Diet

To Lose the Weight, Change How You Relate (to Food)

Why behavioral skills are the key to long-term weight loss

Posted February 21, 2011

Make time to buy & prepare healthy foods

Weight loss is a $40 billion dollar a year industry. Advertisers lure us with images of a healthy and happy life spent running along the beach with the sun shining overhead, then heading home to eat our grapefruit and take our diet supplement. Unfortunately, the reality of long-term weight loss is a lot more complex and involves learning a new set of life skills.

In 2007-8, 34% of the US adult population was overweight and 34% was obese, according to figures from the Centers for Disease Control. Being overweight, especially having excess abdominal fat and insulin resistance, the so called "metabolic syndrome," conveys increased risk for Type II diabetes, high blood pressure, and heart attack or stroke.

Dieting Alone Doesn't Work

Research studies suggest that dieting alone doesn't work for long-term weight loss. In one study, less than 20% of obese participants were able to lose 5% body weight and keep it off for 5 years. One reason for this regain seems to be the body's natural tendency to maintain body weight when food is scarce to prevent starvation. Thus, overly restrictive diets can slow metabolism, requiring further calorie restriction to lose weight. Dieting can also have negative side-effects, including depression, anxiety, irritability, obsessive thoughts about food, binge-eating, and not feeling full, even after a binge. The most effective weight loss programs are those that combine diet, exercise, and psychological intervention. According to the Cochrane review, which synthesizes results of the most recent methodologically sound research, increasing the length or intensity of the psychological components of a weight loss intervention significantly improves patient outcomes. In the future, we should see behavioral interventions increasingly becoming the state of the art in weight loss treatment, as they are for chronic pain and other mind-body conditions.

Cognitive Therapy for Weight Loss

Cognitive Therapy for Weight Loss, developed by Judith Beck, Ph.D. is based on traditional Cognitive-Behavioral principles of planning what to eat, scheduling one's day to include food shopping and mealtimes, arranging the environment to support weight loss and planning for "high-risk' situations, such as a friend's birthday party. The program also includes daily reading of written weight loss goal cards and dealing with counterproductive thoughts about food, such as "I deserve this piece of cake" or "I'll never lose the weight." In a Swedish study, the group randomized to receive Cognitive Therapy lost more weight and kept it off over the next 18 months, while those assigned to a waiting list gained weight over the same period.

Mindfulness-Based Eating Awareness Therapy (MB-EAT)

Pay attention to the crunchiness as you eat an apple

MB-EAT, developed by Jean Kristeller, Ph.D. from Indiana State University, is based on the Mindfulness -Based Stress Reduction (MBSR) approach developed by John Kabat-Zinn & colleagues at Harvard and focuses on developing "innate wisdom" about food and appetite. Mindfulness exercises teach participants to tune into their own bodily cues of hunger and satiety as well as what specific taste or texture they are hungry for. There is also a behavioral exposure component, in which participants expose themselves to increasingly tempting situations, including going to a buffet. The focus is on satisfying and pleasurable eating, rather than restriction. A study of obese people and binge-eaters given MB-EAT showed the intervention was more successful than a control condition at reducing emotional eating and depression. There is a new study in progress adding nutritional advice to MB-EAT to enhance the weight loss component.

Biological & Environmental Factors

The factors maintaining excess weight are different for different people, which is why there can never be a "magic bullet" weight loss cure that works for everybody, despite advertiser's claims. A study conducted in Spain and published in the Journal of Clinical Endocrinology and Metabolism suggests that the hormonal biomarkers leptin and ghrelin were able to identify obese people more likely to regain weight after dieting. It is as if their brains were more resistant to hormonal signals of fullness. Other studies have shown that people prone to emotional eating; eating in response to depression or anxiety, are also more likely to regain weight. There is research suggesting a link between childhood abuse and obesity. Environmental factors such as poverty, lack of access to healthy food and exercise facilities, lack of time, and cultural practices also play a part in the weight loss and fitness picture.

Cognitive-Behavioral Coping Skills for Weight Loss

The following behavioral strategies could help your weight loss plan:

Successful weight loss involves learning new life skills

Schedule your day to allow adequate time for buying, preparing and eating healthy food. Set an alarm if necessary so you don't get stuck watching TV or working at the computer.
Stock up on healthy snacks that have a pleasing texture and taste. You may like the crunchiness of carrots, the tanginess of cheese cubes, or the smoothness of frozen yoghurt. Drinking a cup of hot tea with your midmorning or midafternoon snack may make it last longer and feel more satisfying.
Communicate with family and friends and ask for their support in improving your health. Ideally, working on weight together with a friend or family member means you can encourage and support each other and help keep each other on track.
Stay "in the moment" while eating. Avoid eating at the computer, while driving, or multitasking while you eat. Tune into the experience of eating, what tastes and textures you feel like, how satisfying the food is, and what it feels like to be hungry or full.
Remind yourself several times a day of your weight loss goal and how important it is to you. You could paste a picture of a thinner version of you or write your reasons for losing weight on a note card that you keep with you, or put a picture on your desk.
Don't get caught in thinking traps that can derail you from your diet. If you feel that you deserve something extra for being good, reward yourself with an extra snack or a small dessert that only adds a limited amount of calories. If you have a bad day, don't use it as an excuse to go off your diet for a week. Remind yourself that you need to get back on track as quickly as possible to minimize the damage.
Tell yourself "I can do this." Research shows that self-efficacy, or confidence that you can succeed at reaching your goal, is a powerful predictor of future behavior. If you catch yourself thinking negatively, switch to thinking about other situations in which you successfully learned a new behaviorl. Visualize yourself resisting temptation or throwing the extra weight into the ocean to keep motivated.

Successful weight loss involves learning new life skills

These strategies, accompanied by a reasonable nutritional plan, and increased exercise should help you develop a new relationship to food and increase your self-control. Remember to discuss your weight loss plan with a health professional to make sure it is medically appropriate. If you don't succeed at first, keep trying. Sometimes lasting behavior change takes more than one attempt. You are relearning a healthier way of living and developing a new set of skills, which often takes persistence and determination. The rewards of a better quality of life and, possibly, a longer life, will be worth it. One final caveat is necessary, however. If you have other mental health issues, such as depression or unresolved traumas, losing weight alone is not sufficient, and you should seek affordable professional counseling.