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Extreme dieting, losing stones in a matter of a few months, is becoming more commonplace. There have always been very low-calorie diets, but what has changed is that instead of being slammed by the medical profession as unhealthy, they have lately become more acceptable in the face of the sharp increase in obesity. (The National Institute for Health and Clinical Excellence even recommends them as a valid 12-week treatment to combat morbid obesity.)

An extreme dieter has a disconcerting pattern of
shedding lovers, friends and family along with the pounds

Surgery has also become more commonplace, and recently the Royal College of Surgeons called for gastric weight-loss surgery to be made even more widely available on the NHS. Now, with the increasing number of people embarking on extreme weight-loss options, we are beginning to understand the psychological cost of this sort of dieting on our brain processes and thus on our moods. Ask around and it's easy to find people who are shocked by the personality changes in close friends or family who have gone on extreme diets.

Sarah Marshall, 41, has watched her charismatic head teacher sister Lynne lose three stone apparently at the cost of her flamboyant personality. "Lynne has become a shadow of her former self,' Sarah says. "She used to command attention wherever she went. She was around a size 18, but no one thought of her as fat because she dressed so beautifully and looked confident and healthy. If she'd lost a bit of weight that would have been OK, but she's lost so much that she looks half-starved. Somehow, her sparkle and confidence have evaporated.'

Lynne followed the LighterLife programme for 12 weeks, but has severely restricted her diet subsequently, living on little more than hot water and occasional pieces of fruit, for a further six months. Alarmed colleagues have confided their concerns to Sarah. "In a big secondary school there are crises on a daily basis, and Lynne used to be able to deal with them. Now she's much more anxious, and her neurosis is having an effect on morale. Her appearance is alarming too, she looks pinched and drawn, almost as if she's ill.'

Loosing Sudden Weight May End Up Losing Loved ones
Loosing Sudden Weight May End Up Losing Loved ones

Before (April 2009) and after (December 2009): actress Hannah Waterman dropped five dress sizes, along with her husband.

Sarah acknowledges that she hasn't spoken directly to Lynne about this. "I do think it's difficult,' she says. "It is a really positive achievement to lose weight to stay healthy, but we are so brainwashed into believing that thin is always better that anyone saying you've gone too far is seen as jealous or threatened. I don't want to undermine Lynne's achievement, but in my view thin isn't always best, and certainly not for her. Being healthy and a bit larger is a much better option.'

Psychologist Susan Quilliam believes that, as in Lynne's case, losing weight can "shrink' a personality, too. "By losing the pounds, you lose presence,' she says. "That is why some people prefer to be a bit bigger, a little extra 'heft' is as much a part of their personality as a loud laugh or kindness. Sometimes being too thin is not worth what we have to give up to achieve it.'