If you’ve ever gotten your car stuck in the snow or the mud, you know how maddening it can be to try to find that tiny bit of traction you need to get going again. Despite knowing you’re only digging a deeper hole, you press the gas pedal to the floor, expecting to move forward. The wheels just spin. Being hopeful and having a strong desire to be free don’t fix your problem. Clearly, a tow chain would change everything.
Many of your overweight clients are living this life: stuck like a car with no traction and desperate for a new approach that will help them move forward.
One study found that overweight subjects viewed the problem of obesity as “arising from their personal shortcomings (i.e., motivational and physical),” but this belief was juxtaposed to “blame-absolving accounts often involving specific challenges associated with day-to-day living.” All the overweight subjects “expressed a strong sense of personal responsibility to overcome their weight problems, and looked to another not-yet-tried, technocratic weight-loss program to address the problem, despite all reporting past failures” (Greener, Douglas & van Teijlingen 2010).
In other words, overweight clients are caught in the trap of blaming themselves for their lack of success—all the while resisting taking responsibility for their choices and constantly searching for the next “best” program to come along. Without some key “thinking shifts,” they are destined to keep trying what doesn’t work.
Your overweight clients can free themselves from repeating the same ineffective approach if you help them make these three key shifts:
1. Move away from believing that an all-or-nothing approach is necessary or effective.
2. Move away from trying to go it alone and toward seeking sources of support that are nurturing and effective.
3. Create a wellness vision to discover their personal motivators for change and set goals that fit their needs.
Studies have suggested that greater cognitive dietary restraint—more ability to consciously limit the type and amount of food ingested, in an effort either to lose weight or to prevent weight gain—is a reliable predictor of weight loss, whereas greater disinhibition—more frequent episodes of overeating, a stronger tendency to eat rapidly and higher ratings of perceived hunger (Smith et al. 1998)—is a better predictor of weight gain or weight regain after weight loss (Provencher et al. 2003).
While increased awareness of calories and food choices is important for short-term weight loss, having more emotional control (less disinhibition) is highly associated with keeping weight off for the long term. Researchers have suggested, however, that following a strict and rigid diet can make dieters more vulnerable to losing control of overeating (developing higher levels of disinhibition) (Westenhoefer, Stunkard & Pudel 1999).
Provencher et al. (2003) pointed out that most studies on dietary restraint were conducted on study subjects enrolled in controlled weight loss interventions and were not based on “real life.” In their cross-sectional study of 352 women, Provencher and colleagues concluded that focusing exclusively on cognitive dietary restraint—especially rigid restraint—might not be optimal for long-term control of body weight, particularly in women. To improve lasting changes to eating behavior, Westenhoefer (2001) determined, the principle of flexible control should govern the change process, and rigid control should be discouraged.
So how do we establish flexible dietary restraint that leads to weight loss but does not create a surge in disinhibition, the emotional backlash that leads to yo-yo dieting?
1. We recognize that many popular weight loss plans espouse an all-or-nothing approach, encouraging dieters to eat exclusively from one list and to avoid certain foods entirely.
2. We acknowledge that our media promote a “quick-fix mindset” (Hottinger & Scholtz 2012) that pressures us to seek quick weight loss results to the exclusion of all other positive changes.
3. We encourage an antidote to all-or-nothing thinking: an 80/20 approach that lets clients strive to make healthy choices 80% of the time. The other 20% of the time allows for intentional treats and missed exercise bouts and makes provisions for unintended splurges.
An 80/20 approach can be effective only when clients successfully
- let go of thinking that perfection is necessary (or even possible) for weight loss and weight maintenance;
- learn how to give themselves “real,” or guilt-free, permission to include controlled portions of treats as part of their weight loss programs; and
- develop a recovery plan to rebound quickly from their slips, by “letting go” of a slip when it happens and avoiding subsequent feelings of guilt and negativity.
Going it alone is an unnecessary and, for most, unproductive approach to weight loss. External support increases adherence and improves weight maintenance. With your help, your clients can build a supportive network of professionals, friends and family.
A recurring theme among effective intervention programs is the use of social cognitive theory (SCT) constructs. Studies found that treatment based on SCT helped increase exercise attendance, a result researchers attributed to improvements in physical self-concept, perceived ability to overcome barriers to exercise, and body satisfaction (Annesi & Whitaker 2008; Annesi et al. 2011).
By paying attention to your own feedback and dialogue, you can help a client feel more comfortable with his body and more confident in his ability to stick to his plan. Keep your language, both about yourself and about your client, positive and nonjudgmental. And coach your client to restructure negative comments—about the way his body looks and his physical abilities—to be more positive and self-supportive. One exercise to consider is in the sidebar “Describing a Friend.”
Salvy et al. (2009) showed that peer social support is an important factor in physical activity adherence. And according to Fukuoka et al. (2011), people want real-time interactions with their support networks. This points to using social media to help clients stay on track. Access to 24/7 contact with peers allows clients to reach out for support any time they are struggling with low motivation or experiencing high temptation.
However, Fukuoka et al. also found that interaction with others who are engaged in the same type of healthy-lifestyle program is more valuable to people than an “open” social media experience like Facebook. The most beneficial thing you can do may therefore be to help clients come together in like-minded groups to share experiences, create goals and feel accountable—yet feel safe and not judged. Clients could also be encouraged to do this on their own within their own social circles. Consider the exercise in the “Bull’s Eye” sidebar to help your clients discern those in their circle who are supportive and those who are not.
Basing goals on each individual’s personality, strengths and restrictions versus established, “by-the-book” exercise prescriptions and formulas is important for overweight and obese clients. Many of these clients are susceptible to physical activity barriers such as feeling too overweight, feeling self-conscious, suffering from minor aches and pains, and lacking self-discipline (Napolitano et al. 2011).
In addition, Fukuoka et al. (2011) point out that overweight clients report both a fear of failing and concern over losing interest in the program. This is a delicate balance to manage. On the one hand, setting realistic goals can bolster long-term success (Westenhoefer 2001). Clients who are encouraged to set realistic goals may be more likely to start slowly and build up gradually; they may also feel a sense of relief at not “having to” set goals that could cause embarrassment, seem overly strenuous or lead to injury. On the other hand, losing interest in the plan is a real risk that may increase if a client finds a plan too easy, too predictable or too boring.
A tool that can help clients set effective goals is the SMART technique (the acronym means making goals that are specific, measurable, achievable, rewarding and time-based). Setting goals that are simultaneously achievable and rewarding is particularly important in balancing fear of failure and concern that clients will lose interest. Keeping this balance in mind will help you moderate your clients’ expectations. When you support the notion that modest goals are still valuable goals, your clients have a better chance of setting realistic goals that they will nonetheless find motivating and exciting.
Another tactic for discovering motivating goals is to integrate a wellness vision into the goal-setting process. A wellness vision is a written picture of how you want your future to look: how you want to live your life, what you want to do, places you want to go and how you see your relationships, career, fitness, health and other important parts of your evolving life.
“A vision is a compelling statement of who you want to become, or grow into, and what health-promoting, life-giving behaviors you will be engaging in consistently when you get there,” says Margaret Moore of Wellcoaches Inc. Visions are open-ended, unlike 3-month or weekly goals, which are tied to specific time periods. A vision of what you truly want in your life helps in the creation of your specific goals and, in turn, your 3-month and weekly goals are designed to take you toward your vision. Moore adds, “If you keep your vision in mind and, even better, in your heart, it will serve as a guide to making the choices on your path that move you toward your vision. A compelling and meaningful vision simplifies the process for identifying the strategies, the goals, for taking action.”