An Image Problem : Great Weight Loss Poses Psychological Challenges

Mavis used to weigh 300 pounds.

When she decided to get serious about dieting, she lost enough to need a new wardrobe and to feel pleased with her new silhouette. At that point she lost something else: her husband.

“I was more appealing to him when I was fat than when I was thin,” said Mavis, wryly.

That didn’t stop her determination to lose weight, though it obviously didn’t help a lot. She’s been a member of Overeaters Anonymous for 18 years, and at approximately 170 still has “about 40 pounds to go,” she said after a recent meeting of the group in Costa Mesa .

However, said Mavis (who, like other members of the group, uses a pseudonym when talking for publication), she has a new marriage now, and “this one’s better.”

“Life is sweet today,” said a smiling, though still-chubby Mavis.

Mavis’ experience is not unusual, say psychologists, weight program spokesmen and other dieters.

Joan George of Irvine, who lost 137 pounds through Weight Watchers and now works as one of the group’s instructors, said that while her own marriage survived--and, in fact, “the overall relationship is better because I feel so much better about me”--it wasn’t easy.

At first, she said, her husband tried to sabotage her. “Candy is my Frankenstein,” she said, and her husband knew it. He would bring home big Cadbury candy bars to tempt her.

“But when he realized I was really serious,” said George, “he became supportive.

“Now,” she added, “he’s tremendously proud.”

But it’s not only husbands who panic, added George. She recalled a woman, “probably one of my very best friends.”

“When I started (the Weight Watchers program), I weighed over 70 pounds more than she did,” said George. “She was my cheerleader--until I passed her up.” At that point, the friend “simply stopped talking to me.”

“We were eating buddies,” said George, “and had been on lots of diets together. It totally destroyed our relationship.” Now, she added, the two have rebuilt the friendship, but on a different basis.

It’s not only “other folks” who may sabotage dieters, say the experts: Sometimes it’s the dieters themselves.

And that often relates to problems with body image.

“The concept of body image is basically how we see ourselves,” said Linda Trozzolino, clinical psychologist and director of behavior modification for the weight-control program at Cedars Sinai Hospital in Los Angeles. “A lot of people have distortions: They’re attractive and don’t see it; they’re fat and see themselves as thin, or thin and see themselves as fat.” Whatever the distortion, it can cause problems in a weight-loss program, she suggested.

“If you are going to be thin, you have to see yourself as thin in your mind; if you see yourself as fat, you’re going to be,” said Weight Watchers’ Joan George. “Getting a slender picture of yourself, I would think, is No. 1 in getting and staying there.”

That, she admitted, is easier said than done. George said it took her “at least a year (after reaching goal weight) to think of myself as normal.” With a bit of embarrassment, George told a story: She was working in the kitchen and suddenly “jumped”--there was a thin arm on the counter near her. It was, of course, her own. There were other times when she walked by mirrors or store windows and “didn’t recognize myself.”

“I almost had an identity crisis for a while, wondering, ‘Who am I?’ ” she said. When the dieter cannot resolve such problems, the diet appears likely to go up in smoke--or, more realistically, into a piece of double-chocolate fudge cake.

Dr. Frank Toppo, co-owner and medical director of the Risk Factor Obesity Clinic in Orange, recalled his surprise at the reaction of the first patient he had who lost more than 100 pounds. In order to celebrate, he said, the clinic bought a full-length mirror, so she could admire her newly slimmed self.

“She started crying!” said Toppo. “She didn’t see any difference; yet 100 pounds is a big difference! She still perceived herself as someone overweight and not very attractive.”

In a similar vein, George recalled that “at one time I had lost 50 pounds . . . and felt heavier than when I started! I think that happens because, for the first time, a person is admitting to herself where she is.

“I had hidden under tent dresses, so when I started wearing dresses that fit, it was very threatening.” Her instructor at the time suggested a technique that helped: “She had me come home and try on the dress I had joined (the program) in. It was way out to here!”

If such problems can’t be worked out, said Toppo, the dieter is “guaranteed to gain the weight back.”

Another common cause of problems is the assumption that “thin” will mean the end of all life’s irritations.

“A thin person is someone with no problems, who is never late, who never has runs in her nylons, who has no car trouble,” said Nancy Sullivan of Garden Grove, who lost 160 1/2 pounds with Weight Watchers, where she--like George--now works as an instructor/lecturer. It may be mostly “media hype,” she said, but “we fall for it.”

When the dieter finally gets near or reaches goal weight and that magic fails to happen, disillusion--perhaps assuaged by a diet-shattering binge--is a common reaction, say some of those working with weight-loss programs.

Some women, said Cedars Sinai’s Trozzolino, are “disappointed that taking the weight off doesn’t result in a wonderful boyfriend, a wonderful job. We caution them that losing weight does not guarantee that Prince Charming is going to appear.

“I’ve had patients say they took the weight off, bought new clothes, went to a party and expected men to drop in their tracks,” said the psychologist. When that doesn’t happen, she added, “it’s devastating; they didn’t get the expected payoff.”

John V. Flowers, a clinical psychologist who teaches at Chapman College in Orange and serves as a consultant for Weight Watchers, told of a woman who lost about 75 pounds, then became depressed when she found there was no magical return to the earlier, “thin” life she remembered. Those dreams, he said, were built on old memories of fun at the beach: “not so much swimming; primarily sun and socializing.” But she was older, and the beach no longer offered the same old fun, he said. However, the woman eventually became a success story by finding a new special interest, he said: She got involved in folk dancing.

It’s not simple to make those adjustments, said marriage, family and child counselor Phyllis Daniels of Tustin, who has held weight-loss workshops. All those pounds “served a purpose,” she said. “Weight is a protection, a way of keeping people away and not letting them get close. And the more weight you have, the less close people can come.”

The person who is really overweight “has had an excuse not to get married, not to play tennis, not to go to the beach or to go dancing, not to have children,” Daniels explained. “So now all of a sudden the symptom is gone, but the cause is still there.”

The result: “Here’s this person standing ‘naked’ in public, and feeling uncomfortable in her own body . . . more miserable than when she was fat.” Such people may “slowly start to eat again, to get back the protection,” she said. “They don’t know what else to do.”

Stories told by some of the experts and the dieters themselves suggest that, for many of the overweight, the mere thought of success scares them right back to the refrigerator.

Julie of Huntington Beach, who has dropped from 215 pounds to 130 pounds through Overeaters Anonymous, recalled that “it was safer to be fat than thin.”

“I didn’t have to deal with passes from men, starting a career,” she said. “It was an excuse not to be successful. I could say, ‘If only I were thin!’ ”

Today Julie, who is 5 feet, 5 1/2 inches tall, wears size 10. Talking prior to the Overeaters Anonymous meeting in Costa Mesa, she wore a white knit top, pale yellow slacks and white heels. She’s gone back to college.

But her marriage went through some rocky periods, as her weight could no longer be used as an excuse for family problems and as Julie began expanding her own horizons. The whole family has required counseling, she said. Julie continues attending Overeaters Anonymous--there are 80 different OA meetings each week in Orange County--even though the weight has been gone for three years. As a self-declared “compulsive overeater,” she needs the continuing group support, she said. But it’s worth it: “It’s like a whole new life has opened up for me.”

Nancy Sullivan, 40, who has been at her goal weight for a year and now teaches a popular class designed especially for those with 100 pounds or more to lose, recalled an earlier, unsuccessful weight-loss attempt:

She’d married at 19, weighing 243 pounds. At 21 she decided to lose some weight--”I thought if I were to get thin, I wouldn’t have any problems”--and managed to take off 56 pounds. Then she and her husband went to a party, where “my best friend’s husband made a pass at me.” Sullivan headed back to the safety of food.

Some dieters get closer to their desired weight--even “right on the brink of total success”--when they realize there are new expectations of them that they weren’t prepared for, said psychiatrist David Albin of Orange, who first worked with weight problems as part of a UCLA team in the 1960s. When a lot of weight is lost, he said, there may be a sudden realization that the game rules have changed: “Oh! No more disability! I’ll have to go back to work! I’ll have to find a mate!

“Maybe the devil you have is better than the devil you don’t know,” said Albin. Then, there are those who are scared to even begin:

Tom Thompson, news director for Los Angeles television station KCET, used to be one of them, although he has since lost 174 pounds through the UCLA weight-loss program and now is participating in the Cedars Sinai program to whittle off some pounds that crept back on. But originally--weighing close to 400 pounds--he put off reducing for fear doctors would find health problems: He envisioned reports that “my blood pressure was through the ceiling, my cholesterol level was astronomical, that I had some kind of heart problem.” None of those proved true, he said, and loss of the weight has been “a wonderful experience.” Among the benefits: finding that he “could walk into any normal clothing store and purchase off the rack, without having to go to the fat man’s store” . . . adjusting to the fact that “kids are no longer tugging at their mothers’ skirts, pointing their fingers and saying, ‘Look at that fat man’ ” . . . realizing that, as a single person, his social life has definitely improved.

It “would be impossible,” he said, that he would ever let his weight yo-yo back up.

Many people keep the weight on because that’s how they’ve learned to deal with problems, suggested Dr. Donald Schafer, who was clinical professor of psychiatry and human behavior for 15 years at UC Irvine’s College of Medicine. Now retired, Schafer continues some teaching at UCI in addition to a part-time private practice in Laguna Beach.

He told of one patient, a 350-pound woman who spent an evening with a friend. The two got into an argument, but the woman decided to stop, since she was a guest, although the anger remained. On the way home, said Schafer, she “bought enough food for five meals and ate every bit of it, even though she was not hungry.”

“I interpreted it as cannibalism,” he said. “She was eating her opponent symbolically.” That woman was a psychotherapist, he said, and even though she understood her problem, she was unable to lose weight successfully.

Most experts, as might be expected, report that the successful dieter is the one who has conquered the psychological as well as the physical challenges of weight loss. The commonly reported statistics suggest that such victories are few and far between:

“We estimate that about 62% of all women (nationwide) made a conscious effort to lose weight within the past year,” said Ira Smith, Weight Watchers’ national manager of market research. “We don’t have any figures for success rate. I think the general knowledge within the industry--the number of women successful in keeping off weight--is probably less than 5%. Most go through the yo-yo syndrome.”

However, statistics reported by USC’s Albert R. Marston, a professor of psychology and psychiatry, may offer a clue to successful dieting: One secret, he said, appears to be getting all the way down to goal weight. “For people who lose to goal, the situation is a lot more optimistic than has been believed,” he said. A year or two after reaching that weight, he explained, “94% are still in goal range (less than 15% overweight).”

Those figures, based on a study of 38 women and nine men in Northern California, were reported in January, 1984, in the International Journal of Obesity. The statistics were so surprising, said Marston, that the study was repeated in Southern California. The results were almost the same, and are published in the current issue of International Journal of Eating Disorders, said Marston. The professor, who recently put out a commercial videotape dieting program (“In Control,” MMI Video, Chicago), said that “keeping people in treatment until they reach goal weight is very important.”

Two other clues to success, according to the experts, are changing the behavior patterns that led to the weight gain in the first place--and firmly believing that the weight is going to come off. “If you believe you can do it, you can do it,” said psychologist Flowers. “If someone has tried 53 times and this is No. 54, and they know it is going to fail, they’re in trouble.”

Frequently, said both experts and dieters, a support group such as Weight Watchers or Overeaters Anonymous can improve chances for success; some believe professional therapy is helpful. Yet, many dieters do seem able to pull it off on their own, said both Trozzolino and Marston.

However the weight is lost, said Marston, when the scale gets to that wished-for point, “it is really a time to re-examine life and goals . . . what I want to do with this body I have got.”