If you Weren’t Overeating, What Would You Be Doing More Of? Less Of?'
By Francine Broder, PsyD
Beck Institute Faculty
Susan is a 50-year-old single female employed in the publishing field. During her intake evaluation she described wanting treatment to figure out how to lose weight. She was skeptical that treatment would work as previous counseling had not helped. Susan’s primary care provider suggested that Susan give weight loss counseling another try as her current weight and diet were contributing to her hypertension, elevated cholesterol, and type II diabetes. Susan reported being 60 pounds over her ideal body weight. She had tried many diets that resulted in weight loss but were followed by regain once she returned to her typical eating habits.
A thorough analysis of Susan’s daily schedule and diet suggested several problems.
Susan described skipping breakfast and becoming very hungry before her lunch break and usually got something from the vending machine. Next, she and her co-workers ate fast food for lunch which left Susan feeling lethargic for the remainder of the afternoon. She would stop for take-out food on the way home from work, always bought enough for two meals, and consumed all the food in one night. After dinner she watched TV until it was time for bed.
Cognitive behavior therapy (CBT) is widely accepted as an efficacious approach to treating disordered eating (Murphy, Straebler, Cooper, & Fairburn, 2010). Given that overweight individuals often have a history of disordered eating and failed weight loss attempts, how can therapists best help them work toward their goals, lose weight and improve their quality of life?
Many of Susan’s key cognitions were connected with her core belief of helplessness. "I can't handle feeling hungry,” "Work is so demanding, I can barely keep up," and "I’m too tired to do anything once I get home from work." Given these maladaptive ideas, it is not surprising that Susan adopted maladaptive coping strategies, associated with her assumptions. "If I eat every time I’m even a little bit hungry, I'll be able to cope with work stress, but if I don't, I won't be able to tolerate how I feel." "If I avoid pushing myself to do anything after work, I'll be able to face the next day, but if I do anything besides eat, I’ll make myself more exhausted.” “If I overeat after work, it will make me feel better and I won’t have to think about how depleted I feel.”
Next, we identified Susan’s core values: What was important to her? What were her personal goals? Why would changing her diet be worth caring about? I asked Susan to think about what it would look like to enrich her life. She explained that being healthier and having more energy were very important to her. I next asked her what she would be doing more of and what she would be doing less of if she felt healthier and had more energy. Susan explained that if she had more energy, she would engage in a fun and/or meaningful activity after work instead of overeating and watching TV. She said she would be doing more with other people and be less isolated.
We began by working on ways for Susan to set her environment up for success.
I asked her to recall a time in the past when she packed her lunch for work instead of buying fast food—and to visualize it in detail. She remembered a time when she grocery shopped each week and bought ingredients to make a one-pot meal that she packed for lunches. She also recalled and visualized how organized she felt each morning as she packed her lunch and snacks for the day. Next, I asked her to visualize a time when she arrived home from work and prepared a simple meal instead of picking up dinner on the way home. Slowly, Susan began to imagine a life in which she was caring for herself in the service of her value of feeling better and having more energy.
Susan described being a master knitter in the past. She enjoyed browsing in stores for interesting yarns. She enjoyed the meditative experience of knitting, and especially enjoyed giving the finished projects away as gifts. She was even in a knitting group at one point, which she looked forward to attending each week. I worked with her to connect to the experience of giving a friend a beautiful handmade gift. As she imagined the scene, she described feeling a sense of happiness and pride that she hadn’t felt in a long time. During her therapy with me, Susan collected knitting materials and worked on several projects. She replaced overeating and watching TV with an enjoyable and meaningful activity.
In summary, Susan took steps to set her environment up to work for her by planning and preparing meals to reduce reliance on fast food. Identifying what she was currently doing too much of and too little of provided Susan with an opportunity to make behavioral changes consistent with her value of living a healthier lifestyle and having more energy. An essential feature of cognitive therapy for weight loss is that clients and therapists work together to identify values and examine if current lifestyle habits are consistent or inconsistent with those values.
Murphy, R., Straebler, S., Cooper, Z., Fairbburn, C.G. (2010). Cognitive behavioral therapy for eating disorders. Psychiatric Clinics, 33(3), 611-627.
Beck, J. (2007). The Beck Diet Solution: Train Your Brain to Think Like a Thin Person. Birmingham,
Alabama: Oxmoor House, Inc.
Brown, A. (2017). Bright Spots & Landmines. The Diatribe Foundation.
CBT for Weight Loss and Maintenance
February 14-15, 2019