Psychotherapy for Weight Loss

Health care providers who work with obese patients have noticed how difficult it is for them to lose weight and to keep it off. Diet and exercise are crucial, but in addition, patients can improve their chances by participating in psychotherapy. Researchers have found that patients benefit from a variety of psychotherapeutic techniques during weight loss. Psychotherapy is also essential for helping patients learn new skills to keep the weight off.

What are the Goals of Psychotherapy for Weight Loss?

• Improvement of body image, addressing unrealistic expectations
• Improvement of self-esteem and social adaptation
• Reduction of anger
• Improvement of depression and anxiety stemming from obesity
• Support for patients suffering from dysfunction in family, social and professional settings

What Techniques do Psychotherapists use to help with Weight Loss?

Psychotherapists who work with obese patients recognize the importance of helping patients with body image—the physical, emotional and interpersonal view of one’s body. Many techniques are used to help patients understand the complicated processes that lead to obesity.

• Cognitive-behavioral therapy (CBT) focuses on beliefs and behaviors, with the idea of reducing negative emotions. In treatment of obesity, CBT helps patients reduce distress and learn to think normally about food. It has proven helpful for patients with a history of binge eating.

• Interpersonal therapy concentrates on depression as it relates to interpersonal issues. By addressing depression, this therapy can also help patients reduce distress and learn to think normally about food.

• Body-oriented therapy encompasses all forms of psychotherapy that use body image to help with psychic functioning. Patients increase their self-esteem and social adaptation, which helps them think of their bodies with greater acceptance.

• Cognitive reframing helps patients practice relaxation, learning to think of eating patterns as natural and not problematic.

• Neuro-linguistic programming (NLP), a form of body sensation awareness, is another technique to help patients relax.

• Brief therapy is a standardized treatment, focused on solutions, to help patients use inner resources.

• Visualization helps patients consider new ways of feeling about overeating, leading to new strategies. These include new images and metaphors that operate at a deep level of consciousness.

For obese children, psychotherapists might use the above techniques while also considering issues such as:

• Teasing and body image
• Parents who are over-intrusive or over-stimulating
• Parents who do not know how to show empathy for the child
• Inconsistency on the part of the parents

How does Psychotherapy help maintain Weight Loss?

Some weight loss programs focus on weight reduction and ignore the special risks patients face after they start to lose weight. Psychotherapy addresses some of the underlying issues that get in the way of maintaining weight loss. These include unrealistic expectations in regard to weight loss and appearance. A patient may start a weight-loss program with the idea of losing 20 percent of her weight, expecting to attain an ideal weight. If she loses only 10 percent of her weight, she may feel discouraged and give up, a risk faced by many who start to lose weight. Psychotherapy can help her see the value of what she has achieved and help her take pride in improving her health.

Research shows that patients in psychotherapy who focus on self-acceptance, on keeping weight gain to a minimum, and on implementing lifestyle changes, have a much better chance of success in maintaining weight loss. Many weight loss programs now recognize the importance of providing extra support while patients are losing weight. There is growing awareness that the same factors that originally lead a patient to overeat are still in play during weight loss. With psychotherapy, patients gain very specific skills to continue losing weight.

Are Weight Loss Patients different from other Patients?

Research shows obese patients are twice as likely to suffer from a major depressive disorder than comparable patients of normal weight. Many obese patients also suffer from anxiety disorders and have trouble maintaining personal relationships. In one major study, obese patients were four times more likely to have experienced trauma such as physical or sexual abuse. For these reasons, careful mental health screening is recommended for all patients who participate in a weight loss program.

How does Group Psychotherapy help Obese Patients?

Current literature shows that group psychotherapy can be particularly effective in helping obese patients sort out issues of body image. In a group, patients can support one another in learning to develop realistic body images. With the use of social influence, peer reinforcement, and behavioral contracts, patients in a group setting find they have new resources when they are vulnerable to relapse.

Other techniques that have been effective in group psychotherapy for obese patients include:

• Dance
• Art
• Poetry
• Psychodrama
• Music therapy
• Family sculpting

In family sculpting, each member of the group explains the dynamic of his or her own family, as he or she experiences it. This proves to be a very effective way to look at underlying emotional themes, alliances, distancing, and alienation. Group psychotherapy for obese patients can offer valuable insights that would not be attainable through other methods.

What is the Significance of using Psychotherapy to help Patients with Weight Loss?

Obesity is one of the fastest-growing avoidable health problems in the United States. It is directly linked to life-threatening illnesses such as cardiovascular disease, diabetes, hypertension, and cancer. More than 400,000 people die each year of complications of obesity, so there is great urgency in finding therapies to help people to lose weight and to sustain weight loss. A growing body of literature shows the value of adding psychotherapy to conventional diet and exercise programs. Psychotherapeutic techniques give patients the tools to change destructive patterns, helping them learn to lose weight and to keep it off.

Additional Resources
Ames, GE. Reformulated Cognitive Behavioral Treatment for Obesity: A Randomized Pilot Study Investigating Changes in Expectations for Treatment Outcomes. Ph.D. diss. University of Florida, 2005. Abstract in UMI:ProQuest Information and Learning Company 2008: AAT 3192344.

Blackwood, HS. Obesity: A Rapidly Expanding Challenge. Nursing Management. 2004 May; 35(5):27–35.

Munro, JF. Second-Order Change through Brief Therapy among Obese Clients of a University-Based Weight Management Program. Ed.D. diss. University of Missouri, St. Louis, 2002. Abstract in UMI:ProQuest Information and Learning Company 2008: AAT 3049604.

Weiss, F. Group Psychotherapy with Obese Disordered-Eating Adults with Body-Image Disturbances: An Integrated Model. American Journal of Psychotherapy 2004 58(3):281–303.

Psychotherapy Organizations
American Group Therapy Association

American Psychiatric Association

American Psychological Association

American Psychotherapy Association