As a psychotherapist who has battled his own weight issues, I am often asked if it is necessary to address these issues to achieve long-term weight loss. The answer, as with most things about long-term weight loss is not easy. On an optimistic level, I don’t believe it is necessary. There are some people who wake-up one day and say “enough is enough” or that they are sick and tired of being sick and tired and start on a successful weight loss journey regardless of any hurdles – psychological or otherwise – that they are facing.
In the kind of therapy I practice – and in the way many modalities of therapy are being practiced – the therapist does not deal with a particular diagnosis or condition, though we do understand them quite well. So in some cases, just the act of therapy itself can cause weight loss, or address other psychological issues without directly talking about say “depression” or analysing one’s food diary. I am reminded of many patients who I consulted for the purposes of weight loss where the primary area of discussion has been about their work or occupations. Now this is not to say that one’s work schedule or routine is the issue that is at the root of one’s obesity. Rather, I always recall the words of my clinical supervisor – “Good therapy is done when the patient doesn’t even know that therapy is being done.” What this means is that underneath the conversation, the therapist is addressing issues of avoidance, self-esteem, fear of taking action, fear of failure or fear of change. In fact, often talking about weight – when one is not ready to directly address it - can be embarrassing for people. Moreover, as a therapist, my ability to provide psychologically valid weight loss strategies that will work to address someone’s disordered eating can often be difficult. I am not a nutritionist and as someone who has lost weight long-term, I know that finding a solution to something like binge eating comes from within and not from outside.
So whether a therapist is talking about something as benign as the weather, or about the client’s battle with depression, there is always an eye towards these deeper issues, even if it is done subtly. In fact some other clinical axioms are “You can never win an argument with a depressed person” or “It is difficult to tell a trauma victim that they are a good person.” The reason for this is that attempting to dispel a person’s negative of view of themselves directly is fraught with clinical difficulty. People just do not believe anyone or any evidence that they are worthy, and find ways of refuting those who tell them otherwise, and when the patient does not believe the therapist’s praise, a healing relationship is challenging. In fact, it is this inability to see one’s self as worthy that is often very familiar to those who battle with their weight. Unless the therapist properly balances the optimistic view that change is possible with a patient’s deeply held views that change is impossible, it is difficult to form a healing relationship.
Some caveats are important here. I know some therapists who feel that all weight issues are trauma-based, and take a trauma approach to weight loss with their clients. Since I was not trained directly in trauma and since my own lived experience doesn’t support this, I tend not to use this as a default in my treatment, but at the same time will not exclude it. In fact, many people – even those with complex psychological conditions – are able to achieve the results they want working either with a therapist or a weight loss coach, especially since better diet, exercise and overall health ameliorate many psychological conditions as well as physical ones. However, when barriers to following weight loss advice seem unattainable deeper work may be necessary. It is why I will spend six months with some patients just talking about their work or other life issues, and not even address their food issues directly – especially if the client does not seem ready.
In all cases though, the deeper work around weight loss involves inducing feelings of respect, self-love and care in ways that circumvent an individual’s attempts to see themselves as flawed. The therapist becomes someone who has an optimistic view without being a cheerleader, someone who is consistent without being overbearing and someone who expects progress but does not withhold love when it is not achieved – and all of these are crucial traits that someone must practice internally in order for long-term weight loss. When someone who is facing a psychological condition like anxiety, depression or past trauma cannot learn these principles directly, a good therapist is able to impart them in ways someone will still listen. When that happens, long-term weight loss is indeed possible for those who may feel otherwise.