Environmental influences. Abnormalities of biology or psychology cannot explain the big increases in obesity in modern societies. For this we need to look to the environment. Environmental influences on obesity occur either within a macro or micro environmental setting and can have either a physical or socio-cultural basis.

Macro environmental influences at the physical level are those components of the larger world such as the food supply or technology. At the socio-cultural level, the macro environment represents population and community attitudes, values and norms. The micro environment refers to the immediate physical and social environments such as in the home, amongst peers and social contacts, pressures and attitudes in the family and immediate community. All of these environments can influence body fat levels through the mediation of energy intake or energy expenditure.

Environmental influences represent the public health arm of the obesity problem. While these exist, programs aimed at influencing behaviour at the individual level could only be expected to have limited effect. Any comprehensive approach to the prevention and treatment of overfatness and obesity must then consider both the macro and micro environments.

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In short, these people seem happy with their role as children. The demands made on them are easily met. They succeed at a level that fits their position in life, and thus feel good about themselves.

Come adolescence, however, the child is expected to function in new ways. Now an adolescent’s identity derives more from relating to her peer group than from simply meeting the expectations of adults. An adolescent who has trouble with these new demands begins to feel inadequate, although she may not be able to put her feelings into words. Even the rewards for “good behavior” that the adolescent might once have expected from adults are now less tangible and less frequent. A twelve-year-old doesn’t get a gold star for brushing her teeth every night; such behavior is now expected of her.

Feelings of inadequacy sometimes relate to the bodily changes puberty, as the hormonal onslaught triggers a flood of new emotions. The onset of menstruation forces a girl to think about herself as a maturing woman, a sexual being. For some, the sudden awareness of sexuality may be more than they can bear. Many of my patients appear to weather the storm of puberty for some time, accepting menstruation as a natural part of their development. Often, however, it turns out that they have just been putting up a brave front. Deep down, they are terrified of what’s happening to their bodies.

The fragile personalities these girls develop can be shattered by some devastating event. Such events take many forms, but they usually relate to a loss or a sense of failure.

For example, some anorexics have suffered the death of a parent or a particularly beloved grandparent. Sometimes the loss involves the breakup of the first (and most intense) romance. Some patients, about to enter college, are frightened by the thought of leaving the family or by the pressure to succeed. Divorce, relocation, marriage of a sibling, illness-any of these can shake her sense of security, challenge her ability to meet the expectations placed on her, and rob her of self-esteem.

Of course, the same can be said of anyone. The potential anorexic, however, lacks the inner strength necessary to handle loss, rejection, or change. She has aged, but she has not grown up. She has spent so much emotional energy pleasing others that she has none left to invest in understanding her own feelings. She has never learned to recognize the signals coming from her growing body, her brain, and, for want of a more scientific term, her soul.

Even if she does recognize these signals, she can’t respond to them. Instead she has a vague sense that “something is wrong with me.” She begins to mistrust not just herself but everyone around her. In such a state she can’t make new friends or keep old friendships going. She withdraws further into herself.

Soon her insecurity, lack of trust, and inability to recognize feelings affect her perception. She can’t even see what her own body looks like with any degree of accuracy.

Eventually, though, a kind of transformation takes place in her thinking. She gropes for an anchor to keep her from drifting into an emotional whirlpool. The notion that “there is something wrong with me” becomes “there is something wrong with my body-it’s too fat.”

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For years, Angela used food to block out memories of her painful, | rri unhappy childhood. Eating made her feel warm and fuzzy inside. It was her way of showing herself kindness and love. But it came at a price: By the time she reached her twenties, she weighed 188 pounds.

All the while, Angela’s emotional pain continued to fester inside her. It finally came to a head in an explosive confrontation with her husband. At that moment, Angela realized that she could no longer ignore what had happened to her as a child. It was not only driving her to overeat, it was also undermining her spiritual well-being as a mother, wife, and business owner.

Angela immediately sought professional help. She learned an array of coping skills, including meditation. Now, instead of running to the refrigerator when she feels bad, she heads for a quiet room. For a few minutes, she tunes out the outside world and tunes in to her innermost thoughts and emotions. She tries to identify what is really bothering her, then figures out how to deal with the real problem without turning to food.

Today, at age 34, Angela runs a nonprofit organization that provides personal counseling and career support for sexually abused women. She credits a combination of meditation and prayer with helping her turn her life around. It also helped her slim down: She maintains a healthy weight of 138 pounds.

WINNING ACTION

Use your mind, not food, to mellow your mood. Daily meditation can help you relax, so you’ll be less inclined to plunge into a stress-induced binge. To try meditation, go to a room in your home where you won’t be disturbed. Sit in a comfortable position, then begin breathing slowly and deeply. Concentrate on your breathing. As thoughts enter your mind, acknowledge them, but don’t dwell on them. Continue for 20 minutes. You’ll feel the stress melt away.

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