Want to lose weight? Make friends with those pesky cravings, and connect to more than the number on the scale | Possums for Mothers and Babies

Want to lose weight? Make friends with those pesky cravings, and connect to more than the number on the scale

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Dr Nga Tran - Psychiatrist

You may be one in two Australians at any one time trying to lose weight.  Be it from a recent health scare, a hard word from your doctor, or realising you can’t do something that really matters to you.  Despite shows like “The Biggest Loser”, the evidence of success for people losing a meaningful amount of weight and keeping it off in the long term is very low.

You know this cycle: A certain event spurs you into action; you get motivated and set a plan; you may be able to stick to it for a while; sooner or later, cravings kick in, and you start eating a few of the things you shouldn’t eat, or eat more than you intend to.  You are a rational, thinking, caring human being, and in many ways this behaviour makes sense – eating brings pleasure and/or eliminates unpleasant states such as cravings or boredom.  We know cues are very powerful – if a song can bring back a memory of that first kiss at 16, think of all the associations that may be present with food.  The smell of coffee may bring craving for cake, driving a certain route may mean a particular fast food stop, watching TV may be paired with a packet of chips.  This is works at a very automatic level in your brain, and is much more powerful in influencing your behaviour than menu plans or the future risk of diabetes.  So over and over again, you (and most others) act in accordance to these food cues to reduce cravings, and the longer term consequences fade out your consciousness at the moment of choosing.  Afterwards, you castigate yourself and feel guilty or hopeless.  These very emotions are unpleasant and can again be immediately diminished by food, and the viscious cycle keeps going. 

Traditional weigh loss strategies teach you about nutrition, about counting calories, about distraction techniques to fight urges, and get you to keep a diary of what you eat and your weight.  In basic terms, they teach you to set specific goals and to fight your cravings and urges.  Even with the best programmes and intensive support, the rate of people losing a meaningful amount of weight and keeping it off is very low.

A new study shows that using a different strategy, called Acceptance Based Treatment, achieves much higher success rates.  This study was very well designed and involved nearly 200 people.  The Acceptance Based Treatment lost 13.3% of initial weight at 1 year, compared to the best existing treatment achieving 9.8%.  This is among the largest ever success in behavioural treatment for weight loss without using an aggressive diet regime or medications (most of which have multiple harmful effects and short lasting results).

What is different about Acceptance Based Treatment?  It teaches you accept physical discomfort, such as hunger and craving, without needing to get rid of it with food.  It also teaches you to accept the reduction in pleasure associated with eating.  So rather than a battle between you and your urges, you learn to notice them come and go.  And it teaches you to connect to the values that are important to you about losing weight, rather than just focussing on the goal of losing weight in and of itself.  So, for example, if losing weight means you can run around and play sport with your children/friends, then connecting with this value enables you to be more willing ride out the discomfort.  This actually leads to you choosing differently, over and over again, and gradually form new habits and associations with food.  The reward of doing something that is in line with what you care about is an intrinsic motivator that you can always access.  You learn to be kinder and more forgiving of yourself so are less likely to beat yourself up and more able to stay on track.

These are exactly the principles and techniques we use in Acceptance and Commitment Therapy at the Possums Clinic.  The same principles are applied to problems with alcohol, cigarettes, gambling, shopping, overworking.  In the same way, we help clients be more willing to tolerate anxiety,  depression, traumatic memories, voices, or whatever distressing internal experiences,  in the service of living their lives in a way that is really meaningful to them.



Foreman, E et al: Acceptance-based versus standard behavioral treatment for obesity: Results from the mind your health randomized controlled trial


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