Diet and exercise are vital for weight management, but the psychology behind overeating can sometimes be overlooked. John Maclean discusses eating behaviours and the role of
cognitive behavioural therapy and hypnosis for weight loss
Most weight management is about lifestyle. Around 25% of UK adults are classed as obese and the National Institute for Health and Care Excellence (NICE) reported in October 2013 that £5.1 billion per year has been spent by the NHS on dealing with obesity. Current interventions recommended by NICE include behavioural therapy and lifestyle weight management programmes.
A 2007 report from Foresight, the Government Office for Science, referred to a complex web of societal and biological factors that have, in recent decades, exposed our inherent human vulnerability to weight gain. The pressures in society—fast foods and quick choices—combine to force people into the obese category.
Unless we deal with the reasons behind overeating behaviour, then any strategy will fail. Diets don’t work. Scientific studies have shown in recent years that anyone undertaking a diet for six to eight weeks will put the weight back on and gain more weight within a maximum of two years. Diets are a temporary fix; a magic bullet, and instead we need to look at long-term and lifestyle changes.
It’s vital to treat the causes as well as the symptoms and one of the ways we can do this is to combine strategies such as cognitive behavioural therapy (CBT) and hypnotherapy.
Cognitive behavioural therapy is a form of talking therapy, combining cognitive therapy and behavioural therapy. It focuses on how you think about things going on in your life, the impact that thoughts have on your life—your thoughts, images and the beliefs and attitudes which are your cognitive processes.
It then looks at how you can change any negative patterns of thinking or behaviour that may be causing health or mental health difficulties. The Mind Organisation, and the Mental Health Organisation, are very keen on CBT and so are the NHS. Unfortunately though, there aren’t enough CBT practitioners.
CBT helps the client face responsibility, take control and challenge their thinking about a changing lifestyle. Importantly, it gives people the ability to analyse their own thinking. Quite often we never analyse our own thoughts. We have a thought, we go with it and that’s it—we very rarely ask whether it’s true.
By challenging people to identify and to deal with emotional triggers can help us change their behaviours. It encourages a healthier lifestyle and also breaks the vicious cycle of thoughts, feelings and behaviour. Thoughts create feelings, feelings create behaviour and behaviour reinforces thought—we call this the vicious cycle.
CBT has an effective role in weight management to help a person control their diet whilst providing coping skills and long-term weight management skills. It is also effective to help increase motivation for exercise—without exercise, no strategy will work effectively, so we need to promote exercise and healthy eating.
CBT can also help to change a person’s body image and their expectation of body image. A lot of our clients have a distorted body image—they have a different picture of themselves. It also can improve a person’s self-esteem and help with stress management which is key, as one of the biggest problems with overeating is dealing with stress.
The therapy can help set reasonable goals for both weight loss and weight maintenance for our clients. Most of my clients have a distorted idea of what their ideal weight is.
We have thousands of clients who visit and have very high BMIs of over 35, and they want to be a size eight or ten. Realistically that’s unlikely to happen and if it does they would then require surgical assistance to deal with the excess skin that’s left.
Eating behaviours have their root in three main areas—distorted thinking, limiting beliefs and learned behaviours. Distorted thinking can be described as beliefs that you have that are not true but they shape the way you think.
For example, by thinking “I never succeed in losing weight”, people convince themselves that no matter what they do, they won’t lose weight. We need to bust these myths. I see many clients who say, “My whole family is big, we have big bones”. It doesn’t work like that.
These negative thoughts are rarely challenged and become true to the client so they hold back from making the changes that are needed. These thoughts then become what we call limiting beliefs.
People may believe that if they don’t eat every hour, they get a headache or feel faint, or that their whole family is overweight so they should be overweight. Common beliefs include “I have a slow metabolism” and “My tummy rumbles so I’m hungry”. These might seem silly but they are good reasons why people don’t change and continue to eat the way they do and put on the weight.
Learned behaviours can be broken down into the three main areas; situational, temporal and historical. An example of a situational behaviour could be a person who always sits down to watch television at night with a pile of snacks next to them. While watching television, they continually snack so it becomes automatic.
There may be a particular place they always go that’s associated with food. Or each time they walk into the kitchen, they can’t resist going to the cupboard to check if there are any biscuits. These situations become associated with food.
Temporal or time-related behaviours are fairly self-explanatory. For example, elevenses—everything stops for cup of tea, coffee, a biscuit—and it becomes a habit based on time.
There is a whole generation whose parents went through rationing during the Second World War when nothing was wasted and everything on the plate was eaten. People were told not to waste. This is a cultural and historical reason why people don’t waste food and why they eat larger portions and eat beyond the signal of feeling full.
Another historical habit is the concept of reward. If, as a child, you were rewarded for good behaviour by being given sweets or food, this becomes associated in our cognitive processes so that as adults, we reward ourselves with food. When a celebration is necessary, we go for a slap-up meal or reward ourselves with naughty food. There’s always the excuse that you deserve it. You may deserve it but it’s killing you.
Emotional eating accounts for over 90% of people who are obese. Their eating behaviours are based on emotional patterns of eating—emotional eating, or comfort eating, occurs when you eating for a reason other than hunger. One of the main reasons for it is that people don’t deal with things in their day to day life. People don’t deal with stress and instead find strategies to block the stress out so they don’t deal with the initial problems.
It’s very important that we look at why these emotional behaviours come about. Emotional eating comes on suddenly, rather than slowly as physical hunger does. When eating to satisfy an emotional need, people are more likely to keep eating rather than stopping when they’re full. The danger with emotional eating—other than the weight gain—is that it often results in feelings of guilt which then turn into behaviours and actions and the whole cycle repeats.
One of the first things I do in my clinics is to get rid of clients’ guilt. I tell my clients that guilt is a useless emotion and it doesn’t help. Conscience is a good emotion but guilt isn’t. Guilt is after the fact so why worry about it? Ignore guilt, get rid of guilt and start looking at your own problems.
The main identified causes of emotional eating are boredom, stress and loneliness. Boredom is the biggest cause—when people get bored, the first thing they do is head for the biscuit tin.
We look at alternative strategies and behaviours. If you’re bored, find something else to do. It sounds simple but if you can find a distraction, the hunger disappears because it isn’t real hunger.
Stress is also one of the biggest causes of emotional eating—rather than dealing with the issue that caused the stress, people turn to food. Loneliness is also a cause and encompasses many things including breakdown in relationships or psychological issues that maybe have to be dealt with in another way. We find a lot of people who are overweight tend not to go out or meet people, so they can be quite solitary.
Once you identify these emotional triggers, you can do something about them. Getting people to challenge their thinking; how do I know that thought is true, what’s the evidence that that thought is true?
A simple example: “I’m hungry. How do I know I’m hungry? If I’ve just eaten an hour ago, I’m certainly not hungry.” Getting people to look at the evidence is important and interestingly most thoughts of hunger are actually due to dehydration.
I also use a combination of CBT and hypnosis to change clients’ self-perception and make them view themselves in a different way; to look at themselves honestly, and to be realistic about an achievable body shape and weight.
I assess clients and give them homework, such as keeping a food diary. Our food diaries are very different from anybody else’s food diaries because they are not concentrating on the food—they’re concentrating on the thinking, such as how people felt while they were eating and after they ate something.
What were their thoughts about it? Why did they finish a big plate of food when they didn’t really need it? How did it make them feel? I use the food diaries to identify triggers in eating patterns by analysing the thoughts and emotions involved with their eating behaviours.
I then use reinforcement, hypnotherapy and visualisation—I use the mind-body connection. If you have ever blushed when somebody’s said something to you, the blood cells in your face have opened; the blood has rushed to your face, causing a physical reaction to a thought. Nobody has touched you or done anything to you; you have simply heard or seen something which has had a physical reaction in your body.
I use this to convince a client’s subconscious under hypnosis that they’ve had a gastric band fitted—the Hypno Band. This works combined with visualisation and we use sound effects and smells of an actual theatre. However, it is just a device; a mechanism to help the client to move on. The CBT is the main part of treatment and the visualisation and reinforcement comes about by giving the client homework to do—listening to CDs and reinforcing the change.
Effective long-term weight loss can only be achieved through a change in lifestyle and behavior. Incorrect perceptions and negative thinking play a role in the failure to manage weight. Emotional eating is a major factor in obesity and a combination of therapeutic interventions such as CBT and hypnotherapy can help to identify and change reactions to emotional triggers while boosting self-image and self-esteem. CBT can also be combined with other therapies and strategies such as body-shaping and body-sculpting.
Diet and exercise are important but don’t dismiss the psychology.
John Maclean practices at Newwave Hypnotherapy in Mallorca and Exeter