I n the West, we have long been concerned with how as individuals we can properly manage our lives and bodies. This concern, some argue, has developed since the Enlightenment into a "makeover culture," that is, a culture obsessed with transforming the self through managing the body. The makeover culture, like much in the modern world, emphasizes the importance of aesthetics and promises people with eating and weight problems that they can become more successful and happy if they just have the right tools and the right attitudes.
Today, our diverse tools for self-transformation include plastic surgery, designer diet drugs, and high-powered life coaches. Self-help often implies the intervention by others, whether physicians, psychologists, lifestyle coaches, or the authors of self-help guides. Such self-help books and programs remain a mainstay in the self-improvement industry. While many researchers express skepticism about the efficacy of self-help treatments for obesity and eating disorders, others argue that they provide important tools to help people transform their bodies and their lives. Despite uncertainty about the efficacy of self-help treatments for weight and eating disorders, people continue to buy diet-advice books and join for-profit and non-profit guided programs, spurred on by the promise of total self-transformation.
Popular culture has always been a powerful tool for transmitting narratives about how to act (or not to act) in order to be successful in society, and our contemporary self-help literature is a modern descendant of older didactic traditions in print and oral culture (Dolby 2005: 26-7). The central idea of self-help culture, that it is pos sible to manage one's life through reflection, discipline, and routine is not new either. Judeo-Christian anxieties about bodily disorder extend back to Paul, and his Corinthian epistles are some of the earliest advice literature, explaining how to combat physical temptations to achieve spiritual salvation. Paul, of course, was not interested in the "seven habits of highly effective people" or in losing weight. He was, however, determined that the Corinthians would "glorify God" in the body as well as in the spirit (1 Cor. 6:19-20).
A concern with spiritual development and collectivity were understood as integral to self-help until the late twentieth century. Self-help interventions were generally "cooperative efforts for mutually improved conditions on the part of a community of peers," and much of the early work was done by religious groups (McGee 2005: 18). Grassroots efforts and community improvement typified the self-help model prior to the 1970s, and mutual aid is still an important part of self-help groups (Katz 1981: 135-6). However, in the past thirty years, self-help has come to be associated primarily with individual efforts at self-improvement. Books give advice on how to win friends and influence people, how to get noticed at work, and how to improve our appearances all in an effort to get ahead.
This increasingly competitive culture is fueling a growing self-help industry based on the myth that success and happiness can be achieved through proper life management, and consumers, it appears, are buying in with big dollars. In 2005, one historian reported that "the self-improvement industry, inclusive of books, seminars, audio and video products, and personal coaching, is said to constitute a $2.48 billion-a-year industry" (McGee 2005: 11). A large portion of these profits, no doubt, are from diet and weight-loss books. A 2005 study of commercial weight-loss programs, in particular, reported that "Each year, millions of Americans participate in commercial and self-help weight loss programs" (Tsai et al. 2005: 171).
Because of the proliferation and popularity of self-help weight-loss methods, research on the uses and effectiveness of self-help for weight and eating problems has been increasing since the late 1970s (Katz 1981; Hartley 1994). Many of these studies distinguish between "pure" and "guided" self-help interventions. Pure self-help programs use books that include all of the instructions for completing the program and are undertaken by individuals without therapeutic assistance. Buying a weight-loss manual or other book, reading it, and attempting to follow that program at home alone is pure self-help. Guided self-help, on the other hand, is carried out in contact with a therapist or other "expert." Guided programs may also use manuals, but they supplement individual work with one-on-one counseling and, in the case of self-help groups, group leaders, and peer support (Perkins et al. 2006: 4).
Pure self-help materials are probably the most familiar and accessible. Consumers who want to help themselves recover from weight or eating problems have access to literally hundreds of books on dieting, weight loss, and eating disorders (Santrock et al. 1994: 195-201). Many self-help authors derive their authority as experts from their experiences with food and dieting, and they seek to establish a connection with the reader, who they assume has a similar problem with food. In their books, they combine spiritual and secular traditions of body management and promise to provide the overweight individual with all of the tools he or she needs to transform their lives and bodies. These self-help books (or manuals) range from medical and scientific-based resources to confessional and personal narratives and, as such, vary widely in their content and suggestions for treatment.
Like many diet gurus of the past two centuries, the authors of contemporary self-help diet books frequently use their own experiences with weight loss as a platform for selling their program. For example, Susan Powter, whose confessional diet book Stop the Insanity! and concomitant television infomercial were widely popular in the 1990s, explained in an interview, "I'm not a nutri tionist, I'm not a doctor, I'm not a dietician. I'm a housewife that figured it out" (Fraser 1997: 75). Powter makes clear that her only expertise comes from her own experiences of being fat and losing weight. She uses her own experiences to speak from a place of aggressive authority (Powter is known for yelling at her audience) and motivate people to lose weight the way that she did. Similarly, Richard Simmons has marketed his brand of diet and exercise based largely on his personal experiences with weight and the connection that he feels that shared experience creates between him and his customers (Fraser 1997: 70-1).
Self-help diet books like those by Powter and Simmons almost invariably contrast the disorderly, overweight person (before) with the successful and happy person (after) who has gained self-control by learning to "flip the switch" or "stop the insanity." Jim Karas, for example, speaks to his imagined readers about their dieting history, which he suggests has been a disordered mess of yo-yo diets and disappointments. About their body image and motivation to lose weight, he assumes, "Right now, you are probably comfortable not believing in your ability to flip [successfully complete the program]. You are, however, unhappy with your weight." He immediately follows his comment about body image with, "Holding this book in your hands indicates that you have a desire to change" (Karas 2002: 10). Buying Karas's book, it seems, it the first step in real and lasting weight loss, and he assures his readers that following the written exercises and visualization techniques in his book will "pave the way to successful weight loss" and, it is implied, a more successful life overall (Karas 2002: 3-4).
Like many self-help diet books, Karas also uses metaphors of healing and nourishing to talk about overcoming eating and weight disorders. He advocates starting at "your beginning; that is, your childhood" in order to understand how one's individual weight and eating problems developed (Karas 2002: 13). Karas's method is fairly typical of self-help diet books, most likely because overeating and obesity are often attributed to untreated emotional pain in popular culture. The literature on emotional overeating includes books like Feeding the Hungry Heart (Roth 1982), When Food is Love (Roth 1992), Healing the Hungry Self (Price 1996), and Conquering Compulsive Eating (Katz 1986), which posit the neglected internal self as the root cause of overweight and eating disorders.
Much of this literature views overeating as an addictive behavior because, as Geneen Roth explain, "compulsions, though they manifest themselves differently according to personality, spring from a common source: the hunger of the heart—attempting to satisfy, express, and, at the same time, numb itself" (1982: 5). The compulsion to overeat, according to this model, results from feelings that are "too painful to bear, so, as a way of coping with the discomfort, you resort to binging or grazing on food or starving yourself" (Price 1996: 116). Repressed emotions cause anxiety and discomfort, which the compulsive person assuages by eating. In order to treat the physical weight problem, these self-help authors believe that the dieter must heal emotional and spiritual pain first.
This philosophy of healing emotional pain in order to lose weight also appears in explicitly religious self-help literature. For example, the Weigh to Go: Self-Help Weight Loss Manual, which rightly disclaims in its prefatory pages that it is not "an exhaustive treatise" on the subject of weight loss, quotes Corinthians 1 and 2 and provides spiritual advice about how to lose weight. Overeating, according to the authors, is attributable to "shame issues," which will be healed by God "as you begin to deepen your spiritual life and grow in this area" (McLain et al. 1998: 65). In this view, overeating is a temptation, which may be overcome by turning to God. Following a "one day at a time" program, the overeater should pray to God for self-control because "nothing helps like prayer" (McLain et al. 1998: 37). With faith, the overeater finds the strength to take control of the disorderly behavior and reform his or her life. The best way to lose weight, according to these authors is, "surrendering your care to God first, and then to a physician with experience in weight loss" (McLain et al. 1998:
Despite their rhetorical differences, these and other self-help books promise to give readers all of the tools that they need to understand, control, and transform their thoughts and behavior. However, it is difficult to measure the real success of self-help diet books. Despite high sales, there have not been many studies undertaken to measure the effectiveness of individual programs. The research that has been done comparing "pure" self-help efforts with structured weight loss programs suggests that dieters who go it alone in their self-help are less likely to lose weight than those who participate in a program like Weight Watchers or the Trevose Behavior Modification Program (Hellmich 2003: 80d; Heshka et al. 2003: 1793; Heshka, et al. 2000: 285; Latner et al. 2002). The regular structure and personal contact provided by structured programs, which frequently include group meetings, has been cited as one factor in the greater success that group dieters have at losing weight.
Like self-help literature, most for-profit weight-loss groups are nonmedical, meaning that they are not carried out under the supervision of a physician (Tsai et al. 2005: 173). Unlike diet books, however, group programs use guided self-help methods in which dieters receive one-on-one help from group leaders or nutrition counselors. Jenny Craig and LA Weight Loss, for example, use instructional materials and individual meetings with dietary counselors to help clients lose weight. Weight Watchers also combines pure and guided self-help techniques, providing programs for members to follow on their own at home as well as weekly group meetings (Tsai et al. 2005: 173-4; Womble and Wadden 2002: 547-8). Group leaders and counselors in these programs have varying levels of expertise and education; some are professionally trained in nutrition or kinesiology, but most have little if any training outside of the company that they work for (Fraser 1997: 146-7). At Weight Watchers, for example, the authority and expertise of many group leaders is based, as with diet gurus, on their own experiences with weight loss.
The improved success of dieters in these programs may not, however, rest on the authority (or lack thereof) of the group leader. Research shows that simply being a member of a peer group provides support and motivation that may not be as readily available for the individual dieter. Early research into self-help weight-loss groups indicated, for example, that "identification with a group of peers contributes to the effectiveness of the group" (Bumbalo and Young 1973: 1590). In this view, groups allow people to exchange stories about their struggles and triumphs, which help them to learn from one another how to manage their compulsions. The presence of others who share similar compulsions to overeat, it seems, allows people with eating and weight problems to more objectively understand and control thought and behaviors.
In addition, the ritual weighing-in at groups like Weight Watchers and Taking Off Pounds Sensibly (TOPS) allows members to publicly measure their progress and receive praise and encouragement (Bumbalo and Young 1973: 1590; Stinson 2001: 145-6). The support and accountability provided by the group, researchers argue, may provide increased motivation for dieters to stick to their program each week. The ritual power of the weigh-in is, however, also based on competition and fear of being shamed in front of the group. For example, TOPS, a nonprofit weight-loss support group that was popular in the i970s, was organized around the premise that "women needed to keep an eye on each other" in order to lose weight. At TOPS weigh-ins, "Good Losers" were cheered, and the "Turtles" (slow losers) and "Pigs" (gainers) were derided. At the end of the weigh-in, members who lost the most weight pinned cardboard pigs on the people who gained weight while the rest of the group booed or cheered (Fraser 1997: 150; Latner 2001: 91-2). This ritual of praise and punishment was designed to deter "bad" dietary behaviors and keep members "honest."
Honesty and progress coupled with spiritual rhetoric and healing exercises are also important in Overeaters Anonymous (OA), perhaps the most well-known self-help group for overweight people. OA is a nonprofit twelve-step program that differs considerably from both Weight Watchers and TOPS in its emphasis on spiritual and emotional "recovery." In its online promotional material, OA deliberately sets it apart from other weight-loss support groups, claiming that "Unlike other organizations, OA is not just about weight loss, obesity or diets; it addresses physical, emotional and spiritual well-being" (Anon. 2006). Like print-based self-help, OA sees overeating as an addictive behavior and focuses on healing the emotional and spiritual problems that underlie the compulsion to overeat. In order to work on these problems individually, members read instructional and inspirational materials at home. However, "food addicts" also work with a sponsor, who provides guided self-help, and attend regular group meetings where they support one another to achieve their goal of abstinence from overeating (Wasson and Jackson 2004: 340).
While OA claims that it is not a religious group because it does not adhere to any specific doctrine, it is highly spiritual and faith is a cornerstone of the program. OA literature, like that of Alcoholics Anonymous and other twelve-step groups, assumes that the reader will believe in the existence of a "higher power," who will take on their suffering and heal them (Weiner 1998: 165-6). The first three steps of the program require that food addicts:
i . admit that they are powerless over food and their lives have become unmanageable; 2. believe that a Power greater than ourselves could restore us to sanity;
3. make a decision to turn their will and their lives over to the care of God as they understand Him.
While the compulsory spirituality of OA may turn off some potential members, others see spirituality as central to their success in the program. Participants in a 2004 study of OA and recovering bulimics overwhelmingly cited this spirituality as a key element in their ability to overcome the disorder. Another important element cited in aiding recovery was the food plan (Wasson and Jackson 2004: 352), which is developed individually through guided interactions with sponsors. Weight loss may result from using this twelve-step program; however, spiritual healing and "surrender" are the foremost goals of OA (Anon. 1981: 563; Wasson and Jackson 2004). When a person's internal pain is healed, it is assumed that they will stop overeating, and their weight will no longer be an issue. This assumption may be idealistic, but the few studies which have been done of OA suggest that twelve-step support groups may be useful in supplementing more traditional treatments for obesity.
Self-help ideologies are deeply rooted in Western culture and history, and, while much has changed since the time of Paul, self-improvement messages continue to emphasize discipline and bodily management. Today, a person may choose "pure" self-help by following a diet book, opt for a structured program with guided self-help, or join a support group like Overeaters Anonymous. While reviewers of self-help diet materials argue that "evidence to support the use of the major commercial and self-help weight loss programs is suboptimal" (Tsai and Wadden 2005: 56; Wilson 2005; Womble and Wadden 2002), there is other evidence supporting the efficacy of self-help treatments for eating and weight disorders. In particular, several studies of the role of self-help and guided self-help in treating bulimia nervosa have indicated that both support groups and self-help manuals may aid patients in managing their binging and purging behaviors (Carter et al. 2003; Ghaderi 2006; Pritchard et al. 2004). If this preliminary research is any indication, self-help interventions may provide at least a partial solution to the eating and weight problems that plague consumer culture.
SLG/C. Melissa Anderson
See also Banting; Binge-eating; Brillat-Savarin; Christianity; Nidetch; Peters; Psychotherapy and Weight Change; Religion and Dieting
References and Further Reading
Anon. (1981) "Overeaters Anonymous as Self-Help," The American Journal of Nursing 81 (3):
Anon. (2006) "The Twelve Steps of Overeaters Anonymous," Overeaters Anonymous, available online at <http://www.oa.org/twelve_steps.html> (accessed January 2, 2007).
Bumbalo, Judith A. and Young, Dolores E. (1973) "The Self-Help Phenomenon," The American Journal of Nursing 73 (9): 1588-91.
Carter, J.C., Olmsted, M.P., Kaplan, A.S., McCabe, R.E., Mills, J.S. and Aimé, A. (2003) "Self-Help for Bulimia Nervosa: A Randomized Controlled Trial," American Journal of Psychiatry 160 (5): 973-8.
Dolby, Sandra K. (2005) Self-Help Books: Why Americans Keep Reading Them, Urbana, Ill.: University of Illinois Press.
Fraser, Laura ( 1997) Losing It: America's Obsession with Weight and the Industry That Feeds It, New York: Dutton.
Gilman, Sander L. (1999) Making the Body Beautiful: A Cultural History of Aesthetic Surgery, Princeton, NJ: Princeton University Press.
Hartley, Pat (1994) "Research: Can Self-Help Groups Make Meaningful Contribution?" European Eating Disorders Review 2 (2): 1-5.
Hellmich, Nanci (2003) "Weight Watchers Beats Self-Help Diets," U.S.A. Today, April 9: 8od.
Heshka, Stanley, Anderson, James W., Atkinson, Richard L., Greenway, Frank L., Hill, James O., Phinney, Stephen D., Kolotkin, Ronette L., Miller-Kovach, Karen and Pi-Sunyer, F. Xavier. (2000) "Self-Help Weight Loss Versus a Structured Commercial Program After 26 Weeks: A Randomized Controlled Study," American Journal of Medicine 109 (4): 282-7.
-(2003) "Weight Loss with Self-Help Compared with a Structured Commercial Program," Journal of the American Medical Association 289 (14): 1792-8.
Karas, Jim (2002) Flip the Switch: Discover the Weight-Loss Solution and the Secret to Getting Started, New York: Harmony Books.
Katz, Alfred A. (1981) "Self-Help and Mutual Aid: An Emerging Social Movement?" Annual Review of Sociology 7: 129-55.
Katz, Alice (1986) Conquering Compulsive Eating: A Complete Self-Help Guide, Vancouver: International Self-Counsel Press.
Latner, J.D. (2001) "Self-Help in the Long-Term Treatment of Obesity," Obesity Reviews 2 (2): 87-97.
Latner, J.D., Wilson, G.T., Stunkard, A.J. and Jackson, M.L. (2002) "Self-Help and Long-Term Behavioral Therapy for Obesity," Behaviour Research and Therapy 40 (7): 805-12.
McGee, Micki (2005) Self-Help, Inc.: Makeover Culture in American Life, New York: Oxford University Press.
McLain, Judi G., McLain, Patrick G. and Andreacchio, Russell W. (1998) Weigh to Go: Self-Help Weight Loss Manual, Puckett, Miss.: Aweigh Publishing Company.
Perkins, S.J., Murphy, R., Schmidt, U. and Williams, C. (2006) "Self-Help and Guided Self-Help for Eating Disorders," The Cochrane Database of Systematic Reviews 3 (4): 1-67.
Price, Dierdra (1996) Healing the Hungry Self: The Diet-Free Solution to Lifelong Weight Loss, New York: Plume.
Pritchard, Briony J., Bergin, Jacqueline L., and Wade, Tracey D. (2004) "A Case Series Evaluation of Guided Self-Help for Bulimia Nervosa Using a Cognitive Manual," International Journal of Eating Disorders 36 (2): 144-56.
Roth, Geneen (1982) Feeding the Hungry Heart: The Experience of Compulsive Eating, New York: Signet Books.
-(1992) When Food Is Love: Exploring the
Relationship Between Eating and Intimacy, New York: Plume.
Santrock, John W., Minnett, Ann M., and Campbell, Barbara D. (1994) The Authoritative Guide to Self-Help Books, New York: The Guilford Press.
Stinson, Kandi (2001) Women and Dieting Culture: Inside a Commercial Weight Loss Group, New Brunswick, NJ: Rutgers University Press.
Tsai, A.G. and Wadden, T.A. (2005) "Systematic Review: An Evaluation of Major Commercial Weight Loss Programs in the United States," Annals of Internal Medicine 142 (1): 56-66.
Byrne, K.J. (2005) "Commercial and Self-Help Programs for Weight Control," Pediatric Clinics of North America 28 (1): 171-92.
Wasson, Diane H. and Jackson, Mary (2004) "An Analysis of the Role of Overeaters Anonymous in Women's Recovery from Bulimia Nervosa," Eating Disorders 12 (4): 337-56.
Weiner, Sydell (1998) "The Addiction of Overeating: Self-Help Groups As Treatment Models," Journal of Clinical Psychology 54 (2): 163-7.
Wilson, Stephen A. (2005) "Review: Little Evidence Supports the Efficacy of Major Commercial and Organized Self-Help Weight Loss Programs," ACP Journal Club 143 (1): 36-7.
Womble, Leslie G. and Wadden, Thomas A. (2002) "Commercial and Self-Help Weight Loss Programs," in Christopher G. Fairburn and Kelly D. Brownell (eds), Eating Disorders and Obesity: A Comprehensive Handbook, 2nd edn, New York: Guilford Press, pp. 546-50.
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