Eat Right and Exercise . . . You Talkin’ to Me? Yeah!

For as long as she could remember, Annette Pfau fussed over food.

She counted calories, agonized over eating and scolded herself in sessions before the full-length mirror.

“My memories of junior high school are of constantly eating cottage cheese or some other crash-diet food. Food was always an enormous part of my life,” says Pfau, 33, a Los Angeles graphic designer. “I was always super-conscious of my body image. I felt I had to conform to whatever the standard of beauty is: tall and thin. But I’m not even tall.”

She moved into adulthood even more compelled to mold herself into the image locked in her brain. Dieting and exercising were a way of life.

Then came the revelation.

“It dawned on me one day that I was spending an inordinate amount of time on food. I told myself, ‘This is wrong.’ ”

That was five years ago. Today, with the help of a dietitian, Pfau says she is free from the grip that food, weight and body image had on her.

She exercises and still tries to eat healthfully. But she does not weigh herself, and she has endorsed the body that she was born with.

“I have completely changed my thinking about food,” Pfau says. “It’s like night and day. The main thing I’ve learned is, food is a neutral thing. It’s not good. It’s not bad. Chocolate cake isn’t evil and celery isn’t virtuous.”

Pfau is among a small group of Americans embracing a new model of personal health that is revolutionary for its approach--or lack of approach--to dieting. There is no name for

this model, although it’s sometimes called “health centered” as opposed to “weight centered.”

If it had a motto, it would be: Don’t diet.

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In a nutshell, the health model--which has a growing number of health professionals from medical doctors to dietitians to psychologists behind it--demands an end to restrictive dieting (counting calories, fat, cholesterol).

It not only takes away the scales, but simply asks the individual to try to eat a variety of healthful foods to satisfy hunger, to exercise and--perhaps most central--to accept your body as it is.

Why opt for this stop-trying-so-hard approach?

Because dieting doesn’t work in any permanent way, says Jeanine Cogan, a Washington, D.C., psychologist and public-policy scholar specializing in body image with the Society for the Psychological Study of Social Issues.

“The prevailing model on obesity is now being recognized as shortsighted by researchers across disciplines,” she says. “If restrictive dieting as a treatment for obesity has a 95% failure rate and increases the chance of developing an eating disorder, then dieting is not a successful health behavior.”

Cogan is among a group of psychologists informally pressing the federal government to back a new health-centered approach. (A similar model was recently adopted in Canada as part of a major public health media campaign.)

“This is an idea that has been floating around for many years,” she says. “It’s just now getting some attention. We’re at a point now where even the leading weight loss researchers are saying restrictive dieting isn’t working.”

Psychiatrists too are pushing for the new paradigm.

They have added a category called “binge eating” to the listing of psychiatric disorders, a move that reflects the emotional component to eating problems and acknowledges the large group of Americans who are not bulimic or anorexic but who are troubled by food, body image and weight issues.

Meanwhile, the American Dietetic Assn. has created a branch of training--nutritional therapy--that focuses on teaching this philosophy.

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The new model suggests that if you just eat normally and exercise moderately, you will be mentally and physically healthier and may even lose a modest amount of weight, although the measures of success are whether you are healthy and whether you feel good about yourself.

The model also frowns on the use of obesity drugs, such as Redux and Pondimin, both of which were voluntary withdrawn from the marketplace last week due to safety concerns. The medications suppress appetite, another form of food restriction that goes against the health model.

“You can’t measure self-esteem with a scale,” says Evelyn Tribole, a registered dietitian and co-author of “Intuitive Eating: A Recovery Book for the Chronic Dieter” (St. Martin’s Press, 1995), which looks at the non-diet model. “I’ve stopped using a scale. I’ve changed my motto about nutrition. It now includes having a healthy relationship with food and taking the morality out of eating.”

Adds Frances Berg, a registered dietitian in North Dakota and author of “Afraid to Eat: Children and Teens in Weight Crisis” (Healthy Weight Publishing Network, 1997): “The old paradigm was: First lose weight and then get healthy. The new paradigm is that we need to be healthy first, with the goal of being healthy at whatever size we are.”

But Berg and others acknowledge that it won’t be easy to change the norm of a society in which it seems every advertisement features a gaunt model, in which dieting is an estimated $40-billion business, in which research dollars flow to scientists performing dieting research and in which Americans hold tight to the belief that anything is possible--even altering a body that may be genetically determined to be large.

To embrace a new model, Tribole says, “People have to grieve that they are never going to have a skinny body.”

But Americans won’t buy that concept, says Linda Webb Carilli, general manager of corporate affairs for Weight Watchers International. Five years ago, when Weight Watchers suggested that clients aim for a “healthy weight” as opposed to an “ideal weight,” the idea flopped.

“To tell someone who is a binger, ‘Don’t think about your weight,’ is not helpful,” Webb Carilli says. “You can tell them to think about how healthy they are in other ways. But if that doesn’t match their value system, if that isn’t significant for them, it won’t work.”

According to a 1994 report in the Journal of the American Medical Assn., one-third of U.S. adults are overweight, a 25% increase from the 1960s. A quarter of all teenagers and children are overweight. Obesity rates have soared despite the proliferation of diet programs, pills and foods.

“The myth is that overweight is cured by dieting,” said Connecticut psychologist Lisa G. Berzins before a congressional briefing on eating disorders in July. “The truth is that treating overweight by dieting most commonly results in eventual weight gain. Weight is a complex result of heredity, culture and lifestyle. It is not ‘cured’ by a pill or powder. Some large-size people maintain a healthful lifestyle, yet remain at above-average weight.”

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It’s hard to pinpoint why so many Americans are obese when more people than ever are dieting and obsessing about their weight. Berg, a nutritionist who has studied the issue, blames obesity rates on fewer people smoking, more sedentary lifestyles, higher-fat diets and women being encouraged to gain more weight during pregnancy to have bigger babies (a tactic that may leave some with a healthy baby but a long-term weight problem).

Berg also blames Americans’ approach to food.

“There is a big group of adults and kids who fit the criteria of dysfunctional eating: skipping meals, fasting, bingeing, chaotic eating, under- or overeating for reasons not to do with hunger but with body shape or feelings. They feel ashamed and uncomfortable,” she says.

According to Berg, Americans’ misguided notions about weight and food have led to a range of problems, including obesity, eating disorders, eating dysfunction (a less severe pattern of eating disorders) and size prejudice.

“We need to deal with these things in an interrelated way. Instead, we look at them separately. If we address obesity and help overweight kids, we may increase the other three problems’ severity,” she says.

For example, if children receive the message that being overweight is bad, then they may assume that it’s OK to discriminate against fat people. Another example is the teenage girl who, disgusted with being plump, forces herself to vomit after eating.

“I work with people who have eating disorders, and I can see how . . . classic dieting, even in a healthful way, isn’t really healthful,” Tribole says. “If you are truly focusing on health and healthy behavior, you really can’t do harm.”

But many people assume that good health can be obtained only by achieving an optimal weight.

“One trouble that people have is they say, ‘I’m exercising, I’m fit, my blood pressure and cholesterol are good, but I’m not the weight I want to be.’ The problem with that approach is that it’s a vanity issue. This can’t be a vanity issue,” Tribole says.

And, much worse than being somewhat overweight, the new-model proponents say, is weight cycling--losing, then regaining weight, which takes its toll on the body, particularly the heart.

“Disproportionate attention is paid to the risk of obesity while little attention is paid to the risks of weight fluctuation. And yet there is very good information on this; at least 10 studies have looked at this,” Cogan says.

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Lindsey Elan started battling her weight in high school. It was the beginning of an odyssey that would end with a diagnosis of an eating disorder.

“My girlfriend and I would eat these regimented diets, such as an apple for breakfast, salad with nothing on it for lunch and vegetables for dinner. We would do that for a week before the prom. In college, I would go on liquid diets,” says Elan, 27, a graduate student who lives in Santa Monica.

After graduating from college and living alone for the first time, Elan began to binge and purge. She was eventually treated for bulimia.

“The preoccupation with weight and eating was part of the cause,” she says. “I had to relearn a relationship with food. I had to become comfortable with my body. I realize now that body shape is not what’s important.”

Mechthilde Dunofsky also learned the hard way. Years ago, while working as a model in Europe, she found herself in a battle with food. She starved herself to be skinny, but then began to eat as a way to deal with the boredom of her work.

“I was in a struggle with my weight,” says Dunofsky, now a Beverly Hills psychotherapist who specializes in body image issues. “Finally, I changed careers. I’d had it with eating rabbit food and dreaming each night of chocolate pies and my mother’s roasts. From that time on, I didn’t pay attention to my weight, and I’ve been the same size for 25 years.”

She now counsels clients to toss out the scales and to concentrate on all their positive attributes instead of dwelling on weight.

“I tell people it’s all right to be bigger. You can be attractive if you are healthy, whatever your shape. And people often lose weight easier when they feel better about themselves.”

But can Americans really give up dieting?

“The current approach is so entrenched in all of our organizations and in people’s everyday thinking,” Cogan acknowledges. “I see this as a very liberating message, but that depends on where people are. I think the hardest part for those of us who are advocating this shift is that people do not want to give up the dream that they can change their body size. It’s almost like we’re the bad guy saying, ‘Folks, research says this will have a 95% failure rate. So instead of focusing just on weight as a determinant of health, let’s look at other things.’ ”

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Cogan and others also see the dieting industry as a force to be reckoned with because of advertisements and programs that make dieting look easy.

Last year, Berzins succeeded in helping Connecticut enact the first state laws to regulate diet industry advertising. The laws require diet programs to disclose accurate information regarding long-term weight loss and other health and cost information.

“The diet industry thrives on failure while perpetuating success,” she says.

But many diet companies also discourage highly restrictive dieting, says Weight Watchers’ Webb Carilli.

“If people engage in weight management as restriction and deprivation, it’s definitely not going to work,” she says. “I think [the health-centered model advocates] are trying to free people from that mind-set. We also work toward freeing people from that mind-set. We put a lot of emphasis on choice.”

Under a new Weight Watchers program, foods are assigned a point value to indicate their nutritional characteristics. Clients try to stay within a set number of points per day. But this kind of counting approach would not sit well with the health-centered advocates.

“We’re giving people parameters,” Webb Carilli admits. “People don’t come to Weight Watchers to hear, ‘Hey, eat anything you want.’ These are people who want to have some parameters.”

A similar approach is proffered by Jenny Craig. That program also tries to emphasize choice, moderation and exercise, says Lisa Talamini Jones, director of nutrition and program development.

“We have a menu, but we don’t think of it in terms of restriction. We think of it as a model for balance, variety and moderation. Cookies, for instance, are on the menu,” Talamini Jones says. “That is consistent with what health experts are saying. But you still have to be concerned with your weight. One-third of the population is overweight, and that has important health consequences.”

But the industry is clearly facing criticism. Following on Berzins’ success in Connecticut, a group of health experts is challenging the Federal Trade Commission to toughen diet advertising standards nationwide.

Earlier this year, the FTC denied a petition submitted by a nonprofit watchdog group, the Center for Science in the Public Interest, asking for more consumer information in diet industry advertisements. The FTC, however, agreed to hold a public forum on the issue. The conference will be held Oct. 16-17 at the FTC’s Washington offices.

“We are not taking a stand on whether or not these [diet] programs should be in business,” says CSPI attorney Layla Farzan. “But we want to see data on how effective these programs are. What are the costs, risks, staff credentials? If the data are not positive, people may decide to drop out of them. And the programs will either get better or whither away.”

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Rethinking Weight Loss

More health experts are saying it’s time for Americans to stop dieting and to use different measures--other than their weight--to assess health. This model has already been proposed by the Canadian government.

Current Model: Weight Centered

Dieting

* Restrictive eating

* Counting calories, prescriptive diets

* Weight cycling (yo-yo diets)

* Eating disorders

Exercise

* No pain, no gain; vigorous exercise program

* Prescriptions such as three times a week in your target heart-rate zone

* Burn calories

* High attrition rates

Dissatisfaction with self-image

* Unrealistic goals for body size and weight

* Obsession and preoccupation with weight

* Fat phobia and discrimination against overweight people

* Striving to be a perfect “10” and to maintain an impossible “ideal” (thin or muscular)

* Accepting the fashion, diet and tobacco industries’ emphasis on slimness

New Model Health Centered

Healthful eating

* Take pleasure in eating a variety of foods.

* Enjoy lower-fat and complex-carbohydrate foods more often.

* Meet the body’s energy and nutrient needs through a lifetime of healthful, enjoyable eating.

* Take control of how you eat by listening to your hunger cues.

Active living

* Value and practice activities that are moderate and fun.

* Be active your way, every day.

* Participate for the joy of feeling your body move.

* Enjoy physical activities as part of your daily lifestyle.

Positive body image

* Accept and recognize that healthy bodies come in a range of weights, shapes and sizes.

* Appreciate your strengths and abilities.

* Be tolerant of a wide range of body sizes and shapes.

* Relax and enjoy the unique characteristics you have to offer

* Be critical of messages that focus on unrealistic thinness (in women) and muscularity (in men) as symbols of success and happiness.

Source: Adapted by registered dietitian Frances M. Berg from Vitality, a public health program in Canada.