Tuesday, August 31, 2010

Therapy and Weight Loss

For quite some time, I've been following blogs and forums about weight loss, and occasionally the topic of therapy and the role of psychology come up. Most of the time, people who have lost or are losing weight say that counseling does not assist them in weight loss. Their general attitude is that their issues are biological in nature (e.g., sugar addiction, insulin resistance) or simply the result of poor self-control or discipline. The former can be treated with drugs and lifestyle changes. The latter has to be pushed through by "sheer force of will" until you have magically found the discipline (a notion I reject as I think "willpower" is a useless term which does nothing to assist people in making behavioral changes).

Setting aside the fact that bad habits are psychological issues, I've often wondered why people reject the idea that therapy will aid them in their efforts. I've reached various conclusions, but the primary one is that most weight loss therapy is likely too abstract in its reasoning. There need to be multiple stages to the process, and I think some counselors might be level jumping on the type of feedback they provide. For most people, the fact that their alcoholic father drowned his pain in booze and therefore role-modeled addictive behavior that the person undergoing treatment may be emulating but substituting food instead of alcohol is of limited value in dealing with the problem at hand.

If the information can't be directly applied to a change in lifestyle or at the moment when the impetus to behave destructively is motivated by that underlying psychology, it comes across as merely academic. If you stuff yourself with food to a point of physical discomfort because you create a new discomfort to blunt, mask, or distract yourself from painful emotional feelings, it means nothing as you sit in the therapist's office the day after a binge. The information has to be timely as well as accurate and relevant to be of value in the weight loss process.

In the sterile environment of the therapist's office, when the circumstances that may cause you to eat are far removed from that time and place, it is hard for the counselor to know what is driving you, and it's nearly as hard for you to know. What tends to happen is that it all boils down to "I eat because life is hard and food comforts me." This generic conclusion is of very limited value, particularly when no solution to the pain of your life is forthcoming via therapy.

In essence, knowing the cause doesn't really help with the solution for many people, particularly if the deeper knowledge doesn't come hand in hand with behavior modification therapy that teaches them new and concrete techniques for addressing stress in a fashion which does not involve food, but is adequate for alleviating your difficulties. Of course, for many food addicts, nothing soothes like food and they find all other options falling short in offering a palliative for their pain.

That being said, as someone who feels profoundly that analyzing the psychology of my problems and applying behavior modification techniques to myself have brought me to where I am today, I think that therapy can make the difference between being someone who loses weight and keeps it off and someone who starts to regain with the first forced lifestyle change or bad patch, or, perhaps worse, someone who is obsessed with food in a way which is conducive to physical health.

The process of weight loss is one thing, but living in a manner in which your relationship with food is psychologically as well as physiologically healthy is another. I believe that insights and understanding are something which should be made concurrent with changes in habits or routines, but they should not be expected to have an immediate effect or direct application. It is rather the case that they create a mass of self-knowledge that will reach a critical mass when your understanding of self comes together at later periods of time. This is something I figured out when I talked about my mental conditioning work. I didn't know how I one day stopped obsessing about food or using it destructively. It just seemed to happen, but it actually was the culmination of a great deal of therapeutic effort coming together after months and months of hard psychological work.

Many people believe that thin = cured. They think that as long as they lose weight, they have solved the problem and are effectively dealing with it. To me, this is a very narrow definition of "health" and focuses exclusively on appearances over a balanced existence in which your relationship with food is one in which your thoughts are not consumed by this issue. If you remain preoccupied with food, exercise, and weight throughout your day in a manner which consumes an inordinate amount of time or disrupts your ability to have relationships with others that do not revolve around body image, diet, or exercise, then you probably need some counseling to help you adjust your relationship with food regardless of what your weight is.

A lot of people have no idea what a mentally healthy relationship with food is, and they will fight and argue with you about what is and is not "healthy" based on the composition of their diet, their weight, and health status. Physical health as a result of lifestyle choices does not indicate mental health in regards to food. There are people who are at a healthy weight, eat nothing but healthy food, and still spend their days ruminating about eating. I'm not even talking about pining for a piece of cake or a slice of pizza, but rather people who think about their apple and yogurt snack for hours before they can eat it. They are honed in on food to the point of distraction in a manner which a person with a normal relationship with food does not think or feel.

The aforementioned types of people have all of the behavioral changes necessary in place for weight maintenance and physical health. However, they need counseling to adjust their thinking such that they spend less of their energy on diet and body image and can focus more productively, creatively, and, frankly, in a more fulfilling manner, on other aspects of their lives.

One of the many things I have learned through losing weight is that I was much more dysfunctional overall at the start of my changes in habits and choices than I was before them, and than I am now. The dysfunction was food obsession and there were times when I thought that I could simply not live the rest of my life like that. The preoccupation I had was oppressive, and I'm sure would have continued had I not labored to deal with the underlying psychological issues (particularly in regards to identity, but also all of the stuff I grew up with that caused me to become a food addict). Frankly, I'd rather remain fat than continue to live the sort of torment I experienced during the first 10 months of my weight loss process.

There are people out there who have successfully lost weight who do live in a constant state of preoccupation with food and their bodies, and they are okay with it because they are so deeply immersed in their neurotic obsession with food that they cannot see how dysfunctional they are. To the people around them, they seem to be almost manic and are clearly obsessed, but they cannot gauge themselves by anything other than their bodies. As long as they are thin, they think all is well, and they are some of the people who most frequently say that they feel counseling is not necessary if you want to lose weight. In a way, they are right. If you want to merely be thin, you don't need to have any sort of therapeutic process (be it self-reflection or with a professional), but if you want to live a life in which you are not mentally enslaved to food and preoccupied with your body, you probably need a little psychological work as well.


Anonymous said...

Have you found that you can tell from a person's blog if they will be successful maintainers or not? I have. A key clue to someone who will not maintain a significant weight loss is looking at their food diary. I am fascinated by a blogger who lost over 100 lbs thru WW, using almost all her points on sugar. She hit her goal recently and everybody jumped and clapped for her. Now her posts read "ooops, fell off the wagon", or "taking a day off from counting points, I need this after all my work over the past months". And her food diary remains the same: 90% of her "maintenance" points are spent on cake, ice cream, candy, and other sugary treats. She can't see the link between all that crap food and her continual hunger yet, but I'm hoping she will have a lightbulb moment. I'm sure WW won't tell her, since it is in their interest to keep her re-enrolling.

What amazes me is that none of the readers point this out to her. Is this common in the blogosphere...that everybody remains polite and just claps along? But it is so clear that unless she reorganizes her foods to include more whole and filling foods, she is doomed to gain it all back. And rapidly.

screaming fatgirl said...

I can't say that I've read enough blogs from people who are maintaining to reach any conclusions. What I can tell is whether or not someone who is starting is going to continue. Mainly, I can tell when they are taking on too much at once and are likely to be overwhelmed by the dramatic change.

One of the things about me is that I don't follow blogs which offer up much in the way of food diary information. I have little interest in calorie counts, weigh-in stats, etc. If I don't find some sort of connection to the person, I lose interest in the blog. That's not to say there is no value to such blogs for other readers. It's just not what is of value to me personally since I'm looking for something else in my reading.

I think that the main thing I see is a division between people who have turned their entire existence over to body maintenance and those who have a more balanced approach. The people who have cookies all of the time are little different to me than those who banish them from their homes. That is not to say that either can't succeed at weight loss (as I'm pretty sure both groups can with varying degrees of success), but just that neither has made peace with food. These are people who I suspect may have problems maintaining later.

I have concerns about the "all or nothing" way of eating that you often see whether it is all sugar or all vegetables. Perfection, or attempts to attain it, probably plays a big role in future failure for a lot of people.

All that being said, when you mentioned the "taking a day off from counting points", I thought that is a red flag for future problems. Anyone who lives a lifestyle such that they have to "take days off" or "cheat" on their way of eating is probably on the road to regaining. I think you have to find something you can live with and find a way to be comfortable with it. "Cheating" doesn't exist in my way of doing things. There is eating as much as I would prefer, less than I choose to have, and eating more than I'd prefer.

I tend to look more at the attitude and the balance than the composition of people's diets, but I do think that people who are too rigid are always at some risk of regaining because they require so much structure and just the right circumstances to carry on with their success. Since life is so rarely "just right" and structure can easily fall apart in the face of hardship, I have my doubts. I wish everyone well, but I do have doubts...

Lanie Painie said...

Wonderful post & I totally agree. People who are not willing to work on the mental side of things are not likely to have sustainable success.

screaming fatgirl said...

Thank you, Lainie! I really appreciate that!

Fat Grump said...

SGF...I totally agree with the comment you've just made in response to a ...er..response!:)

You wrote: "but I do think that people who are too rigid are always at some risk of regaining because they require so much structure and just the right circumstances to carry on with their success. Since life is so rarely "just right" and structure can easily fall apart in the face of hardship, I have my doubts."

I think this is the crux of the matter - well it is for me - and it's for that very reason that I haven't joined slimming groups or followed a rigid diet plan. I think some people need structure more than others...but how do you dismantle that structure once it guides your eating? We ALL know the theory and we have to trust ourselves to follow it. We are accountable only to ourselves. I think I may need MORE structure with my plan, but on reflection I am not beating myself up because I can't stick to it:) Hmmm. That doesn't make sense lol...and my weight loss is slow, but if I have learned one thing, it's that I need peace of mind and not constant self-flagellation. An awareness of what I am doing seems to be helpful, whether I get it 'wrong' or 'right' but like you I don't want to think in those terms. I am eating less, moving more and that very loose structure seems OK right now.

screaming fatgirl said...

Grump: "I need peace of mind and not constant self-flagellation."

I feel exactly the same way, and have felt so since I started doing this. I knew that this wasn't going to end up lasting if I was gritting my teeth through it all and feeling boxed in by what I was doing, nor if I was hating myself day-in and day-out.

I can deal with structure, but not too much too fast, and not so much that I feel like I'm in a prison walled off from real world living, eating, etc. Following your blog, it seems that you are following a similar path - introducing changes bit by bit, finding your way through in a manner that works with you life and your well-being. It's not the same menu of choices, but it is similar in that it's not rigid or imposed on you from outsiders.

Perhaps this is something we need more because we're a bit older? I'm not sure, but a lot of younger folks (and by "younger", I mean under 40) seem to have the whole "I have to hate myself or I won't do this" or "my ass needs kicked by someone" thinking. I don't need that, and, even if I did, what happens when you don't have the structure anymore? You regain. It's really better to learn to live in a way which is conducive to slow loss and maintaining. It's just a lot less gratifying to do it that way because people aren't praising your fast losses or offering you support for modest and gradual changes. But, you know, that's okay. I don't need pats on the back. :-)

Anonymous said...

Wow, there is so much great stuff in this post I could go on and on but I want to focus on just one of your points. You said, "Many people believe that thin = cured. They think that as long as they lose weight, they have solved the problem and are effectively dealing with it." Amen, sister! We are no better off psychologically if we are thin and obsessed with the food we are not eating than if we are fat and obsessed with the food we are eating. I applaud you for advocating that we strive for a healthy relationship with food. If it takes professional help to get there, then so be it.

screaming fatgirl said...

Thank you, fatinthehead, for your kind comment, and your support.

I honestly feel that a lot of the diet culture that we are seeing these days not only breeds an unhealthy relationship with food and obsession with body image, but actively advocates it. The result (thinness) is prized over all else, including quality of life. It's so one-dimensional, and it troubles me.

Sarah@LowStressWeightLoss said...

Interesting post. As someone who's been fat all her life, and who has enough childhood dramas to keep a few shrinks drooling I have my own thoughts on this issue.

For me, I've done work in therapy several times in my life - with varying degrees of success (based both on my own commitment to addressing things, the fit with my therapists & other things complicating my life).

I've lost weight successfully while in therapy & while not in therapy.

For me weight management is now worked out emotionally for the most part - mainly for me it's about the effort to do it (in a body that biologically resists quite a bit) and sometimes I work at it, and sometimes I don't but basically I think the bulk of the psych links are clear & managed.

As a person I could grow and develop skills in a few areas but have dealt with the things that I think held me back in the past.

I too am mainly looking for a balanced approach to life (weight included - and not more important than other things).

Val said...

"I eat because life is hard and food comforts me."
There you have it, in a nutshell!
The ol' metabolism becomes successively less forgiving as the years go on, & those 10 lbs that were so easy to drop when you were 25 now takes six mos (or more) @ 45...
& then again, life's too short for me to invest all that energy into obsessing over my food choices. This fat girl's gonna EAT & carry on, not beat myself up for mornings like this one: where I got an apple fritter, but only ate half of it! (very unusual for me which I count as a true success for intuitive eating)

Anonymous said...

Some of the weight loss bloggers I have run across are thin but so eating disordered that it is too disturbing to me to even TRY and read their blogs. If the ONLY two options for living consisted of either being EXTREMELY obese or being obsessive & thin, then I would be hard pressed to choose which one to be...

ON THE OTHER HAND...I sometimes forget that I have a long way to go until I could be declared, officially, at a healthy weight (not overweight or obese.) I can now walk for hours at a time every day, hike up hills, lift weights (strength train) 3 times a week, etc. I wear a size 16, depending on the manufacturer, & weigh approximately 225. According to BMI charts, though, I could weigh 100 lbs less and still be in the *healthy* weight category.

Good god.

That is totally insane, for me, especially at my age. Even 70 lbs less, which is required for official evidence of a *healthy* weight seems nuts. Seriously.

Unfortunately, many people (perhaps women especially) look at BMI numbers, and "ideal weight" charts as if those are holy scriptures. If I had to maintain a supposedly *healthy* weight (by BMI standards, which the medical profession and nurses are taught to believe is appropriate), I would HAVE to become obsessive compulsive. And, frankly, I would rather stay right where I'm at now, instead.

I think I will lose a bit more, but remain fairly sane. And obese. :)

I guess time will tell.


Anonymous said...

I'm with fat grump, I can no longer do the self flagellation. Maybe it's an age/maturity thing, but hating on myself just made everything (not just my weight) worse. My weight loss has been slow, but now I'm here, I suppose, or as here as I'll likely get. The battle has been more psychological than physical, and while I will always have an overdependent relationship with food, it doesn't feel obsessive or unhealthy anymore. So maybe I will maintain, though I will always have to eat less than I'd like (bf points out that most people do this, especially 40+), though it seems as if I have to eat less, exercise more than most.