Cognitive Therapy for Permanent Weight Loss
©Tom Moon, MFT, 2008

 

Q: When I was a boy I was so skinny that my nickname was “Scarecrow.” Not any more. Beginning at about age 25, I started putting on extra pounds. It used to be easy to lose them by going on a crash diet, but I’ve never been able to keep the weight off, and with every year I’ve gotten bigger and bigger. Now I’m officially in the obese category. I have high blood pressure and high cholesterol, I’m pre-diabetic, I’m low-energy all the time, and my doctor told me that unless I get control of my weight I’m setting myself up for a heart attack. My weight has ruined my sex life. I have a handsome face, and guys used to think I was hot, but as heavy as I am now the men I want won’t give me the time of day. I don’t need to look like a movie star! I’d be happy if I could just have a healthy weight, but I’ve tried every diet under the sun, and they all just leave me right where I started. To tell you the truth, I’m feeling depressed and hopeless about my prospects. Have I been fooling myself in thinking I could ever get thin again? Am I just one of those people who are doomed to be fat?

A: I have two suggestions. The first thing you probably need is some hope, so I suggest you access the website of the National Weight Control Registry (nwcr.ws). This organization was formed to counter the common belief that people can’t succeed at long-term weight loss. The NWCR is currently tracking over 5,000 people who have lost significant amounts of weight and kept it off for long periods of time. It’s identifying the behavioral and psychological characteristics of weight maintainers, as well as the strategies they use to maintaining their weight losses. You might find some valuable information as well as inspiration on this site.

I’m sure you already know this, but it bears repeating: there’s no point in going on another “crash diet” to lose weight, because, as you’ve discovered, as soon as you go off the diet and return to your old eating habits, you’ll gain it all back. Your challenge is to commit to a healthy eating plan you can live with for the rest of your life. But before you can do that, you finally have to accept and come to terms with the fact that your childhood days of eating whatever you want are over. But don’t think of that as a unique hardship. You’re actually in good company: virtually everyone restricts their eating in some way, women beginning in their teens, and most men by age 45.

Over time, your eating plan needs to become as automatic and second-nature as brushing your teeth every morning. That’s a major challenge because our eating habits are maintained by a whole matrix of thoughts, feelings, attitudes, and habits which have to be overhauled for any meaningful change to occur. One reason so many people fail at dieting is because they see the problem exclusively as an issue of restricting their eating and give little or no attention to the many psychological changes that have to occur to maintain long-term compliance with their plan.

So my second suggestion is that you pick up a copy of The Beck Diet Solution, by Judith Beck. Despite its title, this isn’t yet another diet book. It’s a six week psychological self-treatment program which applies the tested principles of cognitive therapy to the issue of permanent weight loss. The stated goal of the program is to “train your brain to think like a thin person.” It doesn’t recommend any particular diet plan; instead it teaches you how to diet.

So, for instance, the program teaches students to distinguish between genuine hunger and food cravings (hint: hunger is usually felt as a pang in the stomach and craving as an uncomfortable yearning in the mouth and throat); and offers practical strategies for coping with cravings, stress, and strong negative emotions without resorting to emotional eating. Through specific exercises students learn to stop treating the feeling of hunger as if it’s an emergency; and to learn to treat bouts of overeating as a temporary and solvable problem, not a catastrophe.

Here’s Beck’s description of her program “…“…you’ll learn crucial Cognitive Therapy techniques that you’ll use for the rest of your life. They include planning what you eat, choosing healthy foods, resisting cravings, soothing yourself without turning to food, using good eating habits, and exercising, to name but a few. You’ll also learn essential skills to counter sabotaging thoughts that would otherwise lead to overeating, demoralization, and giving up.” Obviously, none of this is a walk in the park. Changing lifelong habits will require sustained effort, time and patience. But solid research and the success of many thousands show that it’s rational for you to believe that, if you do the work, you can finally gain permanent control of your weight. I suggest you give this program a try.