Using cognitive behavioural therapy to achieve sustainable weight loss

Losing weight and keeping it off can be an uphill battle, and in the UK, it's estimated that 62.9 per cent of us are overweight.Often, though, the secret of long term, successful weight loss isn't just about eating less and exercising more, but of changing your mindset about food so you don't slip back into your old bad habits. This is where CBT could help.

What is CBT?

Cognitive behavioural therapy (CBT) is a 'talking therapy' that focuses on how your thoughts, feelings and attitudes affect how you feel and behave.² It teaches you coping skills for dealing with specific problems. Experts say it may be an effective therapy for weight loss because it focuses on making permanent lifestyle behavioural changes.

One 2016 study found that CBT improved weight loss and quality of life in women with polycystic ovary syndrome, a condition caused by an imbalance of reproductive hormones that increases the risk of obesity.³

A study, published in The American Journal of Clinical Nutrition,⁴ found that 10 weeks of CBT followed by 10 weeks of fortnightly telephone sessions improved weight loss in overweight adolescents. Another trial found that individual sessions of CBT promoted effective but small weight loss in middle-aged women, as well as changes in their quality of life.⁵

The vicious cycle of weight loss and gain

There are countless ways to lose weight in the short term, with crash diets and intense bursts of exercise. But further down the line, weight is likely to creep back on as people slip back into old eating and activity habits.

Research suggests it gets even harder to lose weight the more overweight you are. A study, published in the American Journal of Public Health,⁶ found that obese women have a one in 124 chance of losing weight. Whilst for men, it's even harder, with a one in 210 likelihood of dropping to a healthy weight.

How CBT can help you manage weight loss

CBT works by changing how you think and how you behave in certain situations. It can help you examine the thought patterns and emotional processes that may be sabotaging your weight loss efforts, whilst also changing lifestyle behaviours you may have developed in response to those, such as overeating and not doing any activity. Over time, setting practical goals can help weight loss feel more manageable.⁷

You can learn CBT in individual sessions with a therapist, as part of a group, or through online tutorials. With one-to-one sessions, you will usually meet your therapist for between five and 20 weekly or fortnightly sessions which may last between 30 and 60 minutes. If you think CBT may be helpful, speak to your GP.

Using CBT for weight loss

Here are some practical ways to apply CBT to weight loss:

1. Focus on the here and now. Don't be put off by past experiences when you haven't lost weight or you have, but haven't kept it off.
2. Observe and record your behaviours. Keep a diary of thoughts and emotions, and log the food you've eaten and what exercise you've done. This can help identify specific difficulties and patterns you may have developed, such as how you feel emotionally when you want to eat unhealthy foods or reasons why you're lacking energy. It will give you greater awareness of your own experience and ways to maintain new behaviours.
3. Set yourself realistic goals. Rather than purely focusing on long-term goals, such as how much weight you want to lose, focus on short-term goals, such as eating a salad rather than a bowl of chips for lunch or walking to the train station rather than getting the bus.
4. Challenge negative self-defeating thoughts and replace with realistic ones. Question these thoughts with evidence to support your answers. Create a written list of coping statements, and re-read them when you feel like you're falling into bad habits.