How to help people lose weight

A huge number of people come for guidance for weight change. Frustrated individuals go everywhere, to slimming clubs, bootcamps, to learn why they cannot succeed at weight loss, in the expectation that if they find the reasons for their “lack of willpower”, they will emerge sylphlike from the therapy room with their relationship with food corrected. These clients hope and are led to believe by unspecialised therapists, that they will find an explanation for their failure to lose weight in their childhood adversity, their poor attachment experiences or other traumas. Some clients even think that a hypnotist will convince their rampant unconscious to make a piece of chocolate taste like an onion.

Neither hypnosis nor counselling do the trick. Some therapists have built their reputations on attachment or trauma explanations for obesity, the thinking is that if you have had poor attachment experiences in childhood, you will be unable to use others or your own missing capacity for self- soothing and hence will develop an addictive relationship to substances like chocolate to get you through the slings and arrows  of life. It is a persuasive argument that has poor outcomes for changing someone’s weight. 

Weight-loss therapy rests on the premise that to lose weight (if this is the outcome) several things must come together. There must be Intention, this is about why a person wants to lose weight, and when. A person might want to embark on weight loss, but not yet- and maybe never, because one way of dealing with a problem is to ignore it.

To lose weight, intention has to move into Action, that is all the behaviours that are designed to make change possible. Please don’t assume from this that Action means “dieting” or “going to the gym”.  The intention-action gap is a bridge that is easily broken by temptation, other people or boredom among other things, or by having a very disordered relationship with food.

 It is the therapist’s job to help the client to bridge the intention-action gap and to make many different behaviours sustained for life. Whether you think of obesity as a disease or a moral failure or a curse, people who lose weight and maintain it must change some habits for life. This is the hardest thing of all.  

The weight-loss therapist needs to understand intention and the intention-action gap with compassion and academic wisdom – not with strong opinions and fixated ideas.

Let’s look at Intention to lose weight. Motivation to change is not the same as desperation, although many people who want weight-loss are desperate; they feel bad, moving hurts, maybe they are sick;   or diabetic, they don’t like looking in the mirror and they restrict many of the day-to-day pleasures that they think are allowed for slimmer folk.  I accept a client’s reasons for wanting weight loss, unconditionally and without judgment. I do not show myself enthusiastic about their wish to change their weight. I just  work quietly on what their Intention is about and leave decisions up to them.

The wish to lose weight comes from surface wants like “I want to be able to fit into normal clothes”  and also from deeper existential issues such as wanting to “be” different or to have a different kind of life. Intention is shaped by questions such as – what kind of person would I be if my weight were to change?  Would people who love me / approve of what I want to do, or would I be stepping outside of a family identity?   If I were to lose weight would I be hungry all the time? Will I have to sacrifice too many  nice things?  Would I be able to eat my favourite foods? Would I be the boring person at the party?  Would I be giving away my power to all the people who have said I should lose weight? What will be the costs of not losing weight; do I think I have it in me? Do I really want to follow someone else’s dumb rules. And last but not least, as an example, if I were to lose weight, would I get something really important out of it, like living to see my grandkids grow up. I don’t want to be driven by my hungry needy inner child.

So how do we think about Action? Does it mean going on a diet or going to the gym? Does it mean striving to reach a goal weight?  The answer is no.

Action, strangely enough, doesn’t target weight-loss as a treatment goal. Goal weights are heinous. Action therapy targets the vast range of behaviours and the attitudes that shape our behaviours, that make permanent weight-loss more likely.

Action therapy nudges clients toward some principles of weight change that are known to work, such as eating s…l…o. .w. .l. .y or,  getting rid of the biscuit tin. We are all wired to eat what is in front of our nose. Your kids don’t need biscuits; and I promise that they won’t need psychiatric help because you don’t have a fridge full of KitKats). Action might be something as small as not eating your main meals in front of the TV.  It might mean buying smaller Easter eggs, the day before Easter, not in the middle of January.

Action behaviours are affected by many things, each needing therapist attention or skills work. Old habits, stigma, people who do their best to sabotage you or, simply where you live. Certain skills are helpful, such as cooking, being able to read a food label; or saying no to the children who pester you for crisps in Tesco. Skills for managing cravings do not require years of psychotherapy. There are simple do-able tools that really work. Willpower is simply a neurological muscle we use to manage impulses and compulsions and we know how it can be strengthened.

The Intention-Action Bridge is weakened by unhelpful attitudes that keep a person stuck in their unhappy relationship with food. Limiting beliefs such as “I will die without my treats, or, I should never eat chocolate (or I will be a pathetic weak person) or, I was born to be big so there’s nothing can be done about it – all these mind-worms can be changed. Even an automatic belief like I shouldn’t have eaten that, What’s the point – I may as well carry on eating and I will start again next week.  We can erase this kind of thinking from a person’s mind.

Emotional eating

If we keep the intention-action gap as our central focus for obesity therapy, obviously there are many barriers that thwart Action. One such barrier is emotional eating. Most people with obesity claim that comfort eating is the root of their weight issues. And most therapists believe that it isn’t about food, it’s about feelings. They may be wrong.

Where emotional eating is severe, our person may have an eating disorder and they must not to try weight loss right now. Direct them to an eating disorder therapist. But moderate levels of emotional eating can be treated. This is not the place to describe how we deal with food cravings or undue attachment to foods like chocolate. Suffice it to say that person-centred counselling, dealing with trauma, childhood adversity or adverse attachments all have unsatisfactory outcomes for modifying eating that has little to do with hunger.

When you think about obesity therapy, let go of the notion that we are putting people on a diet or forcing them to change a lifestyle that they know and love, in which they feel comfortable and that is part of their larger system of friends and families. People who shout negatively about obesity therapy remind me of the saying it is the emptiest vessels who make the most noise. Come and see how the right obesity therapy can make a person flourish. Our next training, Essential Obesity, is coming this June. do itnow!