Getting your weight under control

How psychologists help with weight management

Many people struggle with weight control. According to the Centers for Disease Control and Prevention, 33 percent of U.S. adults are overweight and an additional 36 percent are obese. Approximately one in six children in the U.S. is obese. People gain weight in a variety of ways, such as while recovering from an injury or health issue or slowly adding pounds while growing older.

When it comes to losing weight, many individuals know to focus on eating less and exercising more. But a major aspect of weight control involves understanding and managing thoughts and behaviors that can interfere with weight loss.

Seeing a psychologist about weight control

Psychologists are experts in helping people make behavioral and lifestyle changes that assist with weight management. They may work with individuals and families independently in their private practice or as part of a health care team, often in a setting where mental health and medical services are integrated. Sometimes a psychologist will work on weight control with a patient who has been referred by a physician, dietitian or other health care professional.

People who seek help from psychologists range in age from children to adults. They include those who simply struggle with managing their weight as well as individuals whose weight problems are related to chronic illnesses like diabetes and heart disease or other conditions like depression, anxiety or eating disorders.

What happens during visits with a psychologist

An initial visit with a psychologist usually involves a discussion about your history and concerns. This may include your weight management goals and past efforts to lose weight, medical history, stress levels, current life situation and your sources of social support like family and friends.

In order to help you, psychologists also want to learn about your habits and attitudes about food, eating, weight loss and body image that may not support your health goals. Common unhealthy beliefs that patients express include: having to clean off their plate; needing dessert after meals; and feeling like a failure when weight loss stalls. Some typical behaviors include: eating whatever they want after exercise; using food to cope with feelings of boredom or stress; and continuing to eat when they are no longer hungry.

These types of behaviors and beliefs often sabotage weight loss efforts. Psychologists talk to patients about their challenges to making healthy choices and identify the triggers that prompt the patient to make unhealthy choices. A psychologist may also evaluate a patient for anxiety, depression and eating disorders such as binge eating. These conditions can sometimes contribute to weight issues.

Developing a treatment plan

By the end of a first visit, psychologists usually have a comprehensive picture of a patient. They discuss what patients are already doing well and should continue; and they identify areas of need and difficulty related to weight management. After the initial visit, the psychologist and patient schedule follow up appointments and start to create a treatment plan.

Treatment plans differ from one individual to another but tend to be brief. The plan often involves teaching self-monitoring behaviors, changing old beliefs, building new coping skills and making changes to home and work environments to support health goals. Psychologists help individuals address obstacles to weight loss, identify positive ways to change unhealthy habits and develop new skills and ways of thinking.

Many psychologists concentrate on one health behavior at a time. For example, if evenings are a challenging time to maintain good eating habits, the psychologist may ask the patient to keep a log of food eaten in the evenings and make notes about their environment, how they felt and what they were thinking. These factors provide important information about what is driving eating behaviors and helps the psychologist and patient figure out a way to address the behaviors.

Progressing and improving

After even a few sessions, most patients begin to notice changes. For example, patients may start to challenge old beliefs about food and practice new ones that support their health goals.

Together with the psychologist, a patient can determine how long treatment should last. People with extreme anxiety and depression, eating disorders or chronic physical health conditions, may require longer and/or more frequent treatment.

The ultimate goal is to help people develop skills so they can lead healthy lives.

Changing your eating habits

Consider the following steps that can be helpful in changing unhealthy eating behaviors and thoughts:

Monitor your behaviors. Research is clear that people who write down what they eat in a daily log are more successful at losing weight. Record your thoughts, feelings and information about the environment such as where you ate, when and what you were doing. This will help you understand your eating behaviors and identify areas to change.

Track your activity level. This is another important aspect of self-monitoring. It includes not only how much you exercise but also the extent to which you move around during the day rather than remaining seated or inactive. One helpful tactic involves using a pedometer to record the number of steps you take each day.

Eat regular meals. Patients often skip breakfast with the thought they are reducing calories or can “save up” calories for later. But skipping meals can slow your metabolism, make you prone to later eating binges and have a negative effect on your health.

Practice “mindful” eating. Research shows that individuals with eating problems often don’t pay attention to whether they are really hungry when they eat. Psychologists can help you learn mindfulness exercises to heighten your awareness of hunger levels and to make eating more enjoyable.

Understand the things you associate with food. Behaviors are habitual and learned. Sometimes people may associate certain emotions, experiences or daily activities with particular behaviors. For example, if you typically eat while watching TV your brain has made an association between food and TV. You may not be hungry, but in your mind TV and eating are paired together. So when you watch TV you suddenly feel the urge to eat. You can begin to break this association by not eating while watching TV.

Identify your emotions. It’s important to figure out what is happening emotionally while snacking, overeating or choosing unhealthy foods. Identify the feeling: is it boredom, stress or sadness? Patients need to determine if they are really hungry or just responding to an emotion. If you aren’t hungry, find another way to meet that need.

Modify your unhealthy thoughts and behaviors. Reinforcing healthy behaviors is important to achieving your weight management goals. Too often, people have negative thoughts and feelings about changing their health behaviors and see the process as punishment. Some people have an “all or nothing” attitude and think about weight loss in terms of being “on” or “off” a diet. Psychologists work with people to address negative feelings and find ways to reward healthy changes to their eating habits.

The American Psychological Association gratefully acknowledges Amy Walters, PhD, director of behavioral health services at St. Luke’s Humphrey Diabetes Center in Boise, Idaho and Kathleen Ashton, PhD, Bariatric and Metabolic Institute at the Cleveland Clinic, Ohio for contributing to this fact sheet.