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Leaving the Nest

Dr. Ramani discusses the challenges the group will face once the program ends and how to confront them.

By Dr. Ramani


This is it kids –- we are about to send the fledglings from the nest. Into the mean world of fried calamari, Kobe sliders, cocktails, and enabling friends. They had seven weeks of assistance with food, intensive personal training, and group therapy with a psychologist, and it's all about to go away. 

Tonight we learn how they got so overweight, and if they can do this on their own.

During therapy this week (and less than stellar weight losses) they shared how the pounds got on them, and most of us can empathize. They got there by equating love with food, using food as a crutch, a way of making excuses, a mode of coping with depression, a reward, falling in love and the complacence that typically follows, the absence of emotion, self-loathing. 

So the reasons were as varied as falling in love, falling out of love, and everything in between.

Those things are still going to happen to them. They are still going to get depressed, and they are still going to look for rewards and excuses in their lives. 

So when they are sad, or angry, or lonely, or celebrating, how will they stop themselves from reaching for the taco rather than the treadmill? The waffles instead of weights? Four ounces of steak instead of the sixteen ounce cut? Bottom line – IT WON'T BE EASY.  

Jackie pulled an interesting one on them, and I am glad she did it –- she stuck them in a restaurant with forbidden foods, a bit like putting a newly married man in the Playboy Mansion or an alcoholic in a bar. And their emotions ranged from anger to frustration to sadness. Ironically, the voice of reason in the appetizer ambush was Nikki who gave an eloquent discourse on taking responsibility, dropping the emotion about food, and offering alternatives. Even at the beginning of the episode, Nikki fessed up about the fact that this will be a day by day process, a day by day struggle. I would love of course to take some credit for Nikki's new transcendence, but like any good psychologist I must put the credit squarely where it belongs –- the hard work of the client.

Bryan expressed being literally AFRAID of pizza. For the past 7 weeks, our warriors have been living and breathing clean eating and exercise, but with the added pressure/incentive of Jackie and Craig lurking around the next corner and the structure of group therapy. What happens when they are like the rest of us, and no one is watching? When you try to lose weight and finally do lose weight, food can become scary and distortion can kick in. 

Our clients face two sets of risks right now, and these risks sit on a continuum with success, moderation and permanent weight loss in the middle.

Relapse -- Moderation and ongoing weight loss and maintenance -- Disordered eating

Disordered Eating: Fear of food, restriction of food, dyscontrolled eating and compensatory behaviors (excessive exercise, or even more dangerous methods such as purging) are observed in people who develop dysfunctional relationships with food.  And this is not uncommon in dieters. 

Relapse: Falling off the clean eating wagon and going back to old habits. This is also not uncommon in dieters (these are the yo-yo dieters). 

Moderation: Maintaining the clean eating, exercise, sustainable weight losses of a few pounds per week and then long term maintenance. And obviously this is what we want. 

The psychologist and alcoholism researcher Dr. Alan Marlatt wrote about something called the "Abstinence Violation Effect." I call it "The Hell with it Hypothesis." Basically, when we give up something that is as addictive as food and put new habits in place, sometimes we slip and eat a "forbidden" food. The right thing to do is to walk away, treat it as a lapse, and start anew. However, it is common for people to eat that forbidden food and then say, "the hell with it." I already ate half of the slice of cheesecake, I might as well go for it and the bad feeling that accompanies "violating" their dietary abstinence can lead to giving up on clean eating and healthy living entirely. For our gang forbidden "dirty" foods may be a signal to overeat (Shay and her ice cream, Joe and his cheeseburgers). The real trick if Shay slips with a dish of ice cream is to not throw the baby out with the bathwater, and really focus on the clean eating the next day. 

IT WON'T BE EASY. Will they be able to order "clean" when their friends are overindulging? Go to the gym, when they aren't in the mood? Make wise choices at a buffet? Not become frightened by food and start distorting their experience of food? Have they internalized the Jackie/Craig/Dr. Ramani triad – and will they hear our voices when they face these choices and learn to say no themselves.


What do you think looms as the finale nears? Who will be the big loser? Will anyone relapse all the way back? It's a hell of a horse race –- and you will be surprised at how it ends.

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