Q. Why do you think it's so hard for people to lose weight and keep it off?
A. It's not their fault. No one ever taught them how to stay motivated every day, use good eating habits deal with hunger, cravings, and emotional eating, or get back on track immediately after overeating. These skills, however, are all teachable.
Q. How DO thin people think, exactly? How is their thinking different from those of us who struggle with weight?
A. Thin people think differently in many ways. For example, they think that hunger is normal and to be expected. They know that hunger isn't an emergency, that at worst, it's mildly uncomfortable, that it actually comes and goes, and that food tastes better when they're hungry. If it's an hour before a meal and they're hungry, they just usually wait, without even thinking about it.
Chronic dieters, on the other hand, are usually nervous about feeling hungry, so they overeat at meals and snacks, carry food with them, and plan when they'll next have access to food. They think that hunger is unnatural, bad, and that it will get worse and worse until they can't tolerate it any more.
I have people go for several hours without eating (unless they have an interfering medical condition). Every hour on the hour, they rate how uncomfortable their hunger is at the moment and how uncomfortable it was in the previous hour. It's so liberating! People find out that hunger is easily tolerated, that it lasts for maybe 5 or 10 minutes tops, and then goes away altogether. It comes back, but again is only mildly uncomfortable and goes away again.
Q. Does this approach (Cognitive Therapy) really work?
A. I've gotten thousands of emails from people saying that the approach does work. It's not just a diet. It's about mastering skills such as developing a good eating plan, dealing with hunger, and handling cravings and emotional eating. Once you master the skills, dieting gets easier and easier–if you have a workable eating plan.
The Complete Beck Diet for Life provides an eating plan that you learn to modify so you can stick to it for life. From the very first day, you get 150 or 200 calories a day of whatever food you want. You can have a candy bar or ice cream every single day. I want people to learn how to eat moderate amounts of a favorite food from the beginning. No food is off limits. A big problem with many diets is that they make you eliminate certain foods. But most of us are highly likely to return to eating these foods at some point, and unless you've learned how to eat them moderately, you tend to go way overboard, which can lead to weight gain.
You're also guided to make "special occasion" guidelines for yourself. It's perfectly reasonable to have an extra 300 calories once a week when you're eating out or to have extra calories every day when you're on vacation. You may gain a pound or two, but it will come off as you resume your usual eating pattern when you get home. It's much better to have a flexible guideline than a rigid rule that you violate, feel badly about, and then give up altogether.
Q. So there's really no specific "diet" that you have to follow?
A. There is no magic diet. Don't believe all the false claims that are out there! Research shows that any diet works in the short-term if you're taking in fewer calories than you're burning off. There is no magic combination of foods, no magic formula in when you eat. But you won't be able to continue losing weight or keep it off if you're not eating a really healthy diet that is flexible and allows you to eat your favorite foods.
Q. You mention in The Beck Diet Solution that people have "sabotaging thoughts" that interfere with weight-loss success. Can you give some examples?
A. Many sabotaging thoughts start with the words: "I know I shouldn't eat this, but....." We then fill in the blank with all kinds of interesting phrases: "I know I shouldn't eat this, but.....I'm happy/I'm sad/I'm tired/everyone else is eating it/I hardly ever get to have it/no one is watching/it's free/I'll make up for it later/I can't resist/it won't really matter."
Q. Are there specific techniques for replacing these kinds of thoughts?
A. I ask people to write responses to these unhelpful thoughts, read them every morning, and pull them out when they're tempted to eat something they haven't planned. Here are some examples:
• If I eat this, I'll get momentary pleasure but I'll feel badly afterwards.
• If I eat this, I will build up my "giving-in muscle," which makes it more likely that the next time I'll give in and the next and the next–and I won't lose weight. If I don't eat this, I'll build up my "resistance muscle," which makes it more likely that next time I'll resist and the time after that and the time after that.
• If I feel it's unfair that I'm not eating exactly the way others are eating, remind myself that I probably am eating the way that successful dieters and maintainers are eating.
• If I make one mistake, big deal. It probably won't even show up on the scale by the end of the week. But if I fool myself into thinking that I should then eat whatever I want and start again tomorrow, I may eat thousands of calories–which will show up on the scale tomorrow morning and make me very unhappy.
Q. What are some of the things that you recommend that people do as they begin to think about food and eating in a different way?
A. One important technique is to write down all the reasons you have for losing weight. Most people have at least 15 or 20 and keep adding to the list as they find more. You should read your list every morning and also pull it out just before the difficult times of the day. This is a way to constantly remind you why it's worth it to stick to your plan.
You can also create a distraction box for the times you are hungry or want to eat for emotional reasons. Place in the box a list of activities that are highly distracting to you, for example, a list of people to call or email, websites you like to visit, or computer games you like to play. Also include some objects that will distract you from eating such as crossword puzzle, a book of Sudoku puzzles, a DVD, CD, book, magazine, or bottle of nail polish. Polishing your nails is a great activity–by the time your nails dry, the craving has gone away!
Q. What approach do you use in counseling people who have unrealistic expectations about weight loss?
A. If people want to lose a lot of weight quickly, I ask them about their previous experiences. They see what research has demonstrated: the more quickly you lose weight, the faster it comes back on. I also ask them to refrain from setting a final weight loss goal, but instead, to set a goal to lose five pounds. Once they've lost five pounds, they should celebrate and then decide whether it's realistic to lose five more.
Q. How do you get started on a program like this?
A. It's not intuitively obvious how to think like a thin person, but you can learn how through The Beck Diet Solution workbook or The Complete Beck Diet for Life. If you'd like to find a cognitive therapist who can help you go through the program, visit www.academyofct.org or find out more about cognitive therapy at www.beckinstitute.org.
Dr. Judith Beck is the bestselling author of The Beck Diet Solution and The Complete Beck Diet for Life. She is the director of The Beck Institute for Cognitive Therapy and Research, and Clinical Associate Professor in Psychiatry at the University of Pennsylvania.