Deborah Beck Busis, LCSW, Director, Cognitive Behavioral Wellness Coaching Program

The recent Health Psychology study, “Understanding the social undermining of dietary and physical activity behaviors: A systematic scoping review” examined how social undermining of dietary and physical activity behaviors—such as family or others discouraging or sabotaging healthy choices—has been defined, measured, and linked to weight outcomes. Across 33 studies, evidence suggests that undermining is relatively common (reported by ~28% of individuals), with family frequently cited as the source. The authors highlight the need for improved measurement tools and further research to advance understanding and intervention in this underexplored but potentially significant barrier to weight management. Many of the clients we have worked with have experienced social undermining, and we teach them specific Cognitive Behavior Therapy (CBT) strategies to mitigate its impact.    

What does social undermining look like? A client is trying to gear up to go to the gym and a family member says to her, “Why bother? You know you never stick with it anyway.” The client’s first thought is, “She’s right. I never stick to anything for very long,” and instantly she feels shame and angry with herself.  She wants relief from these negative feelings and her mind instantly offers up a habitual solution: food.   

“I hate feeling this way,” she thinks. “I know I shouldn’t eat, but it’s the only thing that will make me feel better.” She opens a bag of chips, meaning to only eat a few, and ends up eating all of them. While eating temporarily distracts her from her negative feelings, once she’s finished she’s flooded with even more self-criticism: “I’m pathetic. I just can’t control myself.” This sets the stage for more emotional distress and potentially another binge. This common scenario highlights several critical targets for CBT: unhelpful thinking patterns, emotional dysregulation/difficulty handling negative emotions, and behavioral cycles that reinforce distress. 

CBT helps people recognize the connections between their thoughts, feelings, and actions. In this case, the cycle looks something like this: 

  1. Trigger: A family member shames her. 
  2. Automatic Thought: “She’s right. I’m hopeless.” 
  3. Emotion: Shame, anger, helplessness. 
  4. Coping Behavior: Eating to escape or distract from the (negative) feeling. 
  5. Short-Term Consequence: Relief in the form of numbing or distraction. 
  6. Long-Term Consequence: Even more guilt, self-criticism, reinforcement of the emotional eating habit, and further distance from health goals. 

This pattern is emotionally painful and highlights the client’s difficulty tolerating negative feelings. The feelings lead her to a short-term behavior that provides temporary relief but ultimately worsens the problem.    

Happy young women jogging along the sunny ocean promenade in fitness clothing.

We help our clients break this cycle by first helping them identify and reframe unhelpful thoughts. The thought “She’s right. I never stick to anything for very long” is an example of overgeneralization, and we help our client examine evidence for and against this thought and respond to it with more realistic thinking, such as, “It’s true I’ve fallen off the wagon in the past but I’m learning skills now that will help me stay consistent. I am capable of getting stronger physically and psychologically.”  

Next, we give our clients psychoeducation about negative emotions and we help them build emotional tolerance skills. We teach them skills like urge surfing (noticing the urge to eat and riding it out like a wave, knowing it will crest and fall), grounding techniques to help them stay present, and building up a whole roster of other ways that they can self-soothe. We remind our clients that feeling better in that moment and achieving their health goals are only mutually exclusive when they use (unplanned) eating to attain the former. We help our clients really pay attention to how they feel after they emotionally eat versus when they use a different, less sabotaging coping mechanism.  

We also help them plan ahead for triggers, such as shame from others. We develop a game plan for exactly what they will say to themselves and what they will do the next time that happens, such as, “If my sister makes a comment about my weight, I’ll remind myself that only my opinion on my weight matters; her opinion matters zero to me. Only I know how hard I’ve been working, and I don’t need to prove anything to her. If I still feel upset, I’ll take a walk and call a friend to help me calm down.”  

Lastly, we remind our clients that making mistakes and experiencing setbacks are part of the process. If they do emotionally eat or have a binge and have a thought like, “What’s the point, I just can’t control myself,” we help them practice self-compassion, recognize that progress isn’t linear, and learn from the challenge so they can have a different outcome the next time.   

While social undermining has the potential to negatively impact someone’s progress towards their health goals, CBT can help them learn specific skills to recognize unhelpful patterns, reframe their thinking, build distress tolerance, and learn from their mistakes. 

Reference:

Scotti, K. B., Lavoie, H. A., Bryson, H., & McVay, M. A. (2025). Understanding the social undermining of dietary and physical activity behaviors: A systematic scoping review. Health Psychology, 44(7), 665–676.