Bio-impedance analysis (BIA). BIA, which measures body fatness through electrical conductivity of body tissue, was introduced in the 1980s. A tiny imperceptible current travels through the water compartment of the body, which is proportional to the fat-free mass (FFM), there being very little water in fat. The more FFM, the more current is conducted. The impedance (or resistance to electical flow) is then put into an equation in the BIA machine to calculate the percentage of body fat. BIA machines are now small and portable and usually involve the wiring of electrodes onto the limbs of the body. The electrical current is slight and nothing is felt by the person being tested.

New developments have now led to BIA measures being combined with ordinary weight scales. By standing on the scales an undetectable electric current is passed through the soles of the feet and a measure of body fat is computed along with body weight. The combination of the two provides an increased diagnostic potential. A good deal of research has been earned out with BIA and comparisons with other measures such as near infrared analysis (NIR, see below) and other criterion measures. Indications are that BIA is significantly affected by fluid content of the body, and although reasonably valid, has a low reliability if not measured under similar conditions on each occasion.

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The medical model follows certain logical steps: evaluating the patient and the problem, arriving at a proper diagnosis, designing a treatment plan, then carrying out that treatment. This approach takes each person’s individuality into account and looks at all the forces that may be contributing to the disorder. It also lets the physician choose from many therapeutic strategies to find the ones that have the best chance of working.

Such an approach is vastly superior to one in which a doctor assumes from the beginning that all eating disorders result from one cause-for example, a defective sense of self-esteem. Such restrictive, simple-minded thinking can lead to one-dimensional therapy that fails to address the multifaceted-perhaps I should just say human-nature of the disorder. As the saying goes, if all you have is a hammer, then every problem is a nail. It is better if the physician takes into account the nuts and bolts of the problem as well.

The medical model has limits. For one thing, anorexia and bulimia are not really like pneumonia. Most people would agree that there is nothing good whatsoever about pneumonia, unless you happen to be the bacterium that goes around causing it. Similarly, there is very little “good” about psychiatric disorders such as schizophrenia or depression.

However, I believe there is something positive that exists in the strangely inverted world of eating disorders. That positive element concerns the patient’s attempt to exert her willpower to solve what she perceives as a problem. Rather than lying back passively and falling victim to the raging psychological and social forces that swirl around and inside her, she has adopted an active, even aggressive stance. She is taking a decisive course of action to achieve a goal-a goal she is willing to risk her life to achieve. While her goal is unreachable and her method is harmful, I feel her basic impulse is good and worthy of respect: She is trying to deal with a difficult situation by taking control and finding something in her life that makes her feel successful, special, and proud. In a strange way, eating disorders express a very American kind of thinking: Pull yourself up by your bootstraps, get a hold of yourself, improve your life, set a goal and work hard to achieve it, distinguish yourself. However, the approach taken by the bulimic or the anorexic is too rigid, too extreme, and is completely out of harmony with the needs of the body and the mind. The strategy is doomed to fail. When it does, the patient will suffer guilt, despair, and a sense of worthlessness-the very feelings that precipitated the disorder in the first place.

My approach as a physician is to recognize the complexity of the problem and try to take into account the many psychological and social factors that affect a patient. I accept that she is trying to solve her crisis, and I will try to help her channel that energy in a healthier way. When this approach works, the patient changes her faulty patterns of thinking, alters her destructive eating behavior, and improves her relationships with other people. Ideally, she leaves treatment with the resources she needs to cope in healthy ways with the pressure to be thin, pressure that will undoubtedly continue over the years.

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After years of failed attempts to lose weight, Jeanette, of White Plains, New York, finally took control of her eating habits. She reduced her portion sizes and cut out junk food. Sure enough, the pounds started disappearing.

Although she was encouraged, Jeanette realized she still had one hurdle to overcome. While she ate healthfully during the day, as soon as she arrived home from work, she’d be hit with the overwhelming urge to binge.

Like most of us, Jeanette felt tired at the end of the day. Just thinking of the chores and errands that she still had to do made her anxious and tense. To soothe herself, she would head straight for the refrigerator and grab the first food she saw.

Jeanette started thinking about her postwork behavior and about a theme of the Overeaters Anonymous meetings that she had attended. The two seemed to tie together.

“Overeaters Anonymous doesn’t concentrate too much on the food thing,” Jeanette says. “The emphasis is on the head. They say that if you get your head straight, your body will follow.”

Jeanette knew that her postwork binges were driven not by hunger but by her emotions. So she decided that instead of calming her nerves with food, she’d sip herbal tea.

As soon as she walked in the door in the evening, Jeanette would head straight for the kitchen and brew a cup of tea. Then she’d curl up someplace quiet to relax and recharge for the evening. Her daily tea time became a treasured ritual as well as a means of stopping the munchies that threatened her weight-loss goals.

Jeanette, who’s now 60, eventually lost 140 pounds. And she has \ kept the weight off for more than 18 years.

WINN IN C A C TJO N

Sip tea to de-stress. There’s no question that stress is a

big cause of weight gain. Find your own way to unwind, like Jeanette did. You’ll probably find that a lot of things in your life—hot just your waistline—will begin to come I do into better focus.

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