Jason was a 15-year-old white male who lived with his mother and niece. He expressed a desire to be a healthier weight, but was having difficulty with managing his weight and had not been successful in a general weight management program. His body mass index (BMI) was at the 98th percentile for his age and gender. Jason’s specific concerns included low motivation to change eating and activity behaviors, difficulty resisting cravings for less healthy foods, and lack of social support around weight loss from his family and friends.
Given these concerns, Jason’s psychologist focused on two areas during his brief treatment. The first was on improving Jason’s eating behaviors by addressing his low motivation, reducing cravings and binge eating, and improving family communication around eating. The second area of focus was on improving his physical activity by increasing opportunities for activities with friends and family. Jason was the primary participant in treatment because of his desire to take greater ownership of his own health and behaviors. This was considered appropriate by the psychologist given his age and developmental stage.
The initial target of therapy was improving Jason’s motivation to make changes. He believed that making changes would be difficult, stressful, and not necessarily effective. However, Jason also said that he wanted to make changes to his weight and health in order to increase his self-esteem and feel more comfortable around his friends who did not struggle with their weight. Jason’s psychologist used motivational interviewing techniques to draw attention to the discrepancy between Jason’s stated goals and his ambivalence around related behavior change. Addressing these concerns at the start enabled Jason to make progress on his other treatment goals as his motivation increased.
Social support around making behavior change was difficult, given that Jason’s friends did not experience difficulties with their weight, and their social activities often centered on food. To address these concerns, Jason learned how to plan ahead of social activities, specifically by identifying healthier options and appropriate portion sizes at the restaurants his friends typically frequented. Jason also developed strategies for feeling included while making choices more in line with his health goals. In addition, he determined that his friends enjoyed some activities that involved physical activity (walking on a trail at a nearby park, for example) that he could suggest without referencing his health or weight loss goals. Further, Jason’s psychologist used cognitive behavioral strategies to target Jason’s negative self-image, which developed in response to his friends’ focus on appearance and their seeming lack of difficulty with weight.
Jason’s relationship with his mother was also a barrier to making changes to his health behaviors. His mother was included in a few of the sessions in order to address their communication difficulties and increase Jason’s support from his family. During these sessions, Jason and his mother discussed common triggers of arguments about food. For example, Jason’s mother reported that she “couldn’t help” but make comments to Jason about making good choices when going out with friends. Jason noted that he often responded by eating “to spite” his mother. The psychologist helped Jason and his mother develop and practice new communication strategies related to food and exercise topics. These strategies included Jason giving his mother concrete suggestions about how she could provide needed support, such as buying healthful foods at the market and helping plan family activities that included physical activity.
Recognizing that inappropriate dieting has been linked to the development of eating disorders, the psychologist wanted to address binge and emotional eating and establish healthier coping patterns. The psychologist provided psychoeducation about food cravings and binge eating. The psychologist also used mindfulness strategies, such as increasing Jason’s attention to his physical sensations, to illustrate key differences between craving and hunger. The psychologist conducted two in vivo food exposure sessions in which Jason brought a frequently-craved snack and then was guided through a mindfulness activity.
As their sessions progressed, Jason reported paying more attention to his internal hunger, craving, and fullness cues. He became aware of high-risk time periods for losing control over eating, such as being hungry and stressed. Jason began to track his moods and eating behaviors, specifically around binge eating, in order to identify binge triggers and use his new cognitive behavioral skills to manage his emotions without the use of food. Pre-planned healthful meals and small snacks also helped prevent him from becoming overly hungry.
Jason was able to improve his motivation, achieve behavioral goals through increased social support and communication, and address problematic areas of cravings and binge eating. Working with the psychologist, his BMI began to decline. He then focused his efforts on interventions managed by other members of the multidisciplinary team.