Some Notes on Cognitive Behavioral Therapy

In the area of weight loss for health, two things are clear: Long-term sustainability is the prevention of relapse, and relapse avoidance is long-term viability. Is Cognitive Behavioral Therapy (CBT) an answer that stands up to the test? It seems both sturdy and flexible enough to adapt to many needs. Childhood Obesity News talked about some of the sub-varieties.

The whole point of it is to break negative behavior cycles and create new patterns. Any program with a chance of lasting has to address all areas of life — the family, the peer network at school or job, the community at large, and presumably must also harmonize with a person’s moral and spiritual beliefs and practices. It’s a tall order.


A 2017 multi-author paper concentrated on CBT as a weight loss aid, and particularly in relation to mHealth. It’s all about “the integration of Internet-based technologies into psychological and multidisciplinary protocols according to a stepped-care approach.” mHealth is described as “the delivery of preventive, monitoring, or clinical procedures and protocols through the mobile communication devices, such as mobile phones, tablets, personal computers, personal digital assistants, biosensors, and other up-to-date technological devices.”

When it comes to obesity, traditional chronic care management apparently has revealed some thin spots. Typically, distance has been a problem. Patients are unable, or simply not inclined, to make repeated journeys. But everything has changed since the introduction of interventions that include “cognitive, behavioral, or cognitive behavioral techniques compatible with a CBT approach.”

One interesting telephone-based CBT intervention, planned to improve eating and psychosocial functioning, has been tested in a preliminary study… Another interesting project was the positive online weight reduction, a web-based weight management intervention focused on supplementing a telephone-based support in web-based obesity treatment protocols… Moreover, the mHealth applications have achieved positive results in adult obesity and in childhood obesity too.

Rajesh Sagar is co-editor of A Practical Approach to Cognitive Behaviour Therapy for Adolescents, which discusses CBT beyond mental disorders and is described as “one of the few books to discuss CBT with adolescents from a non-Western perspective.” The book includes separate chapters on stress management, anxiety management, treatment for substance abuse, and a chapter on obesity, written by Tanu Gupta.

The team of Rajesh Sagar and Tanu Gupta appeared again, as co-authors of a report in the Indian Journal of Pediatrics on “Psychological Aspects of Obesity in Children and Adolescents.” While Dr. Pretlow has heard from and interviewed young people who claim that obesity does not present them with any extra burdens, Sagar and Gupta find such kids experiencing psycho-social problems that are far from trivial.

They suffer from depression, anxiety, eating disorders, stress, body shape concerns, and low self-esteem. In the researchers’ opinion,

Therefore it becomes imperative for the clinicians/pediatricians to broaden their clinical assessment and include screening of important psycho-social factors within the clinical examination of childhood obesity.

Researchers at Flinders University in Australia wanted to know more about elaborate-intrusion theory, and techniques known as cognitive defusion and guided imagery, and specifically whether chocolate cravings can be curbed by them. Journalist Rae Johnston wrote,

With chocolate recognised as one of the top cravings in western society, cravings occur in two distinct stages: the initial intrusive thought (caused by environmental cues, like pictures) and the subsequent elaboration (where vivid imagery of the craving becomes persistent). Cognitive defusion targets the first stage of the craving […] and taking the initiative to quickly distance yourself from this craving thought — and see it as something which doesn’t necessarily have to be followed by action.

Lead researcher Sophie Schumacher emphasizes the importance of instantaneous response, because the sooner a craving is recognized and addressed, the sooner it can be sent away. After that, guided imagery takes over.

The researchers confirmed that the starting place is awareness of how thoughts influence behavior, and that all thoughts do not need to be acted on. If everyone acted according to these understandings, not only would obesity be affected, but the world in general would be a better place.

Your responses and feedback are welcome!

Source: “Cognitive behavioral therapy to aid weight loss in obese patients,”, 06/06/17
Source: “A Practical Approach to Cognitive Behaviour Therapy for Adolescents,”, 2015
Source: “Psychological Aspects of Obesity in Children and Adolescents,”, 11/18/17
Source: “Australian Scientists Know How To Stop Your Mid-Afternoon Chocolate Cravings,”, 03/10/17
Photo credit: Spencer Means on Visualhunt/CC BY-SA

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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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