CBT for Weight Control

CBT for Weight Control

Olivia E Bogucki, PhD

Olivia E Bogucki, PhD

Olivia E. Bogucki, Ph.D. is a medical psychology fellow in the clinical health psychology track at Mayo Clinic. She holds an academic appointment as an Assistant Professor of Psychology at Mayo Clinic College of Medicine. In her clinical practice, she provides short-term evidence-based psychotherapy for a broad range of behavioral health needs in an integrated care setting. Her research focuses on population-level care for mental health conditions, implementation science, and program development and quality improvement within integrated care settings.

CBT for Weight Control

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It can be challenging to control your weight. In today’s modern world, it is more convenient to order take out than to cook a meal and take the elevator instead of the stairs. Over time, a pattern of eating unhealthy foods and being sedentary can lead to excessive weight gain. While many of the factors associated with weight (e.g., genetics, metabolism, finances, lived environment, etc.) are not in our complete control, there are lifestyle factors that can be adjusted. In particular, nutrition and physical activity have the strongest evidence for maintaining a healthy weight.

What you eat has a big impact on your health. Studies have shown that individuals who eat a healthier diet are at lower risks for chronic health conditions like cardiovascular disease and diabetes (Dietary Guidelines Advisory Committee, 2015). Our conceptualization of a healthy diet has seemed to shift over time as different diets have become more or less popular. This can make it challenging to figure out the best way to fuel your body. In general, a healthy diet includes a variety of vegetables, fruits, whole grains, lean proteins, healthy fats, and plenty of water plus limited sugar, sodium, saturated fats, and alcoholic beverages. Overall, the goal is to consume food that allows you to obtain the proper amount of nutrients and calories and fits with your taste buds, cultural traditions, and financial circumstances (U.S. Department of Agriculture and U.S. Department of Health and Human Services, 2020). There are online resources (https://www.cdc.gov/nutrition/) to learn how to eat a healthier diet that fits with the above factors. Additionally, working with a registered dietitian can be helpful for learning about the type and amount of food that your body needs to maintain a healthy weight.

Your health is also impacted by the amount of physical activity that you engage in. Studies have suggested that individuals who engage in greater amounts of physical activity are at lower risk for cardiovascular disease and diabetes (Eckel et al., 2014). While the recommended amount of weekly physical activity is 150 minutes of cardio and two days of strength training, any increase in physical activity is a step in the right direction (Center for Disease Control and Prevention, 2020). There are many different types of physical activity that you can choose from. The trick is figuring out how you enjoy moving your body. Running, brisk walking, swimming, biking, hiking, dancing, and team sports like tennis, basketball, and volleyball all get your blood pumping. While weight lifting is the most common type of strength training, you don’t actually need fancy equipment. Activities like yoga, pull-ups, push-ups, and sit-ups allow you to use your own body weight to strengthen your muscles. There are online resources (https://www.cdc.gov/physicalactivity/) to help you figure out how to fit the right amount of physical activity into your daily life. Tracking your steps or coordinating exercise with a friend or family member can help keep you accountable to your fitness goals. 

If managing your weight is challenging, there are additional strategies that can help. Cognitive behavioral therapy (CBT) is a type of psychotherapy that focuses on the interaction between thoughts, feelings, behaviors, and physical sensations. CBT has been shown to result in greater amounts of weight loss than other strategies that only focus on diet and exercise (Jacob et al., 2018). CBT for weight management specifically targets the behaviors and thoughts related to diet and exercise.

Behavior is one of the main areas of focus in CBT. It can be challenging to establish a dietary and exercise plan in the short and long term due to the lifestyle changes that can be required. Changing nutrition, portion size, and physical activity also means changing the food you purchase at the grocery store, the meals you cook at home or order at restaurants, the activities you do during your free time, and the way your structure your daily life. While it is often tempting to change everything at once, this can be overwhelming and set you up for failure. Instead, it is important to focus on goals that you can actually achieve. Setting SMART, or specific, measureable, action-oriented, realistic, and time-oriented, goals can help you to be more successful in changing your behavior over time. Starting small allows you to build up to your overall goal. For example, try adding one more serving of vegetable to your diet to work your way up to the recommended daily serving of 2 to 3 cups. Tracking your progress over time can create a sense of mastery and control over your behavior and increase your motivation for continued change. Maintaining these changes requires the new dietary and exercise plan to become part of your life. The more that you do something, the more automatic it becomes. However, creating a new habit takes time. In fact, studies suggest that it takes on average 66 days for a new habit to stick (Lally, Van Jaarsveld, Potts, & Wardle, 2010). Of course, there will be days that engaging in your dietary or exercise plan will be hard—if not impossible. This can lead you to give in to temptation or give up on your goals. That is where the skill of targeting our thoughts can help.

Thoughts are the other main areas of focus of CBT. Making and maintaining a dietary and exercise plan can be challenging when negative thoughts come up. The most common types of negative thoughts related to dietary and exercise changes center around deprivation, unfairness, discouragement, and disappointment (Beck & Busis, 2017). For example, you may have the thought that you “need to have a sweet treat to make it through the day” (deprivation), “deserve another serving of cake because everyone else is having one” (unfairness), “did not lose any weight this week so it is not worth trying” (discouragement), or “should have been able to run the whole mile rather than walk a lap” (disappointment). These thoughts can have a big impact on the how you feel and behave. Feelings of sadness, frustration, apathy, guilt, or shame can lead us to make unhealthy choices, give ourselves permission to break our plans, or completely give up on our goals. Luckily, changing these thoughts to be more accurate, helpful, and compassionate can have a big impact on feelings and behaviors. By decreasing the strength of negative emotions, you are more likely to behave in a way that aligns with your dietary and exercise goals. While noticing and changing your thinking patterns is often very challenging at first, it does become easier over time.

Managing your weight is a process. The good news is that you have the chance to make healthier choices every day. If you find that you are having a hard time identifying, implementing, or maintaining your dietary and exercise goals, CBT for weight management can be helpful. While working with a therapist is one possibility, CBT-based apps like Noom are an accessible and affordable option. These apps not only put CBT-based strategies and skills in the palm of your hand, but are backed by research. Over 75% of app users lost weight by tracking their progress on their dietary and exercise goals (Chin et al., 2016). Whatever strategy you choose, improving your diet and increasing your physical activity is step towards a healthier life. 


References

Beck, J. S., & Busis, D. B. (2017). The diet trap solution: Train your brain to lose weight and keep 
it off for good. Hay House, Inc.

Center for Disease Control and Prevention. (2020). How much physical activity do adults need? 
Retrieved from https://www.cdc.gov/physicalactivity/basics/adults/index.htm

Chin, S. O., Keum, C., Woo, J., Park, J., Choi, H. J., Woo, J. T., & Rhee, S. Y. (2016). Successful 
weight reduction and maintenance by using a smartphone application in those with 
overweight and obesity. Scientific Reports, 6(1), 1-8.

Eckel, R. H., Jakicic, J. M., Ard, J. D., de Jesus, J. M., Houston Miller, N., Hubbard, V. S., ... & 
Yanovski, S. Z. (2014). 2013 AHA/ACC guideline on lifestyle management to reduce 
cardiovascular risk: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Journal of the American College of Cardiology, 63(25 Part B), 2960-2984.

Jacob, A., Moullec, G., Lavoie, K. L., Laurin, C., Cowan, T., Tisshaw, C., ... & Bacon, S. L. (2018). 
Impact of cognitive-behavioral interventions on weight loss and psychological outcomes: A meta-analysis. Health Psychology, 37(5), 417.

Lally, P., Van Jaarsveld, C. H., Potts, H. W., & Wardle, J. (2010). How are habits formed: 
Modelling habit formation in the real world. European Journal of Social Psychology, 
40(6), 998-1009.

U.S. Department of Agriculture and U.S. Department of Health and Human Services. (2020). 
Dietary guidelines for Americans, 2020-2025. Retrieved from 
https://www.dietaryguidelines.gov/

Dietary Guidelines Advisory Committee. (2015). Scientific report of the 2015 dietary guidelines
advisory committee: Advisory report to the Secretary of Health and Human Services and the Secretary of Agriculture. Retrieved from https://health.gov/our-work/food-nutrition/previous-dietary-guidelines/2015/advisory-report

Olivia E Bogucki, PhD

Olivia E Bogucki, PhD

Olivia E. Bogucki, Ph.D. is a medical psychology fellow in the clinical health psychology track at Mayo Clinic. She holds an academic appointment as an Assistant Professor of Psychology at Mayo Clinic College of Medicine. In her clinical practice, she provides short-term evidence-based psychotherapy for a broad range of behavioral health needs in an integrated care setting. Her research focuses on population-level care for mental health conditions, implementation science, and program development and quality improvement within integrated care settings.

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