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Sunday, October 31, 2010

Learn What Works Better Than Dieting for Weight Management

Research shows 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 your body's natural tendency to maintain body weight when it detects that food is scarce. Thus, dieting can slow metabolism, requiring further calorie restriction to lose weight.  Severe calorie restriction causes negative psychological effects, including depression, anxiety, irritability, obsessive thoughts about food, binge-eating, and not feeling full even after a binge. 
As psychologists and counselors, we have much to contribute in the weight loss arena. The most effective weight loss programs are those that focus on  nutrition, exercise, and psychological intervention. According to a recent Cochrane review, which aggregates results of many research studies, increasing the length or intensity of the psychological aspects of a weight loss intervention significantly improves patient outcomes.

Cognitive Therapy 

A psychological intervention for weight that has some research support is Dr Judith Beck’s Cognitive Therapy for Weight Loss. Cognitive Therapy is based on traditional Cognitive-Behavioral principles of planning what to eat, scheduling your day to include food shopping and mealtimes, arranging your 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 flashcards and countering counterproductive thoughts about food, such as “I deserve this piece of cake” or “I’ll never lose the weight.” In a Swedish study, a group that received Cognitive Therapy lost more weight and kept it off over the next 18 months, while those assigned to a waiting list control group actually gained weight over the same period.  

Mindfulness-Based Eating Awareness Therapy (MB-EAT)

MB-EAT  is based on a mindfulness philosophy 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 tastes they are hungry for (e.g., salty vs. sweet). There is also a behavioral component in which participants learn to tolerate 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 that this intervention was more successful than a waiting list control condition at reducing emotional eating and depression.

A multi-faceted problem

It is important to keep in mind that 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 advertisers' claims to the contrary.  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. Other studies have shown that people prone to emotional eating, that is eating in response to depression or anxiety, are also more likely to regain weight. There is a research link between child 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. Finally "fat shaming" and stigma create extra stress for our patients that can interfere with weight loss efforts.

Final Thoughts

As psychologists working with overweight or obese patients, we need to individualize treatment to our clients’ lifestyles, biological makeup, and emotional and environmental factors. We also need to use approaches that have research support. We should work collaboratively with other professionals, such as exercise trainers, nutritionists, and doctors, to most effectively help the patient. The rewards of this work are that you can teach people new healthy lifestyles that should help to improve both the quality and quantity of their lives. Finally, it is important to assess and treat shame and low self-esteem issues in patients with disordered eating. We need to empower patients psychologically as well as changing behavior!  
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