Psychotherapy of Weight Loss
Dr Jonathan Haverkampf, M.D.
There are many approaches advertised to reduce weight but I want to focus on one of them, which I also find the most important one, the psychotherapeutic approach. Being overweight or underweight can be due to a medical condition, which needs to be excluded first. Also, there may be a perception of being overweight even when the body weight is normal or even low, such as in the case of anorexia.
Body Mass Index
The first question if one’s body weight is too high. A good tool used in many medical settings is the body mass index (BMI). Roughly, a BMI of 18.5 to 25 is seen as ‘normal’, although this always depends on the individual cases, if there are medical or other reasons to divert from it. But the BMI is usually good starting point.
If the BMI is greater than 25 and there is an increased calorie intake (without clear binge eating), the situation appears to be relatively straight forward. One’s ‘intake’ is too high. Reasons for such behaviour, absent any medical condition, can be manifold.
‘Taking in’ food can have a soothing and calming effect because it reconnects one with the world, also in a physical way. But there can also be neurobiological processes, reaching back into the time when a baby sucked at the mother’s breast, which get activated and lead to a secretion of hormones and neurotransmitter substances which have a calming and relaxing effect.
Food intake therefore can be too high because of tensions or stress that increase the urge for relaxation and calming.
Stress and Tension
Psychologically, there can be a number of reasons for stress and tension, including a
- deficient sense of self
- lack of boundaries
- strong emotions of loneliness, sadness or even anger that cannot be communicated.
Since there are so many possibilities in terms of psychological dynamics that can trigger and maintain a calorie intake above normal, it is always important to look at the individual case.
There can be several reasons which lead to weight problems. Traumatic life experiences, unstable relationships, low self-esteem, and more are commonly present, but this need not be the case. In a number of instances eating more than one can metabolize may also be a ‘bad habit’ in the sense of a behaviour that has been learned and is difficult to unlearn. Maybe it is out of convenience or a lack of awareness, but change may also be difficult because one does not know how to go about it. Some structure and planning is usually required, at least when it comes to deciding what to order in a restaurant. There are many self-help books and therapists who can help one to deal with this problem. Cognitive Behavioural Therapy (CBT) often provides an effective approach if deeper personality issues and more severe mental health problems are not present.
Self-Esteem and Self-Confidence
In another article, I have discussed what to do about low self-esteem and low self-confidence. Psychodynamic therapies are helpful if there are ‘deeper’ issues are present. Insight at least shifts the underlying emotions away from the eating problem towards other strategies. But over the long-term the resolution of conflicts or any other underlying issues that are present and maintain the weight problem usually also make the weight problem go away or improve it considerably. Learning to experience and accept oneself more fully is often helpful in reducing an unwanted behaviour, such as elevated calorie intake.
The Sense of Self
The main strategy should be to focus on establishing a sound sense of self that increases happiness and enjoyment in life. This often means identifying one’s values, interests and aspirations. The more the focus can shift to enjoyable ways of constructing one’s life, the less a weight problem will be an issue. The less one actually has to think about the ‘weight problem’ the less it often is a problem, but this requires living more fully. This does not mean drastic changes in one’s life, but a gradual process towards a more fulfilling life in single steps.
Dr Jonathan Haverkampf, M.D. MLA (Harvard) LL.M. trained in medicine, psychiatry and psychotherapy and works in private practice for psychotherapy, counselling and psychiatric medication in Dublin, Ireland. The author can be reached by email at firstname.lastname@example.org or on the websites www.jonathanhaverkampf.com and www.jonathanhaverkampf.ie.
This article is solely a basis for academic discussion and no medical advice can be given in this article, nor should anything herein be construed as advice. Always consult a professional if you believe you might suffer from a physical or mental health condition. Trademarks belong to their respective owners. No checks have been made.
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