Recent Thoughts on Cognitive Behavioral Therapy and Obesity


There are a few truths about obesity treatment that seem to be hard and inescapable facts. One is that obesity is multi-factorial, which foretells almost certain failure for any modification attempt that approaches from only one direction. The byword could be “Diversity or Doom.” Along with this comes the realization that when psychological factors are involved, weight loss is a very difficult goal to attain.

Granted, the widespread availability of low-value and even harmful food is quite a problem. But the sad case is, no matter how many delicious vegetables a person has access to — and no matter what kind of perfectly balanced diet or exquisitely calibrated exercise program might be available for the taking — psychological barriers will try very hard to block the road.

A messed-up mind can deny, filibuster, flip-flop, and veto, as skillfully as any politician. If the head isn’t in the game, the body’s health will always hang by a precarious thread.

This brings up another seemingly immutable truth. As long as the patient lives, even the most spectacular weight-loss success story can never be deemed permanent with certainty. Because long-term weight management is such a complicated, multi-factorial task, relapse is always a possibility and is, in far too many lives, a reality.

According to a multi-author paper published last year, obesity is a highly complex disease. If that description sounds familiar it is because, as mentioned above, the conclusion is foreordained and obligatory for all researchers to mention.

This must be discouraging for scientists who work in the field, because finding The Answer is such an attractive career goal, and no obesity expert anywhere is likely to find The Answer, ever. Seemingly, the most that anyone dedicated to providing a solution can hope for is to contribute a small bit to the solving of a huge, many-tentacled problem.

The authors of “Cognitive behavioral therapy to aid weight loss in obese patients” enumerate the factors in play: genetic, biological, familial, social, cultural, environmental. Then, of course, there are the behavioral and psychological, which can so easily throw a monkey wrench into the works even when all the other factors seem perfectly amenable.

In one corner of the obesity puzzle, cognitive behavioral therapy (CBT) has become a star, recognized as the best established treatment for binge eating disorder (BED). BED is the most common eating disorder, and “there is a strong association between obesity and BED even if obesity is not a criterion of BED.”

Obese binge eaters tend to have more deep and stubborn psychological problems than obese patients who are not classified as binge eaters. They are more likely to be ineffective and tend to have greater body dissatisfaction, and suffer from lower self-esteem, and to engage in more “emotional” eating. They need more psychological support.

Fortunately, they are able to be helped by CBT and it begins to appear as if even Internet-based, guided self-help CBT can be of use to them in managing the BED. This report says that CBT…

[…] does not necessarily produce a successful weight loss… CBT can significantly reduce binge eating episodes, promote days without bingeing, manage eating, and reduce shape and weight concerns, without directly affecting body weight…

Wait, what? That seems a very discouraging prospect. But the authors go on to repeat:

Although the comprehensiveness and the practical nature of CBT approach are positive, this psychotherapy does not necessarily produce a successful weight loss…


CBT is traditionally recognized as the best established treatment for BED and the most preferred intervention for obesity, and could be considered as the first-line treatment among psychological approaches.

Your responses and feedback are welcome!

Source: “Cognitive behavioral therapy to aid weight loss in obese patients,”, 06/06/17
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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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