Therapy and the Formerly Obese

[boy looks askance at woman, with caption 'So you're telling me ... people pay people to tell them to eat less?]

Depression can be caused by interpersonal difficulties, and can in turn can cause further difficulties in getting along with other people. For people prone to overeating, this can result in a vicious cycle where social malaise causes unhealthy eating patterns, which in turn lead to more problematic social interactions.

Any childhood obesity intervention needs to take social relationships into account. Childhood Obesity News suggested that while boredom can lead to bad habits like recreational eating, an overscheduled life filled with high expectations can be just as dangerous. When people try to fix life situations, they often go too far the other way. The formerly obese seem almost of a single voice when urging a sufferer to hook up with therapy and/or a support group, especially if their problems include a gnarly issue like being an abuse survivor.

On a webpage that unfortunately can’t be located anymore, a formerly obese person praised the virtues of The Self-Esteem Workbook, a self-directed program that his therapist had recommended. Put together by Glenn Schiraldi, a psychologist and health educator, it offers “twenty essential skill-building activities, each focused on developing a crucial component of healthy self-esteem.” One exercise is to list all the behaviors that are not helping a person’s self-esteem, such as negative self-talk and mirror avoidance, so they can be consciously considered and worked on.

On that same lost page, a formerly obese person recommended Dialectical Behavioral Therapy to “everyone.” The endorsement read, “It’s been studied and peer reviewed and proven effective at helping people with all kinds of emotional issues.” DBT is a specific variety of cognitive-behavioral psychotherapy that helps the patient identify the thoughts, beliefs, and assumptions that are putting up roadblocks. One description says:

In DBT people are encouraged to work out problems in their relationships with their therapist and the therapists to do the same with them. DBT asks people to complete homework assignments, to role-play new ways of interacting with others, and to practice skills such as soothing yourself when upset.

With Cognitive Behavioral Therapy (CBT) the person learns techniques to monitor and change eating habits, and to change his or her ways of reacting to stress and difficult life situations. Ashley Gearhardt, a clinical psychology doctoral student who studies food addiction at the Yale Rudd Center for Food Policy and Obesity, says that support programs, particularly 12-step ones patterned after Alcoholics Anonymous, coupled with CBT can help people cope with food addiction.

In the view of Dr. Ian Campbell, chair of Britain’s National Obesity Forum, very few obese people are actually addicts in the classic sense, but for the few who are, CBT is their best hope. Also via the United Kingdom’s National Obesity Observatory, we learn from the publication Obesity and Mental Health that…

A comprehensive review of psychological interventions for overweight or obesity concluded that behavioural and cognitive behavioural therapies make a significant difference to the success of weight management interventions, especially when combined with diet and physical activity.

It’s always important to get rid of negative self-talk. For instance, a person in the habit of scolding herself or himself by thinking, “You fat pig, you did it again,” is taught to give that up and adopt positive self-talk instead. Part of this involves telling yourself how wonderful you are. Proponents advocate starting each morning with affirmations about the awesomeness of both oneself and the upcoming day. Some feel that “I’m awesome!” is too generic, and recommend choosing a different trait every time. Wake up, look in the mirror, and say “I like my eyebrows,” or “I like my curiosity about how things work,” or whatever.

A participant known as “Plingie” gives an example, making a positive quality from the fact that he necessarily has to work harder than slimmer people do, just to drag his bulk from place to place. His self-talk included the mantra “I AM STRONG because I’m carrying myself every day. I am carrying 400 lbs every day. I am STRONG.”

Your responses and feedback are welcome!

Source: “The Self-Esteem Workbook,”, undated
Source: “An Overview of Dialectical Behavior Therapy,” undated
Source: “Conquering Food Addiction,”, 01/18/11
Source: “Food addiction: know the facts,”, 01/05/2013
Source: “Obesity and Mental Health,”, March 2011
Source: “I’m a pe teacher who needs advice about a morbidly obese student,”, 01/28/14
Image: Internet meme

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Profiles: Kids Struggling with Weight

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The Book

OVERWEIGHT: What Kids Say explores the obesity problem from the often-overlooked perspective of children struggling with being overweight.

About Dr. Robert A. Pretlow

Dr. Robert A. Pretlow is a pediatrician and childhood obesity specialist. He has been researching and spreading awareness on the childhood obesity epidemic in the US for more than a decade.
You can contact Dr. Pretlow at:


Dr. Pretlow’s invited presentation at the American Society of Animal Science 2020 Conference
What’s Causing Obesity in Companion Animals and What Can We Do About It

Dr. Pretlow’s invited presentation at the World Obesity Federation 2019 Conference:
Food/Eating Addiction and the Displacement Mechanism

Dr. Pretlow’s Multi-Center Clinical Trial Kick-off Speech 2018:
Obesity: Tackling the Root Cause

Dr. Pretlow’s 2017 Workshop on
Treatment of Obesity Using the Addiction Model

Dr. Pretlow’s invited presentation for
TEC and UNC 2016

Dr. Pretlow’s invited presentation at the 2015 Obesity Summit in London, UK.

Dr. Pretlow’s invited keynote at the 2014 European Childhood Obesity Group Congress in Salzburg, Austria.

Dr. Pretlow’s presentation at the 2013 European Congress on Obesity in Liverpool, UK.

Dr. Pretlow’s presentation at the 2011 International Conference on Childhood Obesity in Lisbon, Portugal.

Dr. Pretlow’s presentation at the 2010 Uniting Against Childhood Obesity Conference in Houston, TX.

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