Psychotherapy is the new frontier in weight management

By Bernard Muthaka

For close to a year, Hayana Yusuf only wore the saree wherever she went and her friends had started wondering loudly about her fashion sense. After all, she had always had a reputation as someone with a passion for the latest fashions.

“I had long stopped shopping for clothes as I was embarrassed about my size.  In about three years, I had gone from size 10 to almost size 14. Coupled with my short stature, my weight was giving me nightmares,” says Hayana.

She says the first signal for her was when she realised most of her clothes could no longer fit. Once in a while friends and colleagues would comment how she must have fallen into good fortunes, given the weight she was putting on.

“The first surprise I got was when I was told at a clinic I went to that my body mass index indicated I was in the Class 2 obesity category,” she recalls.

At Limohouse Clinic, Hayana was put under weight loss psychotherapy; an approach that experts now say is a crucial component of any successful weight loss regimes. Research studies are indicating that dieting alone does not work for long-term weight loss. Published studies estimate that on average, less than 20 per cent of obese people are able to lose 5 per cent body weight and keep it off for a long time.

They explain that when the body is exposed to dieting, it has a natural tendency to maintain body weight to prevent starvation.

“Restrictive diets can slow metabolism, requiring further calorie restriction to lose weight,” says Dr Lyudmyla Shchukina, who runs Limohouse Clinic.

Negative side effects of dieting include depression, anxiety, irritability, obsessive thoughts about food and binge-eating.

Experts now say the most effective weight loss programmes are those that combine diet, exercise and psychological intervention. They say increasing the length or intensity of the psychological components of a weight loss intervention significantly improves the chances of positive outcomes.

When Hayana started the programme, she was given a diary, which would help her track her food intake. 

“Psychotherapy for weight loss involves principles of planning what to eat, arranging the environment to support weight loss and daily monitoring. This programme does not stop a person from eating any particular foods, but it gives them discipline,” says Dr Shchukina.

Explaining the reason for the unsatisfactory outcome of most diet regimes, Dr Shchukina says the factors maintaining excess weight are different for different people, which is why there can never be a “magic bullet” weight loss cure that works for everybody, despite advertiser’s claims.

Dr Shchukina says psychotherapy helps to develop a nutritional plan and a new relationship to food.

Hayana says she has learnt to control her food intake and learnt many new things about food categories. Between April last year and today, she has lost 13 kilos.

“Apart from psychotherapy, today I only take medication for stimulation of my metabolism and I have a reasonable exercise regime,” she says, proudly adding that she is back to her size 10 clothes.

Experts say women are more at risk, because they have lower metabolic rates than men and they are also less likely to be physically active. This means that men burn more calories per kilogram than women, reducing their rate of weight gain if they overeat.

Apart from the well-documented health effects of obesity, the problem also affects people mentally.

What clinic does to obesity patients to lose weight

In one study of people who had undergone surgery for weight loss, majority said they would rather be deaf, diabetic or suffer bad heart disease than return to being overweight.

At the Limohouse Hospital Clinic, obesity patients have a choice of the psychotherapy approach or surgical weight loss treatment.

The clinic offers services such as insertion of the gastric band, gastric sleeve resection and gastric bypass.

For those seriously obese and who wish for faster results, the gastric band is a popular option.  

The procedure involves insertion of a silicone tube around the upper part of the stomach to make it smaller and therefore limit the amount of food the stomach can hold. 

This helps the patient to feel full sooner and thereby shed weight.

The connection between long-term weight loss and changes in personality was emphasised in a recent study by the National Institutes of Health, which stated that since weight can be an emotional issue, it is conceivable that weight gain may lead to long-term changes in psychological functioning.

The author recommended that even where patients have undergone procedures like gastric bypass, they should still address any psychological issues that may have caused the weight gain in the first place.