The Solution Diet: (Part 2 )

When a San Francisco dietitian teaches overweight adults how to examine their feelings, they learn the skills they need to resist overeating.

Laurel Mellin began teaching skills to overweight adolescents to help them keep from overeating. As she got to know the parents of the kids in her Shapedown classes, she noticed many of them didn't have these skills themselves. No wonder, then, that their children weren't able to distinguish sadness, say, from the desire for a heap of onion rings. To these kids, and often to their parents, every one of life's jabs and stings felt like hunger. It seemed to Mellin that the parents in the group -- and other adults as well -- could benefit from her approach.

That hunch was borne out once she tried teaching The Solution to adults. Northern Californian Pat Cherry, one of the first to complete the program, is one of the 22 people who participated in the pilot study. Cherry still stores Hydrox cookies -- her old nemesis -- in the pantry. But before indulging she stops and asks herself, "What am I feeling?" Even if she tosses back a Hydrox or two, she can now distinguish between eating to fill her stomach and eating to appease her heart. Learning the difference helped her lose -- and keep off -- 30 pounds she'd dragged around for years. "I live the Solution every day," she says.

Several months after Sue Ann DeBower's phone call, Sally Shreve reconsiders saying no to salvation. Her on-again, off-again engagement to her boyfriend, Dan, is off, and she is beginning to give up hope that she will ever have the family she's always wanted.

Buying her dream house on a quiet leafy lane in a suburb of San Francisco does not revive her spirits. "Sally's afraid to be alone," her friend DeBower says. "With this move, she's really feeling kind of desperate."

'Stuff it and eat'

It may seem odd that with her personal life troubling her, Shreve is thinking about signing up for a weight-loss program. But she has long been aware of a link between her relationship difficulties and her tendency to overeat. When she was married at age 23, she walked down the aisle at a healthy weight for her 5-foot-10 frame. As her unhappiness with the union grew, so did her girth. "Instead of dealing with issues in my marriage, I'd just stuff it and eat," she says.

When her marriage ended, she tried Weight Watchers, then a program called Thin Within, in which participants recite affirmations as a path to change. She tried even more faddish approaches such as subsisting on nothing but grapefruit and eggs.

"It seems like it just got worse every time I dieted," she says. "If I gained 20 pounds after the last diet, then it was 40 pounds the next time.

"It's not like I don't know what takes weight off. You eat lots of fruit and vegetables, and you exercise. Duh," she says. "But getting myself to do it has been another story."

Finally Shreve decides to bury her reluctance and sign up for a Solution group at the University of California at San Francisco. On Thursdays, when the group meets, Shreve leaves work early so she can be among the first to arrive. Critical of her own looks, she hates appearing anywhere late and having heads turn to watch her enter the room.

What others see, however, is not what Shreve imagines. Tall, blond, and professionally successful, Shreve has a commanding, sporty presence -- as if she might race yachts or play polo on the weekends. She's the sort of woman who could easily inspire envy, if it weren't for the fact she lavishes warm attention on everyone she meets.

By 5:30, Shreve and a dozen other women are settled around a conference table cluttered with bottles of mineral water and copies of The Solution, each book liberally plastered with stick-on notes.

Tonight, four weeks into the program, there will be little talk of weight-loss staples of diet and exercise. These topics are explored further in the final weeks, but most class time is focused on self- nurturing and setting limits. Each week the class has been assigned homework to reinforce these skills. The tasks include penning journal entries and writing "feeling letters," a method of expressing painful emotions.

Shreve finds herself resisting Mellin's terminology, saying it sounds "psychobabbly." Yet she's been faithfully attempting to keep up with the program. Not that it's been easy. Three weeks each month she travels out of state to meet with clients all day and schmooze over business dinners at night. "I'm going a mile a minute most of the time," she says. "I barely have time to go to the bathroom."

Substitutions for eating

But she's been stealing moments where she can -- in a cab, in an airport lounge -- to ask herself the key questions. Before calling for room service, for instance, she makes herself stop and think, "'What I'm feeling?' 'What do I need?' 'How do I know?'" Nine times out of 10 she discovers she doesn't really need to eat. If she's reaching for food because she's feeling tired, she might take a nap instead; if she wants to unwind, she calls a friend.

Still, she tells the group, "All this checking in is so much work that sometimes I want to close my eyes and make it go away."

In this week's class, Shreve learns that other women are also having difficulty monitoring their emotions.

"It's hard, hard, hard," complains an outdoorsy-looking woman in a bright red Synchilla jacket. "I don't think of it. Don't want to do it."

One woman announces to the group that this week has been so stressful she intends to keep comforting herself the only way she knows how: by gorging. Shreve, sitting to her left, pats the woman's forearm sympathetically.

Sensing the mood in the room spiraling downward, Mellin jumps to her feet and initiates a lesson in defining boundaries. After you check in on your feelings and ask yourself what you need, you must follow through. That means setting clear limits -- even in situations where the stakes are high.

Shreve's current dilemma involves Dan, her sometime fiance. "Dan's a total weightist," Shreve tells the group. She knows she needs to ask Dan to stop making critical comments about her weight, but she hasn't been able to muster up the courage to do it.

Mellin suggests a little role-playing. A woman selected to play Dan looks Shreve in the eyes, and remarks, "Seems like you've put on some weight."

As in real life, Shreve can't tell Dan how much the judgment hurts. As she struggles to do so, she begins to weep.

Mellin, crouching on the floor near them, gently asks, "Why are you crying?" She presses Shreve to keep focusing on her emotions until she faces what Mellin calls the "essential pain" of confronting Dan. Finally Shreve gulps out her fear that if she tells Dan how she feels, he might leave and she would find herself alone -- one of those inevitable losses she's kept out of her thoughts by distracting herself with food.

Then Shreve dabs her face with borrowed tissue, turns to the woman playing Dan, and says: "I just can't live with the way you treat me about my weight."

The mood in the room breaks as the whole group erupts in cheers.

During the first few weeks of the program, Shreve's weight jogs up and down by one or two pounds. Then, in the final weeks, she drops five pounds. Mellin says once students become comfortable with their newfound skills, they tend to lose about a pound a week.

Yet Mellin advises students not to be too concerned with tallies. "The Solution is not about weighing 100 pounds for life," she says. "The idea is to get within your genetic comfort zone and stay there because the drives to overeat have been turned off."

Ten weeks into the program Shreve is exercising more consistently than she did in the past, when she'd make it to the gym once or twice a week. The practice of limit setting has brought discipline to her workouts, and now she spends an hour a day on the stair stepper or running along the San Francisco Bay.

This is progress, and it's heartening. But will the program really provide the salvation that Shreve and others seek? Is it, as Mellin has said, "the universal solution ... a way to end the agony forever"?

Not for everyone

Obesity experts are reserving judgment. For one thing, many are wary of the notion that there could be a single answer to the problem of excess pounds. "Everyone says they have the solution," says Kelly Brownell, a psychologist and obesity researcher at Yale University. "But obesity is much too complicated to have just one solution."

Complicated, indeed. Studies show that overweight people vary in more ways than they are similar, suggesting that people put on pounds for many reasons. Genetics, obviously, is one of them. (Mellin doesn't deny that heredity is a factor, but she downplays its role, saying that most people have some control over their girth.) Other causes can be as simple as a lack of exercise or an unhealthy diet, completely apart from emotional issues.

Researchers also make point that Mellin's initial study had no control group, a measure essential to airtight research. And they believe her sample of 22 people is too small to suggest meaningful conclusions.

For these reasons, experts tend to discount Mellin's claim that The Solution is the first treatment documented to lead to long-term weight loss. Until more definitive evidence about the Solution is in, it's not valid to compare it with other weight-loss techniques, says Michael Hamilton, an internist who directs the Duke Diet and Fitness Center in Durham, North Carolina.

Overall, then, the program may not be the universal solution Mellin would like to think it is. But it may well be at least a partial solution for the subset of dieters who resemble Sally Shreve in their eating patterns.

Scientific quibbles aside, the experts do agree that in several ways the program is on solid ground. Like Mellin, many who work with overweight people have observed that some eat to satisfy an emotional rather than physical hunger. Teaching such people to interpret and act on their feelings as a way of breaking unhealthy eating habits, they say, simply make sense. Then, too, the behavioral and cognitive techniques that Mellin uses are well tested, the nutritional advice that clients receive is sound, and expectations about how much weight they can lose are kept within reasonable bounds.

It's also worth noting that the Solution has no damaging side effects. That alone puts it ahead of many weight-loss products and schemes on the market.

Finally, the Solution fosters skills that are clearly helpful in areas that transcend weight. Regardless of whether she ever loses another pound, Sally Shreve is learning to be more at ease with her own emotions and to handle relationships more deftly -- achievements that must rate at least as important as a slimmer profile.

It's just as well Shreve isn't hearing the experts hem and haw. She's so encouraged by her progress that she's begun a second 12-week course and has lost another five pounds. For her, the vision of salvation is getting sharper.

"I'm beginning to see my way now," she says. "Each little victory makes me believe I can make this part of my life."

One such victory is scored on the afternoon Shreve manages to confront her fiance, Dan, just as she'd practiced in class. Instead of abandoning her, as she had feared, he agrees to try harder to understand her weight problem. He'll start by reading The Solution.

Invigorated by her success, Shreve welcomes her father for a weekend visit. Although he was recently diagnosed with Alzheimer's disease, he seems his usual self as he putters around her new home assembling furniture. Only once, when he goes off hunting for a screwdriver, does he become disoriented.

A relapse

After she hugs her father goodbye, Shreve drives straight to the grocery store and stocks up on candy and chips. A feelings check or limit-setting exercise never enters her mind; in fact, she's not thinking at all.

Shreve gorges for several days. She abandons her homework and neglects the three phone calls she's supposed to make each week to stay in touch with others in the class.

On the fourth day she forces herself to call a classmate. "The drive to eat is just huge," she tells the woman, her normally robust voice reduced to shaky whisper. "I'm acting kind of kooky here, and I can't figure out why."

Her classmate suggests that worry over her father may be compelling her to binge. But the connection doesn't click into place for Shreve until the Thursday night meeting. During a letter writing exercise she finally realizes that her father's frailties terrify her -- and make her want to eat.

On the following weekend Shreve opens all the windows of her Cape Cod style home. Surrounded by bird songs and the smell of new paint, she sits on her couch and spends two hours writing in her Solution journal, pouring out her feelings about seeing her parents age.

Later in the day, she calls her three brothers and asks them to help her compile a book of family stories to give their father. "Remember the time Dad bought 25 pounds of spaghetti and wrapped it and put it under the Christmas tree to tease us?" she asks one of her brothers, laughing now.

Shreve initially turned away from The Solution out of fear that if she stopped using food to block her feelings, she'd be overwhelmed by life's inevitable disappointments. What this week's episode teaches her is that she can meet misery head-on, and there will eventually be an end to the crying.

"I really followed The Solution process almost to the letter, and it worked," Shreve says, looking back on the week. "It's not like I can make my fears go away, but now I can do something more constructive with them. I don't have to keep swallowing what I feel."

References

Interview with Laurel Mellin, founder, The Solution

Interview with Sally Shreve, participant, The Solution

Interview with Pat Cherry, participant, The Solution

Interview with Kelly Brownell, Yale psychologist and obesity researcher

Interview with Michael Hamilton, internist, Durham, N.C.

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