Can Cognitive Behavioral Therapy for Weight Loss Help Patients?
— By Dawn M. Sweet, Ph.D
Including cognitive behavioral therapy as part of your patients’ weight loss program could help them identify and mitigate thought patterns that amplify weight gain.
Healthy eating and becoming more physically active represent more traditional approaches of behavior modification for weight loss. While this two-pronged approach of healthy eating and exercise is a critically important strategy for weight loss for patients with obesity, cognitive behavioral therapy (CBT) for weight loss represents another important behavioral therapy for weight loss.
Cognitive behavioral therapy is an evidence-based therapeutic approach that helps people identify and modify problematic thought patterns that contribute to a particular problem, such as depression, anxiety, alcohol use, drug use, or eating disorders.1 While unwanted weight gain is certainly related to food consumption and a sedentary lifestyle, there is also a psychological component to weight loss, thus considering psychologically-based interventions such as cognitive behavioral therapy for weight loss can help patients with obesity address underlying psychological mechanisms that may be contributing to their weight gain. Because CBT uncovers thought patterns, patients with obesity who participate in behavioral therapy for weight loss can — with the assistance of a trained professional — identify and develop strategies to mitigate the problematic thought patterns that contribute to unwanted weight gain.
Principles of Cognitive Behavioral Therapy
According to the American Psychological Association (APA),1 cognitive behavioral therapy is premised on three core principles that suggest psychological problems arise, in part, from the following behaviors: (1) unhelpful or faulty ways of thinking; (2) learned patterns of unhelpful behavior; and (3) learning better ways of coping with psychological problems to relieve their symptoms.
Treatment with a CBT-trained therapist focuses on recognizing distorted thinking that may be contributing to problems, using problem-solving to cope with difficult situations, and cultivating more confidence in your own abilities. Treatment, which focuses on the present rather than the past, places the focus on the individual learning to recognize problematic thought patterns and adopting strategies and coping skills to change their own thinking and behavior. CBT is relevant in the context of weight control because negative arousal states can lead to negative thought patterns and maladaptive coping strategies such as binge eating.
Using Cognitive Behavioral Therapy for Weight Loss, Binge-Eating
According to a 20172 study, to optimize successful long-term weight loss for patients with obesity, weight loss programs should address psychosocial and psychological issues, particularly self-esteem, stressful life events, eating disorders, and anxiety. An earlier study3 acknowledges the benefits of psychological therapies for in-patient treatment management of unwanted weight gain.
In the context of binge-eating, a contributor to unwanted weight gain, CBT, a type of behavior modification for weight loss and maintenance, is recognized as the optimal approach and considered as the “first line of treatment” for psychologically based treatment approaches.4 As early as 2004, the National Institute of Clinical Excellence recommended CBT as the treatment of choice.2
In a randomized control trial5 of 125 patients with obesity (Mage = 44.8; SD = 9.4; BMI = 38.8; SD = 5.8) and a binge eating disorder, participants were randomly assigned to one of three treatments, CBT (n = 45), Behavioral Weight Loss (BWL) (n = 45) , and Sequential CBT + BWL (n = 35). Therapists were trained in each therapeutic approach, and therapy CBT or BWL sessions lasted 60 minutes for 24 weeks while the Sequential CBT + BWL was organized such that CBT was delivered via 16 sessions over 16 weeks followed by 16 BWL sessions over 24 weeks. Completion rates were 76 percent for CBT (n=34), 69 percent (n=31), and 60 percent for CBT + BWL (n=21). Completion rate differences were non-significant through the 12-month follow up period.
Results suggest that all three therapeutic approaches improved binge eating, though CBT was found to be superior to BWL for reducing binge-eating frequency through the 12-month follow-up. BWL was associated with significant but modest weight losses through the 12-month follow-up period; however, substantial weight loss was not achieved with CBT. The authors state that weight loss in the context of binge eating has been an elusive finding, though the authors do point out that binge-eating remission was prospectively associated with greater weight loss. For example, binge-eating abstinence post treatment yielded a 4.3 percent decrease in BMI at the six month follow up and those patients had a 3.5 percent BMI decrease at the 12-month follow up, suggesting that the cessation of binge-eating may play a role in weight control. Finally, sequencing CBT and BWL was not efficacious for binge-eating or weight loss.
Addressing Patient Behavior in a Clinical Weight Loss Setting
Addressing psychological factors that may contribute to unwanted gain is an important strategy for ensuring successful long-term weight loss. Behavioral therapy for weight loss and behavior modification for weight loss and maintenance should be integrated as part of a holistic approach to helping patients with obesity succeed at losing weight. Cognitive behavioral therapy for weight loss is a recognized, evidence-based strategy for helping patients with obesity have agency in their weight-loss journey because it gives them the tools, they need to identify problematic thought and behavioral patterns and then modify their thought and behavioral patterns accordingly. Behavioral therapy for weight loss is an effective and complementary adjunct therapy when paired with an exercise program with a healthy eating plan that might include a Low Calorie Diet (LCD) or Very Low Calorie Diet (VLCD) utilizing nutritionally formulated meal replacements.