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Rosalyn (not her real name), 43, a teacher in New Jersey and a client of Beck's, prides herself on being a logical person. She knows that after more than a year of Weight Watchers, she is, at 170 pounds, 102 pounds lighter than when she started, and she has gone from a size 26 to a size 12. "But I have had to work at thinking of myself as smaller. That when I meet people, the first thing they think is not 'Boy, she's huge.'" One night at a family gathering, Rosalyn's sister, who is of average size, came up with an idea. "She made me switch clothes with her," Rosalyn recalls. "She said, 'I know we're the same size.' So I put on her clothes, and they fit. That was mind-blowing." Rosalyn continues to work at knowing she has lost the weight. She sometimes goes out for retail therapy: Even if she doesn't intend to buy anything, she picks size 12s off the rack and tries them on; she says she's surprised, then reassured, when the pants fit: "There are times that the waistband on a pair of pants looks tiny to me."

Gina MacDonald, a dance movement therapist in Branford, Connecticut, has many techniques for helping her patients banish what she calls the "ghost image" of their heavier bodies. In one, patients get involved in literally redrawing their body map. They stand in front of a large piece of paper while partners trace a precise outline of their bodies. When they step away and look at what their size really is, "they do not believe it," Macdonald says. She also has clients close their eyes, envision their bodies, then place their hands out in front of them at the width they believe their waist is. "I have them open their eyes and look at their hands, and I guide them back to where they should be. They can see the difference in inches. Some start crying."

Sometimes a woman must recalibrate her body image before she can begin to address her weight issues. For years Michele Secaul, 45, an office manager who lives in Boca Raton, Florida, thought of herself as a floating head. She could look in the mirror at her face—how many times had she heard she had a pretty one?—but not below it, at her 288-pound body. Desperate about the shape she was in, she tried a movement therapy class at the Renfrew Center, a facility that treats eating disorders, in Coconut Creek, Florida. It was the "lotion therapy" that finally helped her connect her head to that body. Although she hated to touch herself, the therapists made her go home every day and gently apply lotion to her whole body—"to feel my body, to take care of it, respect it," she says. It was this reconnection that prompted her to want to address her weight issues.

Secaul had a gastric bypass and within a year weighed 150 pounds and was a size 10. "I was on top of the world, but again, I wasn't really dealing with how my body had changed," she says. The weight started coming back on—almost 40 pounds—until she went back to movement therapy and realized she was no longer applying her lotion. Once more, she had lost the connection between her head and her new shape. Now she does lotion therapy every night. Inhabiting her body again has allowed her to be kinder to it—she eats mostly protein, walks three miles a day, and has lost 20 pounds. "It's when I lose touch with how my body feels and how I feel about it that I put on weight. That's the key."

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