It is not unusual for patients to talk about weight loss and dieting in sessions. In fact, nowadays, it may be unusual if they didn’t. Unfortunately, worry about body size, health and diet is a normative part of Western culture. Weight loss diets started to gain traction in the 1970s. I was a child of the 80s, when fat was the culprit to weight gain and early demise. Food and diet fads have come and gone over the years. Currently, “health” versus weight loss appears to be more of the focus, but when you really unpack health with patients, it often comes down to weight loss. Despite counting points, calories, carbohydrates and fat grams, body weights in the United States have been on the rise.
We are inundated with weight, shape, and “health” messages about what we should and shouldn’t be eating. The authors of Intuitive Eating say the media makes it sound like we are one bite away from death. For our patients (and yes, even us), it can be overwhelming and downright confusing. No wonder clients come in and seek our advice.
So What is a Therapist to Do?
Given the bombardment of information that our patients (and we) receive daily about food, weight, shape and health, chances are that clients are going to bring these topics up in sessions. Furthermore, most therapists today provide holistic services exploring with clients their lifestyle to help support well-being and mental health. Adding to the complexity, as therapists, we live in a body and are not immune to messaging about food, weight and shape and have our own stories around food and our bodies.
As therapists, we can offer a unique space for people to discuss their relationship with food and their bodies. All too often, I have encountered well-meaning therapists offering dietary or weight-loss advice to clients that may be more harmful than helpful.
Getting clear on your own food, weight, shape and health story and beliefs and values is a good place to start. Secondly, getting clear on the counterproductive and even harmful effects of dieting is important.
Clinical Issues to Consider
1.Dieting is a known risk factor for developing an eating disorder. The causes of eating disorders are very complex. Researchers have identified several risk factors for developing an eating disorder, which include dieting, temperament and gender. Not all people who diet will develop an eating disorder, but dieting can increase the risk. Your patient may already have an eating disorder and they may or may not have disclosed it to you. Dieting only makes the eating disorder worse.
2. Dieting doesn’t work for long-term weight regulation. Scientists don’t have any good data that show that dieting works consistently in reducing weight in the long term.
3. Dieting can lead to weight gain. Dieting can produce short-term weight loss, but more often than not, it leads to the regaining of lost weight and sometimes even more. Some clinicians argue that the losing/gaining of weight, also known as weight cycling, is what causes health problems (vs. elevated body weight).
4. Dieting can interfere with quality of life. Diets often promise control over food and even our lives. Starting a new diet can feel exhilarating. Dieters report that they often spend more time thinking and fantasizing about food once they have started dieting. Restricting the types and quantities of foods you eat can lead to feeling more out of control with food, often leading to binge eating type of behavior.
Dieting can lead to avoiding certain social situations in order one to stay on the diet. Studies show that dieting leads to more preoccupation with food and weight. Preoccupation with food and weight leads to feeling less and less in control.
Additionally, when dieters are not able to follow their diet (not because of laziness or lack of willpower), it can lead to an increase in feelings of shame and failure. These feelings can often drive us further from self-care, and in some people, it can lead to overeating.
5. Dieting doesn’t equal improved health. Many embark on a diet in the name of improving health. In fact, dieting does little to improve health. Dieting teaches us to pay close attention to food and exercise, but once off the diet, health-promoting behaviors go out the window. The exercise stops and the overeating begins.
In fact, there is compelling scientific evidence that eating nutritious foods and regularly exercising–in the absence of weight loss–can significantly improve health.
Therapists can use the following techniques to explore food, weight and body issues with clients:
- Rule out current or past history of eating disorder. Remember, you can’t tell by looking at people if they have an eating disorder. Clients with a history of dieting are at risk for a full-blown eating disorder.
- Address shame and feelings of failure associated with many failed diet attempts. So often, people who have failed at dieting blame themselves, despite the research that shows that dieting is not effective for long-term weight loss. Oftentimes, folks feel pressured by family members, friends and healthcare providers to lose weight.
- Assess for current or past weight-based victimization. If your patient lives in a larger body, chances are they have experienced weight-bias or bullying.
- Explore family of origin issues around food, weight and shape. Many eating and body image issues are inter-generational.
- Food is part of heritage and culture. Explore what roles food play in your client’s culture.
- Food can be as used to cope with uncomfortable feels and as a distraction. Assess whether patients are using food (or exercise) to excess to regulate emotions and teach them other ways to manage feelings.
- Talk about what your patients can do to improve their health. Most of our patients value their health and do want to take care of their bodies. But for folks who have chronically dieted, avoidance behaviors (because dieting hasn’t worked) may start to occur–iIn some cases, avoidance of health-promoting behaviors all together. Help clients bolster behaviors (weight is not a behavior) that can promote health, such as eating nutritious foods that they like, practicing movement that they like, quitting smoking, reducing alcohol intake and going to the doctor regularly.
As therapists, we work really hard helping people navigate their psycho-social well-being. It is our job to encourage and teach them to stay connected to themselves in order to live a fulfilled life. Dieting, following food fads and focusing on looks keeps us and our clients disconnected from ourselves and experiences with food and our bodies. With the tips above, you can help offer your patients, particularly those living in larger bodies, a new narrative to become more connected to their experiences with food and their bodies to live healthier lives.
Alison Pelz is a psychotherapist and has been a registered dietitian for more than 16 years specializing in the treatment and prevention of body image disturbance, eating disorders and other fitness and weight-related concerns. She is a Certified Intuitive Eating Counselor. Currently, she maintains a private practice in Austin, TX. To get a free therapist guide to helping your clients make peace with food and their bodies go to http://www.alisonpelz.com/continuing-education-counselors/.