How fat is too fat?
What’s the best diet plan?
How can you keep the weight off?

BY JILL KRAMER

As early as kindergarten, Clark found refuge in food. Each day when he came home he’d park himself in front of the TV, stuff his face with cheese and crackers and zone out. He went on his first diet at age 10, when his mother enrolled him in a weight loss program in Corte Madera. “You’d go in and ride this exercise bicycle and they’d record how much you rode and chart your path from like here to Los Angeles,” he says. “I never made it out of Corte Madera.” By the time he was 27, he weighed 300 pounds.

One-third of Marin children are overweight and one-quarter of seventh-graders can’t pass an aerobic capacity test. And 9.3 percent of Marin adults are obese. Statewide and national statistics are even worse. The Centers for Disease Control has characterized obesity as an epidemic. It increases our risk for diabetes, heart disease, stroke and cancer. We keep trying to lose weight—Americans spend $33 billion a year on weight-loss programs and low-cal foods—and we just keep getting fatter. The percentage of the population that is obese has doubled in the last 40 years.

Basically any diet you try will work for a while. The problem is the rebound effect. Diets make most people fat. “They did studies to see how they could get people who were too thin to gain weight,” says weight control therapist Beth Tabakin, “and the thing that worked was to put them on diets. They’d lose weight initially, then a month later they’d gain 10 pounds.”

Part of the reason for that, says Tabakin, is that dieting slows your metabolism. “Your body is an incredibly efficient machine. People can live for years with very little to eat. They survive because their metabolism slows down enough that they still get nourishment for their brains and nerves.”

There are also psychological factors, as Tabakin discovered 24 years ago when she ran groups for Weight Watchers. The program had worked like a charm for her—she’d lost the 50 pounds she’d gained during pregnancy and had popular classes running in Mill Valley, Larkspur and San Rafael. But people would drop out and she never knew why. At the time, she had some behavioral psychology training she’d picked up while working toward a master’s degree in special education, but it became clear to her that her knowledge wasn’t deep enough to help many of the dieters in her classes. “People were there with what I perceived to be emotional needs and it wasn’t just behavioral and I was clueless. I had what I call CDS—clue deficiency syndrome,” she says with her characteristically quirky sense of humor.

So Tabakin went back to school, earned a Ph.D. in clinical psychology, studied the literature and eventually drew the conclusion that there was no conclusion to draw. The psychological factors in weight control vary from person to person. The key to losing weight and keeping it off is as individual as your fingerprint.

For some people, the answer can be quite simple. “I had one client who was a lawyer—he was a smart guy but he was ignorant about calories. He just ate what he liked,” says Tabakin. “And once he realized how many calories were in his food, he cut out all the high-calorie stuff and lost weight.” For another client, the solution was to buy new, smaller-sized dinner plates. With less food on the table—but the illusion of abundance—the whole family lost weight.

It’s important, says Tabakin, to not feel deprived. “Life can beat you up enough without you having to be unkind to yourself and deprive yourself.” Tabakin keeps an emphasis on the positive, even in the terminology she uses, because our words can influence our thoughts on what and how we eat. She doesn’t like the word “diet”: It implies something you start and stop, rather than a life-long preference; and it starts with the syllable “die.” She speaks of “getting rid of” weight rather than “losing” it: You don’t want to find it again. And she suggests talking to your food. “Not necessarily out loud in a restaurant,” she adds. “But look at your food and say, ‘Are you good enough for my fine body?’ It’s a different perspective than, ‘I’m a bad person, I can’t eat this, my thighs are too fat so I can’t have you.’ ”

Tabakin used this technique to cure herself of her addiction to chocolate. “What worked for me was this: If chocolate cake were the mate in my life, would I continue to date him? Looks good, smells good, is great in bed—and you feel abused after each night together. It transformed my thoughts about chocolate. For me to eat something that tastes great going down but makes me sick is like being with a beautiful man who treats me badly. I still really love chocolate, but I don’t eat it to the point of being sick. I’m in control of the chocolate.”

CLARK, WHO’D BEEN dieting since the age of 10, knows all about food addiction. He finally conquered his weight problem by joining a 12-step program, Food Addicts in Recovery Anonymous (FA). He dropped 130 pounds and has kept if off for three-and-a-half years. I met him in the lobby of the office where he works in Larkspur. A slender young man with dark curly hair, when he first walked up to me I thought I must have the wrong guy. It was hard to imagine he’d ever been fat. That’s why he brought the photographs along. There he is at age 21, weighing about 250. At age 27, he’s even bigger. At age 29, he sits next to his girlfriend (now his wife), both of them as round as beach balls. At age 30, there they are again, transformed into an attractive, slim, healthy-looking young couple. That picture was taken two years ago.

Looking back, Clark says he’d been using food like a drug all his life. It was a method of escape—he would eat himself into a trance. He used other drugs throughout high school and college, but food was always his drug of choice. (He asked that his name be changed for this story.) “I’d go out to a club and use cocaine,” he says, “and when I got home I’d use pills and pot to come down and make me hungry so I could eat.”

At the same time, he’s tried every type of diet. He went to an eating disorders clinic for a while. He’s also been through years of therapy. He’s lost and regained weight again and again. “It used to be that I couldn’t go a minute without thinking about food. My life used to be consumed with food—what I was going to eat next, when my next meal was going to be, where I was going to go to get it—just like a drug addict.”

Even FA didn’t work at first. “I struggled a lot in the first nine months,” he says. “I couldn’t give up the food. It was my best friend. It was more important to me than anything.” Like other 12-step programs, FA requires each member to have a sponsor, a more experienced person in the group who provides guidance. “I’d fire my sponsor and leave the program for a week or two and just binge my brains out, get really miserable and then come back. I’d eat until I made myself sick and I’d pass out at night I was so full. I didn’t want to eat any more but I couldn’t stop. I went through about five or six sponsors over the first nine months.”

But during those first nine months, Clark says, he wasn’t committed to the program. FA members are expected to surrender to a “higher power” and follow a strict regimen of prayer, reading, meditation and close contact with the sponsor. It wasn’t until he “hit bottom” that Clark agreed to follow the rules. And what was “bottom” like for him? “Bottom was lying to my girlfriend and to my sponsor that I was sticking with the program and then hiding in the closet, eating in secret. Bottom was sitting in front of See’s Candies opening and closing the door—going in, getting back out, going back to my car, turning around and going back in—wanting so bad to go in there and buy chocolate. That pain was, like, immeasurable. And I finally gave up and said, OK, I’ll do it your way, and I’ve been with that sponsor ever since.” Seeing the change in him, his girlfriend joined the program, too.

Beyond losing weight, Clark says they’ve both lost their obsession about food. “Now I can go into the market, I can walk by the bakery counter with all that stuff in there and I don’t even notice it. This isn’t will power, which never lasts. This is actually freedom from food obsession.” What’s more, Clark is exercising regularly, for the first time in his life. “In FA, you don’t have to exercise to lose the weight. I lost all the weight through the food program. But over the last few months, I’ve started exercising. I still have to push myself to get to the gym and go on hikes, but I do it now because it feels good and it’s good for my health.”

Good health is, after all, the best reason to maintain a normal weight. In fact, if you eat a nutritious diet, you stay physically active and your cholesterol, blood pressure and blood sugar levels are fine, it probably doesn’t matter what you weigh. The definition of “normal” weight is just an approximation anyway. The standard weight measurement is the body mass index. (To calculate it, divide your weight by your height squared, then multiply by 703; or use the BMI calculator at the CDC Web site.) But the “normal” BMI range—18.5-25—is the same for men and women. And it doesn’t account for muscle mass. So you can be built like a rock and come up with a BMI in the “overweight” or even “obese” range.

There has also been some debate about whether a BMI of 18.5-25 is ideal. A recent study conducted by a CDC researcher looked at the relationship between BMI and death. Although the greatest number of deaths by far were associated with obesity—a BMI of 30 or more—there was no increased risk of death for the “overweight” category, a BMI between 25 and 30. Previous studies had similar findings: The lowest risk of death is at a BMI of 25, while the “underweight” and “overweight” risks are about equal.

The CDC backed way off its study soon after it was published; the last message the agency wants to send is that it’s OK to be overweight. For one thing, most of the deaths associated with a low BMI were among elderly people. Also, the study only looked at mortality—it didn’t consider disease.

“Weight is a marker for a lifestyle that is out of balance for that individual,” says Dr. Gail Altschuler. “When people are carrying around 30 or 40 or 50 pounds more than their frame was really designed for, there are quality of life impacts: Do their knees hurt? Does their back hurt? Do they get out of breath? Are they developing illnesses?”

THE NUMBER ONE disease associated with overweight is diabetes. “Ninety percent of people with adult-onset diabetes are obese,” says Altschuler. If your blood sugar is on the rise, it’s a warning signal that should not be ignored. “By the time you become diabetic, you may have lost 50 percent of your kidney function,” she says. You’re considered diabetic when your blood sugar is measured at 126. But a pre-diabetic condition—anything over 110—can also cause serious problems. “Diabetes is a microvascular disease. It changes the nature of the small blood vessels that supply the retina, the nerves, the kidneys. And we don’t experience the symptoms until those conditions have been present for a long time.”

As a general practitioner, Altschuler had been advising patients for 23 years to keep their weight down. But it wasn’t until her own weight ballooned in the last few years that she gave much thought to how that could be done. Last year she devised a program for herself of diet and exercise. She took off 32 pounds and has kept it off since last July. “And I was shocked at how much better I felt,” she says. “Things that used to hurt don’t hurt anymore.”

For starters, Altschuler began going to the gym and taking long walks. “I made it like a religion, just like I wouldn’t go out of the house without brushing my teeth,” she says. “In the beginning, you just have to kick your little booty out the door. But the more weight I lost, the more I enjoyed the exercise, and I’d resent it if I couldn’t exercise.”

She also cut out the processed foods. “Just because it’s in a box doesn’t mean it’s food,” she says. “When you eat a lot of processed foods, a lot of sweets and starches, you tend to continually trigger the impulse to eat more. You eat sweets, your body puts out insulin, then uses it all up and you feel more hungry. So you never stay satisfied very long. You feel hungry throughout the day.”

Another problem with processed foods is that they usually contain high fructose corn syrup, a sweetener that laces everything from sodas to canned soups, ketchup, breads and cookies. Unheard of before the 1970s, 63 pounds of the stuff is now consumed every year by the average American. It’s cheaper than sugar for food processors, but it’s metabolized differently—and could account for much of our increasing obesity. “When you eat fruit, your body breaks up the sugar into small particles, it goes to the liver and it’s used as energy. But when you have high-fructose corn syrup, your body doesn’t break it down,” says Altschuler. “It turns off the enzyme that makes you burn it up and it turns on the enzyme that makes you store it.”

Instead of eating processed foods, Altschuler prepares home-cooked meals for herself. “I cook on the weekends and bring my lunches to work all week,” she says. “I’ll have chicken or fish and a salad and vegetables or a great soup that I’ve made and it’s delicious. I have two or three fabulous meals every day and maybe a protein shake in-between. I keep snacks in my car. I don’t leave much to chance. And it takes some planning, but it’s not that hard and it’s part of taking care of yourself.”

Altschuler was so delighted with her own success, she decided to gradually devote more and more of her practice to helping her patients lose weight. She uses her own experience as inspiration, but she doesn’t expect that what worked for her will necessarily work for others. “There’s no one system that works for everyone,” she says. “We adjust the program week by week to fit the person’s lifestyle so that they can sustain it. It’s very personal.”

As of May 1, Altschuler closed her family practice so she could focus full-time on bariatrics, or weight loss. She’s now in the process of becoming certified as a bariatrician. Her patients are slimming down, and Altschuler is bursting with enthusiasm for her new mission. “Helping people to achieve an appropriate weight and a healthy lifestyle is the single most meaningful contribution I can make to their health.” Punching her arms to the ceiling as if she’d just scored a touchdown, she crows, “It’s good work!”

To contact Food Addicts in Recovery Anonymous, call 800/600-6028 or log on to www.foodaddicts.org. A similar program is Food Addicts Anonymous, www.foodaddictsanonymous.org. Both groups meet regularly in Marin.