Fran Weiss , LCSW-R, BCD, DCSW, CGP
Ask the Expert...Fran Weiss, LCSW-R, BCD, DCSW, CGP, is an individual and group psychotherapist in private practice in New York City. She is on the faculty at Mt. Sinai School of Medicine, Sr. Psychotherapy Consultant to the New York Obesity Research Center, St. Luke's Roosevelt Hospital Center, NYC, a member of the American Group Psychotherapy Association and the Eastern Group Psychotherapy Association, Academy for Eating Disorders, National Association of Social Workers, Private Section. Board Certified Diplomate. She is the creator of B.I.T.E. The Body Image Transformation Experience® and has written and lectured extensively on issues of weight, self-perception and body image. She also runs workshops for and mentors mental health professionals.
Articles:
Q&A
The Hollow Victory of Weight Loss
B.I.T.E. The Body Image Transformation Experience®
Dear Fran,
I am in my 30's, single and about 50 lbs. overweight. I have lost weight several times in the past but have regained it. I want to lose weight more than anything, but this time I can't seem to take any of the right steps. I know that my life would be so much better. I'd be happier, buy better clothes, have more dates...everything would be better! I've tried all of the popular diets, been to different programs. They all seem great at first. I get excited about being thin, and then I have some kind of problem in my life, not even a big problem, and I find myself overeating again. It makes me feel like the whole thing is hopeless, or maybe it's me that's hopeless. Is this the kind of problem that you work with?
Janet
Answer:
Dear Janet,
Yes. I work with people who want to understand the internal conflicts that are getting in the way of having lives they want. It sounds like you have been at the 'weight loss business' for a long time, with some positive and some not-so-positive results. The good news is that you have been a participant in your weight loss process. You know that you can succeed and you're not willing to give up. The bad news is that something inside of you, which you are not fully aware of, is getting in the way of your ability to hold to your course. We both know that losing weight can be a very difficult process. Weight loss is not like finishing a term paper. Once you've researched the material and written the paper, the task is finished. After weight loss, there is the ongoing work of maintenance.
My work and research have illuminated several things:
- Diets alone don't work
- Traditional psychotherapy helps people understand themselves, but isn't enough for eating behaviors and permanent
- weight loss. Internal makeovers (body image change, self image) need to parallel external changes (diet, behaviors).
Maintaining weight loss requires continuing commitment. But you are not hopeless; many people have faced the same problems and overcome them. You may need to understand the emotional underpinnings of your attitudes to food, weight and body image. Perhaps there was a time in your early life when overeating was a soothing remedy for fear or loneliness.
People struggle to let go of overeating, because it immediately alleviates stress--and is soothing, like a best friend. Even when the situation changes, the ‘solution' becomes the problem. Seen from this perspective, an ambivalence about losing is understandable. It takes work to recognize what the original problem was, to what extent it is still operative in your life, and to really get it that you have different choices now. It takes strength to endure the pain of old losses that you masked with food. Once you understand the inner mechanics, learning to regulate your feelings is like learning to regulate your food intake—not easy, not something that can be done all at once, but something that makes obvious sense, like diet and exercise.
I would recommend that you find a therapist with a solid grounding in interpersonal issues and a sub-specialty in issues of weight and body image. In my work I make use of a team including a licensed nutritionist, an internist and an endocrinologist, but the focus is on individual and group therapy to comb your early history for clues about your current distress, to explore feelings about self and change, and to offer empathic support.
Question:
Dear Fran,
I am so upset. I STILL FEEL FAT AND UGLY after having lost about 75 pounds! I am a woman in my mid 40's. I have always had a weight problem. At least I thought I had a weight problem. For my entire life, in my family, my weight was the focus of my parents' life. I was just never right to them. Now, when I look at childhood pictures of myself, I recognize that in fact I wasn't that different from any other kid around. Perhaps I was chubby, but if I saw a kid like that on the street I'd think she was cute. But I felt like a monster. And my weight loss and now slim body has NOT changed the way I feel about myself. I am VERY disappointed. When I am objective, I can look in the mirror and see that in fact I weigh much less. I think I do look better. I am now able to buy clothes in my favorite shops, the kind of little dresses and skirts I used to long for. I thought if only I could wear those pretty things I would be happy. BUT, now I'm wearing them and I still don't feel right. It's like I just don't fit in. Men have been paying more attention to me than ever. I find myself ANGRY as well as flattered. I want to get even. WHERE were they when I was 75 lbs. heavier? Why do they have the right to approach me now, when before they would not even look twice? Sometimes I want to say insulting things to a man who has just paid me a compliment! Am I crazy? Instead of feeling beautiful, I feel like the same old ugly, fat person! Is this normal? Help!
Angela
Answer:
Dear Angela,
I welcome your letter, since I believe that it captures how many feel after they've accomplished the feat that you have. 75 lbs. Congratulations. Now, of course the problem is twofold: keeping it off, plus mourning what might have been. Often losing weight catalyzes grief for missed as well as painful experiences. Putting weight back on masks the painful grief (temporarily.) (I don't mean to be negative, but this is always the challenge.) And you and I both know that unless your "still fat and ugly feelings" don't shift, your frustration may lead you down the slippery slope to overeating. What you present as your problem is 'huge'. So, one step at a time. You have apparently, with great effort, managed to accomplish 'outside change'. This is certainly NOT a small feat. Now you will need to embrace 'inside' change, an‘inner make-over' if you will. What I'm about to say is not a "blame game". But, apparently, something in the way your family of origin operated made weight and looks a central focus. Often this is a result of parents' frustrations with their own lives. (This is a bit like the old story of yelling at the cab driver when you are really angry at your boss. The low man on the totem pole gets it. In a family that place is usually reserved for one or more of the kids.) One thing to note right away: THIS IS NOT YOUR FAULT!
Body image, our perception of ourselves in size, shape and emotion evolves during our formative years. The process of growing and maturing to adulthood builds on this initial framework. We inherit our biological make-up from our parents, and then we learn about ourselves through their eyes. (Grandparents, siblings, and others can have a powerful effect as well.) At first, we are like sponges. We absorb all of the information we pick up from our parents--what they say and what they don't, their body language and how they treat us. Finally we become old enough to question these perceptions and to form truly separate identities. But by then we have 'taken in' a lot of stuff-- good stuff and not-so-good. We make our parents into parts of ourselves and their voices become our own. It sounds like you took in, over a long period, some profoundly negative messages. No wonder your feelings about yourself are so harsh! No wonder you can't enjoy your success. You have accomplished a "Hollow Victory"— weight loss without all of the goodies one would expect to follow.
Therapy can work to counteract your distorted self-image, and to bolster the part of you that was strong enough to lose 75 lbs and clear enough to see that you were in fact a cute little girl, not a monster. While individual work is important to give you the undivided attention you need (which people treated as reflection of their parents' unhappiness sorely need) group therapy also offers powerful advantages. Group is a safe place to gain emotional experience in the world, to see through your own misunderstandings and those of others. You are mirrored not only by the therapist but also by a gathering of your peers. Common and forbidden subjects are explored behind closed doors where confidentiality is guaranteed and everyone is looking at the light and dark sides of themselves.
I've created a short-term group workshop, B.I.T.® The Body Image Transformation Experience®, which focuses on working with participants to shift the kinds of distorted self-perceptions that plague you. This kind of workshop can be an introduction or an adjunct to continuing therapy. None of this is easy, but it works.
Question:
Dear Fran,
I'm not sure you're the right person to ask, but I don't know who would be. I am filled with shame and moral judgments about myself. I have struggled with my weight and feelings about myself for a long time. I come from a regular family. Mom and Dad worked; like my siblings, I was expected to do well in school and be a good person. My parents aren't deeply religious, but do follow the Golden Rule and believe in self-respect and self-reliance. I did fine as a teenager, I never got in trouble, and I thought that would continue.
But when I got to college it was like it all crashed down on me. I was anxious all the time. There were so many people with so many different ideas and opinions. We were told we were adults now. I liked the freedom, I was happy, but I couldn't stop eating. I continually struggled with food. Thank goodness I never threw up or did any of that stuff, but I gained about 40 lbs. I tried to pretend I didn't care. Then I graduated and got a job where I had to present myself to new people all the time, and I couldn't stand the idea of being fat anymore. It seemed pathetic and unprofessional as well as making me feel unattractive. I worked very hard at dieting and exercise and have managed to control my food.
Now I am having another problem. Dare I say it? I have become out of control sexually. I think more in my head than in actuality, at least so far. I am always thinking about men. I live in a big city and nobody can tell me what to do, but I have to look in the mirror every morning. I'm afraid that my compulsion for food has now shifted to sex. I am doing things I never dreamed of and am very embarrassed…ashamed. Please help me. I don't want to become fat again.
Chloe
Answer:
Dear Chloe,
You are a very brave woman to write. I am certain that what is going on in your mind is also going on in others who have had the "fat/ eating struggle". Thank you for the opportunity to delve into this with you!
First of all, slow down. You are not alone in this. And though you need to be careful, you are not crazy or bad. You're going through what most people go through as teenagers; if they're lucky, they have involved parents to help them understand and handle sexual urges. If your development got stopped or frozen (which is what it sounds like) and you're only fully facing these feelings now, it's not surprising they're hitting so hard. It's difficult to be a teenager at 25. But it's even more difficult at 35 or 45, so it's very important that you address these issues as soon as possible.
You need to talk out your feelings, not act them out. Many of my patients who have had experiences like yours say that what they really want is to be hugged, but think they have to have sex to get affection. Or they want love but imagine that sex is all they deserve or can expect. Sexual desire is wonderful but, like the desire for food, it can cover up a lot of other needs. It's the great pretender. Sexual development and its relation to identity, morality, dignity…all the big issues...is very complicated and different for everyone. To struggle with it is to be human and alive, but you don't need to struggle alone.
What kind of woman do you want to be when you grow up? (I know you're already grown, but some parts of us grow faster than others.) Asking this question with a therapist or in a group can lead to surprising and reassuring answers. You're reaching out, which tells me you do respect yourself and care about living a good and satisfying life. Don't stop now.
Question:
Dear Fran,
I'm a 40 year old guy with a more than decent job, married, two kids. It's a good life except that I'm 100 pounds overweight. My wife says I'm a walking heart attack. My cardiologist warns me drugs alone won't control my cholesterol, my boss is on my case, my kids, you name it. The thing is, they're all right and I know it. If I keep on like this I'll die, though I don't admit to anyone that I'm afraid. I pretend everything is OK, because no matter what they say, nobody really wants to hear that it isn't. I can't just go on a diet. I've tried. I can't stick to it. I get too hungry. All I think about is food, and then I can't focus on work, I can' t be a good father and husband. I've always eaten to deal with anxiety.
When I was 5, my mother told me my father was sick and might lose his job, and then I'd have to support the family. I was the eldest child, the only son. I didn't know how crazy that was, I just worried how I was going to do it, and I ate more. But I ran around a lot as a kid and was an athlete in high school so weight wasn't that much of a problem. Now I'm in a sedentary job, I don't have time for the gym or any fancy programs; I'm on call 24/7 with my boss (I'm the director of public relations for a large corporation) and my wife works so I have to help at home too. Did I mention my mother has early Alzheimer's? I'm not trying to feel sorry for myself, but it's like it's all slipping away.
A few years ago my wife said I wasn't attractive to her because of my weight. It made me angry but now she's started gaining weight herself and she not attractive to me either. I don't say that, of course. I pretend I'm too tired, just like she pretends she' s too tired. There are a million books telling me what to do, but I still feel like nobody understands. I can't afford to get caught up in my personal problems. My wife says men never want to go to therapy but you know what? We don't have the luxury. Nobody's handing out sabbaticals to guys like me. Sorry for the rant. I know I'm in trouble but I really don't know how to deal with this.
Peter
Answer:
Dear Peter
You've certainly got a lot on your shoulders! Your wife, your mother, your kids, your boss…what about you? Who takes care of you? I think you understand your situation pretty well, and you're right that nobody is going to hand you a sabbatical or take over your responsibilities. But maybe some of what you think of is your responsibility really belongs to others. If you're a hundred pounds overweight and your cardiologist is worried, dealing with your personal problems is not a luxury. To be blunt— who would take care of your family if you dropped dead?
Given the little bit of history you've related, I understand why you feel the way you do. You were made to be a parent before you were allowed to be a child. You missed out on something very important, something we all need for our development, which is a time to grow and learn in an atmosphere of safety and security. Now you are whipping yourself into a frenzy to achieve that security but you're like a teenager driving 100 miles an hour. It's a lot more likely that teenager will smash the car—and himself—than get anywhere he needs to be.
You need to fix things inside, and I'm not just talking about your heart. Therapy does take time and money, but so do the kind of disasters you're headed for. You know how they tell airline passengers to secure their own oxygen masks before their kid' s? I think you understand why they say that. I do get it that dieting brings anxiety, which feels intolerable, but it doesn't have to feel intolerable. That's the child in you who had to carry too much by himself. The point of therapy is not being alone with these feelings anymore. You can't relive your childhood but you can learn to understand it, to regulate your feelings and your hungers, and more objectively strike a balance between your desires and the demands of others. Maybe you have to make changes in your job or home life, maybe not. But you certainly have to learn to live with Peter, to take care of him as well as you do the rest of the people you love.
Fran Weiss, LCSW-R, BCD, DCSW, CGP, is an individual and group psychotherapist in private practice in New York City. She is on the faculty at Mt. Sinai School of Medicine, Sr. Psychotherapy Consultant to the New York Obesity Research Center, St. Luke's Roosevelt Hospital Center, NYC, a member of the American Group Psychotherapy Association and the Eastern Group Psychotherapy Association, Academy for Eating Disorders, National Association of Social Workers, Private Section. Board Certified Diplomate. She is the creator of B.I.T.E. The Body Image Transformation Experience® and has written and lectured extensively on issues of weight, self-perception and body image. She also runs workshops for and mentors mental health professionals.
Fran Weiss does not necessarily endorse the Eating Disorder Hope website or its contents. This email response service is provided by her to share her knowledge and experience with treatment providers to individuals suffering from eating disorders and those struggling with eating disorders. It is the privilege of Eating Disorder Support to publish her thoughts here.
By Fran Weiss LCSW-R, BCD, DCSW, CGP
Have you ever wondered why you are so capable in so many other areas of your life, but not in your interaction with food? Ask yourself the following questions:
- Do you use food to regulate feelings, tension, impulses, or anxiety?
- Are you in "eat", before you know it, and can't remember how you got there?
- Are all of your important goals put on hold until you can figure out what to do about your eating, weight and body image, or perception of yourself?
- Are you aware, that no matter how many promotions you have been awarded at work, that there is no internal promotion, your internal emotional life continually and simply remains flat and lacking?
- Does a central part of your self esteem maintain a self regard of "fat, ugly, and unworthy"?
- Does a part of you feel stuck at a very early age still listening to an old story about yourself and the world, without being able to shake it?
- Does your "call to food" trump staying present and seeing food simply as food?
If this sounds like you and if you are tired of simple answers that haven't worked for you, or dare to delve beneath the "how to" of dieting and food regimens, consider transcending traditional therapy.
The conundrum of treating the overweight individual has been a challenging and daunting dilemma for all involved. This has been true from both sides of the treatment partnership, you, the patient as well as the helping professional, those in the mental health field and the medical profession. The hollow victory and pseudo cure of weight loss is the signature for many who struggle with weight regulation. Despite appearances weight loss alone is not authentic or permanent. Many who struggle with weight regulation remain miserable. In my work, I see two types of pseudo-cures.
- You've lost weight, but with out the internal change to correspond with weight lost.
- You understand all about food, weight, and obesity and even emotional components of yourselves. You've changed internally, but not lost weight.
B.I.T.E.® The Body Image Transformation Workshop was developed to address these specific issues. The B.I.T.E.® Workshops are not fast fixes and easy answers. B.I.T.E.® is a unique Workshop experience, a challenging opportunity to appreciate, comprehend, and change your interaction with:
- Yourself
- Your body image
- The process of eating
- Your relationship with food.
B.I.T.E.® is a structured 24 week program of two interconnected Workshops followed by a Mentoring group. B.I.T.E. ® integrates with individual therapy, nutritional work, and exercise. Participants find that after all of the years of talk therapy, the work of the B.I.T.E.® Workshops moves them into an action mode of authentic change. Participating in B.I.T.E. is a unique experience combining the techniques of group psychotherapy, recent research in neuro-psychology, and recent developments in attachment theory, integrated with authentic movement therapy on body image. The workshops address resistance and fear of change, body image, and the integration of mind and body.
