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Lose Weight through (Mental) KungFu!!

A Psychological Approach to Obesity Prevention Dr. Alvin Ng Lai Oon Health Psychology Programme School of Healthcare Sciences Faculty of Health Sciences Universiti Kebangsaan Malaysia

Why Psychology?
Weight management behaviour change
e.g. less energy intake, more energy expenditure

Behaviour change requires motivation Motivation requires inspirational thoughts Behaviour change also requires understanding of a persons motivation, habits, triggers and maintaining factors of a behaviour Psychology needed to change behaviour and MAINTAIN CHANGE!

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Psychological Approach
Methodologically changing thoughts and behaviour in changing motivation and feelings Thoughts: motivation, positive thinking Behaviour: coping skills, rewards Outcomes = positive emotions, improved quality of life and life skills to keep weight healthy!

Biopsychosocial Interaction: Hot Cross Bun Model

THOUGHTS

BEHAVIOUR

BODY FUNCTIONS

EMOTIONS

ENVIRONMENT (Physical + Social)

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Problems with Obesity

Physical
Health risks diabetes, CVD, cancer, arthritis

Psychological
Prevalence of mental disorders increases with BMI (Becker et al., 2001)

Social
Prejudice/discrimination lazy, dysfunctional, Schooling early exit Job less likely for promotion, earn less Relationships less chance

Usual Intervention
Self-monitoring
most important to tracking success and problems

Behavioural changes
goals and rewards for eating modifications & physical exercise, self-monitoring

Cognitive-Behavioural methods
enhancement of self-esteem, relaxation, coping skills, assertion training, stress management

Social support peer, family

emotional, encouragement, material resources, information, and networking

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Psychological Approaches
Cognitive behaviour approach Skills first, behave later
Change thoughts and learn psychological strategies first Implement behaviour change once skills are learnt (helpful thinking and assertive skills) Skills facilitate behaviour change (i.e. eating less, more physical activities)

Why skills?
To address problems with behaviour change i.e. dieting, increasing physical activities When skills are in place
Change is easier with practice Stress is expected and manageable Relapses can be handled, if not prevented Daily motivation can be put in place

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Skills Needed
Daily motivation and reminders Managing hunger and craving Consistent good eating habits Making time and energy: priorities Respond to sabotaging thoughts by practising (with response cards) Coping skills regardless of triggers

Common Problems in Change

Lack of monitoring Procrastination Intense cravings and preoccupation Emotional eating Difficulty differentiating desire vs. actual hunger Environmental cues Black and white thinking e.g. perfect diet or failure Lack of ability to feel full Diet only, no exercise Social influence Relapse

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Main Components of Weightloss Intervention using Psychological Approach (Beck, 2008)

1. Thorough assessment 2. Realistic expectations and priorities
e.g. target only 3kgs can do wonders E.g. ideal weight not BMI but settling after a balance diet/lifestyle

3. Creating time, energy and resources - priority 4. General life improvement and stress reduction - thoughts 5. Physical activity / exercise 6. Daily motivation and monitoring of weight 7. Self-efficacy and support 8. Consistent eating habits

9. Dealing with hunger, craving and emotional eating - Normalising eating patterns 10. Planning and monitoring food intake 11. Addressing emotional issues 12. Go towards normalcy getting back on track 13. Nutritional counselling 14. Nutritional planning and sticking to it 15. Maintenance and relapse prevention 16. Focus on healthy weight for LIFE.

www.beckdietsolution.com

Eating for Stress Reduction

Stress is as emotion that can be reduced by eating

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Risk Factors in Weight Gain / Weight Loss Failure

Emotional eating Eating fast until filled All-or-nothing thinking Self-sabotage Poor coping of temptations High variety of food Television use Usual: fast food intake, high calorie diet, low exercise

Cognitive Model
Cognitions control behaviour reaction Situation / Trigger Automatic (sabotaging) thoughts Reaction Behaviour (emotional and physiological) Mislabelling hunger Giving self permission / excuse
E.g. Its ok because (justification to eat)

Other dysfunctional thoughts (cognitions)

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Unhelpful Thoughts
Dieting has to be restrictive Should be easy / Too hard High expectations shoulds, or else, perfectionism Good vs bad foods only Hunger and cravings are intolerable Weightloss should be consistent
Biology can show otherwise e.g. hormones Therefore need to keep weighing

Need to be full Easily discouraged after water weight loss Negative emotions Sabotaging permissions / entitlement vs. unfairness I can, too Helplessness giving up. Its not point Unworthiness Why bother?

Preparation
Friendship and warmth in relationship Thorough assessment Expectations Goals: Easy target + plan reward
E.g. 2kg and think of reward

Instill hope Full steam ahead do it properly Reduce shame desensitisation and restructuring negative thoughts
E.g. weight is only a number, not an identity

Increase motivation reasons to lose weight general to specific

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Strategies
Monitor weight daily
To show direct behavioural contributions to weight change or hormonal factors

Behavioural changes thought, regularise eating patterns, gradual changes

Sit down, eat slowly, mindfully Credit self with rewards

Supportive environment (social and physical) Creating time daily scheduling / plan activities and keep to it

Fasting experiment: Hunger is not all that bad

Experiential activity: Differentiating hunger from craving/desire Avoid lunch, check stomach (only when medically ok to do so)
If empty then hunger If not empty then desire

Aim: To decatastrophise hunger

Rate discomfort and compare to other discomfort Usually hunger is pretty mild compared to other pain Desensitise hunger get used to it, get distracted

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Just Do It!
To avoid over-eating How I feel is irrelevant I just gotta do it Do according to plan Satiety kicks in after a while. Just stop eating and get distracted. Imagine consequences e.g. discomfort Review motivational questions e.g. advantages vs disadvantages Reduce opportunities
E.g. distance, distract x 5, relax, drink, read diet/exercise/health stuff

Beat the Emo

Cope with negative emotions Problem-solving Respond to distorted / dysfunctional thoughts Accept distress let it go, and move on Respond to excuses / permission-giving thoughts Anti-craving techniques

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Plan and Monitor

Cope with need for spontaneity / freedom Planning is important and need to be instilled Review behavioural patterns freedom usually leads to weight gain Planning helps with control Spontaneity underestimates eating Do first, cope later

Mindful Eating
Focus on really enjoying food Eat slowly One mouthful at a time

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Keeping On Track
Prepare in advance Anticipate problems and difficulties Address sabotaging thoughts Coping skills response cards Extra food experiments Every bite matters Keep habit in focus, not calories

Coping with Relapses

Responses to sabotaging thoughts Beware of self-criticism Reward self for stopping at any point Watch for unhelpful black/white thinking Problem-solve Continue planned activity / reasonable eating

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Deal with Thoughts

Small steps to counter too hard / cant keep it up No choice to counter dont want I dont care - yes, its true.. For now. But later may care. So do something. Dont have to now but consequences are?

Addressing Real Life Problems

Culture Family Travelling Eating out Food pushers What else?

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Lifetime Maintenance
Lifetime eating plan Deal with stagnancy Lowest achievable weight vs Lowest Maintainable Weight Constant monitoring Regular assessments Stay consistent as planned accept relapses and get back on track Become a coach

Real Life Practice for Compromise

Eat sitting down Eat slowly and mindfully Reward self take credit Fruits and veg at beginning of meal Portion plate Limit junk food and caloric drinks Walk more every day Have social support / coach

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Empowerment
Have control over eating/behaviour, rather than the other way around Learn coping skills for factors that trigger unnecessary eating. Restructure unhelpful thoughts / attitudes Learn assertion skills Alternative activities to prevent over-eating Reward effort Groups and models can provide good support and motivation

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Its OK to have chocolate but the idea is to have a little and really enjoy it, instead of going for quantity
Ruth Quillian-Wolever Duke Center for Integrative Medicine

Approaches in Children
Positive eating messages
Inculcate positive attitudes towards eating E.g. Eat more veggies and fruits, rather than enforcing restrictions which lead to future negative impact on eating behaviour

Associate healthy eating with fun and acceptance Actively involve parents in intervention to support diet, physical activities, and monitoring

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Treatment guideline
Address cognitive barriers directly Plan long-term strategies inc. relapse prevention Concentrate on sustainable behavioural strategies
Simple (e.g. Burn extra 100 calories a day) Plausible (e.g. Smaller serving portions) realistic / everyday use!

Understand the patient

Margraf. Weighty matters, 2000. Data on file. F. Hoffmann-La Roche

It is also important to
Be aware of issues affecting overweight people, e.g. genetics, dieting, physical activities, mental health Understand that an overweight persons problems are not always as a result of their weight and that therapy does not bring thinness. Be aware that resolving life issues doesnt necessarily lead to weight loss

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Recommended References
Cooper, Z., Fairburn, C.G., & Hawker, D.M. (2003). Cognitive-behavioral treatment of obesity: a clinicians guide. New York: Guilford. Fairburn, C.G., & Brownell, K.D. (Eds.) (2002). Eating disorders and obesity: a comprehensive handbook. 2ed. New York: Guilford. Beck Diet Solution
www.beckdietsolution.com

National Weight Control Registry

www.nwcr.ws/

THE END

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