Saturated fats are usually solid at room temperature (such as dripping, butter or chocolate). They keep fairly well and this makes them attractive to food manufacturers. They also make crisp biscuits and pastry and crunchy coatings on fried food. Because they’re cheap, have a relatively long shelf life and are useful in processed foods, saturated fats are widely used by food manufacturers. Food labelling does not always indicate whether a fat is saturated or unsaturated.

*91\186\4*

Take, for example, the problem of overeating, technically known as hyperphagia. The urge to consume excessive quantities of food can arise when the hypothalamus becomes damaged due to a head injury, tumor, or some other cause.

Endocrine disorders, such as diabetes or hyperthyroidism, can disrupt metabolism, causing the patient to burn energy at an abnormally high rate. When energy stores are depleted, the body, in a kind of metabolic panic, turns on the hunger drive to compensate.

Prescribed medications and illicit drugs also affect eating behavior. Some antidepressants and antipsychotic medications may increase appetite and lead to weight gain. Marijuana is a well-known cause of binge eating. In some patients, frequent abuse of marijuana contributes heavily to the bulimic cycle.

The congenital defect known as Prader-Willi syndrome causes ravenous appetite with poor ability to feel full; the eating thus continues unabated and leads to massive obesity. Abnormal eating occurs in the Kleine-Levin syndrome, which is also marked by periods of extreme sleepiness.

In most of these cases, it’s easy to spot the cause of overeating. Sometimes, though, the cause is more subtle. One of my patients, a sixteen-year-old named Sarah, suffered from a form of epilepsy that produced certain kinds of brain seizures. Two years before, she had started dieting to become thin. She developed anorexia and later became bulimic as well. During a seizure she flew into a rage at any object that happened to be in sight at that moment-a lipstick container, a telephone, whatever.

Sometimes the focus of her rage was the food on her plate. Because food enraged her so much, she stopped eating, eventually losing so much weight that she had to be hospitalized. Specialized brain-wave recordings revealed that her seizures occurred in the part of the brain that controls emotional states, rather than in the part responsible for muscle activity. In Sarah’s case, an anticonvulsant drug played a vital part in treating her eating disorder.

As in anorexia, the distorted attitudes and bizarre behavior caused by bulimia may be confused with other psychiatric illnesses such as schizophrenia. In rare cases, a patient may indeed have both an eating disorder and schizophrenia. Recognizing the presence of both conditions is crucial, since therapy designed to correct one problem may have no effect-or an adverse effect- on the other.

*30/35/5*

Like everyone else in her family Sarah had always been over- t weight. “I believed that I was destined to be that way so I didn’t pay much attention to my food choices or exercise as much as I should,” explains the 31 -year-old Elizabefhtown, Pennsylvania, resident. And it showed: Over the years, her weight crept toward 200 pounds. j

Then Sarah’s mother developed health problems because of her excess weight. Shaken by her mom’s poor health, Sarah felt that her own weight might put her at risk for illness in later years. So she decided to do something about it.

Her first step was to join a local gym. But with her hectic work schedule, she had a hard time keeping her promise to go every day. That’s when she came up with the idea of adding her workouts to her appointment calendar.

Keeping those exercise appointments isn’t always easy. “But even on the busiest days, I make every effort to get to the gym,” Sarah says.

Sometimes, special occasions—like a party for a friend’s birthday or a coworker’s promotion—coincide with Sarah’s scheduled workout time. On those days, she simply plans her workouts for the morning. She arrives at the celebrations feeling good that she didn’t shortchange her health.

But when she receives a spur-of-the-moment invitation to join her coworkers for an after-work happy hour, Sarah politely declines. “I always say no without feeling guilty,” she says.

Her commitment to exercise, combined with a healthy diet, has paid off: Sarah lost 55 pounds within about a year, and she has maintained her weight at a trim and toned 145 pounds for more than 2 years. She has even won gym-sponsored fitness contests for the most pounds and inches lost.

S WINNING ACTION

Schedule your exercise as you would a meeting. If you’re busy like Sarah, pencil your exercise on your calendar just like other important things you must do. And don’t cancel!

*84\89\8*