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Weight Control in Eight ACTS
Lee Kern, LCSW
The skills and tasks of weight loss are much like pieces of a jig -saw puzzle. No one
piece is a solution; but when all the pieces are put together, dramatic results can occur. I
call the numerous strategies that lead to success the ACTS (Active Change Targets) of
weight control and will illustrate them, including case examples, below. Each ACT
represents a mental, emotional or behavioral task that most successful losers employ.
Martha began her weight loss efforts at 220 pounds. She had tried every diet but couldn't
make them last. Typical of many "yo-yo-ers" she felt she was a failure, saw herself as
weak, having no willpower, and ashamed. She felt out of control of food and not sure
what to do. A doctor suggested obesity surgery, but she did not feel ready to take such a
drastic step.
Nick started a serious weight control program at 260 pounds. As an ex-addict, he had
successfully used recovery programs to maintain many years of abstinence. Food was
harder to deal with. He had to live with it day in and day out, and therefore relapse was a
part of his pattern. When his weight was up, he just didn't feel the way he wanted. His
self- esteem went down, and his blood pressure increased.
Through working with people like Martha and Nick, I have come to appreciate the
complex nature of long-term successful weight control. Recovery from compulsive over
eating is a dynamic and integrated process: dynamic, in that people need to make active
use of coping tools; integrated, in that there are numerous strategies that need to be
woven together into the fabric of success. The following eight ACTS (Active Change
Targets) are tools that help build the house of lasting weight control.
MOTIVATION. Motivation is a fluid process that involves "yes" and "no" forces.
Martha's painful knees, and Nick's high blood pressure are examples of negatives (no's)
each wanted to get away from. And each hoped to enjoy certain benefits (yes's) of longer
-term success. Martha wanted to look better and be able to dance at an upcoming family
wedding, and Nick looked forward to playing racket ball and greater sexual self-
confidence. Motivation is enhanced when external forces, such as concerns about
appearance, combine with internal forces, such as self-esteem and confidence. In
addition, people need to continually assess their priorities and support them with specific
actions, keeping the gap between values and behavior as narrow as possible.
MINDSET. Recovery requires the proper perspective. Clients need to view the problem
as food dependence, not as weight. This was not a difficult shift of focus for Nick, who,
as a recovered addict, was used to paying attention to substance use. But Martha believed
that once she got her weight off her problem would be behind her. This type of denial sets
up the rationalization that once weight is lost, "I can go back to the way I used to eat."
When the problem is seen as the relationship with food, there is an understanding that
recovery is a life long process of living with food in a different way. It is also important
to avoid over expectations from weight loss. It does not guarantee you will meet the man
of your dreams, or that you will get a work promotion.
CONSCIOUS EATING. Nick and Martha had random and inattentive eating patterns.
Nick grazed through the day, eating small amounts multiple times. Martha bought large
fast food meals and ate them rapidly, on the go. Success requires strategies for managing
food day to day and a system for understanding food use tendencies. A food diary is a
powerful tool for achieving these goals. It serves as a way to plan meals ahead of time,
and encourages self-reflection: 1) Why this urge, and why now? 2) Am I about to use
food to meet a psychological need, such as to reward, distract or escape. 3) Can I produce
the desired effect (relax, calm, soothe) in another way? People also need to heighten
their nutritional IQ by learning about calories, food groups, portion sizes, food shopping
and restaurant management.
SELF MONITORING. Denial is at the core of problems that are addictive in nature.
Rationalizations are used to justify the next episode of excess. Martha frequently used the
"I'll start a diet on Monday" excuse, and Nick often thought "I've had a hard day and I
haven't eaten much, so I deserve it." To counter these tendencies, people need to commit
to techniques that keep them honest about what they do and why they do it. 1) Weigh
frequently and track or chart the weights. 2) Write down everything that is actually eaten.
3) Tune into hunger awareness and rate it. 4) Monitor urges and cravings and their
possible connection to moods, stress, external cues, time of day, situation. 5) Keep track
of all physical activity.
LIFESTYLE. Overeating often happens in a context of lifestyle imbalance. Martha's
lifestyle was full of obligations of care for an elderly mother, a demanding husband, and
needy friends. She used to enjoy travel and art galleries, but she could not identify any
current healthy pleasures, which set up the use of food as her only form of pleasure. On
the other hand, Nick's golf lessons and volunteer work helped replace the past reward
and stimulation functions of his binges. Success requires a lifestyle infrastructure with the
following components: 1) Regular physical activity 2) Activities that produce feelings of
productivity and pleasure 3) Healthy forms of self-nurturing 4) Leisure time that yields
fun, joy and play.
STRESS MANAGEMENT. Overeating episodes often occur in order to create the stress
reducing effects of calming, soothing, comforting and escape. To counter these
tendencies, people need to use more functional relaxation strategies, such as deep
breathing, meditation, visualization or tension release. Managing stress also means
effective problem solving. For example, Martha's stress was reduced once she arranged
in home elder care for her mother. Nick reduced his stress by viewing the sexual
frustrations with his girlfriend as an opportunity to improve communication with her.
INTERPERSONAL SUPPORT. Studies suggest that people are more likely to succeed at
long-term weight loss when they lean on others for support. Martha and Nick arranged to
have regular phone coaching sessions during which their weight, eating, lifestyle and
motivation were monitored. Some people find Overeaters Anonymous or Weight
Watchers meetings helpful, while others have personal trainers or nutritionists. There are
many excellent self-help books available, and online web-based support networks are
also an option. Competence is not a solo act-we need teaching, coaching, mentoring and
challenging.
RELAPSE PREVENTION. Success involves slips and setbacks. Nick's relapses began
with innocent grazing on fruit, leading to meals of high fat deli foods and sweet snacks
and desserts. Martha would respond to frustration with night binges. Both had to learn
how to avoid setting up relapses and how to do damage control once they occurred.
Effective strategies to achieve these goals include: 1) Monitor warning signs such as
changes in attitude, mood or routine. 2) Keep tempting food items out of the house. 3)
Learn from a slip by asking how things can be handled better the next time. 4) Maintain a
vigilant attitude by anticipating trouble. 5) Track progress and keep successes in mind.
These eight ACTS highlight the active and complex nature of weight control and provide
a constructive view of the strategies for recovery. Regardless of the approach taken
(surgery, medications, diets), cognitive and behavioral strategies enhance the likelihood
of success. Martha and Nick used the ACTS to lose 20 and 25 pounds, respectively. The
ACTS make it clear that those who commit to new ways of doing things will win at
losing.
Submitted by Lee Kern, LCSW
Clinical Director
Structure House
919-313-3124
Lee@structurehouse.com
2/22/06
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