Weight Loss: The Integration of Mind and Body
Many people believe that they know what a healthy diet for losing or maintaining weight loss looks like. As a clinical psychologist who has worked with bariatric surgery patients for six years (I have done more than 1,100 pre-surgical evaluations for bariatric surgery) and non-surgical candidates on healthy weight loss for more than 30 years, I am actually not sure that the average person could describe a healthy, balanced diet or the most effective types of exercise for weight loss.
There is a tremendous amount of misinformation out there as well as weight-loss formulas that do work in the short-term, but not the long- term. For ultimate success, one needs a multi-dimensional, multi-discipline approach. There are so many short-term weight loss programs available and, unfortunately, few produce long-term results. While it is true that some of my patients are reasonably knowledgeable about a healthy diet when I start working with them, many are not. They also have limited or no knowledge about exercise and what are the most effective forms for weight loss. It is also true that those that are knowledgeable about good nutrition are not always successful in achieving and maintaining healthy, long-term weight loss.
Weight loss is a huge mind-body issue, meaning that you have to learn a lot of factual information about nutrition, exercise, etc., but then you have to integrate this into who you are as a person. That is, people have to know how to eat in a healthy manner and how to exercise effectively. Knowledge, however, does not necessarily translate into behavioral change. In my work with patients, one component of treatment involves assessing patient knowledge of seven basic skill sets:
* Nutritional information
* Planning and organizational skills (e.g., planning for meals,
shopping, cooking, eating out)
* Knowledge of and motivation for exercise
* Treatment of major psychological conditions that may affect eating
patterns (e.g., uncontrolled depression, anxiety, mood disorders,
eating disorders, history of sexual trauma)
* Family dynamics that support or hinder weight loss success
* Level of commitment and motivation for success
* Knowledge of self-medication for emotional issues (e.g., excessive
use of alcohol or drugs, liquid calories, etc.)
Once we have assessed these skill areas, the patient has a better idea of their strengths and weaknesses and where they need to focus their initial attention.
Many people use food for comfort and to combat emotional issues such as anger, stress, boredom, and sadness. In fact, carbohydrates tend to metabolize into the brain neurotransmitter serotonin, the same chemical thought to be affected by most antidepressant medications. There is a tremendous amount of recent information that helps us to better understand how to manage these psychological aspects of weight loss.
The use of functional MRIs has allowed us to look more closely at the brain’s response to food. Recent research suggests that the food we eat and the weight we gain can actually change our brain’s response to food. To complicate things a bit more, not all people are affected equally. David Kessler, who was a former head of the FDA, describes a “syndrome” that affects approximately 70 million Americans that he refers to as “Conditioned Hypereaters.” People with this syndrome actually respond differently to food than people without this syndrome.
There is also recent research in the area of neuro-psychopharmacology that suggests the response to food in some individuals is much closer to addiction than previously realized. Brian Wansink, who runs the Food and Brand Lab at Cornell University, has conducted numerous studies that indicate external factors play a much bigger role in how much we eat than internal sensations of fullness. There has also been some limited research that indicates people can re-program these neurological patterns through introceptive awareness training and other forms of mindfulness training.
Finally, there are several phases of treatment to help people obtain successful, long-term weight loss. Phase 1 involves getting individuals started on a healthy eating and exercise plan and to start this journey of self-exploration. Phase 2 encompasses developing the seven skills mentioned earlier and reaching their goal weight. Phase 3 is similar to a “relapse prevention” model in treating addictions. During this phase, people learn skills for staying on track and preventing weight re-gain.
Thomas Barr, Ph.D. has more than 20 years as a clinical psychologist. He
has 30 years of experience using clinical hypnosis, specializing in anxiety and depression, chemical dependency, pain management, eating disorders, and adjustment disorders/life transition.