One way of selecting a group is by severity of the illness. Patients who binge and purge frequently (at least once a day for several years) but who aren’t in immediate medical danger may need an intensive program with several sessions a week. Twice-a-week bingers might do better in a more relaxed program.

In any case, group therapy should focus on symptomatic eating behavior. When patients regain healthy control over their eating, they can work more productively on other issues.

One such issue is assertiveness. We spend a lot of time discussing ways of handling apologies, compliments, and criticism. One patient complained, “I always do exactly what my husband tells me to do. If I don’t he’ll sulk and pout and make me feel guilty. Maybe we bulimics need a ‘Just Say No’ campaign of our very own!”

Problems: As in anorexia, some common features of bulimia can interfere with group therapy. One writer, Janice M. Cauwels, put it this way: “Bulimics tend to distrust people, especially other women, and most of all bulimic women.”

Bulimics can be perfectionists. If other members of the group don’t quite live up to their expectations, they may feel frustrated or angry.

Some patients place too much emphasis on food. They may use a “verbal binge” as they would a food binge to escape from their feelings. Group should address this issue. For example, during one session a patient said, “Hilary talks so much about food that I feel like I’m stuck in quicksand. I think she’s just doing that so she won’t have to talk about her problems with her boyfriend.”

Some patients expect a “magic cure,” believing that if they just show up at group meetings their symptoms will disappear. The group can help them confront and deal with this misconception.

Gradually, members realize that getting better takes time and work.

As with any group, feelings of competition and rivalry may emerge among patients. In groups that have a more psychodynamic orientation, members – guided by the therapist – can explore such conflicts. Doing so usually results in a deeper understanding of how the patients’ feelings influence their past and present relationships.

Group therapy should offer patients positive role models. Sometimes, however, newer members may feel jealous or inadequate when they see how other people have succeeded at reducing their symptoms. Conversation should focus on such feelings, especially if the patient’s pattern is to binge immediately before or after the group session.

One final note: Eating-disordered patients with drug or alcohol problems need additional help, because such problems can both substitute for bulimic symptoms and trigger them. Abstinence from substance abuse is usually a prerequisite for successful eating disorder treatment.

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When she was 31, Rita, an IRS program analyst from Alexandria, Virginia, decided to join Weight Watchers to unload some extra pounds that had accumulated over the years. “I just overate, and I didn’t know what I should eat to be slim,” she explains. She followed the program to the letter, taking off 22 pounds in 12 weeks.

After the birth of her son some 5 years later, Rita developed chronic sinus infections. Four sinus surgeries later, she found that she had gained 30 pounds. “I had put on so much weight that I moved up 3 clothing sizes,” she says. She went back to Weight Watchers, and this time, she took off 30 pounds in 18 months. “I wasn’t quite as vigilant about sticking with the program,” she admits. “I knew it would work. I just had to be patient.”

On both occasions, Rita used a tape measure—not a scale—to monitor her weight-loss progress. She found that by checking the circumference of her bust, waist, hips, and thighs once a week, she had a more accurate record of her changing body shape. “Even the second time, when the pounds came off slowly, I could count on my tape measure to show that I was improving,” she says. “Some part of my body was getting smaller, even if the scale didn’t show it.”

Rita, age 45, now serves as a program leader for Weight Watchers. “I started there as a receptionist in 1988, and they let me stay even when I regained weight,” she says. “That really inspired me tunity to tell others how valuable a tape measure can be as a weightloss motivator.

WINNING ACTION

Trade your scale for a tape measure. A scale won’t tell you how your body composition has changed, but a tape measure can. As you lose fat and gain muscle, certain body parts get smaller. To check the size of your waist, wrap the tape around the narrowest part of your waist, roughly halfway between your bottom ribs and your hipbones. For your hips, wrap the tape around your hips and butt at their widest points, usually slightly below the actual hipbones. Write down younmeasurements, then track them from week to week.

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