2. Have you lost a significant amount of weight, especially recently?

3. Have you restricted food intake through dieting or fasting?

4. Do you burn off energy through excessive exercise?

5. Do you have urges to binge?

6. Have you “purged,” either through vomiting or laxative or enema abuse?

7. Do you set dieting “goals,” then reach them, only to set yet another goal?

8. Do you think about food constantly?

9. Do you feel uncomfortable eating in front of others?

10. Do you turn down spontaneous invitations to eat in places other than your home, say, in restaurants or at parties?

11. Do you have set routines you feel you must follow during a meal? If you don’t follow them do you get angry or tense?

12. Do you take very small bites while eating, or do you count your bites?

13. Do you insist others eat while you resist eating?

14. Do you make a point of weighing yourself or looking in the mirror several times a day?

15. Does your mood depend on how much you have eaten? Are you happy if you eat nothing, sad if you eat anything at all?

16. Are you more socially isolated than you were, say, three months ago?

17. Are you a perfectionist? Are you overly critical of yourself?

18. Do you ever feel depressed or sad for a long time for no identifiable reason?

19. Are your menstrual periods irregular-not occurring every 25-30 days, or occurring an average of fewer than ten times a year for the past two years?

20. Do you feel cold all the time, or need extra layers of clothing?

21. Have you experienced low blood pressure, dizziness, or fainting spells recently?

You can use this test to raise your awareness about the possibility of serious problems.

Remember, eating disorders can only be treated successfully if they are detected early, and the earlier the better.

*9/35/5*

“Everyone in my immediate family is overweight,” says the Salisbury, North Carolina, resident. “And in my extended family— among grandparents, aunts, uncles, and cousins—there are lots of health problems. Heart disease, cancer, and diabetes are pretty common.”

Even with her doctor’s dire warning, Sandra didn’t get serious about slimming down until 10 years later. By then, she had gained almost another 100 pounds, reaching her top weight of 491 pounds.

“In those 10 years, I had made some halfhearted attempts at dieting, but they weren’t successful,” Sandra recalls. “I reached a point where I was tired of being so heavy. And because of an inheritance, I finally had the money to do something about it.”

In February 1997, she entered Structure House, a weight-loss facility in Durham, North Carolina, about 90 minutes from her home. “I went there on the advice of friends who were familiar with the Structure House program,” she says. “They really believed that it could help me.”

Sandra stayed at Structure House for 11 months. While there, she received individual counseling to help her confront and cope with some painful issues from her past. “I learned that many people use food to avoid dealing with their problems and that I was one of those people,” she says. “I had been overeating since I was a child.”

As Sandra began to address her own issues and learn more positive ways of handling them, she was better able to control her eating habits. “Through counseling, I learned that eating couldn’t solve my problems—that I had to find other ways of coping,” she says. “I started talking with friends, telling them what I was thinking and feeling. If a friend wasn’t available, I’d write down my thoughts instead.

“The ultimate goal of counseling is to resolve the underlying problem,” Sandra continues. “That actually makes things harder for a while. There were times when I got so overwhelmed with my issues that I had to step back and take a break. But eventually, I’d move on.”

By the time she left Structure House in January 1998, Sandra had lost 138 pounds. She continued to follow the eating-and-exer-cise guidelines that she had been given, and once a week, she made the 90-minute drive to Durham to meet with a Structure House counselor. “Losing weight was tougher on my own than at Structure House,” she says. “It definitely wasn’t a straight line. I’d make some progress, then take a couple of steps backward.”

But Sandra was determined. In a little more than a year, she took off another 130 pounds, dropping to 223 pounds.

Sandra, now age 36, would like to lose another 70 or so pounds. To that end, she continues to eat healthfully and exercise regularly, and she sees a counselor every week. The therapy is excellent, she says, and it has helped her tremendously in dealing with the issues that contributed to her weight gain in the first place.

“People constantly tell me what an inspiration I am and how I give them hope,” Sandra adds. “But I couldn’t have done what I did if I hadn’t learned to face my problems.”

*63\89\8*