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Carolyn Hax

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Posted at 07:00 AM ET, 08/01/2011

A new approach to weight loss?

Some people insist that weight management is largely a matter of personal responsibility, that we are all ultimately in charge of deciding what goes in our mouths. Others maintain that managing weight means fighting colossal societal forces that few of us have sufficient personal strength to combat.

A paper published in the August issue of the Journal of the American Dietetic Association makes a case for a third approach; specifically, a way for weight-loss counselors to frame weight-management efforts that both acknowledges environmental forces and makes room for individual responsibility.

Noting that body weight is largely determined by genetics, the paper points out that people who are obese can easily feel defeated, especially when they’re told that the only way for them to lose weight is to exert willpower. When that approach fails, as it almost always does, people feel increasingly helpless -- and stigmatized as lacking willpower.

Instead of preaching willpower in the face of an our “toxic” food environment, the paper says, counselors might see better results if they understand and are able to explain to clients that their weight and eating behaviors result from the brain’s biological response to external factors. Our built-in reward systems cause us to seek out pleasures, including highly palatable foods. At the same time, stress weakens our inherent capacity to inhibit that drive. On top of that, we are wired to value short-term rewards over long-term ones; for example, the paper says, most people would choose to receive $200 today over the promise of $300 in a year.

Recognizing these powerful forces can put weight-loss efforts into a different perspective. And, the paper says, harnessing that knowledge can help a person take personal control over his weight. It also would allow weight-loss counselors to build a program around combating those brain behaviors through behavior modification tasks such as currently are used to support, not lead, weight-loss efforts.

So, instead of beating the willpower dead horse, obese people could be encouraged to work around the reward/inhibition system in their brains by ridding their homes and offices of foods they know contribute to their being overweight. They could be counseled to write grocery lists featuring healthful foods and stick to the list at the grocery store. And they could focus on daily goals such as achieving a favorable balance of calories consumed and expended rather than on a long-term goal involving loss of a large number of pounds.

Dietary lapses or failures should be conceptualized as the result of brain systems interacting with a toxic food environment and not as a reflection of poor personal choices or lack of willpower. Even if this approach is no more effective in producing weight loss than current practices, it is much less likely to elicit patient stigmatization.

By  |  07:00 AM ET, 08/01/2011

 
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