We advise against this alcohol consumption while using QWL. Substantial amounts of alcohol (2 or more cocktails a day) add calories and lack the nutrients which are especially important to sustain health while dieting. While one is on a restricted caloric intake, substantial amountsof alcohol also place additional demands on the liver and may have an adverse effect on thatorgan.

Try to abstain during the weight loss period, if possible, as alcohol in moderate quantities may be reintroduced during stabilization. If you “must” continue to drink alcoholic beverages on a daily basis, suggest trying to limit this to 2 oz. of scotch or bourbon per day mixed with 2 to 4 oz. of Perrier or club soda, or diet soda. This behavior will likely interfere with reaching goal weight in the estimated period of time.

Anorexia nervosa is an emotional disorder related to eating behavior in which the individual has an unusual fixation on weight, often with a distorted body image (seeing herself as overweight even though she may, in fact, be quite thin) and habitually binges then under-eats, or stops eating completely in an attempt to reduce her weight to abnormally low levels. This is a potentially hazardous situation, as anorexics may continue their efforts to lose weight to the point of serious malnutrition or even death. Clients who present themselves at the initialconsultation and are obviously of normal or below normal weight for their height and frameare, therefore, do not need this program and should refrain from using it.

Occasionally, an individual who begins the program in an overweight condition and has had particular difficulties with compulsive eating may develop a complete reversal and drasticallyreduce her food intake after a period of weight loss. If a client in later stages of the program or in stabilization has reduced below normal weight for her height and frame and stops eating inorder to continue to lose weight to abnormally low levels, we recommend seeing a physician for guidance.

Perhaps the most common type of compulsive eating is “nighttime eating”. The practice of raiding the icebox during the mid-evening or arising from bed for a midnight snack can become so ingrained in a client’s habit structure that it takes on a ritual significance and is difficult to eliminate. Because the need for energy during sleep is so little, evening is the single worst time to eat, and this bad habit must be corrected to allow adequate progress while losing weight and to allow success at stabilizing the body at goal weight once the goal is reached. The difficulty in correcting this problem is that nighttime eating has little or nothing to do with hunger, appetite, or nutritional needs. It is simply a bad habit.

Rather than eliminate this behavior “cold turkey,” we suggest that you substitute other things as a replacement. Some examples are:

• Brush your teeth (when teeth are clean, people tend to avoid food).
• Start a hobby (craftwork, puzzles, knitting, sewing, painting).
• Exercise (walk, isometrics, deep breathing, running in place, sit-ups, yoga, stretching).
• Manicure or polish nails (men and women).
• Call a friend.
• Do some housework or bookwork or balance your budget.
• Drink something cold and calorie-free (diminishes appetite).
• Take a long, hot bath (heat raises body temperature, lowering appetite).
• Buy three books you really want to read, put them in a special place, and read them only when you feel the desire to begin the nighttime feeding ritual; thus, this will become something special rather than just general reading.

Because nighttime eating has such ritual significance, it is best to ritualize this substitute in the same way. The greater structural similarity the substitute shares with the nighttime eating ritual, the more complete will be its ability to satisfy as a substitute. These similarities are present in what we shall call the “herbal tea ritual.” To perform this ritual, the client should purchase three different teas to choose from. This choice corresponds to the choice made in initiating nighttime feeding and is an important part of the ritual. Once the choice has been made, preparation of the ingredients and materials involved will be the next step. This will involve boiling the water, preparing a cup, cutting a slice of lemon, squeezing the juice into the cup, if desired, deciding whether to use Sweet n Low, etc. The last part of the ritual is to sit down and drink the tea. This ritual is particularly satisfying as a substitute because: it deals with ingesting a substance in place of food; it satisfies the sweet tooth and taste/ oral sensations; it provides a feeling of fullness; and it raises the internal body temperature, which lowers appetite.

A second ritual is the hot bath. The warm water is relaxing, which can effectively help combat built-up stresses. The temperature of the water will warm the body and help reduce appetite. Using several types of bath oil will allow the choice to begin the ritual, as in the herbal tea ritual. Or, utilizing the three books mentioned in option 9 above, a combination of the bath/reading rituals can be suggested.

Anything that takes a fair amount of time and involves the structural similarities discussed above can work as an effective substitute. Particularly good are activities that involve using both hands, since this makes it difficult to eat while performing the action. Creating these substitute habits will make it much easier for your clients to overcome the behavior complexes that caused their weight problems initially and that would otherwise continue to lurk in the background, ready to wreak havoc with their weights once stabilization is attempted.

Another type of compulsive eating can be termed inappropriate eating; i.e., eating to cope with a problem situation in one’s life that eating does nothing to help resolve. This might be boredom, anger, fear, depression, anticipation, or any other strong emotional situation. To deal with this type of eating behavior, suggest that the client use the “9-minute rule,” which involves three steps.
The first step is to become aware of the various triggers that can cause initiation of the inappropriate eating. Write these causes down on a piece of paper. Secondly, when this sort of situation occurs, determine which cause is active in this incident, take a piece of paper, and record the time of day. For the next 9 minutes, the client should watch the clock and write down the reasons s/he wants the item of food.
At the end of this period, you will find either that the desire for the food has vanished or, if it has not, you should have the item of food. This last option makes the waiting more bearable, while at the same time teaching the client that it is possible to be in some control over these sorts of impulses. More often than not, the impulse is a transitory one, the client will find that the desire does vanish with the passing of this brief amount of time.
The period of time is set at 9 minutes because it is an odd period of time requiring the actual monitoring of a clock, preventing “cheating” by rushing the delay. Allowing eating of the item should the desire still be there takes away part of the guilt and self-hate that is a common emotion compulsive eaters feel after they give in to this impulse.
Being in some rational control for perhaps the first time, being able to create a bargain with themselves that they can keep, will create better self-esteem, and help break the vicious cycle of compulsion / self-loathing / more compulsion to deal with the stress of self-loathing.
Further behavioral strategies can be found in such books as Eating is OK, Fat Chance in a Thin World, Learning to Eat Like a Thin Person, and Obesity: The Behavioral Strategie

A more detailed self-assessment type of diary can be very useful to clients who are having difficulties following the nutritional plan and are unsure of the causes and solutions. A diary that includes references to food intake and amount, time, place, feelings, etc., can aid in the identification of the particular stimuli that hamper self-control. Creative strategies can then be devised to eliminate or modify the stimulus and/or the client’s problematic response (eating).

Our virtual counseling staff can be extremely helpful by offering guidance in creative problem-solving when the need is indicated. Here’s one practice:

Take a sheet of paper and divide it with a line down the middle. Head to the left-hand column “Problem Times” and the right-hand column, “Solutions.”

List the problem times they can think of and work out as many alternative solutions as possible: any problems related to time, either time of day, time of week, or time of month. If there must be problems, these are the best kind because they recur with predictable regularity.

Examples:
“Every afternoon, I eat while I make dinner.” “Every evening, I munch while I watch TV.” “Saturday nights, I eat candy at the movies.” “Sunday brunch, I eat sweet rolls.”
“Just before my period, I go crazy for chocolates.”

We suggest they have at least two alternate strategies, and experiment until you find the best one. The sheet can be posted at home as a reminder of what needs to be done.

One type of solution to the time-related problem is based on the technique of delaying and distraction finding a strategy to help you tolerate the urge to eat and get past the hunger period.
An example is the late afternoon nibbler. She may come home from work at five, tired and tense, be faced with children and their problems, and expect to get dinner ready for her husband’s arrival at 6:00. A possible solution involves assertiveness and relaxation. She can tell her family that her real arrival time is 5:30 and that from 5:00 to 5:30, they are unavailable except for emergencies (real ones!). During this time she relaxes, in whatever way suits her individual preference: lying down, napping, having a bubble bath, reading, puttering in the garden, meditating, or simply doing nothing.
She may find it necessary also to assert herself in getting the family’s help in preparing dinner. The relaxation will reduce hunger and also give her more energy to be with the family for the rest of the evening.

A completely different solution could involve calorie budgeting. This woman could try allotting a certain food serving for an “arrival snack” something enjoyable to tide her over to dinner (for example, a small fruit serving).

Scheduling and planning for a snack is an important technique in solving problem times. It’s a good one for the late-evening snacker, too. He could allot some food from his daily total for the evening. An important principle here is planning and labeling. These snacks should be clearly set and limited. It’s even helpful to pre-package and label them. For example, one client of ours selected his favorite vegetables, put them in sandwich bags, and attached a label to each: “Monday night, 9 o’clock,” “Tuesday night at 10,” etc.

A similar time-related solution can be used for the pre-menstrual “craving” situation. That is, if she can expect those days by marking the calendar, she can make an extra effort to provide other non-food pleasures for herself. Pre-menstrual tension can also be relieved by planning some relaxing and pleasurable events or physical activities for those days.

20 30 minutes 3 times per week, burns approximately 200 calories.

20-30 minutes 3 times per week, burns off 200 calories.

20-30 minutes 3 times per week. (recommended for people less than 25 lbs. overweight). It burns approximately 300 calories per half hour.

20-30 minutes 3 times per week, burns 250 calories per half hour.

Low to high level of difficulty

Simulated cross-country skiing. 20-30 minutes 3 times per week, burns 300 calories per half hour.

Again, incorporate an exercise program into your weekly routine, but also utilize calories by increasing your normal activity.

Here are a few suggestions: