1. All measures used should be appropriate to the individual and their situation, taking due concern for the privacy and sensitivity concerns of the individual.

2. A variety of tests specific to the client and based on individual characteristics, needs and requirements is preferable to any one single measure.

3. Minimum measurements should include weight, height, (calculated) BMI, and waist and hip circumference (calculated WHR).

4. Measurements should be carried out using standard protocols from recognised bodies such as the Society for Anthropometric Measurements or from the anthropometric standardised reference manual.

5. The validity, reliability and interpretation of all tests carried out should be known and, if required, related to the person being measured. This is especially important for the more high tech measurements such as BIA and MR.

6. All measurement should, where possible, relate to appropriate norms within the population and ethnic group being tested. Where these are not available, ‘next best’ norms should be used with the possible inadequacies of this being explained to the client.

7. Care should be taken to ensure equivalent levels of hydration and digestion at different measurement periods (especially for BIA measures).

8. Body fat percentages should not be inferred from skinfold measures with very overfat or obese people.

9. Clients should be discouraged from weighing themselves too frequently (i.e. more than once per 1-2 week), because of me effect of fluid changes on body weight.

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Technological developments in the area have led to a number of different machines now being available for directly or indirectly measuring body fatness. Some of these are extremely expensive and would not be used in the normal day-to-day counseling situation. Others are now becoming more portable and more accessible and provide at least an opportunity for adding to other measures. The current range of machines include: underwater weighing, bio-impedance analysis, etc.

Computerised tomography (CT) scans. Computerised tomography is another radiography technique of body fat assessment which has limitations because of its relatively high level of radiation exposure and cost. In the past, this has been used for assessing other forms of body tissue such as tumours, but it is also possible to assess body fat. The expense of the procedure, however, is unlikely to make it readily available. Also CT scans only do regional assessments rather than a total body fat record.

Magnetic resonance imaging (MRI). MRI is a technique based on the manipulation of protons and electrons in body atoms to give colour pictures of different body tissue. MRI machines are used for medical diagnosis such as the detection of cancers and, as such, are usually based in hospitals and are extremely costly. The future use of CT and MRI for more accurate measurements of abdominal fat is likely, but still only in a research context.

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A similar language problem exists with bulimia. The word comes from the Greek meaning “ox hunger”- certainly a vivid image. Before the 1980s, doctors used the term bulimia exclusively to mean a disorder of overeating. But, like anorexia, the word refers only to a particular symptom: in this case, binge eating. It doesn’t include the flip side of the binge, the purge. The term is thus too narrow to describe the many different eating patterns that characterize the disorder.

For example, all bulimics eat large amounts of food, but there is a wide variation in weight. Some patients are exclusively bulimic, but roughly half of all anorexics also binge and purge. Their starving bodies scream for food; once they yield, they may consume an enormous amount at one sitting. To keep their weight down, these people desperately try to get rid of the meal. Still other bulimics were once self-starvers; they have returned to their normal weight but continue to binge and purge. It’s important to recognize these variations, because they each call for a somewhat different treatment.

In the mid-1970s someone coined the term bulimarexia (“hunger/starvation”) to describe the condition in which a purge follows a binge. Not a particularly graceful word, bulimarexia never caught on. British experts chose to use bulimia nervosa. As with anorexia nervosa, the term distinguishes the symptom from the syndrome and shows that the disorder has both psychological and physical elements.

Only in the late 1980s did doctors in this country accept bulimia nervosa as the best name.

If this seems a bit confusing, take heart-even medical professionals are sometimes bewildered by the subtleties of these terms. I’ve mentioned the debate to show how our perceptions of eating disorders change as we learn more about them.

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1. Do you binge often?

2. Do you feel your eating behavior is out of control?

3. Do you purge through vomiting, or using laxatives or enemas?

4. Do others in your household complain that you spend too much time in the bathroom?

5. Do you exercise excessively or use diet pills?

6. Are you constantly dieting or weighing yourself?

7. Are you preoccupied with thoughts of food or calories?

8. Do you plan binges or hoard food in anticipation of a binge?

9. Do you eat in secret or mislead others about your food intake? (For example, do you order a

salad while eating out, but go on a binge once you are home and alone?)

10. Do you make excuses for the quantity of food you are buying-for example, telling the person

behind you at the checkout stand that “company is coming”?

11. Do you spend large amounts of money on food?

12. Have you ever shoplifted food?

13. Are you very angry with yourself when you feel you have eaten too much, even if it is just an

extra nibble?

14. Does feeling good about yourself depend on your ability to exert total control over eating or

weight?

15. Do you isolate yourself from others if you feel a few pounds overweight?

16. Do you depend a great deal on others for approval?

17. Do you have difficulty asserting yourself even if you know you are right?

18. Are you excessively moody?

19. Are you excessively fatigued?

20. Have you noticed puffiness in your face or swelling in your neck glands?

21. Do you have trouble with your teeth, such as pain or discoloring?

22. Have people around you mentioned they have noticed unusual or offensive odors?

23. Has your weight fluctuated a lot recently?

In this inventory there is no arbitrary number of “yes” answers that would indicate the presence of an eating disorder. Instead, you can use it to raise your awareness about the possibility of serious problems. If there is reason for concern, I urge you to see your doctor for a complete evaluation. Don’t put it off. The longer an eating disorder persists, the worse it gets.

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Julie Portner has a special fondness for french fries, chocolate, and cookies. But she knows that eating too much of these foods isn’t good for her figure. So when she’s tempted to overindulge, she reminds herself about her wardrobe. In an instant, the temptation passes.

It was her wardrobe that first gave Julie the incentive to slim down. “Winter was coming on, and none of my winter clothes fit me anymore,” explains the 38-year-old Ra’anana, Israel, resident. “I wouldn’t be able to wing it as I had done through the summer by wearing loose-fitting shirts and elastic-waist shorts. But I wasn’t about to go out and buy a whole new wardrobe, two sizes larger.”

At 5 foot 2 and 138 pounds, Julie wasn’t obese, but she wasn’t happy with how she looked or felt, either. “Some people asked if I was pregnant, because the weight came on so fast—about 17 pounds in 5 months,” she says. “I was heavy and unfit, and I felt unattractive.”

Determined to begin losing the extra weight before winter arrived, Julie signed up for Weight Watchers in the fall of 1996. The program taught Julie how to make healthy food choices and control her portion sizes. It also persuaded her to exercise, inspiring her to walk for 40 minutes on an almost daily basis.

But what really made a difference, she says, was the program’s monthly weigh-ins. “They gave me incentive to continue eating healthfully and exercising regularly,” she explains.

Within 6 months, Julie lost 20 pounds. She looked trimmer, and she felt better. But the real payoff came when her too-small winter clothes fit comfortably again. “Actually, I reached my goal weight in April 1997, after winter was over,” she says. “I made do that season by covering buttons and zippers that wouldn’t close with baggy tops and sweaters. It was just good to know that my wardrobe would fit the next time that winter came around.”

In the years since she shed the extra pounds, Julie has maintained her weight at 118 pounds. She continues to eat healthfully and exercise regularly, though occasionally she finds herself tempted by french fries, chocolate, or cookies. In those situations, she reminds herself about how hard she worked to slim down and how nicely her wardrobe fits. Usually, that’s enough to convince her to walk away.

“I’ve reached a point where my desire to continue fitting into my clothing is stronger than my desire to overeat,” she says.

WINNING ACTION

Let your clothes help you overcome a craving. You spy a pint-size container of your favorite premium ice cream, and you feel your willpower weakening. What to do? Try conjuring an image of your favorite dress or pair of jeans. Think about how nicely it fits and how good it makes you look, or about how close you’ve come to being able to wear the garment after years of hanging it in the back of your closet. Now, is that ice cream worth it? Probably not.

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When thoughts of food draw Cynthia Herrmann toward the fridge, she distracts herself by grabbing a magazine or newspaper and heading for the couch. This little trick has helped her ride out many a craving—and get rid of 92 unwanted pounds.

Cynthia, of Laurel, Maryland, didn’t always have such control over her cravings. They’re one reason why her weight went over 200 pounds—not once, but three times. The third time came as Cynthia neared her 40th birthday in 1991. “I had been losing and regaining ever since I was a teenager,” she says. “Finally, I just got tired of having to wear size-22′/2 dresses. I swore that I would lose the weight and keep it off.”

At 232 pounds, Cynthia figured that she had her work cut out for her. At first, she tried modifying her diet on her own. “I ate more fiber-rich foods, especially fruits and vegetables, because I knew they would fill me up faster,” she says. “I chose lean meats and low-fat dairy products, and I switched to healthier cooking methods.”

The weight came off slowly but steadily, and within 4 years,

Cynthia plateaued at 170 pounds. At that point, she decided to join Weight Watchers, where she learned to keep a food journal to monitor her eating habits. “Through the journal, I realized that I had a tendency to eat past the point of fullness,” she says. Within 8 months, 30 pounds melted away.

Finally at her goal weight of 140 pounds, Cynthia set aside her J food journal—and the pounds started creeping back. “I wasn’t eating well consistently, and I started giving in to cravings again,” she says. “I was better off when I wrote everything down.”

But Cynthia didn’t want to resume journaling. As much as it had helped her, it came to serve as a reminder of her missteps and mistakes. Discouraged, she searched for an alternative to rein in her cravings.

Cynthia believed that by distracting her attention at the first sign of a craving, she could buy time until she determined whether she was experiencing genuine physical hunger or emotion-based “head hunger.” That’s when she hit upon the idea of picking up a magazine or newspaper and forcing herself to read for 15 minutes. If she still felt hungry when she was done reading, she would know that her body was demanding food, and she’d eat. Often, though, she’d get so absorbed by what she was reading that 30 minutes would fly by—and when she was done, her craving was gone.

Picking up a newspaper or the latest issue of a favorite magazine when she feels hungry has helped Cynthia, now 48, maintain her 140-pound figure for almost 4 years. “Taking the time to distinguish between physical and emotional hunger has made all the difference,” she says. “I’ve learned to pay closer attention to why I want to eat and, when necessary, to address the real issue—be it stress or boredom or something else.”

WINNING ACTION

Pick up a juicy magazine instead of a juicy meal. When hunger js more mental than physical, divert your brain with a tempting book or magazine. Many times, I find that I’m just looking for a way to treat myself after a long day. I like to keep issues of fun magazines—Vogue, Vanity Fair, or People—around to indulge myself. If you’re still hungry after 15 minutes of reading, chances are, it’s true hunger and you should eat.

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