"It depends on your goal," I replied. "If you want to stay at 180 pounds, you'll have to keep eating exactly as you have been. If you're willing to gain a few pounds, you can eat a little extra. What's your preference?"
Like many dieters, Jean half-believed that she could somehow magically go "off" the diet and eat exactly the way she used to eat without regaining weight. Although disappointed, she understood the reality of the situation and decided to stay at the same caloric level. Six months later, she raised the level, deciding that being able to eat some more was worth the few extra pounds she'd gain.
The bottom line of the CBT approach is that maintenance is really no different from the losing-weight phase of the plan, and dieters continue to eat in the same way. When the approach succeeds, most skills, such as eating everything sitting down, slowly and mindfully, have become automatic habits by this point. Dieters can reinstitute other techniques, such as reading response cards, on an as-needed basis, whenever motivation starts to slip or they're going through a difficult stretch.
It took Jean just about a year to lose 48 pounds. Initially, we had weekly sessions, and then spaced them out to once every two or three weeks, with brief weekly phone calls. Toward the end of the first year, I was seeing her once a month. We continued to have occasional booster sessions or phone check-ins after that. Jean has now maintained a weight loss of 44 pounds for the past four years—a goal she never thought she'd achieve.
Hope for the Future
Perhaps the most important lesson I've learned from my clients and other clinicians is the necessity of preparing dieters for difficult times. Dieters get fooled when they start a diet. Initially, they find dieting easy. Why? Because they only begin a diet when they're feeling highly motivated, and losing a significant amount of weight the first week—most of which is actually only water weight—keeps them motivated.
But dieting gets harder for everyone after a few weeks or months. Fortunately, dieters don't need to plumb the depths of their psyches to find out why dieting has become more difficult. To lose weight, they don't need to radically change their relationships with other people. They don't need to look for unconscious reasons for abandoning their efforts. They just need to learn basic cognitive and behavioral skills, including motivational techniques to get themselves to use these skills, regardless of how they're feeling. In this way, they can successfully lose weight, much as they've been successful in other areas of life.
In the past 30 years, CBT has been shown to be effective for a host of psychiatric, psychological, and behavioral problems. It's good news that a clear, systematic, easily teachable clinical approach for weight loss and maintenance is beginning to emerge and a scientific foundation for this approach is being established. If the encouraging studies on CBT, like those published in the last few years, continue, we may be entering into a new era—one in which Americans turn away from trendy, often dangerous diet fads and stop wasting billions and billions of dollars. After decades of dismal results for this public-health crisis, a truly effective, empirically supported way of helping people safely and reliably lose weight is finally on the horizon.
Judith Beck, Ph.D., is director of the Beck Institute for Cognitive Therapy and Research and associate professor of psychology in psychiatry at the University of Pennsylvania. Her books include The Beck Diet Solution: Train Your Brain to Think Like a Thin Person and accompanying workbook and The Complete Beck Diet for Life. Contact: email@example.com.
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