that they were not the only ones struggling with weight related issues. Although many weight preoccupation issues are discussed in informal social situations, the depth of isolation, loneliness or frustration was usually not shared as readily among friends or acquaintances particularly when one is obese.
• Instilling hope:Repeat dieters often feel hopeless and isolated. Through the group process, members developed hope and optimism for the future.
• Altruism: Helping others and in turn helping themselves, helped members to feel good about themselves and increased self esteem.
• Acquisition of knowledge and skills: Educating group members about what is KNOWN about dieting and weight preoccupation as opposed to what is commonly BELIEVED was an essential part of the group's goals. Techniques such as irrational eating were discussed and utilized by some members as a method of learning how to disempower food.
• Catharsis: Expression of feelings and disclosure of experiences served to reduce anxiety and aided in the achievement of goals in conjunction with knowledge that was gained.
• Corrective emotional experiences: It was important for members to separate the guilt and self-loathing that often resulted from weight preoccupation. Members needed to explore and sometimes express strong emotions in resolving these issues.
• Reality testing: The groups provided multiple perspectives. The group provided feedback for sharing and comparing perceptions, feelings and facts. Through sharing thoughts and feelings, it was reassuring to find that others may have felt the same way or had similar experiences.

The group setting provided women with an opportunity to examine their relationships with food and weight within the framework of their own life experience and to place these personal experiences within a societal context (Friedman, 1993). This is consistent with utilizing a person-in-environment perspective.

Group Goals and Objectives

It was important for the goals of the group to be clearly defined and stated during recruitment, screening, and throughout the group in order to maintain its focus. The goals of Beyond Dieting were consistent with Corey's (1990) description of person-centered group goals. The group provided a safe environment to allow exploration and disclosure of feelings. The focus of the group was to be on present day issues and helping members develop confidence in their own strengths and judgments. Feelings of openness, honesty and spontaneity were encouraged. For those who felt alienated, alone, hopeless, and unworthy, it was hoped that feelings of security and support would be achieved in the Beyond Dieting setting.

The specific goals of Beyond Dieting® were:

• To educate: It was very important for the group to have an educational component. Most people receive information about dieting and weight preoccupation through a variety of sources such as popular books, magazines, television, weight loss agencies and the medical community. People will often informally discuss dieting and weight loss information that is learned through various sources. Much of this information comes from sources that are recommending or selling their own weight loss techniques and is based on the belief that diets are effective in dealing with both weight issues and weight preoccupation and on marketing principles. Therefore there are usually biases inherent in most information received. I believed that most people were poorly informed and know little concrete data or research about dieting and weight preoccupation. It was important that Beyond Dieting provide accurate information for discussion and therefore increase the awareness and knowledge of members. Presentations of current beliefs and controversies as found in both the popular press and scientific journals were included for discussion in most weekly sessions.
• To increase self esteem: Individuals who struggle with weight related issues often have low self esteem (Campbell, 1977; Overdahl, 1987). It was hoped that self esteem would be enhanced as awareness about body image and self esteem issues were explored in a supportive environment.
• To explore one's relationship with food: Through the process of repeated dieting and weight preoccupation, it was hypothesized that most members would have a dysfunctional relationship with food. It was important for the group to look at the meaning that they had given food and explore the power that food had developed for them. It was important to learn that there was more to eating than hunger. Members' current eating styles may have reflected their relationship with food and were to be discussed and evaluated in a non-judgmental setting. It was hoped that through the group process and experience, normalized eating would be discussed and encouraged.

It was clearly stated that Beyond Dieting was not a diet and that the group would not focus on weight reduction or dieting. Often "Diets in Disguise" (DD's) allude to the notion that if one can make "peace" with food, then weight will be lost. It was important that group members were aware that Beyond Dieting would not encourage this belief. Members were not weighed, there were no food plans or promotion of dieting behavior. Over time it was hoped that participants of the group would develop greater knowledge about dieting and obesity, increase self esteem, create a better relationship with food, and develop healthier lifestyle choices with improved eating patterns.

Overview

The next chapter provides a literature review of what is currently believed about dieting and obesity. Chapter 3 describes the methodology of the group through data collection, extraction, and analysis and discusses group structure and group processes. Chapter 4 profiles each participant of the group, while chapter 5 presents and describes the ten sessions of Beyond Dieting. Chapter 6 looks at the findings from members' perspectives and a discusses the themes that emerged. Chapter 7 presents the conclusions of the group program and offers some considerations for future groups of Beyond Dieting.

Conclusion

This thesis describes the development of a psychoeducational program called Beyond Dieting. It describes the experiences of a group of overweight women who were repeat dieters that ran in the Spring of 1995. Weight preoccupation and repeat dieting are common occurrences in our culture that are detrimental to the health of those who share these practices. Beyond Dieting was conceived as a group approach to explore the discussions of these issues with chronic repeat dieters and to facilitate discussion, education, and exploration of feelings connected to their experiences.