One major difference between self-help gr0Ups and therapy is cost. Professional therapy, by definition, involves people who are reimbursed for their time. Self-help groups are usually free, though they welcome donations. While therapy groups usually meet in clinics or professional offices, self-help meetings take place wherever adequate (and, one hopes, free) space can be found.

A self-help group usually does not screen members; anyone may join. In contrast, a support group or a professionally led group may ask that prospective members meet with leaders before attending to make sure that there is a “fit.” Attendance at self-help groups is voluntary; therapy group members are expected to show up.

A handful of self-help groups require their members to participate in some kind of professional therapy. Most make no such demand, although they sometimes encourage their members to get other help. This can be especially important in dealing with eating disorders, since these are sometimes life-threatening illnesses that require a doctor’s attention.

Having a professional involved with a self-help group is both a blessing and a curse. In the “plus” column, professionals are usually up to date on the latest information. They can teach useful skills relating to self-esteem, assertiveness, and better communication. Professional leaders can often help by developing meeting guidelines and then stepping back from the group while remaining available for consultations as needed.

In the “minus” column, a group may feel it must surrender its autonomy to the professional. Members may thus forget the original goal, which was to look to them for support. Professionals may confuse self-help with group therapy, and lose sight of the needs of group members.

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Ask John Therkelsen how he feels since he lost 189 pounds, and he’ll likely tell you that he is healthier, has more energy, and has a brighter outlook on life. It’s these sorts of positive changes—not just the decreasing number on the scale—that kept him on track for weight-loss success.

“Had I focused only on how many pounds I was taking off, I don’t think I would have remained as strong and determined as I did,” says the 53-year-old Colonia, New Jersey, resident. “What kept me going was how good I felt and how much more I could do.”

John had been heavy for most of his life. But his love of sports kept him active—until he developed plantar fasciitis, a painful foot condition, in 1996. Suddenly, he found himself sidelined, unable to golf, bowl, play tennis, or engage in other activities that he had always enjoyed. In the 2 years that it took his foot to heal, his weight climbed to 364 pounds. By that time, he was so out of shape that he couldn’t resume his active lifestyle.

Realizing that he was dangerously obese and that he needed help to slim down, John researched several weight-loss facilities before settling on Structure House, located in Durham, North Carolina. “A coworker had recommended Structure House to me, and several health-care providers whom I know personally gave it their thumbs-up,” he says. He signed up for an 8-week residential program, during which he learned about the three major components of weight loss: nutrition, exercise, and he psychological aspects of food and eating.

The education and support that he received enabled John to lose 56 pounds during his 8 weeks at Structure House. Once he returned home, he continued to follow the Structure House eating plan and to track his calorie intake. He made visits to a local gym and looked for ways to increase the amount of activity in his daily routine, like walking to work or to the grocery store. He also eased back into the sports he loved—tennis, golf, and skiing.

As determined as he was to slim down, John understood that he had a long way to go before he reached a healthy weight. To keep himself motivated, he looked for other markers of his progress. And he found plenty: his increasing strength and stamina from regular exercise, his lower blood pressure and cholesterol readings, his more positive attitude. “Watching all of these things improve provided tremendous motivation for me,” he says. “It really kept me encouraged.”

By spring 1999, a little more than a year after starting his weight-loss program, John stabilized at 175 pounds. His waist measurement shrank from 60 inches to 34, reducing his clothing size from a 3X or larger to a medium. Needless to say, he’s fitter, healthier, and feeling better than ever.

John will be the first to tell you that slimming down takes time and commitment. “But so many positive changes occur along the way,” he says. “Look at these other accomplishments as part of your success, even if weight loss is your ultimate goal.”

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