Psychotherapy may help the obese lose weight: behavior modification insufficient.(Clinical Rounds)

NASHVILLE, TENN. -- Psychotherapy is the key component of a successful weight-loss program for many obese patients, Gwendolyn Pla, Ph.D., said at the annual meeting of the American College of Nutrition.

Behavior modification is a widely used tool in weight-loss programs, but "using a smaller plate or chewing food thoroughly ... is like putting a Band-Aid on a large wound for obese patients with substantial emotional and psychological problems related to being overweight," said Dr. Pla of the department of nutritional sciences at Howard University, Washington. "These patients need psychological counseling."

Most obese patients don't respond well to the initial strategy of providing information about diet, exercise, and eating behavior. "Very few obese patients--even those with serious conditions such as diabetes and cardiovascular disease--can take this information and fly with it," said Dr. Pla, who also has training in psychological social work. "Many obese patients are deeply conflicted about their desire and need to lose weight." She recommends "meeting obese patients where they are" to begin a process of healing and dietary change. "Discuss and validate a patient's feelings and experiences as a way of getting to a place of change."

Reaching out this way sends a different message from dictating a new diet and lifestyle. "If you say, 'Let's do the Atkins or South Beach diet,' then you are not likely relaying the message that you appreciate a patient's current circumstances. Obese patients need to know that you care about them and will work with them to get through the process of losing weight."

Overeating and being overweight can serve a variety of psychological functions, Dr. Pla said. These functions include:

* Self-worth and satisfaction. She cited the example of a morbidly obese female patient in her early 40s with diabetes and a ...