For as long as she could remember, Annette Pfau fussed over food.
She counted calories, agonized over eating and scolded herself in sessions before the full-length mirror.
"My memories of junior high school are of constantly eating cottage cheese or some other crash-diet food. Food was always an enormous part of my life," says Pfau, 33, a Los Angeles graphic designer. "I was always super-conscious of my body image. I felt I had to conform to whatever the standard of beauty is: tall and thin. But I'm not even tall."
She moved into adulthood even more compelled to mold herself into the image locked in her brain. Dieting and exercising were a way of life.
Then came the revelation.
"It dawned on me one day that I was spending an inordinate amount of time on food. I told myself, 'This is wrong.' "
That was five years ago. Today, with the help of a dietitian, Pfau says she is free from the grip that food, weight and body image had on her.
She exercises and still tries to eat healthfully. But she does not weigh herself, and she has endorsed the body that she was born with.
"I have completely changed my thinking about food," Pfau says. "It's like night and day. The main thing I've learned is, food is a neutral thing. It's not good. It's not bad. Chocolate cake isn't evil and celery isn't virtuous."
Pfau is among a small group of Americans embracing a new model of personal health that is revolutionary for its approach--or lack of approach--to dieting. There is no name for
this model, although it's sometimes called "health centered" as opposed to "weight centered."
If it had a motto, it would be: Don't diet.
In a nutshell, the health model--which has a growing number of health professionals from medical doctors to dietitians to psychologists behind it--demands an end to restrictive dieting (counting calories, fat, cholesterol).
It not only takes away the scales, but simply asks the individual to try to eat a variety of healthful foods to satisfy hunger, to exercise and--perhaps most central--to accept your body as it is.
Why opt for this stop-trying-so-hard approach?
Because dieting doesn't work in any permanent way, says Jeanine Cogan, a Washington, D.C., psychologist and public-policy scholar specializing in body image with the Society for the Psychological Study of Social Issues.
"The prevailing model on obesity is now being recognized as shortsighted by researchers across disciplines," she says. "If restrictive dieting as a treatment for obesity has a 95% failure rate and increases the chance of developing an eating disorder, then dieting is not a successful health behavior."
Cogan is among a group of psychologists informally pressing the federal government to back a new health-centered approach. (A similar model was recently adopted in Canada as part of a major public health media campaign.)
"This is an idea that has been floating around for many years," she says. "It's just now getting some attention. We're at a point now where even the leading weight loss researchers are saying restrictive dieting isn't working."
Psychiatrists too are pushing for the new paradigm.
They have added a category called "binge eating" to the listing of psychiatric disorders, a move that reflects the emotional component to eating problems and acknowledges the large group of Americans who are not bulimic or anorexic but who are troubled by food, body image and weight issues.
Meanwhile, the American Dietetic Assn. has created a branch of training--nutritional therapy--that focuses on teaching this philosophy.
The new model suggests that if you just eat normally and exercise moderately, you will be mentally and physically healthier and may even lose a modest amount of weight, although the measures of success are whether you are healthy and whether you feel good about yourself.
The model also frowns on the use of obesity drugs, such as Redux and Pondimin, both of which were voluntary withdrawn from the marketplace last week due to safety concerns. The medications suppress appetite, another form of food restriction that goes against the health model.
"You can't measure self-esteem with a scale," says Evelyn Tribole, a registered dietitian and co-author of "Intuitive Eating: A Recovery Book for the Chronic Dieter" (St. Martin's Press, 1995), which looks at the non-diet model. "I've stopped using a scale. I've changed my motto about nutrition. It now includes having a healthy relationship with food and taking the morality out of eating."
Adds Frances Berg, a registered dietitian in North Dakota and author of "Afraid to Eat: Children and Teens in Weight Crisis" (Healthy Weight Publishing Network, 1997): "The old paradigm was: First lose weight and then get healthy. The new paradigm is that we need to be healthy first, with the goal of being healthy at whatever size we are."