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There is no way at present to distinguish between individuals who will or will not develop an eating disorder subsequent to dieting. There is also no way to identify who will or will not be damaged by repeated weight cycling. It is uncertain whether some people will need constant support and monitoring to maintain fat loss. It may be that a different approach needs to be taken for people with a food dependence from the traditional approaches used in behavioural and self-management practice.

A further model for eating disorders has been proposed with reference to obesity and non-purging bulimia, which suggests that repeated cycles of dieting and regaining weight lead to food dependence.” Dependence is defined as ‘the failure to stop using a substance that is deleterious to health and where use results in short term mood alteration’. In this model, food (specifically those foods which are reserved for bingeing episodes) becomes a psychoactive substance. In common with other psychoactive addictions it has the following characteristics:

• food is used in larger amounts, or for longer periods than the person intended

• there is a persistent desire or effort to cut down or control intakes

• there is a continued use of a food despite the knowledge that there is a persistent or recurrent physical, social or psychological problem caused by its consumption

• there are ‘withdrawal’ symptoms—cravings, anxiety, tension, depression—when the food is not available.

Obese and bulimic clients frequently report bingeing in response to stress, frustration, rejection or other negative emotional states, and it seems likely that both uncontrolled eating and the kinds of food used (high carbohydrate/fat) act synergistically to lower the internal arousal state. Few of these clients are able to activate behavioural self-management techniques at these times.

This presents the fat loss counsellor with a major dilemma; on the one hand is the desire to encourage healthy weight loss, but on the other is the concern about encouraging restrictive eating disorders. Unless the counsellor turns away a client, leaving them at the mercy of someone less scrupulous, they have a responsibility to be helpful, and above all, to do no harm. The following are some guidelines for counsellors, based on this ‘do-no-harm’ principle:

Myth-information. Tai Chi, the ancient Chinese art of movement, is a form of relaxation which may, indirectly, have an effect on nervous eating and thereby improve body fat levels. The physical component of Tai Chi alone, however, is not sufficient to create a significant energy deficit.

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