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In a youth-oriented culture, age is notorious for adding the injury of declining health to the insult of increasing invisibility. Whether what's hurting is psychological, physical, or a package deal, managing weight may need to take a backseat to pain management.

Judy, a 56-year-old globe-trotting CEO whose mother had told the young Judy how beautiful she'd be if she were thin and gave her amphetamines at age 14, was too busy to deal effectively with her arthritic knees and debilitating depression. Her ostrich style of managing distress-burying her head in potato chips-had only increased her burden by 50 pounds. It was getting harder to ignore her orthopedist's concern. He wanted to schedule a second knee replacement. Harder still was her husband's indifference to her (since her apple shape had rounded to grapefruit, she feared he'd leave her for a younger woman).

She knew she needed to lose weight, but her knees ruled out running, the only slimming strategy that had ever worked for her. She started hypnotherapy expecting me to tell her what to do. Instead I told her about a depressed client who'd lost 60 pounds while on antidepressants. (Antidepressants have a generally good track record of decreasing binge eating as they alleviate depression.)

"Not another pill!" she told me. Her pillbox was already brimming with joint and heart medications. If the physical pain let up, she was sure the emotional distress would, too. If only she could find nonsurgical relief. That hopeful thought led to a second opinion from a more conservative doctor who was able to treat her pain without an operation and, as anticipated, lift her spirits. Just as helpful were cognitive-behavioral pain management techniques, including recognizing feelings and situations that exacerbate pain and then trigger bingeing. (The same behavior modification techniques helped Judy curb her potato chip consumption.)

Successfully managing her pain left Judy feeling much more capable, allowing her to take care of other pressing business. With a little help from Jenny Craig's home delivery service, she dropped two sizes.

Until you realize that addressing life issues is addressing weight loss, shifting to "I can" is impossible.

Next: Getting what you need

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