Eating a healthy diet and exercising sound like easy ways to lose weight, right? Although it sounds simple, losing weight is difficult for many people. This module discusses why losing weight can create a mental challenge. It also reviews the various resources that are available to help and support you and how you can obtain that help.
Why Might I Need Psychological or Social Support While Losing Weight?
The relationship between weight gain and mental health is complicated. How do we know which one comes first—the mental-health issues or the weight gain? However, just because you are gaining weight, it doesn’t mean that you have mental-health issues or a psychiatric disorder. And, even if you suffer from a mental-health problem, it doesn’t mean that you will gain weight. Psychological support and social support while losing weight is important to jumpstart and to maintain your weight-loss efforts.
Why Is Psychological Support Important?
Studies have shown that being diagnosed with overweight, obesity, or severe obesity might be associated with psychiatric conditions (e.g., major depressive disorder [MDD], dysthymia, bipolar disorder) or personality disorders (e.g., antisocial, avoidant, schizoid, paranoid, obsessive-compulsive personality disorders) (Petry et al, 2008).
Most people with overweight or obesity do not have a mood disorder (e.g., depression). It has been shown, however, that those who seek help for their mood disorder might have excess weight. Additionally, mood disorders are common in those who are seeking help for obesity. Some researchers have suggested that depression might subside after you complete a weight-loss program (e.g., if your depression began after your weight gain), but if you are obese and suffer from a mood disorder, both need to be treated for effective weight loss (McElroy et al, 2004).
Severe obesity is not only associated with depression, but also anxiety disorders, particularly in women (Scott et al, 2008). With anxiety comes an increased level of cortisol, a hormone that increases your appetite (especially for sweet food) and stimulates growth of fat deposits in your abdominal area (see Figure 15-1). Increased levels of cortisol have been found in individuals who are obese or have a large waist circumference (Jackson et al, 2017).
Difficulties with emotional regulation are also associated with higher weight (Kass et al, 2017). Although you might not be aware of it, one of your main coping skills when you are stressed or depressed could be emotional eating. Emotional eating involves eating without being hungry. You might eat for comfort when you are stressed, sad, or angry. It is important to learn effective coping skills to deal with stress and depression instead of emotional eating. Rather than eating to cope, healthy coping skills include deep breathing, the practice of yoga, or use of other relaxation techniques.
Children, especially girls with overweight and obesity, have lower self-esteem. Children with low self-esteem usually feel lonely, sad, and engage in risky behaviors (e.g., smoking cigarettes, drinking alcohol) (Strauss, 2000). Additionally, low self-esteem is linked to poor body image. As such, the best way to assist with weight loss in adolescents is to promote proper eating habits and physical activity, while focusing on positive attributes through psychological support (Peas et al, 2000). Whether you have a psychiatric disorder or not, psychological support during attempts to lose weight is beneficial for maintaining a healthy outlook on the weight-loss process.
Why Is Social Support Important?
Most activities are more fun when done with someone else. Individuals who commit to weight-loss programs with a friend obtain benefits, as well. Working out with a friend can increase your commitment and your enjoyment from the program. Roughly two-thirds of those who joined a weight-loss program with a friend maintained their weight 6 months after the program ended, as compared to those who joined the program alone (Wing & Jeffery, 1999). For children, it helps to have peers and family members working toward the same goal, all committed to the program. Increased family satisfaction and how happy a parent is with their life is associated with a child’s successful weight loss (White et al, 2004). Whether you are trying to lose weight or you know someone who is losing weight, it is beneficial to have a support system to facilitate motivation and to stay positive during and after the process.
What Are Group Therapy and Overeaters Anonymous?
Several types of therapy are beneficial for weight loss. You can participate in group therapy or individual therapy depending on your preference. You can even combine them. Within group therapy and individual therapy, there are a variety of approaches.
Group therapy usually involves five or more individuals with one or more psychologists or other licensed mental-health professionals (e.g., licensed clinical social worker, psychiatrist). The groups typically meet at least once a week for an hour or more to discuss a specific topic, emotional response, or behavior. According to the American Psychological Association (APA), group therapy is beneficial for several reasons:
- Members of the group form a support network and are there to help you with ideas on how to deal with certain situations.
- You gain perspective on your problems by listening to the struggles of others.
- You learn from different people who come from diverse backgrounds and have varied personalities. Group therapy helps you put yourself in someone else’s shoes and think about different approaches when you’re facing a problem.
If you are interested in group therapy, one popular type of group therapy is Overeaters Anonymous (OA). It is a nonprofit organization (supported solely by donations) that is led by volunteers. OA believes that obesity results from compulsive eating linked with negative emotions. OA’s premise is that excess food consumption has led to excess weight, and this guide has taught you that obesity is much more complex than evaluating excess food consumption. OA takes an emotional and spiritual approach using the 12-step program.
However, OA states that atheists and agnostics are welcome. Each OA group is different, so it is important to meet with several of them to see which one fits you best. OA also utilizes the following tools for recovery:
- A plan for eating: for example, abstain from compulsive eating
- A sponsor, who guides you and encourages you to call when you suspect you will relapse
- Regular meetings that help you identify your problems
- Writing about how you are feeling
- Reading literature that reinforces the 12-step program and 12 traditions An action plan with attainable goals
- Anonymity so that you do not feel vulnerable
- Service: if you help others within the group, it will help your recovery
Unfortunately, no studies have shown the effectiveness of OA; however, that doesn’t mean it isn’t an effective option for helping you to lose weight. It will be very helpful if you feel like you need emotional support when you are trying to lose weight (Tsai & Wadden, 2005).
Other Group Therapy Options
There are a variety of ways to participate in group therapy sessions. You can join non-medical commercial programs, organized self-help programs, internet-based commercial programs, or medically supervised proprietary programs. Most weight-loss programs have not been studied extensively, except for non-medical commercial groups (e.g., Weight Watchers), where individuals were shown to lose weight; however, there was a lot of attrition from the program. Table 15-1 provides you with information about each weight-loss program that includes group therapy (Tsai & Wadden, 2005).
What Is Individual Psychotherapy?
Individual therapy, or one-on-one therapy, occurs when an individual and his or her psychologist or other licensed mental-health professional work together. Even when one-on-one psychotherapy is embarked upon, several different types of therapy can be employed; the strategy depends on the training and theoretical orientation of the psychologist or licensed mental-health professional and what will work for the individual (APA). Types of therapy includes:
Cognitive-behavioral therapy (CBT)
This is a practical approach in which you track your behaviors and reactions to certain events and use new skills that your therapist teaches you.
Psychoanalytic therapy and a humanistic approach
You will spend time talking to the psychologist or other licensed mental- health professional to get to the root cause of your problem.
Even though individual therapy might be less daunting than group therapy in the beginning, it has been shown that group therapy can reduce weight and body mass more than individual therapy (Renjilian et al, 2001).
What Types of Behavioral Interventions Might I Try?
Behavioral interventions lead to better outcomes than educational interventions alone (e.g., reading pamphlets or websites on nutrition and physical activity). This is because educational interventions tend to teach people what to change and not how to change. Behavioral interventions often focus on problem-solving tools (Figure 15-2) to help people understand what leads them toward unwanted behaviors (like over-eating) and show them how interventions can change behaviors. An example of this is shown in Figure 15-3 (Foster et al, 2005).
Among behavioral interventions for weight loss, combined behavioral interventions, exercise, and diet is better than any one approach alone (Johns et al, 2014); for example, CBT along with exercise and diet produce better results than just using exercise (Shaw et al, 2005). Most behavioral interventions incorporate CBT-based steps. To get a sense of how CBT works, look at the different steps shown in Figure 15-3 (Strecher et al, 1995).
Although CBT focuses on goal-setting and behavioral changes, it does not necessarily address psychological conditions (e.g., depression, anxiety) or issues that underlie obesity (e.g., stigma, isolation, low self-esteem) (Shaw et al, 2005) mindfulness-based interventions (Figure 15-4), can help to improve eating behaviors (binge eating or emotional eating), depression, eating attitudes, anxiety, and BMI (Rogers et al, 2017).
Mindfulness is the awareness that comes from paying attention to internal and external sensations and thoughts, in the present, and non-judgmentally seeing things as they are (Teasdale & Segal, 2007). Most mindfulness therapies include the following:
Classroom activities: for example, lectures, discussions, and exercises Lessons on meditation
The opportunity to practice (for at least 30 minutes) by yourself.
Through these different components, you learn how to accept your circumstances and emotions, even if they are very challenging. You can become more aware of your emotions and be less reactive to situations; this will allow you to make better choices that align with your health goals. You will also learn how to practice mindful eating (involving eating slowly, being aware of your hunger, learning how to savor your food, and knowing when you’re satiated) while also practicing self-acceptance (Kristeller & Wolever, 2010). Through becoming more aware of your emotions and practicing mindful eating, you will learn how to deal with your emotions and to create healthier habits to deal with your emotions, rather than suppressing emotions with food.
It is important to remember that mindfulness strategies are helpful, but they are more effective when combined with an appropriate diet and exercise regimen along with behavioral components of CBT (Olson & Emery, 2015).
How Can I Get a Referral for Help in My Community?
There are several paths that you can take to help with your weight-loss goals. Determining the best therapy option for your weight-loss plan can seem daunting; however, health professionals can guide you through the process. You can find more information about weight-management groups from your local hospital or you can talk with your primary-care physician to obtain a referral to the type of support group or individual therapy that is most appropriate for you. If you are interested in individual therapy, you can do the following:
- Ask your physician or another health professional for a referral
- Call or search on-line (through your local or state psychological association) to find a licensed psychologist or other licensed mental- health professional
- Use the APA’s professional locator at https://locator.apa.org.
- Use the Association of Behavioral and Cognitive Therapies (ABCT) therapist locator at https://www.findcbt.org/xFAT/.
If you are interested in group therapy, you can do the following:
- Contact non-medical commercial groups (e.g., Weight Watchers, Jenny Craig), internet-based commercial programs (e.g., eDiets.com), organized self-help groups (e.g., Overeaters Anonymous); for these programs you do not need a referral. You can go on-line and find a location for the in-person groups and get started. It might be beneficial to try out different groups to see which one is the best fit for you.
- Contact medical weight-loss programs. Because these cater to severe cases (typically involving obesity-related health complications), most of them require a physician referral because patients go on very low-calorie diets, for which medical supervision is required.
In sum, psychological and social support are key components to help you reach your weight-loss goals. Group therapy, individual therapy, or a combination of the two, can provide meaningful support. CBT can teach you how you will implement your weight-loss plan. Further, mindfulness-based interventions address psychological issues that underlie weight gain and provide access to other resources. These psychological interventions can provide the support needed to ensure that your chances of reaching your weight-loss goals are maximized.