Weight Management

As a psychologist in private practice I tend to work with people who are able and willing to pay top dollar for expert consultation. In fact, most of my clients are impressive individuals who have achieved success in many areas of their life – except, of course, weight management. It is not for lack of effort or nutritional knowledge; many have read books, taken classes, and have a good understanding of the physiology of weight management. In other domains, when they want to accomplish something they learn what they need to learn – perhaps by reading a book or taking a course. They tend to work intelligently and industriously – often developing skills along the way – until they achieve their goal. Not so with weight management. Clients are often apologetic during our first session, embarrassed by their history of repeated failure in a domain of life they consider important. There are many books and programs focused on weight management, and heretofore none have produced satisfactory results for a reasonable percentage of users. This kit is different. It can produce good long-term outcome for a large proportion of users. The caveat is, only a small segment of the population can be a user: The kit is designed for those who have sufficient cognitive resources to make sense of the complex and often counter-intuitive information that follows. Part of your responsibility is to use what you already know to select a diet or lifestyle that is best matched to you and your current circumstance. There are many diets and programs to choose from. After weeding out the ineffective and the downright fraudulent you will be left with some options with which you could become comfortable and which – if you followed it -would produce a higher quality of life for you. Most clients have a good idea of what to do, the problem is getting the self to do it – and to stick with it to prevent relapse.Presented here are tools to get yourself to do what your rational processing system concludes is in your own best interests. Dietary rules, recipes, and exhortations to exercise are deferred to other authors. Rather, our focus is volition – that is, the ability to follow a course that you set for yourself so that you behave in a way that is good for you and that supports what you stand for.
Perseverance and Self-Efficacy

Sometimes the use of a technical term has the advantage of providing a shorthand way of referring to a new concept. Self-Efficacy refers to your belief in your competence in a specific area of life. Many overweight individuals have high self-efficacy regarding their parental skills or business abilities, but low self-efficacy when it comes to weight management.
People with high self-efficacy can tolerate physical discomfort, surprising amounts of frustration and failure, and yet persevere, creatively solve problems, and stay the path until one way or another they reach their goal. In contrast people with low self-efficacy abandon the effort after minor discomforts or frustrations. Their reasoning may be: “After all, I’m not going to make it anyway, why suffer more than necessary?” or they may experience a subtle alteration of state or a feeling – e.g., hopelessness, exhaustion, anger at self. The diminished self-efficacy that result from repeated dietary failures, makes the overweight person want to abandon the effort and turn over the responsibility of solving this problem to an external agent who would do a better job. The desire for an external solution to a personal problem sets up a kind of trap. The person trades self-reliant problem solving skills for some magical external solution - the more magical, the more seductive. Unfortunately, magical solutions tend to fail, which paradoxically strengthens the trap - a trap that prevents most people from ever achieving good long-term outcome. Rather than be actively involved in the creative process of developing a path that would lead to a successful outcome and taking responsibility for following it, those who have lost faith in their ability to succeed tend to passively present themselves for treatment. The passivity shows up when patients too easily commit to procedures that are unlikely to work for them, or when patients publicly accept the program rules and restrictions that privately they don’t expect to follow. Self-sabotaging traps are self-perpetuating, because they have a recursive structure1 One frequently observed example is called the Failure Syndrome: Low self efficacy → hope for an external rescue → perception of the self as the “patient” [the recipient of treatment] rather than as the responsible agent of change → uncritical acceptance of unrealistic outcome goals and preposterous weight loss schemes →failure to achieve outcome goals→ abandoning the plan → weight gain → demoralization and diminished self-efficacy→ greater dependence on external source of rescue.
Ahead is a goal of great value to you, but, alas, the path to it does not yet exist. The path of greatest advantage emerges as you follow a course that produces the best outcome for you, as judged by you. Critical to following this path is avoiding the traps and pitfalls that predictably lead to relapse and demoralization.
Weight management is an extraordinarily difficult skill to master. The reason for the 85-95% failure rate among dieters is that most underestimate the resources required to achieve their goal and overestimate how easily it can be done. This is a challenge worthy of your respect.
It is assumed that you already understand the physiology of weight management. If this is not the case there are pages with information and links at www.psycharts.com. However, despite the fact that you probably know a lot about this issue and you are pretty smart, you have not yet achieved your goal. Why?
Illusions & Self-Sabotage
The short answer [follow the links for a more detailed explanation]: They are taken in by illusions, which make each step along the path seem like the best choice at the time. Several factors conspire to encourage a first lapse [for more on this, please visit: The Imp of the Perverse], which often damages self-efficacy. So the consequence of a single innocent slip may be the development of a complete relapse.
We perform badly not because we want to fail, but because we are duped into behavior that is counter to our own interests. When we review a relapse, the errors which are so obvious to us in hindsight were not so obvious when they were made. We do not learn from painful experience, because we are repeatedly taken in by illusions. For a direct experience, please visit Optical Illusions.
Considering the difficulty of this path, how can good outcome be achieved?

The Default PathGood outcome is the byproduct of doing the right thing for a long time. Happily, the consequence of following a certain path for a long time is that it becomes easier to follow.
It is through real time practice that you train your body how to perform; after repeated practice performance becomes effortless and requires little cognitive resources to execute successfully – see the Karma of Practice. During the early stages of this journey you will have to expend energy to mindfully guide your behavior during high risk situations in order to set good precedent for coping successfully in the future.
Most people do not cope well during relapse crises, because they are not prepared. There are few instruction books on how to get yourself to perform well in the face of powerful local factors such as stress and temptation. A primary goal of this kit is to provide the intelligence that will help you perform as intended at the moment of decision, so that you exercise and hence strengthen effective coping reactions to the high risk situations that lie ahead.
Two Paths to Self-Determination
v When someone achieves remarkable results – e.g., impressive weight loss – it is usually the result of following an Impeccable Path. This is a comparatively easy path to follow, while you are on it. The problem is that once you are off it, you are out of control. Once the politician takes the first bribe, it is a small step to the second, an even smaller step to the third. [S]he is corrupt, and no longer an honest politician. Once the original commitment is lost, it is usually lost forever. Following a vegetarian regime is an example of an impeccable path. There are no decisions about eating meat. Many people happily and effortlessly remain vegetarians for long periods. However, those who attempt this lifestyle, but occasionally allow themselves to eat meat have a different experience: they have to continually make decisions. Weight loss through protein sparing fasting is an example of the using the Impeccable Path to promote weight loss. Those who follow it report: “It is easy because there are no decisions.” For a description of how this approach to weight management tends to play out, please visit Two Surprises.
v The Open Path is a less rigid approach – here the person is free to choose. While it may be liberating, the freedom to use good judgment rather than being bound by rigid rules comes at a price: At any and every choice point you must have access to sufficient cognitive resources required to size up the situation on the fly, make the right decision, and get yourself to adhere to it.

Footnotes:
1. The Failure syndrome is an example of a self-defeating recursive sequence of internal states and external events that recreate the conditions for the recurrence of each other. The recursive structure here is based on the emotional reaction to a perceived failure. The emotional reaction to the expectation of failure motivates actions which increase the likelihood of future failures, and consequent emotional reactions, etc. Another example: Depressed emotional state → negative perceptual bias [perceiving the self as worthless, the future hopeless, etc,] → negative outcome expectancy→ decreased motivation [energy for problem solving behavior and perseverance despite local discomfort and frustration] → ineffective overt behavior → disappointing outcome → confirmation of the original bias.