Cognitive-Behavioral Therapy in Weight Management

by Scott Zimmerman, Ph.D.

Copyright 2002-2004 by Scott Zimmerman

Questions or comments? Write scottzimmerman@cs.com

Cognitive Behavioral Therapy (CBT) is "a form of psychotherapy that emphasizes the important role of thinking in how we feel and what we do. Cognitive-behavioral therapist teach that when our brains are healthy, it is our thinking that causes us to feel and act the way we do. Therefore, if we are experiencing unwanted feelings and behaviors, it is important to identify the thinking that is causing the feelings / behaviors and to learn how to replace this thinking with thoughts that lead to more desirable reactions." (quoted from the National Association of Cognitive-Behavioral Therapists web site).

Applying CBT to Weight Management

In this article, I try apply principles of CBT, as I understand them, to weight management. To use CBT to lose or maintain your weight, you need to make cognition shifts. A cognition shift is simply a new way of thinking, a new set of attitudes. After all, a big part of weight loss and weight management is, let's face it, faulty thinking. Here are some cognition shifts that have helped me lose, and hopefully keep off, 65 pounds:

  1. Don't go on a diet, but rather develop a new lifestyle, something you can live with for the rest of your life.
  2. Think of your new lifestyle as dynamic, not static. That is, your new lifestyle habits must evolve through trial and error. If one thing doesn't work for you, try something else. If that doesn't work, try something else. If your situation in life changes, you might have to make weight-management lifestyle modifications. In other words, solve problems and meet challenges as they arise. Never give up.
  3. Take the attitude that you don't have to be perfect. For successful long-term weight loss or weight management; you only have to stick with your program 80-90% of the time.
  4. Think of a behavioral setback as a learning experience, not as a failure. Faltering is not failure. Everyone experiences setbacks and lifestyle detours. The successful weight manager doesn't let negative experiences lead to discouragement, but rather asks (unemotionally, if possible) "What went wrong? Why? What can I learn from my negative experience? What can I do to avoid this setback in the future? What steps can I take to avoid the situation that let to the setback."
  5. Base your new lifestyle on sound principles. If you're doing the wrong thing, the probability of long-term success is small. Your lifestyle should include proper nutrition, aerobic (cardio) exercise, weight (strength) training, stress management, and cognitive-behavioral modification. If you leave out any of these parts, you decrease your chances of long term success.
  6. Apply good principles by doing things you enjoy. Find a lifestyle you can live with, not necessarily a "perfect" lifestyle (if such exists). Can't live without ice cream? Then eat it, but in small quantities or in nonfat or low-carbohydrate versions. Hate running? Then walk, bike, hike, dance, spin, box, play basketball, play tennis, or do a combination of things. Hate cooked broccoli? Then eat green-leaf lettuce salads. Hate meditation or yoga for stress management? Try self-talk (affirmations), uplifting books, humanitarian service, prayer, or other things to calm and uplift your soul. Find things that help manage your stress and improve self-esteem. (Better still, never tell yourself you "hate" something, as explained later.)
  7. Learn to cook your favorite foods the healthy way. Buy a book on low-fat and/or low-carb cooking, adjust your attitude so that you eventually convince yourself you enjoy the challenge and the taste of foods low in saturated fats and/or low in high-glycemic carbohydrates.
  8. Expand your sphere of physical activities and nutritious foods. Even things you think you hate might become enjoyable with a little effort and a cognition shift. 
  9. Stress long-term enjoyment above long-term self-discipline. You can "grit it out" for only so long. You can deny yourself and feel deprived for only a few days or weeks. But eventually you'll go back to bad habits. Instead, make sure you're eating things you really enjoy. Make sure you exercise in ways that are fun and natural.
  10. On the other hand, use self-discipline. Yes, your new lifestyle should be comfortable and enjoyable, but you still have to keep at it.
  11. Remember that attitude follows action. Contrary to what you might think, our attitudes don't so much dictate our behavior as our behavior dictates our attitudes. If you don't like exercise, just get going at it. If you don't think you want to eat nonfat versions of mayo, cheese, salad dressing, and so forth, just try it for a while. You'll be surprised how soon you start to like it.
  12. Stay positive. Don't ever say, "I hate this," but rather say "I will get to enjoy this more and more as I do it more and more." Don't say, "I'd rather die than go without [fill in your favorite high-fat, high-sugar food]," but rather say "I will gradually decrease my intake of [whatever], but I never have to live completely without it."
  13. Every day, "self-talk" a list of affirmations--descriptions of not necessarily how you are now but how you want to be. Here are some of mine: "I am an athlete." "I love being active in mind and body." "I eat light and right, day and night." "I love the slightly empty feeling." "I love fresh fruits and vegetables." "I love living a healthy lifestyle."
  14. Be willing to pay for better tasting, healthier, easier to prepare nutritious food. For example, I buy low-fat frozen chicken breasts because they are healthy, tasty, and easy to prepare. I pay extra money to get high-quality nonfat or low-carb ice cream. I buy high-quality, very low-fat hamburger, cheese, ham, egg substitute, and so forth. But in the long run, I'll be way ahead financially, because I will be healthier and eat less junk food. (As a bi-product, I've also learned to enjoy my own cooking rather than eating out, thus saving me lots of money.)
  15. Don't think that getting thin will lead to happiness. In fact, maintaining a successful weight-management program requires emotional strength and a healthy self-image, not the other way around. Don't blame your problems in life on your weight. Ask yourself, "If I were thin, what would I do?" And then go do it now, before you get thin.
  16. And most importantly, develop a mission in life, and live that mission. Through whatever means possible (meditation, brainstorming, reading, prayer, organized religion), find out the main purposes of your existence. Write a personal mission statement. Base it on things over which you have control, and then live each day how you were meant to live. This will become your great source of self-esteem, which goes way beyond how much you weight or how you look. Your value is not in your appearance but in your heart. As you make that great cognitive shift, you'll find within yourself the strength to stay on your weight management program, your lifestyle for better, healthier living.

Other Ideas to Apply CBT to Weight Management

Here are some activities that apply principles of cognitive-behavioral therapy (CBT). These sometimes work for some people. Pick the ones that like; ignore the rest.

  1. Write things down--goals, plans, aspirations, feelings, successes, setbacks, analyses, and results. You might want to keep a weight management journal or diary to record these things.
  2. Count things--calories, fat grams, carbohydrate grasm; weight lifting poundage, sets, reps; miles or minutes of aerobic exercise. You might want to keep a food diary and weight-lifting diary.
  3. Count successes. Buy a wrist counter or just carry a little piece of paper. Every time you do something positive in your weight-management lifestyle, add one to the count. For example, giver yourself a count if you pass on pizza or sugary soda pop, another count if you stick to your planned breakfast menu, another if you walk up the stairs instead of taking the elevator, another if you park your car a block away from work and walk the rest of the way, another when you work out on the weights, and so forth. This helps you realize how much success you're having, and keeps you from focusing on your failures.
  4. Plan things--menus, aerobic exercise time and activity, strength training, stress management activities. And then follow your plan.
  5. Lead yourself not into temptation. For example: Don't go into the kitchen. Don't shop while hungry. Don't buy junk food. Don't go out to eat. 
  6. Reward yourself for small victories. Develop a simple reward system, as simple, in fact, as saying "I feel good about myself for doing that." Reward yourself a dozen or more times a day.
  7. Drink lots of water. When you start to feel hungry, drink water instead of eat. Sometimes signals from your body are misinterpreted as hunger when they are really thirst.
  8. After dinner, shut down the eating machinery. Quickly put food away, clean up the kitchen, do the dishes, and turn out the kitchen lights. Get started immediately on a pre-planned activity to get your mind off eating--like reading a good book, listening to music, working on hobbies and personal projects. Floss and brush your teeth. Go to bed early, if necessary.
  9. Either weight yourself very frequently or very infrequently. I myself am a frequent weigher. I weigh when I first get up in the morning, right after I exercise, after I step out of the shower, and just before I go to bed. This accustoms me to seeing fluctuations in my weight, so that I'm not discouraged when my weight goes up and down, as long as I see a general downward trend. It also helps me cut back more on those days when my morning weight is up. Other people, however, don't like to see the fluctuations, so they should weigh only once a month or so. (I think even weighing once a week is too often, because if you're losing one pound a week, you can catch yourself at a low one week and a high the next week, and think you've gained weight when in fact you've overall lost weight.) Psychologically, for some people it's just too distressing to not see the weight come off as they'd like, when in fact they might be losing fat and gaining muscle tissue.
  10. Make a list (List A) of low-saturated-fat, low-sugar, high-nutrition foods that you enjoy. Make a second list (List B) of high-fat or high-sugar or not-so-nutritious food that you feel you can't live without. And make a third list (List C) of the latter kind of food that you have eaten regularly in the past but can easily do without. Now plan your menus that emphasize the foods in List A. Include also in your menus other low-fat, low-sugar, high-nutrition foods that you don't normally like, but add these foods in small amounts. In your dietary plans, go ahead and plan to eat foods from List B, but cut back on the frequency and quantity, but don't omit them entirely. Otherwise, you'll feel deprived.
  11. Remind yourself that little changes go a long way. A little exercise, for example, is much better than none at all. Cutting out half the fat is better than not cutting any fat. In other words, don't fall into the all-or-nothing thinking. That's when you say, "I'm off my diet, so I might as well make the most of it," and the next thing you know you're bingeing.
  12. Get connected. I'm not talking here about the Internet, but about social contact. When you have social support, your lifestyle has a better chance of succeeding more consistently. When I lost 65 pounds, my wife lost 30 during the same time period, which was a huge help because we had similar goals, aspirations, and food. Furthermore, I go jogging every morning with my 24-year-old daughter. We prod each other to get up at 5:30 a.m. even when we're tired, and hit the road. But you can also find supportive people online, at gyms, in your neighborhoods, lots of places.
  13. Recite more affirmations. Here's my long list:

    I am slender and healthy.
    I control my thoughts and actions.
    I like my body.
    I am happy with my life regardless of my weight or my appearance.
    I am always excited and enthusiastic about taking care of my body and losing weight.
    I don't have to be perfect today.
    I live in the present.
    I make small improvements in my life everyday.
    I choose to be cheerful and happy today. I love life.
    I have a mission in life and I am fulfilling it.
    I have faith that when I need extra strength or ability, it will come to me.
    I don't let myself get overly hungry, angry, lonely, or tired (HALT).
    Frequently during each day, I relax my entire body and calm my mind.
    I manage my thoughts, attitudes, habits, and time.
    I eat the right foods in the right amounts.
    I enjoy eating small portions of the right foods.
    I love the feeling of being in control of my eating.
    I love fruits and vegetables, whole grains and legumes..
    I enjoy being mildly hungry; it gives me a feeling of lightness and self-control.
    I hate the overstuffed feeling.
    I feel comfortable turning down food--at any time and at any place under any circumstances.
    I take the time to prepare and eat the right foods.
    I eat light and right, day and night.
    I exercise with regularity and consistency, week in and week out, year in and year out.
    Exercise never costs me time but saves me time in the long run.
    I love swimming, biking, running, hiking, and other aerobic exercise.
    I keep physically strong through exercise and strength training.
    I am an active, healthy, athletic person.
    I have a mission in life, and I'm following my mission.

Good luck, and happy losing!