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By Jane St. Clair

Cognitive behavioral therapists have been helping alcoholics and drug abusers recover from addictions for decades. Now promising new research indicates that they might be able to help people achieve permanent weight loss. If the research holds up, cognitive behavioral therapy (CBT) will become one of just a few treatments proven to be medically effective for weight loss.

While anyone will lose weight by making physical changes such as eating less and exercising more, few people are able to keep weight off permanently. This is because they need to make mental changes – they need to learn to think like thin people – and that is exactly what cognitive behavioral therapists teach them to do.

One Swedish study of 107 obese people found that the group who underwent CBT for 10 weeks lost 17 pounds while those who had no interventions gained weight. Eighteen months later, the CBT group had lost another five pounds, while the control group was still gaining. Another study that used brain-scanning technology found that CBT actually causes changes in the brain stem and cortex areas (Beck).

Why Is Maintaining Weight Loss So Difficult?

Maintaining weight loss is difficult for several reasons. First, it takes a heroic, sustained effort to decrease calorie intake and increase your exercise time. Studies have found that constant self-monitoring – writing down your calories and keeping an exercise diary – works. One study found that if you count anything, whether fat grams, carbohydrates, calories, fiber grams, or whatever, you will lose weight.

However, these steps take a lot of time and must be a priority. Just skipping one day will cut a week’s weight loss in half. Most people, especially those with a genetic tendency to be overweight, become discouraged because it takes so much time and effort to make a little progress. Cognitive behavioral therapists can help them by serving as personal coaches who look over their daily charts.

Another pitfall in weight loss is that most overweight people believe that losing weight will radically change their lives. They are among the 56% of women and 43% of men who are dissatisfied with their bodies. Typically, they want to lose between 10% and 30% of their body weight, but reach a plateau after losing about 10%. The loss may not fulfill their goals of becoming more self-confident, popular, attractive, or achieving advancement at work. Their effort goes unrewarded, and they give up.

What Does CBT Do?

Cognitive behavioral therapists can help overweight individuals realize that self-confidence is not just about physical appearance. For example, some studies show that normal weight teens who believe they are overweight have the same suicidal thoughts as those who are actually overweight. Therapists can help them set more realistic goals and expectations, and to understand that losing small amounts of weight over the long term is an amazing achievement.

Another way CBT is effective is by helping the person get rid of negative, defeatist thinking. For example, many overweight people overreact to feelings of hunger. A thin person will feel hungry but just wait until it is mealtime. Many overweight people eat because of external cues, such as food commercials on television, food smells, or because others are eating.

People on weight loss regimes also sabotage themselves by such self-defeating thoughts as “I lost weight so now I can go back to eating what I want,” or “I exercised today so now I can eat more.” Many allow a small indulgence to turn into a food binge by thinking “I blew my diet today so I may as well just let loose.” Staying on the regime without losing weight can be so difficult that many people give up. Their attitude becomes, “No matter what I do, nothing will work.” A cognitive behavioral therapist can help them question such assumptions, affirm the progress made so far, and change negative thought patterns.

When CBT is used for weight loss, usually the individual sees a therapist once a week for eight to 12 weeks. Some therapists help clients self-monitor every day by phone or email.  Cognitive behavioral therapists do not psychoanalyze or talk about childhood issues. Rather, the therapy is short-term and goal-oriented. It has been effective on children and young people enrolled in weight loss immersion programs such as weight loss summer camps and weight loss boarding schools. Once they return home, their therapist may continue working with them via computer.

The medical profession is actively looking for proven solutions to America’s obesity epidemic. Over half of all American adults are overweight as are one-third of our children. Medication might work in the short run. Stomach surgery is effective only if the patient maintains lifestyle changes over time. Cognitive behavioral therapy may become one of the few breakthrough treatments science is searching for.


 


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