Conflicting Research on Dieting

Deborah Beck Busis_2014-2015By Deborah Beck Busis, LCSW

Director, Beck Diet Programs

 

A recent article published in the New York Times, “After ‘The Biggest Loser,’ Their Bodies Fought to Regain Weight,” details how most of the contestants on the television show, “The Biggest Loser,” regained much, if not all of the weight they had lost while on the show. The article also describes how the contestants’ metabolisms slowed down as they lost weight and did not return to their original level once they regained their weight. The level of the hormone leptin, which influences hunger, also did not return to the original level, and in fact, reached only about half of what it had been before they started to diet.

The article certainly is discouraging. It also emphasized that the dieters, who lost weight through extreme calorie restriction and high levels of exercise, had to eat substantially fewer calories (up to 500 calories less) than other people who hadn’t dieted, to maintain their weight loss. We don’t believe the situation is hopeless, however. There is a significant amount of research that shows that while there is a change in metabolism as people lose weight, the amount varies. These studies generally show that the metabolic penalty is between 20-200 calories and that this penalty decreases modestly in the year following weight loss. On the other hand, a meta-analysis that was published in 2012 found no change in the metabolic rates of dieters.

In our program, most people have been able to lose weight and keep it off—when they’re willing to have periodic booster sessions to keep their cognitive and behavioral skills sharp. There are several key components of our weight loss program that are drastically different from what the contestants on the “The Biggest Loser” do. First and foremost, our clients do not lose as much weight and they do not lose it quickly; usually, the rate is half a pound to two pounds per week.

Along with slower weight loss, our clients also follow diet and exercise plans that fit in with their lives. In terms of exercise, none of our clients devote the nine hours per week that the “Biggest Loser” participants were advised to do once they returned home. Although the article didn’t describe the specific diets participants followed while they were being filmed, it is likely that the diets were quite restrictive, both in terms of number of calories and the types of permitted foods. This, too, is quite contrary to our program. From the start, we work with our clients to incorporate all their favorite foods into their diets in reasonable ways. We work hard to ensure that our clients only make changes in their eating that they can sustain in the long term.

When helping our clients make changes in eating and exercise, the two words that we constantly use are reasonable and maintainable. We have found that when dieters lose weight eating or exercising in a way they can’t maintain, they invariably gain the weight back when they revert to old behaviors.  Most of our clients don’t lose as much as they’d like because to do so would require unmaintainable eating and/or exercise plans. But they do get to a place where they feel strong and in control of their eating; their health is better; they have gained most of the advantages of being at a lower weight; they experience far fewer cravings; and they feel confident that they can keep doing what they’re doing. They not only know what to do but also can competently solve problems and address dysfunctional thoughts and beliefs that interfere with maintaining the needed changes in behavior.

As far as we can tell, “The Biggest Loser” is the antithesis of our program. Although we haven’t had our clients track their metabolisms before and after weight loss, we assume that taking a much more measured approach is part of what enables our clients to lose weight and keep it off.  While doing it this way is less compelling in the moment, because the pounds fail to drop off at lightning speed, it seems to pay off in the long term, as dieters lose weight by putting behaviors into place, supported by changes in cognition, that they can ultimately maintain.

 

Are you a professional who works with dieters?

Learn more about our upcoming workshop: CBT for Weight Loss and Maintenance. 

Grant Porteous, LMSW and Kevin DeBruyn, LMSW – Workshop Participant Spotlights

TKevin and Grant November, 2015raveling from Traverse City, Michigan, Kevin and Grant attended the 2-day CBT for Weight Loss and Maintenance workshop taught by Deborah Beck Busis, LMSW.

Kevin DeBruyn, LMSW, is the founder and owner of Adaptive Counseling and Case Management, which helps chronically ill patients manage their health care and achieve a healthy lifestyle. Grant works as a clinician at Adaptive Counseling and Case Management.

Many chronically ill patients have issues with weight loss and maintenance, which made this workshop a perfect fit. Both use evidence-based treatments in their practice and were interested in training in CBT. Synthesizing CBT with health care made this workshop a unique fit and had the benefit of being, as Grant stated, ” straight from the horses mouth.”

Their best take aways?

Grant: The framework and process demonstrations through roleplays and case examples

Kevin: “I learned many new ways to structure what I’m already doing” to engage the client and move through treatment

Focusing on Long-Term Weight Loss: The Art of the Possible

Judith Beck_Deborah Beck Busis_2014-2015.jpgDeborah Beck Busis, LCSW

Diet Program Coordinator

Beck Institute for Cognitive Behavior Therapy

A recent article in the American Journal of Public Health (Fildes et al., 2015) reiterates the disheartening statistics on weight loss. This study and many others have shown that most obese people who lose weight gain it back.  In our experience, a major reason for this outcome is that dieters make changes that they are unable to sustain. For example, they reduce their calories too much, eliminate favorite foods, decline social events that include food, or set exercise goals that are too strenuous or time-consuming. When they inevitably return to previous eating, social, and exercise habits, they regain weight, feel helpless, become hopeless and stop their weight loss efforts altogether.

 

To reverse this trend, we ensure that every change we suggest is reasonable and maintainable. This means that dieters usually do not lose weight as quickly as they have in the past or lose as much weight as they would like. But they are much more likely to keep off the weight (plus about five pounds or so) that they do lose. Our philosophy is that successful weight loss entails figuring out the art of the possible.

 

One of our dieters, for example, had a very busy schedule and disliked cooking. Through a variety of standard cognitive therapy techniques, we helped her prioritize exercise and healthy eating and then did problem solving. She committed to exercise 30 minutes three to four times a week, which meant reducing (but not eliminating) the time she spent watching television and reading for pleasure. She also chose not to cook dinner at home, so we created a list of healthy take out and frozen options and planned when she could make the time to pick up her food.  Could we have persuaded her to commit to several hours of shopping and cooking every Sunday to prepare healthy meals for the week? Probably. But as she disliked cooking, it seemed likely that at some point she would stop prioritizing and scheduling cooking and be left unprepared with no healthy food for the week.

 

Another dieter really loved pizza but believed, like many people, that he had to stop eating it altogether to lose weight.  Dieters frequently try to eliminate certain foods or entire food groups, but they almost always revert at some point to eating their favorite foods again (which is fine, as long as it is in moderation). Once they begin eating the “forbidden” food again, though, they overdo it, because they haven’t learned to plan when and how much they’re going to eat nor how to stick to this plan. They interpret their abstinence violation as a sign that they are off track and then have difficulty regaining control over their eating overall.

 

We taught this dieter a combination of cognitive and behavioral skills so he could stay in control around pizza. First we made a plan. He would go to a pizza shop several times and order two large slices to take out. We identified likely thoughts that would interfere with this plan and created strong responses that he read before he went. He practiced this plan several times, bringing the pizza home so he wouldn’t have immediate access to more. Once he gained confidence in his ability to eat a reasonable amount of pizza in a controlled environment, he practiced eating pizza in more difficult circumstances–when he went out to dinner and to a party. Each time we predicted the thoughts he might have that could lead him off track and developed coping cards for him to read. He was able to gain the skills and confidence to control himself around pizza, which significantly increased the probability of his keeping weight off long-term.

 

It just doesn’t work for most dieters long term to make changes they can sustain only in the short term. We believe that reversing the dismal statistics on weight loss starts first with a focus on the art of the possible and is predicated on two words: reasonable and maintainable.

 

Weighing patients within cognitive-behavioral therapy for eating disorders: How, when and why

New Study (1)Abstract
While weight, beliefs about weight and weight changes are key issues in the pathology and treatment of eating disorders, there is substantial variation in whether and how psychological therapists weigh their patients. This review considers the reasons for that variability, highlighting the differences that exist in clinical protocols between therapies, as well as levels of reluctance on the part of some therapists and patients. It is noted that there have been substantial changes over time in the recommendations made within therapies, including cognitive-behavioral therapy (CBT). The review then makes the case for all CBT therapists needing to weigh their patients in session and for the patient to be aware of their weight, in order to give the best chance of cognitive, emotional and behavioral progress. Specific guidance is given as to how to weigh, stressing the importance of preparation of the patient and presentation, timing and execution of the task. Consideration is given to reasons that clinicians commonly report for not weighing patients routinely, and counter-arguments and solutions are presented. Finally, there is consideration of procedures to follow with some special groups of patients.

 

Weighing patients within cognitive-behavioural therapy for eating disorders: How, when and why:Behaviour Research and Therapy, Volume 70, Issue null, Pages 1-10 Glenn Waller, Victoria A. Mountford

 

Workshop Participant Spotlight – Sandra Pasek

Traveling to Beck Institute from Poland, Sandra Pasek works as a psychologist and life coach treating individuals with health issues. She is currently interested in incorporating CBT into her work of implementing holistic health in Poland because “CBT is proven, scientific, and you can see the results.”

 

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Sandra was excited to attend this workshop, CBT for Weight Loss and Maintenance because it focused on many of her interests that dieters struggle with across the world, such as coping with stress, losing weight, and maintaining healthy lifestyles. “No matter the country and geographic location, people all around the world face the same issues.”

 

Ms. Pasek enjoyed that this workshop used actual client examples to illustrate using structured treatment to help dieters avoid getting off track and maintain a weight loss plan. “I liked the real-life examples; it wasn’t just theoretical.” From this workshop, she learned help dieters “focus on what [they] did right” and give themselves credit for positive food and exercise choices, motivating them to make more healthy decisions. “Weight loss is not magic, it takes focus and determination.”

CBT is Effective for Childhood Obesity

According to a recent study published in Quality of Life Research, Cognitive Behavior Therapy (CBT) can be effective in reducing obesity and increasing health-related quality of life (HRQOL) in children. The current study, based in the Netherlands, sought to assess the effects of a family-based multidisciplinary CBT, aimed at reducing Body Mass Index (BMI) and improving quality of life in obese children in comparison to standard care. Those who participated (n=81) ranged in age from 8 to 17 years. The children were randomly assigned to receive the multidisciplinary CBT intervention (n=41) or care as usual (n=40), including advice regarding nutrition and physical activity. The intervention consisted of a 3 month screening phase involving a dietician, child-physiotherapist and child-psychologist. Afterward, there was a 3 month intensive phase consisting of group meetings for the children and their parents. Treatment was also followed by booster sessions; totaling a period of 2 years.

Following 3 months of treatment and at the 12-month follow up, multidisciplinary CBT was found to be statistically significant in reducing the BMI of participants. An ANCOVA test showed a decline from 4.2 BMI-Standard Deviation Score (SDS) at baseline to 3.8 BMI-SDS at the 12-month follow-up; there was no change in the BMI-SDS of the control group.  Analysis for health-related quality of life was based on child report (DISABKIDS) as well as parent report. Immediately following the intervention there were improvements in quality of life as measured by the HRQOL, though non-significant at that time. However, the results from baseline to the 12-month follow up showed that there was a statistically significant increase in quality of life, both physically and emotionally.

This study is important as it shows the longitudinal effects of a Multidisciplinary CBT, whereas most similar studies have only shown short term effects. Though further longitudinal studies of this kind are needed, the results suggest that a family-based multidisciplinary CBT can be an effective treatment for reducing BMI and increasing health-related quality of life in children suffering with obesity.

Vos, R.C., Huisman, S.D., Houdijk, E.C.A.M., Pijl, H., & Wit, J.M. (2012) The effect of family-based multidisciplinary cognitive behavioral treatment on health-related quality of life in childhood obesity.  Quality of Life Research, 21(9), 1587-1594