Help Clients Move Past the All-or-Nothing Mindset

Give clients a sound approach to realistic lifestyle change.

By Greg Hottinger, MPH, RD
Aug 2, 2016

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 move away from believing that an all-or-nothing approach is necessary or effective.

Choose an 80/20 Approach

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.

Support your clients with realistic goals that help them feel successful and give them the tools they need to live a healthy life.


References

Greener, J., Douglas, F., & van Teijlingen, E. 2010. More of the same? Conflicting perspectives of obesity causation and intervention amongst overweight people, health professionals and policy makers. Social Science & Medicine, 70 (7), 1042–49.
Hottinger, G., & Scholtz, M. 2012. Coach Yourself Thin. New York: Rodale.
Provencher, V., et al. 2003. Eating behaviors and indexes of body composition in men and women from the Qu├®bec family study. Obesity Research, 11 (6), 783–92.
Smith, C.F., et al. 1998. Association of dietary restraint and disinhibition with eating behavior, body mass, and hunger. Eating and Weight Disorders, 3 (1), 7–15.
Westenhoefer, J. 2001. The therapeutic challenge: Behavioral changes for long-term weight maintenance. International Journal of Obesity Related Metabolic Disorders, 25 (Suppl.1), S85–8.

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Greg Hottinger, MPH, RD

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