How to be a good loser – Part 1: the psychology of weight loss

by Shachi D. Shantinath, Ph.D.

Originally published at www.HealthandAge.com, 2001.

Weight Loss and Psychology

Everyone knows that if they only eat less and become more active, they will lose unwanted weight. But is it really as simple as that? As anyone who has ever tried to manage their weight can tell you, that is not the case. Yes, eating less and moving more play a role in weight loss. But these factors do not exist on their own. They are in turn influenced by your emotions, as well as your overall lifestyle.

While everyone can agree that weight loss is a challenge, many people do not realize that there is a large body of research findings that can inform and assist you in your efforts to manage your weight. Current thinking now suggests that the best way to address the problem of overweight is to tailor the approach for each person.

Researchers suggest that for people who are moderately overweight (defined by a Body Mass Index of over 25), psychological approaches are helpful. For those who are considered obese (defined as a Body Mass Index of over 30), a combined pharmacological and psychological approach is considered to be more helpful. In other words, those who are heavy benefit from psychology. Those who are very heavy can benefit from both psychology and medications used in combination. (For more information on Body Mass Index and how you can calculate yours, please see link at the end of this article.)

However, the decision whether to use psychology on its own or in combination with medication must be decided on a case by case basis, in consultation with your physician.

Cognitive-Behavior Therapy

The majority of psychological approaches to weight loss come under the heading “Cognitive-Behavior Therapy” (often abbreviated as CBT). CBT consists of a combination of techniques and approaches that seek to modify a person’s thoughts and behaviors as they relate to a problem – which in this case deals with weight, eating and exercise.

A key idea behind this is that negative thoughts or unhealthy behaviors do not just happen automatically. Rather, they are the result of earlier learning and life experiences. Through CBT, new thoughts and behaviors can be learned so that they replace the maladaptive ones. Eventually, over time, these healthier thoughts and behaviors become integrated into a person’s life, in turn promoting weight loss and / or long term maintenance of the loss.

The “cognitive” part refers to how people think about themselves, situations, their environment and their weight. The idea here is to first become aware of these maladaptive thoughts and then learn to replace them with more encouraging statements. For instance, an overweight person may be saying to him or herself “It is no use. I am destined to be fat.”

The “behavior” part refers to exactly that – those things that are related to behavior. For instance, it may be customary in some families to eat in front of the television. But this is not the best way to become satisfied with one’s meal. For someone else, behavior may refer to automatically reaching for a bag of candy when he or she is under stress.

Because everyone has different reasons for doing what they do, you can think of the components of CBT as a kind of cafeteria or buffet, from which you select what you need. The main elements of this menu include such things as learning to become aware of yourself, changing your environment so that it is health promoting, becoming aware of your automatic thoughts and negative self-image, learning how to handle stress better and getting adequate support and encouragement from other people.

Furthermore, these approaches function like components which can be integrated with one another, so you can then tailor your approach according to your particular needs.

Developing Self Awareness

The process of developing self-awareness is referred to as “Self-Monitoring” by psychologists. It can involve being aware of what you eat, how much you move or what kind of thoughts you may be feeling. It can be as simple or complex as you want to make it.

In working with my clients, one of the first steps in the weight loss process is what is referred to as a “Food Log”. They are asked to keep track of what they eat for a period of three to four days. From this, we can gather insight into when they eat, how they eat and more importantly, what emotions they are experiencing when they eat. (A forthcoming article in this series will describe the use of a food log in detail.)

Food logs are not about the Diet Police! They are merely tools intended to raise your awareness of your eating patterns. Too often, we tend to eat automatically or with many distractions- such as television. The idea behind a food log is to become aware of the many little things you may be eating during the day that you do not even notice. (Remember, even little bites of snacks can add up to significant calories.)

Research has shown that many people underestimate the amount of food they eat. A food log is one way to get at a more accurate understanding of how much you ate. And because emotions influence eating behaviors, a food log is also a good first step towards developing an awareness of how you might be eating to soothe yourself.

Developing an Awareness of Your Thoughts

Because our thoughts exert such a great influence both upon our behaviors and our feelings, it is important to become aware of them. Psychologists refer to the process of developing an awareness of one’s thoughts, and altering maladaptive ones, as “Cognitive Restructuring”.

Returning to the example from the beginning of this article, a person may say to him- or herself: “It is no use. I am destined to be fat.” They may not even be aware that they are saying such things to themselves. It may, in fact, exist as an assumption in the back of their mind.

The focus of cognitive restructuring is to become aware of such thoughts and learn to challenge them. Persons learn alternative dialogue and perspectives. So, a more constructive response might sound like this: “I know it is tough, and it will take some time. But I can do it. I need to be patient and I need support. But it is doable.”

Modifying Your Environment

Also known as “Stimulus Control” among psychologists, the idea behind this technique is that you identify and change things in your environment so that there are fewer cues or triggers for eating, and more cues and triggers for activity.

For one person, it may mean not keeping high fat snacks in the house. For another person, it may mean keeping walking shoes next to the door so that they serve as a reminder to get in a daily walk.

Stress Management

Because stress is one of the main reasons people overeat and thus experience lapses in their effort to lose weight, it is important to pay attention to this. Various methods for reducing tension have been found to be helpful, including such things as deep breathing, progressive muscle relaxation and meditation. All of these offer you a way to reduce your stress response in emotionally charged situations, and in turn, reduce the risk of stress related eating. (For more information on the use of meditation in the context of weight loss, and on how to cope with getting upset, please see links at the end of article.)

Support from Significant Others

Called “Social Support” by psychologists, this refers to the network of social relationships we have in our lives from which we derive psychological comfort and encouragement.

Having social support in your life will increase the likelihood that you will be successful in your weight loss effort. Social support can take many forms. It can mean having a weight loss “buddy” with whom you check in periodically to keep track of progress, and to get and give encouragement. It can also mean involving your family in your weight loss effort. You may turn to them for encouragement, support and assistance with trying our new behaviors – such as initiating a program of regular walking. Of course, health professionals – especially psychologists – can also serve as sources of support during the weight loss process and maintenance thereafter. Some people also turn to virtual communities on the Internet for support.

In sum, social support can take many forms. Anything that helps people feel connected to others and reduces their sense of isolation is beneficial, even if the contact is not specifically focused on weight loss.

Outcomes of Cognitive-Behavior Therapy

CBT has been found to be effective in bringing about moderate amounts of weight loss in a gradual and safe manner – over a period of time. Typically, when carried out by psychologists, CBT lasts approximately twenty weeks and draws upon a combination of methods described above.

Studies of weight loss programs using CBT report an average weight loss of 8.4 kg (18.48 lbs.). Patients retain about two-thirds of this loss up to one year after completing treatment. Unfortunately, long-term studies have found that for the most part, patients eventually return to their initial weight within 3 to 5 years of ending treatment.

Keeping weight off is a challenge for patients, practitioners and researchers. Now, some studies are beginning to look at how people can keep this weight off for longer periods of time.

A common element among those programs that have demonstrated long term weight loss is that they viewed the condition of overweight or obesity as a chronic condition, and in response, provided on-going support even after the formal treatment phase ended. Studies have also looked at how people can modify their activities so that they can better keep weight off once it is lost. One promising study looked at the role of home based exercise equipment in keeping weight off. (For more information, see link at end of this page.)

Summary

Despite the limitations of CBT – the main one being that it is difficult to achieve lasting weight loss- it has been shown to be effective in the management of overweight and obesity. While more research is needed to look at ways to improve weight loss maintenance, there is enough evidence that shows the value of these methods.

So if you find yourself thinking about losing weight, in addition to eating less and moving more, I suggest you give some of these techniques a try – and you might find that they offer you just the extra help you need in your weight loss effort.

Footnotes
1. Behavioral Treatment of Obesity T.A. Wadden, G.D. Foster, Medical Clinics of North America, 2000, vol. 84, pp. 441–461
2. What is the role of cognitive-behavior therapy in patient management? J.P. Foryet, W.S.C. Poston III, Obesity Research, 1998, vol. 6, pp. 18S–22S

Copyright S.D. Shantinath, Ph.D. All rights reserved.