Before I try to lose weight, I need to find out why I’m fat

I can imagine readers will be surprised that I, a psychotherapist of all people, should declare root-cause analysis to be ‘fat logic’. Of course, I’m not trying to say that there are no psychological reasons for unhealthy body weight. Ultimately, most people realise that being under- or overweight is bad for them. The same is true of lots of things: vegging out in front of TV when you should be tackling your tax returns, or ignoring the strange noises your car is making because you can’t be bothered to take it to the garage this week.

A lot of people have the wrong idea about what psychotherapy is capable of. It’s not like in the movies, where ten therapy sessions lead to a realisation that the client was sexually abused as a child and has since been overeating to give herself a ‘protective barrier’ of fat, and now that the reason is known, the fat shield falls away of its own accord. I’m not saying that those kinds of cases don’t exist, but when 60 per cent of the population are overweight and one in five is obese (Mensink et al., 2013), there is reason to believe that not every spare tyre is the result of a tragic past or deep psychological problems. I am the last person to deter anyone from seeking help through psychotherapy if they feel the causes of their overweight condition are psychological in nature, but that kind of search for one single cause is often what stands in the way of change.

In psychotherapy it’s also sensible to address an obvious problem right at the start, since insights often only come after change is made. If a client’s behaviour serves to conceal another problem, it’s often brought to light by them changing their behaviour patterns and seeing what comes up.

In an article by the British journalist and author Johann Hari (2014), he discusses cocaine, which is considered to be one of the most addictive drugs. In the 1980s, experiments showed that nine out of ten laboratory rats became addicted to cocaine when they were given water laced with the drug. But one psychology professor questioned those results, pointing out that the rats were kept in their bleak cages alone, with nothing to do but take the cocaine. So he built a little play park for rats, with toys, tunnels, good food, and lots of other rats to play with. He offered the rodents cocaine in that environment. He found that the happy rats were not particularly fond of the cocaine water and consumed less than a quarter of the amount taken by the unhappy rats. All the lonely rats became intensive drug users, while the happy rats did not, and did not die of cocaine overdoses.

In a follow-up experiment after 57 days, the scientist placed the severely addicted, unhappy rats into the nice, play-park cage. The animals displayed some withdrawal symptoms but stopped taking the cocaine water and were able to return to a normal life.

I find this experiment hugely fascinating and I think the results can be applied to other behaviours. Addiction covers a broad spectrum and doesn’t always have to involve a physical dependency — just think of shopaholics or gambling addicts. Excessive eating doesn’t always share the full set of characteristics of an addiction, but over a longer period, it does tend in that direction.

Eating can be a strategy for coping with feelings like stress, boredom, or loneliness. In a relationship, it can also be an expression of love and affection, for example, in the form of cooking for a partner. This only becomes a problem when eating is the only strategy for coping with those emotions, and a dependency on it develops in the absence of any other way of handling those situations — like the rats in their lonely cage, who had no alternative.

Of course, that doesn’t mean every overweight person leads a bleak and dismal life. It just means that they may have no alternative for coping with certain situations.

I once had a client who was unable to kick his heavy smoking habit. His job was so stressful that his occasional cigarette breaks were the only opportunity to take a couple of minutes off, as his highly perfectionistic nature prevented him from taking any breaks voluntarily. Without the excuse of addiction, he would have continued working without a break until he dropped. Our therapeutic approach was to find strategies that would enable him to allow himself to have other types of breaks and to question the ingrained idea that he must always work to the point of exhaustion.

Behavioural patterns can also become vicious circles over time. Being overweight can become a barrier to finding other ways to gain satisfaction or relieve stress. When moving becomes difficult so that exercise isn’t enjoyable, a lot of possibilities are out of reach. You don’t need to weigh 150 kg and be unable to move for this to happen. Even an extra 10 kg can make physical exercise more difficult and strenuous, and less enjoyable, so that the overall experience becomes negative rather than positive.

This is compounded by the existence of several bodily mechanisms that make it difficult for us to change our habits at first: gut bacteria, which foster our preferences for certain familiar types of nutrition; the reward centre in our brain, which prefers the high-calorie food it knows; and our blood-sugar regulation system, which makes us want to take counter-regulation measures when our blood sugar level drops.

It’s a mistake, though, to react to those initial difficulties by thinking things will never change and just giving up. Reprogramming both your body and your habits takes a few weeks or months, but once that’s happened, the new lifestyle no longer feels like a permanent struggle.

The point is that removing the deeper cause is almost never successful. Someone who uses chocolate as a strategy to cheer themselves up, to relax, or as a reward isn’t going to be able to give up chocolate by banishing stress from their lives forever. But it is possible to find alternative strategies that work just as well.

Some of those strategies have to be built up with hard work, until a point is reached where the pleasure of playing a certain kind of sport, for example, is comparable to that of eating a piece of chocolate. Initially, exercising may even cause stress, and doing it feels as if it warrants the reward of a bar of chocolate.

That’s a normal reaction, though. Changing habits is hard work, and the phase in which it takes place is a difficult one. On the other hand, it’s also a phase that can provide a great sense of achievement at the successes that the new pattern of behaviour brings. That’s one of the reasons why I believe it’s so important to gather as much basic knowledge as possible about nutrition, calories, and weight training, to stave off the danger of not recognising the positive results of that laborious process of change and therefore giving up, twice as frustrated as before.

Ideally, that difficult phase of adopting new habits will also include a lot of positive experiences. That may include watching the numbers on the scales go down, feeling the changes in your body, receiving positive and encouraging comments, or discovering fresh interests. It can provide the motivation to keep going. Without positive reinforcement, it would require almost superhuman self-discipline not to give up.

The successes must be in relation to the effort. The results of a slow, gradual change in lifestyle will come less quickly, but that kind of change is usually seen as less difficult. A radical change, on the other hand, needs to bring with it rapid positive results.

It can have a powerfully disheartening effect, when, for example, a very overweight man makes the decision to focus his effort on exercise, overcomes all his misgivings, and starts going to the gym five times a week in the belief that exercise is the answer. He might feel uncomfortable there and feel as though everyone is staring at him, and he might find the physical exertion very difficult. And then despite the massive effort he’s putting in, his lack of general fitness means the results are rather modest. Although he gives his all for a whole hour, sweating and pushing himself, he only manages to burn off a measly 400 kcal. Doing what feels to him like an extreme exercise program five times a week, he manages to work off 2000 kcals, which is equivalent to about 300 g of body fat, which in turn works out at a little more than 1 kg in a month.

Losing just 1 kg for all that hard effort will probably lead him to feel very frustrated. It’s also compounded by the fact that most people find endurance training increases their appetite, either making it even more difficult to eat less, or tempting them to replace the burned energy straight away — with well-meaning protein shakes, or in the form of a ‘well-earned’ reward. Because of this, the man may even gain weight rather than losing it, despite all the effort he’s put in. For a month or so, he might be persuaded by well-meaning remarks telling him that he must be gaining muscle mass. But when success continues to elude him, he’ll eventually give up, thinking, ‘I invested so much and achieved nothing. Losing weight isn’t an option for me.’

Counting calories is similar. Some people launch a half-hearted attempt to start counting, investing time and energy in it, but then too often slip into guessing (I can’t weigh that right now, but it must be about fifty grams … or maybe more like forty), cheating (It was just a little bit, I don’t have to count it), or forgetting (I’ll write down that bar of chocolate in my food diary when I get home this evening). Eventually, the calorie-counting process becomes so inaccurate as to be useless.

In these cases, the only thing that helps is to make sure that the results match the investment. As I see it, the best way to achieve this is to concentrate 90 per cent of your efforts on your diet, and to really take it seriously. This is true irrespective of the size of your target caloric deficit. It doesn’t matter whether you want to lose a lot of weight quickly and run a big deficit, or you’re aiming to shed 2 kg or less per month and only need to cut back a couple of hundred calories — both strategies are justified. The important thing is not to sabotage your own efforts by falling into the abovementioned traps and decimating your deficit every day.

People who are already physically fit can earn their deficit with exercise, seeing as that investment is considerably less challenging for them and yields greater results. In some cases, they won’t even need to use dietary methods to save on calories. Whether you find it better to do more exercise and go hungry less, or do less exercise and go hungry more is simply a matter of individual preference.

In my opinion, people who aren’t physically fit should not initially think of exercise as a way of losing weight, but should start by concentrating on getting their body into a state in which it is able to do sport at all. As an initially unfit person, any activity to build up muscle mass or improve fitness should not be seen in terms of burning calories (and should not be included in a calorie-deficit calculation), but should be seen as an investment in future fitness.