Why is it so difficult to lose weight and keep it off? By now, the "how" is no mystery: everybody knows the drill, whether you want to lose 2 pounds or 200. Just decrease your calories and get more exercise. And millions of people routinely set off with high hopes determined to do just that. Nevertheless, study after study indicates that while many succeed in losing some weight, the long-term results are overwhelmingly poor. The unfortunate reality is that if there's one thing as common in America as someone on a diet, it's someone who's fallen off a diet---who's gradually (or quickly) regained every ounce he or she struggled to lose, often adding pounds along the way. Why is it so hard to stick to a healthy eating plan and a reasonable exercise regimen?
From the viewpoint of Cognitive-Behavioral Therapy (CBT), the reason isn't hard to find: knowing what to do and knowing how to get yourself to do it are entirely separate skills. When it comes to changing behavior, especially long-term, habitual patterns, getting yourself to do something different, even when you know it's good for you, depends largely on what you tell yourself: that is, on your thinking.
For example, let's say you're at a dessert party and see five really delicious pastries. Will you end up eating too much? You probably will if you think, I don't care. I don't want to deprive myself. It isn't fair that everyone else gets to eat whatever they want, and I have to settle for one small piece. By contrast, if you say to yourself, "I'm going to pick my favorite dessert. I'll eat one small piece slowly and enjoy every bite. I know I'm going to feel so proud of myself," you stand a much better chance of not overeating.
Like depressed clients---or those with anxiety, substance abuse, or eating disorders---people who repeatedly find themselves unable to regulate their own weight typically can't get past their negative, dysfunctional thinking. After many years of practice, it's clear to me that to achieve their goals, unsuccessful dieters don't need to uncover hidden motivations or explore the hypothesized childhood origins of their problems. Instead, they need to learn how to address the dysfunctional thinking that leads to overeating.
I've developed a program for nonpsychiatric (and noneating-disordered) individuals that utilizes the basic principles of CBT to address overeating directly.
Perhaps the most basic tool that helps clients learn the cognitive skills they need to adhere to their diets is the use of index cards on which they write messages they'll need to read when they're tempted to overeat. They develop the practice of reading "response cards" containing these helpful messages every morning and at least one more time, at their most vulnerable part of the day. Here are a few examples of response-card messages:
- I can eat whatever I want, whenever I want, or I can be thinner. I can't have it both ways.
- Hunger and craving always pass. I can make them go away faster by focusing my attention on something else.
- My body doesn't know it's a holiday. It'll process food in exactly the same way as on other days.
Reading these cards daily, even when motivation is high, allows dieters to immerse themselves in crucially important ideas that prepare them for the inevitable difficult times, especially the thoughts that lead to negative, motivation-sapping emotions: This is just too hard leads to discouragement. It's not fair leads to anger and a sense of deprivation. I really want to eat this right now leads to disappointment. Dieters can't prevent these sabotaging thoughts from entering their minds, but if they've been practicing helpful responses, they'll be able to deal with them and modify their habitual eating behavior.
Successful Weight Loss and Maintenance
The single most important lesson I learned early in my work with dieters is that it's a mistake to ask them to develop the cognitive and behavioral skills they need to stick to a diet at the same time they actually start their diet plan. It's too difficult for most people to change their eating plan and simultaneously learn the skills that will enable them to stick to it. Instead, I've developed a 5-stage program, in which dieters don't change when they eat or what they eat until they've mastered basic skills. It follows this sequence:
Stage 1: Developing pre-dieting skills (learning how to stay motivated, getting oneself to use good eating habits, dealing with hunger and cravings, and recovering immediately from an eating mistake)
Stage 2: Regularizing eating (eating according to a schedule)
Stage 3: Changing food selections (making changes that one can continue to follow for a lifetime)
Stage 4: Planning for special occasions (making decisions in advance that allow one to eat more flexibly)
Stage 5: Staying motivated for life---especially when the scale stops going down, or there's a lapse or relapse
There's no special "maintenance phase." When dieters' weight reaches a plateau, they keep on eating in the same way they did when they were actively losing weight. Whatever changes dieters make in their eating, they make permanently.
Hope for the Future
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.
This blog is excerpted from “I Think, Therefore I Eat." Want to read more articles like this? Subscribe to Psychotherapy Networker Today!
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