Nicole Avena Ph.D.

Food Junkie

Perfectionism and Self-Criticism

These two factors can derail successful weight management.

Posted Apr 27, 2020

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You want to lose weight but you’re not sure which diet to choose. You spend time looking at keto, paleo, intermittent fasting, gluten-free, or the latest fad diet du jour. But are you looking in the wrong places? Did you ever think that your mindset and coping style, which for some people can be displayed as perfectionism or self-criticism, could be just as important to losing weight as which foods you put on your plate or the time of day you’re eating?

One Size Does Not Fit All

The problem with fad diets is that they are uni-dimensional. They generally focus on food alone as the treatment to lose weight despite the complexity of the disease of obesity and the multiple factors that control body weight.  

They also assume that all of us will respond the same way to one diet despite the known genetic and metabolic variability among individuals. One-size-fits-all fad diets will never be the long term solution to managing your weight since they disregard the importance of the variability of each person’s lifestyle.

More specifically, fad diets don’t take into account who you are, how you approach and live your life, how you handle stress, manage your mood, or if you get enough sleep. They also don’t consider whether you eat on the run or have time to cook, your food likes and dislikes, how you handle eating temptations, or whether you move or don’t move your body.

As a physician, researcher, educator and clinical obesity expert, I have been intrigued by the importance of psychosocial and behavioral factors as being some of the most important drivers when it comes to successful weight management. This interest has been the focus of my research and subject of my most recent self-help book, Six Factors to Fit: Weight Loss that Works for You!

Background Research

Early on in my career, I developed a lifestyle habits quiz that captured my observations regarding the eating, exercise, and coping lifestyle patterns that prevented people from losing weight and keeping it off. Perfectionistic and self-critical tendencies were two of the coping issues I observed in my patient population and were included in this quiz.

In 2004, the quiz was posted online and taken by more than 740,000 people from 200 different countries. This treasure trove of information, which represented a diverse group of people from multiple cultures, communities, and lifestyles, allowed me to reorganize and streamline the approach.

Using this data, I teamed up with a biostatistician to use a scientific method called factor analysis which allowed me to take a deeper dive into the quiz responses. I was able to shorten the quiz from 66 to 27 items and simplify the lifestyle habits from 21 down to the current 6 factors.

This new Six Factor Quiz was also independently validated with another group of individuals who completed it online as part of a prospective research study. After the entire process was subjected to peer review, my article "Development of a Six-Factor Questionnaire for Use in Weight Management Counseling" was published in 2016 in the journal Patient Education and Counseling. This validation of the re­search methods and Six Factor Quiz confirmed the basis for the program in my book, Six Factors to Fit: Weight Loss that Works for You!.

Among the six factors identified that are linked to overweight and obesity, three focus on diet and physical activity (Convenient Diner, Easily Enticed Eater, and Exercise Struggler) while the other three address mindset and coping issues (Fast Pacer, All-or-Nothing Doer, and Self-Critic).

Herein I discuss two of the most interesting mindset and coping-related issues that are not typically included in a weight management treatment plan — perfectionism as seen in the All-or-Nothing Doer factor and self-criticism as seen in the Self-Critic factor.

Perfectionistic Tendencies

Those who score high for the All-or-Nothing Doer factor, often display all-or-nothing thinking and perfectionism. This can involve thinking in immoderate, black and white terms – good and bad – with no middle ground.

So when it comes to eating, foods may be either good or bad or you follow the diet 100% or do nothing at all. You may also label yourself as a diet success or diet failure. But to succeed at managing your weight long-term, you need to be able to enjoy moderate amounts of treat foods so you don’t feel deprived. You also need to recognize that slip-ups are part of the healthy weight management process. Being able to moderate one’s goals and focus on progress and not perfection is key to long term success.

In addition to being rigid in thinking, being rigid in habits can also set you up to fail. If you set your goals too high and get discouraged if you don’t reach them, you are likely to get frustrated, feel emotionally distressed, and abandon the diet program entirely.

Life is sure to get in the way of everyone’s plans now and then and being flexible allows you to adapt and make changes. For example, if you can’t get to the health club because you’re too busy, you can still get in more steps (take stairs instead of the elevator, walk the dog longer, pace while talking on a conference call) during your normal day’s routine. Or if you can’t eat your healthiest meal, you can choose the next best option instead and not beat yourself up about it.

Although challenging for the All-or-Nothing Doer, striving to be a B student is a good therapeutic strategy, where 80% of the time you can do well, leaving 20% for life balance and not being perfect. It is also important to adopt a moderate mindset to your weight loss goals and identify other ‘non-scale’ measures of health; noting quality of life changes along the way such as having more energy, feeling less stressed, being more confident, or sleeping better help to mark your progress.

Self-Criticism Tendencies

Those who treat themselves poorly and engage in negative self-talk often score high for the Self-Critic factor. Self-criticism, however, is not a character flaw. Instead, it’s a coping style that may have been learned and triggered in the past due to hurtful or stigmatizing experiences with family members, friends, coaches, teachers, or even health care professionals.

It’s not uncommon for people to blame themselves for being self-critical despite the fact that their negative thoughts may be continually reinforced by others and the media. Weight stigma is also associated with psychological distress such as depression and anxiety.

When self-talk turns negative and self-defeating for those who struggle with weight, this can keep their mood low and deplete them of the energy and focus they need to help themselves lose weight and get healthier. Examples of self-sabotaging thoughts may be: “I shouldn’t have eaten that cake. I’m such a loser” or “Here I go again, I knew I’d start gaining the weight back.” Many of my patients dealing with these issues are surprised to learn the negative impact self-criticism can have on their quality of life and ability to manage their weight. Negative self-talk can lead to overeating, depressed mood, skipping workouts, and lack of motivation.

Self-criticism often leads to distorted thoughts that sabotage one’s weight loss efforts. When this occurs, a technique called cognitive restructuring can help reframe their thinking from self-defeating thoughts to self-helping thoughts. For example, instead of thinking “My feet hurt when I walked around the block during my lunch hour. I will never be able to increase my activity level," you may reframe your thoughts to “It would probably be helpful to change into my gym shoes for my lunchtime walks. Slowly increasing the time I spend walking may also help my body ease into it.”

Acceptance-based approaches that include mindfulness and self-compassion can also help people be more accepting and better follow through with healthy lifestyle behaviors. When the psychological distress from long-term self-criticism poses an insurmountable barrier to improved health and weight loss, I encourage my patients to consider working with a mental health professional who can provide therapeutic interventions to help adopt healthier ways of thinking and feeling.

Perfectionism and self-criticism are just two of the many psychosocial and behavioral factors that can impede weight loss. For this reason, it is important that individuals seeking weight management embark on a program that is personalized for them and provides a multidimensional approach to treatment.

To find out what factors are preventing you from losing weight and keeping it off, you can take my Six Factor Quiz and get your personalized results.

Dr. Robert Kushner is Medical Director of the Center for Lifestyle Medicine at Northwestern Medicine in Chicago, Professor of Medicine, Northwestern University Feinberg School of Medicine, Past President of The Obesity Society, author (or editor) of 12 books, 58 book chapters, and over 200 scientific articles on overweight, obesity, and nutrition and a founder of the American Board of Obesity Medicine that certifies physicians in the care of patients with obesity. His new book, Six Factors to Fit: Weight Loss that Works for You!, designed for individuals wanting to lose weight and the health care providers who counsel them, is published by the Academy of Nutrition and Dietetics. Visit his website and follow him on TwitterFacebook, and LinkedIn.

References

Kushner RF, Kushner N, Blatner DJ. Six Factors to Fit: Weight Loss that Works for You! Academy of Nutrition and Dietetics; 2020.