Excess body weight is a common problem across the developed world caused by eating more calories than is being used through daily activities and exercise. Body fat stored build up over time, can become harder to loose and cause a range of long-term health problems.


Treatments for weight loss


There are many treatments available to help people lose weight, but the problems is usually more complex than a single solution like diet, excersize, medication or surgery can solve. The most important aspect of any treatment is to make basic lifestyle changes which achieve a reduction of energy intake and an increase in physical activity. This is an essential part of any attempt to lose weight! 


Certain medications can help with weight loss safely but there is always a risk of side-effects. Likewise, surgery can have serious complications and is usually reserved for the most severe of cases and only be considered with careful considerations of risks and benefits.  


What is cognitive behavioural therapy?


Cognitive behavioural therapy (CBT) is a type of psychological therapy that is used to treat many different problems ranging from anxiety and depression, to weight loss. CBT alone does not cause weight loss but can help people achieve and maintain the lifestyle changes necessary to loose weight.

CBT can help a person to lose weight by:


  • Learning method to control their diet more easily

  • Helping set achievable goals for weight loss and maintenance 

  • Provide coping skills to handle the inevitable lapse into over-eating 

  • Enhancing motivation to do physical activity and exercise

  • Setting long term weight maintenance strategies

  • Addressing problems with self-esteem, body image and unrealistic expectation and demands

  • Helping with managing stress better and avoid ‘comfort eating’ 


Recent clinical research has repeatedly shown CBT to be valuable and effective in addition to diet and exercise plans for weight loss: people who had both CBT and lifestyle changes lost more weight than those who only had lifestyle changes. The same is true for medication and surgical procedures for weight loss. In fact, CBT alone (i.e. with no diet, exercise, medication or surgery) was also found to be helpful for some people to tend to binge eat. CBT alone will not work for everyone and combined with lifestyle changes the results are always better.



The Journey to Losing Weight ... 


Why do you want to lose weight?


Losing weight is hard and you need very good reasons to lose weight. There can be many reasons but the most common reason is to change to better shape and feel less fat. Hopes may be to improve appearance, attractiveness and wanting to wear more fashionable outfits. These might motivations might do no more tha enforcing negative self-views of themselves and self conscious and embarrassed around others. Another reason people want to lose weight is that they lack self-confidence.


To some people body shape is closely linked to self-worth and self-confidence. The desire to improve health might be a less common or less important reason. There are other reasons like wanting to be more active for activities or to overcome a physical form of illness or immobility. As seen above the majority of patients see weight loss as the only way of achieving some benefit that is very important to the patient. These benefits are the patient’s ‘primary goals’ and while they are not always directly linked to weight loss fulfilling these primary goals are of the highest importance to the patient.


How much weight do people expect to lose?


Many people set unrealistic goals for weight loss over unrealistic timescales, which makes their goals impossible to meet. Some say weight loss is simply a matter of self discipline and society’s obsession with body image and being very slim is the best way to be. This causes many people linking body image with beauty, confidence and self respect. The result is that people set goals to lose unrealistic amounts of weight in the hope that this will fulfil their primary goals.


Primary goals & weight loss


It is easy to see that many of the primary goals are only loosely connected to weight loss. In some individuals it is important to lose weight to achieve better health but other primary goals often have no connection to body weight. Goals about self-confidence, better social or work skills or even how attractive a person considers themselves are not really dependant on their weight.


When people actually start to lose weight


When someone starts to lose weight they are usually successful for a short time. The first problem is that after several months and a 5-10% weight loss the loss of weight stops due to normal body processes. At this point a person has not yet achieved their ‘primary goals’ (as these are not really weight based). As a result people become discouraged, often underestimate their achievement and ignore any benefits like greater fitness, a change in clothes size or having more energy.

At this point one of three things can happen:

1 Most people think that their goals are unachievable and give up on weight loss (at least for some time).

2 Some people continue to try and often do lose more weight. However, there comes a time when more weight loss becomes impossible and these people also give up.

3 A small minority do reach their goal weight but often this does not fulfil their primary goals and they give up on any form of weight control.


Regardless if the person reaches their weight loss goals, primary goals remain unachieved and therefore the person is at high risk of lapses. These lapses usually involve over-eating, which results in weight gain. This weight gain is then seen as a failure resulting in further dieting and then further lapses. Over time there develops a yo-yo-ing style of weight loss with large losses followed by weight being regained.


Maintaining healthy weight


People can work hard to try to and reduce their weight but often tend to make less effort to maintain the new lower weight. This can be due to one of two common reasons:

A person not fulfilling primary goals and the idea that with even more weight loss these will be fulfilled.

A person neglecting the benefits they have already achieved.

However without weight maintenance people return to their prior lifestyle habits and soon begin to 



Therapy (CBT) for Weight Loss ...


Successful and sustained weight loss is not always a simpe issue and often involves dealing with issues of body image, self image, confidence and self respect. For this reasons CBT can be useful in several stages of a weight loss program. Here is an example of an individualised CBT weight loss program: 


Step 1: Refining your motivation


Why do you want to lose weight? How much weight do you want to lose? As mentioned before many people dismiss the weight loss they have achieved and any benefits they have had. This leads them to become discouraged with weight loss. Reflect on how far you've already come and be happy with your achievements. This allows you to separate weight goals from life goals.


1: Lifestyle changes


This is the start and the most important part of losing weight. A diet should be started to encourage healthy eating that provides nutrients and vitamins but reduces calories. There must also be a focus on increasing activity. The aim is to increase a person’s activity level in general (eg take the stairs not the lift, walk more, etc) rather than simply increasing formal exercise (such as in the gym). If the patient has a steady general increase in activity they are more likely to continue this into the long term once the initial enthusiasm has worn off.


Step 2: Problems with the diet


Once the above is in place it is important to address the problems that can cause a person to abandon their diet. Issues include motivation, frequent snacking, drinking alcohol or sugary drinks, binge eating and eating in response to mood. CBT can help some of these problems. CBT has been proven to be very good at improving mood and so can help with managing comfort eating.


Step 3: Body image


As mentioned before the majority of people who try to lose weight have very negative views about their body image. This part applies the basics of CBT to try to change a person’s view of their body image and its importance to them. Body image is very important in our society but body image should not define a person. Therefore CBT can be used to correct a person’s obsession with body image and to show them that there is more to a person than how they appear.


Part 5: Setting life goals


Often, the real reasons a person wants to lose weight are unrelated to their actual weight. This is where CBT is very important in addressing false negative self-beliefs and unhelpful assumptions that influence your thoughts, feelings and ultimately, actions. Let us take the example of a patient who is trying to lose weight as they currently lack self confidence. The person believes that external appearance is the most important aspect of their lives and because they view their appearance in a negative way they view themselves as a person in a negative way. In social settings they may become extremely self conscious, leading to feelings of anxiety that in turn lead to the person being quiet and withdrawn, so the person lacks self confidence. If the person receives therapy and they begin to understand that there is more to them then merely their external appearance then the situation can change. The person becomes less self conscious of their image, thus they are no longer anxious and thus their self confidence increases. Helping a person achieve their primary goals is an extremely important step in allowing them to lose an appropriate amount of weight and then maintain this weight.


Part 6: Maintenance


Long term maintenance is extremely important to ensure a person has a steady weight. CBT can be used to reinforce the significance of the weight already lost and encourage ongoing weight control. There must also be an emphasis that dieting is a set of flexible guidelines and not a set of rigid rules. A person may break their diet on occasion and this is not the end of the world and the patient still has control over their weight.




Weight loss is not easy andtakes a lot of effort. However, the reasons people want to lose weight are often … to  negative views of body image and a lack of social skills and confidence. Weight loss therefore becomes a method by which people hope to improve social skills, etc. CBT is vital in helping people separate these goals from their weight loss goals. After the patient understands that the two are different CBT helps the patient fulfil their primary goals separately form their weight loss goals. The result is that people become far happier with themselves and with the weight they lose resulting in long term weight control.


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