Anorexic patients often have trouble with the idea of group therapy. They resist relationships because they fear rejection. They use their thinness as a shield to protect them from having to deal with other people. If they feel anxious, they tend to respond by losing more weight or running way. Because their social skills aren’t as developed, they may need more support than other members.

However, group therapy can help some anorexics precisely because it shows them how to express their feelings and interact with others. Recently Pam, a former patient, called to tell me how happy she was in her new job as a receptionist. We shared a laugh, because before treatment, Pam was notoriously shy and refused to speak to anyone. Her experience in group gave her the emotional strength to reach out to others. Now here she was, greeting visitors and talking on the phone – tasks that, just a year before, would have driven her to starvation.

When the members of a group are more compatible-similar in age, level of education, length of illness, and so on-there is usually greater group cohesion. Group therapy also stands a better chance of helping if the anorexic is not severely ill, is highly motivated, and has responded to other treatments.

It sometimes works to have at least one patient in the group who has returned to a normal body weight and maintained that weight for a period of time. Such people serve as role models. Similarly, including a patient who is on her way to recovery, who can express her feelings more easily, helps shift focus away from body weight and onto other issues.

Inpatient programs: Because they are more severely ill and their treatment is more intense, inpatients are generally willing to take part in groups. The size of the group varies. Sometimes inpatient groups are larger than outpatient groups, but because each patient may take part in several group sessions a day, she has more chances to contribute.

Of course, the goal of hospitalization is to get the patient better and send her home as soon as possible. Thus inpatient groups, by definition, are short-term groups.

A challenge comes when the patient must make the transition from the hospital to the outside world. We encourage patients who respond to the group approach to continue with therapy as outpatients.

Outpatient programs: Outpatient anorexic groups work better if their numbers are small -groups of four to six patients may better address interpersonal problems than groups of seven or eight, the size of most other outpatient therapy groups.

Programs vary, but most groups meet once a week. It’s probably best if the group plans to run for at least six months, and if it is an “open” group – that is, it allows members to come and go. This policy helps replenish the membership and keep the group operating when patients drop out, as some inevitably will.

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For Cindy Engle, a family reunion ended a 14-year pattern of losing and regaining weight—and helped her permanently part with 20 pounds.

Like both of her parents, Cindy had struggled with her weight for most of her life. From the time she was in her late twenties, she tried just about everything to slim down. “I followed far too many diet plans. I took diet pills. I even ran half-marathons,” says the 42-year-old mother of two from Sierra Vista, Arizona. “Sure, I’d lose weight. But the pounds would always come back.”

In the summer of 1998, Cindy attended the fateful family gathering. “When I looked around, I noticed that everyone had gained 5 to 10 pounds—maybe more—since the year before,” she says. “That day, I made a serious commitment to losing weight.”

Cindy wasn’t about to accept what seemed like her genetic destiny. Because she already led a fairly active lifestyle, she decided to focus on revamping her eating habits. After reading up on nutrition, she began building her meals around fresh, nutritious foods: fruit for breakfast, salads and lean proteins for lunch, and lean meats for dinner. She also began drinking lots of water—at least eight full glasses a day.

Within 4 months of making these simple dietary changes, Cindy had taken off 20 pounds. She has maintained her weight at a healthy

117 pounds ever since, thanks to her dietary vigilance and her com- : f mitment to jogging 40 to 60 minutes, three or four times a week.

WINNING ACTION

Reject the family fat gene. Do your relatives—especially parents, grandparents, aunts, and uncles—struggle with their weight? If so, you may have a genetic predisposition toward overweight. That doesn’t mean you should accept it. Studies show that your lifestyle choices—what you eat and how much you exercise—are far more important than your genes in determining your weight.

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