1. Is there a history of problem drinking in your family?
5 No
4 One close relative
3 More than one close relative
2 I used to have a drinking problem
1 I currently have a drinking problem
2. On the average, how many cigarettes a day do you smoke?
5 None, and I never have
4 None now, but I used to smoke regularly
3 Less than half a pack
2 About a pack a day
1 More than a pack a day
3. How many times in the past year have you been hospitalized?
5 Not at all
4 Once, for a minor problem or childbirth
3 More than once, but only minor problems, no surgery
2 Once for major illness or surgery
1 More than once for major illness or surgery
4. Does your family have a history of cancer, or other immune-suppressive disorders?
5 No history
3 One immediate family member
2 More than one immediate family member
1 I myself have had such disorders
5. How many prescription medicines are you now taking?
5 None
4 One or two
3 Three or four
2 Five or six
1 More than six
6. Do you use illicit drugs?
5 No
4 Not now, but I used to
3 Yes, but infrequently
2 Yes, regularly
1 I am/have been a problem drug user
7. How often do you eat cured or processed meats? (i.e., bacon, sausage, luncheon meats)
5 Never
4 Very infrequently
3 At least once a week
2 Several times a week
1 At least once a day
8. When you shop, do you read food labels for additives?
5 Yes, and I avoid foods with a lot of additives
4 Sometimes, but I don’t always bother
2 Very rarely
1 I don’t really care at all
9. Based on your recent health, do you expect to get sick in the next six months?
5 Definitely not
4 Probably not
3 Maybe one minor cold or flu
2 Probably more than one minor illness 1 I am sick right now
10. Are you taking antibiotics for any medical problem?
5 No
4 Not now, but within the last year
3 Off and on
1 Yes
11. Do you have allergy problems?
5 Never
4 I used to, but no longer
3 Mild, seasonal problems only
2 Mild year-round problems
1 Allergies are a real problem for me
12. How do you describe your health?
5 Excellent, as always
4 Better than before, and still improving
3 Usually good
2 Not as good as it used to be
1 Poor, or getting worse
13. How regular are your bowel movements?
5 Very regular
4 Usually regular
3 Bouts with diarrhea
2 Not very regular
1 Often constipated
14. Which best describes your attitudes about health?
5 The way I live effects my health. I make it a point to treat my body well.
4 Though usually in good health, I’m destined to be sick occasionally.
3 My health is about average, and there’s not much I can do about it.
2 In 20 years, I will be much less healthy than I am now.
1 I worry a lot about my health.
15. Overall, your diet is:
5 Excellent
4 Better than average
3 About average
2 Could be better 1 Poor
TOTAL LIFE-STYLE IQ SCORE
*65\242\2*
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.
*223\186\4*
