Many people will try the latest fad diet to lose weight, but few will get permanent results and some may develop serious eating disorders.

The use of diet pills and laxatives only complicate matters.

The best way to lose weight and keep it off, experts say, is to work with a doctor, a nutritionist and a therapist to develop a moderate strategy for healthy eating, regular exercise and an attitude shift.

"Diets are all extreme, unbalanced protocols," said Dr. Patrice Lockhart, medical director of the New England Eating Disorders Program at Mercy Hospital. "It's like pulling a pendulum back and letting it go. Anything that aims to control eating has the potential to swing things the other way. The only way to lose and keep weight off in a healthy way is a balanced approach."

The case against dieting is strong, according to information from the National Eating Disorders Association.

One study found that, on any given day, 45 percent of American women and 25 percent of American men are on a diet. Another study found that 95 percent of all dieters regain lost weight within five years. Yet another study determined that 35 percent of dieters reach a point at which eating habits become unhealthy, according to the National Eating Disorders Association.

"Ninety-five percent of the people we see started with a diet," said Lockhart, whose program takes in about 300 new patients each year. "No one starts a diet saying, 'I want to be anorexic or bulimic.'Ý"

In the United States, about 10 million women and 1 million men have anorexia nervosa, which is self-imposed starvation; or bulimia nervosa, which is secretive overeating and purging. Another 25 million Americans have binge-eating disorder, which is compulsive overeating without purging, according to the eating disorders association.

Eating disorders can be influenced by a wide range of psychological, social and biological factors, including low self-esteem, depression, anxiety, family dysfunction and sexual abuse, as well as the narrow cultural equation of beauty and thinness, according to the association.

A dieter's initial goal may be to lose weight or be healthier, prettier or more popular, Lockhart said. The hope may be to look like a favorite model, movie star or pop singer. The real outcome can be tragic, with anorexia having the highest premature fatality rate of any mental illness.

Purging is one of the most harmful diet-related behaviors, Lockhart said. It includes a variety of activities meant to compensate for overeating, such as vomiting, taking diuretics or laxatives and exercising compulsively. She also warned against using diet aids to accelerate weight loss, boost energy or substitute for healthy eating.

"They're not allowing the body to regulate its own metabolism," Lockhart said, adding that weight lost with help from diet supplements is difficult to keep off.

Ally Day's experience with bulimia illustrates one of the more unfortunate potential outcomes of dieting. 

Day, 22, is a technology fellow with Island Institute who lives and works on Vinalhaven. Her eating disorder took hold gradually, starting with occasional fasting and binge eating when she was 9 years old.

By age 12, she was fasting regularly and lost 30 pounds between seventh and eighth grades. She was never considered overweight or underweight, and baggy clothes were in fashion at the time, so the most she heard from her family and friends was concern that she looked tired all the time.

She added purging to the mix of unhealthy behaviors when she was a student at Deering High School in Portland. By the time she was a freshman at the University of Maine at Farmington, she was binge eating and purging four to five times a day.

That December, she checked into Mercy Hospital's eating disorders program for the first of three inpatient stays in one year. The first two times, she left the clinic thinking that her bulimia was under control. The third time she left knowing that recovery would be a challenge for the rest of her life.

"My good days far outnumber my bad days," she said. "It's not that I don't think about my disorder or that I don't skip a meal once in a while, but I eat more healthy than a lot of other people my age."

Lockhart suggests eating a balanced diet from all food groups and in amounts necessary to provide the right amount of calories to maintain body weight within a person's ideal range. Weight loss should be slow and steady to be effective, she said.

To develop a healthy weight-loss strategy, Lockhart recommends consulting with a primary-care physician first to rule out other medical issues and learn about other possible treatments, such as psychological, nutritional and fitness counseling.

That approach proved successful for Ally Day, who said she's in "steady recovery" from bulimia.

"At the end of the day, it's about getting back to basics and learning what it is to be a healthy eater," she said.

Staff Writer Kelley Bouchard can be contacted at 791-6328 or at: kbouchard@pressherald.com