Managing Your Weight

How a Psychologist Can Help

When you consider the professional services typically provided by a psychologist, you may think of evaluation and treatment for mental health issues, such as depression, anxiety, or even severe forms of mental illness like schizophrenia. Even in the absence of diagnosed psychological conditions, psychologists can help individuals work through relationship problems, family turmoil, or other difficult life circumstances or stressors. While psychological services are often an important part of treatment for all of these conditions and situations, psychologists can also play a very important role in improving behavioral and physical health conditions and outcomes for clients. Indeed, some psychologists are trained and experienced in helping clients improve self-management of chronic medical conditions, including diabetes, heart disease, and obesity.

Changing behaviors

Weight loss is a common goal for many individuals with diabetes. Losing weight can result in significant improvements in diabetes control and the prevention of diabetes-related complications. Weight-loss efforts including lifestyle modifications involve numerous behavioral changes related to energy intake (eating) and energy expenditure (physical activity). Changes to your diet typically focus on reducing calorie, fat, and/or carbohydrate intake. Increasing your physical activity may include starting or intensifying a formal exercise program and/or increasing your level of informal physical activity. Psychologists are specifically trained to help individuals modify all sorts of behaviors, and this can include efforts to modify your eating habits and level of physical activity.

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In addition to behavior changes directly related to what you eat and how much you exercise, weight-loss programs target many other behaviors that have been shown to help people lose weight safely and effectively. These other strategies include regularly monitoring your food intake, including counting calories and fats, as well as consistently weighing yourself to see what effect your actions are having. Other important skills include learning to problem-solve and deal with difficult situations that can derail your progress, as well as learning to effectively set goals for yourself. As you navigate the challenges of behavior change, stress management and time management can also be important tools for success. An experienced psychologist can help you develop and refine these self-management skills that will be important for your weight-loss success.

Not just food and exercise

Successful weight loss involves more than simply changing your eating behaviors and exercise routine. While these external behaviors are the foundation of a successful weight-management plan, it is also important to address your “internal behaviors.” These include your emotional responses and mental interpretations of various situations and circumstances.

Do not underestimate the influence of your thinking, or “self-talk,” on how you respond in situations and the healthy (or unhealthy) choices you make related to food and physical activity. This self-talk includes how you interpret situations and how you evaluate your abilities to make healthy lifestyle choices in these situations. What you think to yourself about your own abilities, as well as the intentions of others, can influence how successfully (or unsuccessfully) you deal with other people and challenging social pressures that you encounter.

Sometimes your thoughts may become overly critical, negative, or even irrational. This type of negative self-talk can be very destructive to your motivation and confidence to stick with your healthy lifestyle plans. Psychologists and other mental health professionals can help you learn to identify negative and destructive self-talk and develop more productive and accurate ways to think about yourself, others, and situations.

To further illustrate how eating behaviors, thoughts, and emotions are closely connected, consider all of the various reasons you may experience an urge to eat. People tend to eat for many different reasons, including a response to negative emotions such as sadness, boredom, anger, or frustration. Sometimes food serves as a reward for a job well done or as a comfort following some disappointment. On some occasions it is an integral part of a social gathering or special event, or food can simply be associated with particular activities through repeated habits (such as eating popcorn when watching a movie).

These examples illustrate the points that 1) eating is not just about food, and 2) people sometimes eat for reasons other than physical hunger. Food can serve many different purposes in your life beyond simply replenishing your energy supply.

Given the numerous ways in which food is used and the many reasons a person may eat, it is important to learn to identify what triggers you to eat so that you can learn to adopt different responses in those situations. Whether you are an emotional eater, a social eater, or have other triggers, a psychologist can work with you to identify your specific triggers, what roles eating and food play in your life, and how to modify these responses in healthier ways that can also help you lose weight.

Healthy body image

Your thoughts and feelings about your body shape and size, or your body image, are also important to address as you attempt weight loss. Consider the example of two individuals who both decide to lose weight and both weigh the same initially. The first person loses 50 pounds, yet she still feels very unhappy with her body when she looks in the mirror. She focuses mostly on her “problem areas” that still need work. The other person loses 10 pounds. Although she has more weight that she would like to lose, she focuses on the improvements she can see in her body shape and size and feels more satisfied with her body.

These examples illustrate several points, including the following:

• Your actual body weight and your perceived body image may be related but are distinct constructs.

• Simply losing weight does not guarantee improved body image.

• Learning to adopt a healthy and positive body image is important regardless of how much weight you lose.

Negative self-talk (what you feel and say about yourself) can make you feel very unhappy about your body. Psychologists can help you identify and challenge these negative and critical thoughts with more positive and accepting self-talk so that your weight loss can be accompanied by improved body image as well.

Long-term weight management

Losing weight requires a multitude of behavioral and cognitive changes that are not always easy. If you have ever lost weight and then tried to keep it off, however, you may agree that keeping the weight off for the long term is the greater challenge. Why is long-term success so elusive? In addition to several physiological processes at work within your body that may fight against maintaining a steady, reduced weight, there are a variety of environmental and psychological factors that can interfere with your success.

First, most people today live in an environment in which they are surrounded by cues that promote unhealthy behaviors, including the intake of high-calorie, high-fat foods. The environment also promotes a lot of sedentary behaviors that minimize your opportunities to burn extra calories. Also, there are numerous social situations in which high-calorie foods are typically available, and there may be people pressuring you to eat at these occasions.

In addition to these external factors that can hinder your long-term success, individuals who have lost weight and are trying to keep it off sometimes report feeling bored and frustrated with the continued requirements to self-monitor and record their food intake, plan their meals, maintain a reduced-calorie diet, engage in regular exercise, and stick with all of the other strategies that are important for weight management.

Similarly, the very process of weight loss can become less reinforcing over time. For example, when someone is first losing weight, he may have more energy, his clothes may fit better, his doctor may notice improvements in his medical conditions, and significant others may notice and compliment him on his weight loss. Over time, however, these reinforcers tend to decrease and become less frequent. After all, maintaining the same (albeit healthier) reduced weight is less rewarding for many than the weight reduction experienced earlier on in the process.

Another “psychological” challenge to long-term weight management is the differing strength or value placed on short-term versus long-term consequences and rewards for engaging in weight-loss efforts. For any lifestyle changes you want to make, there are potential positive benefits (pros) as well as negative consequences (cons). Some very important and valued benefits may include improving the control of your diabetes, preventing diabetes-related complications, having better mobility and energy, and perhaps even extending your life! While these are very desirable and achievable outcomes, most of these are not fully realized until much later on (potentially years later).

Balanced against these long-term benefits are certain costs that go along with behavioral changes associated with weight loss. For instance, you may feel like you are giving up some of your favorite foods, exercise may make you feel sore or tired at first, you may feel like your routines are disrupted, etc. Unfortunately, many of these negative consequences or costs are experienced right away. Thus, some of the short-term effects of weight loss can be negative, while the long-term effects are quite positive. However, it can be challenging at times to persevere through the negative consequences experienced early on to achieve these long-term benefits.

Collectively, all of these factors can make long-term weight management challenging. Psychologists can offer support in several ways by helping you do the following: 1) Develop and stick to your new, healthier habits; 2) Tackle your negative thinking or destructive relationships that are getting you off-track; 3) Effectively cope with slips when they occur; 4) Structure your routine and environment to reduce your exposure to high-risk situations and/or learn better strategies to deal with them when they occur; and 5) Maintain your motivation as you pursue your weight-loss goals.

Reasonable goals

The good news is that many people successfully lose weight as part of a lifestyle approach focused on dietary changes, increased physical activity, and other behavioral strategies, and long-term success in keeping the weight off is possible. It is also important to note that even a modest amount of weight loss, ranging from 5% to 10% reductions, has significant health benefits for the prevention and management of many medical conditions, including diabetes.

Several organizations, including the Institute of Medicine and the National Institutes of Health, have concluded that this is an appropriate goal for improving health and quality of life for overweight and obese individuals. Keep in mind that this amounts to a weight loss of 10–20 pounds for an individual initially weighing 200 pounds.

Seeking the assistance of a psychologist

If you are interested in trying to lose weight and think that a psychologist or other behavioral health specialist may be helpful to you, then there are a few practical tips to consider as you explore your options. Consider consulting your primary-care physician or specialty provider about a referral to a psychologist. Your physician may have recommendations or working relationships with psychologists who offer this type of service. Also, if your insurance coverage includes behavioral or mental health services, you should be able to obtain from your insurer a list of licensed psychologists who you can then contact to get additional information about their services, availability, specialty, etc. Ideally, try to identify a psychologist who offers specialized services related to behavioral medicine, health psychology, weight loss, and/or the management of chronic medical conditions.

Whether you seek the assistance of a psychologist or other health professional, a self-help group, or an informal support network of family members or friends making similar lifestyle changes, or elect to do it on your own, remember that weight loss is an achievable and worthwhile goal. If you are currently struggling to manage your weight and are interested in losing weight, the physical and mental benefits of weight loss can be significant.