Mind & Body

Scaling Down

Losing weight may be more about what's going on in your head than about what's on your plate.

Scaling Down
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At only 4'11", Maria Lugo-Perrin was carrying way too much weight- 240 pounds-on her tiny frame when, in the summer of 2006, a flyer for a weight-loss program at the Beck Institute for Cognitive Therapy was slipped under her office door. Intrigued, Lugo-Perrin went to one of the meetings. "I thought it sounded wacky," admits the 39-year-old Philadelphian, a self-described veteran of diet pills and grapefruit plans. "But I decided to give it a try." The program, which uses verbal and written exercises to teach its clients how to examine recurring self-sabotaging thoughts and counter them with positive, proactive ones, worked. Lugo-Perrin attended hour-long weekly sessions for 12 months, and she credits the Beck Institute with helping her stick to her goals, even in her darkest hours. By the end of the year, she had lost 65 pounds.

Lugo-Perrin is one of many who are benefiting from the current focus in obesity research on the power of the mind. New studies show that certain "hardwired" thoughts-habitual, subconscious patterns that control what we eat and why-can be reprogrammed with astonishing results. Of course, during any attempt to lose weight, you'll always have to reduce calories and exercise more, but many researchers now believe that changing the way you think about eating and exercise may be the secret to establishing a healthier routine.

Consider Amy Mapes, a 34-yearold high school teacher in Seattle, who lost 18 pounds in 16 weeks after joining a program that stressed mindfulness; or Todd Frank (a pseudonym), 62, an architect based near Boston, who lost 40 pounds in two months and credits his success to hypnotism. Like Lugo-Perrin, they have learned to think themselves into new habits. "Our bodies have powerful instincts-developed when fat and sugar were scarce and the hunt for food could be exhausting- to eat and rest as much as possible," explains Deidre Leigh Barrett, Ph.D., an assistant clinical professor at Harvard Medical School's Behavioral Medicine Program and author of Waistland: A (R)evolutionary View of Our Weight and Fitness Crisis (W. W. Norton, 2007). "But overriding instincts when they've become counterproductive is exactly what our giant brains evolved to do. We have this wonderful capacity to check whether our first impulses and cravings are actually best for us."

Instead of following diets, Lugo- Perrin, Mapes, and Frank are now focused on making good decisions. It's not what they eat but how they live that defines their food choices. That difference, many weight-loss experts believe, is what will help take off the pounds and keep them off for good.

Think more, eat less
Lugo-Perrin had dozens of reasons to lose weight before she discovered cognitive therapy. Avoiding life-threatening illnesses was one of them, since health complications related to obesity plagued her family. She lost a sister to diabetes four years ago, and her mom died of complications of the disease at age 72. Another sister and a brother are living with diabetes now. Heart disease was an additional threat: Four months before she joined the Beck program, her 32-year-old nephew died of a massive heart attack. "That really opened my eyes," she says.

Having tried diets without success, she believes cognitive therapy permanently changed her perspective by altering her inner dialogue. Notably, she no longer simply reacts to distressing events by eating-but instead stops and thinks about what's really best for her. "Recently, I lost my job. In the past, I would have treated myself to a cheesecake or a gallon of ice cream and said, 'I deserve this, I had a rough day.' But instead I went to the gym," she says. "I knew eating would just make me feel bad about myself. Once you practice that kind of thinking, it stays in your head."

Indeed, recent evidence suggests cognitive therapy can have a significant impact on weight loss. In a 2007 study published in the International Journal of Behavioral Medicine, Swedish researchers compared weight loss among women in a cognitive therapy group with women in a group that received advice on exercise and other behavioral changes. At the end of ten weeks, the cognitive therapy group had lost an average of 19 pounds while the other group had lost only 1.5 pounds. Moreover, 18 months down the road, the cognitive therapy participants had maintained an average loss of 13 pounds while the other group maintained a loss of only half a pound.

The program Lugo-Perrin attended outside Philadelphia was run by Judith Beck, Ph.D., author of The Beck Diet Solution (Oxmoor House, 2007) and daughter of cognitive therapy pioneer Aaron Beck. The author says many people subconsciously give themselves permission to eat foods they shouldn't. "They might say to themselves, 'It's OK because I'm upset.' Or, 'It's OK because this is a special party,'" says Beck. "We have thousands of these sabotaging thoughts. You need to look at the situation differently and practice alternative responses like, 'I'll feel better about my body and have more energy if I don't overeat.'" She has patients write down compelling reasons why they shouldn't eat and read them at least twice a day.

Lugo-Perrin also keeps a list titled "Advantages to Not Overeating" hanging on her refrigerator. "It's the little things I wanted to accomplish," she says, "like being able to wrap a towel all the way around me, that help me open the refrigerator and take out what I'm supposed to eat, not what I want to eat."

Keep practicing
While doing anything well requires practice and repetition, those methods are rarely applied to developing better eating and exercise habits. But they should be, says Barrett, who helped Frank take off 40 pounds through hypnosis this year.

"I used to eat a lot between meals, and when I'd be driving to meetings, I'd always stop for a candy bar or blueberry muffin," says Frank, who also used hypnotherapy to kick a smoking habit several years ago. After undergoing five sessions over the course of about three months with Barrett last year, he no longer makes it a practice to stop and snack. What's more, he has started exercising- he's up to four times a week on the elliptical trainer, plus long walks with his wife.

While no one knows for sure how hypnosis works, Barrett believes it has to do with the way habits form in the brain. She points to brainscan technology as a useful tool for understanding the phenomenon. Studies show that when people do something often, like walk a familiar route, the action is controlled by an unconscious area of the brain called the basal ganglia, allowing us to operate on autopilot. But when we do something new, the prefrontal cortex, an area of the brain involved in decision-making, is in control. The key to losing weight may be in reinforcing a new practice, like healthy eating, often enough that it becomes a habit-literally moving control of the action out of the prefrontal cortex and into the basal ganglia.

That's something you can make happen through repetition-say, by training yourself to automatically order fruit instead of a cookie at your office cafeteria-but hypnotherapy may provide a shortcut. "It might be that the experience you have during hypnosis simulates the practice enough to speak to the basal ganglia," says Barrett. "During hypnosis, imagery becomes very vivid, almost like having the real experience. People can see themselves having a light breakfast, then going several hours without thinking about food, and having a salad for lunch."

Hypnosis, she adds, puts you in a deeply relaxed yet hyper-attentive state, so you're more open to embracing ideas on a subconscious level. It also "triggers the reward centers of the brain, so you get positive feedback even before you've actually lost weight. That can help people stick to the new habits."

Research has demonstrated that hypnosis can increase the likelihood that someone will keep to a new resolution, but there are no studies that have examined the underlying brain mechanism. Frank says he isn't sure what made hypnotherapy work for him, but offers this: "I was really ready for a change, so maybe I was open to suggestion."

Staying present
Like a lot of people, Mapes describes herself as an emotional eater, someone who has always soothed herself with food. Until last year, she had also been quick to get discouraged when her plans to eat healthy went awry. "I would just let it get worse, eating badly for three or four more days," she says.

For help, she turned to Weigh to Go, a new eight week-long program offered by Bastyr University, a college of holistic medicine in Seattle. The program helps participants develop an exercise plan but does not prescribe a precise diet. Instead, clients are urged to eat whole foods and to re-proportion their plates so that half is devoted to fruits and vegetables, one quarter to lean protein, and one quarter to whole grains. They are also taught the basics of mindfulness and self-care. "A lot of people who have weight problems are nurturers-they give to everyone else but themselves," says Elizabeth Taylor, Psy.D., R.D., director of the program and clinical director of the master's of science program in nutrition and clinical health psychology at Bastyr. "We really try to get people to realize that taking care of themselves is not a selfish act-that it's essential for life."

Through counseling sessions at Bastyr, Mapes began to think of eating well and exercising not as something negative that she has to do, but as something positive that she's doing for herself, and that's made a difference in her resolve." If I eat something like a bowl of ice cream, I don't beat myself up about it anymore," she says. "I just return to healthy eating."

Bastyr's focus on mindfulness- simply put, staying aware of the moment-also helped Mapes learn to recognize when she was eating mechanically, or using food to cope with stress. Mindfulness does not require meditation, says Ellen Langer, Ph.D., a Harvard University professor of psychology who has written three books on the subject, including Mindfulness (Addison Wesley, 1990). "It's the simple process of actively noticing new things," she says. "That puts you in the present and gives you control over your actions that you might not otherwise have." Pay mindful attention, for instance, and you may realize you don't need your customary three o'clock candy bar. Mapes has learned how to stay mindful even when she's had a rough day: She's more likely to seek support from family or go for a walk with a friend than to indulge in rich foods.

The concept of mindfulness is not new. Among other things, it has long been recognized as one of the benefits of yoga, and it may be one of the reasons yoga has been linked to weight control. For instance, in a 2005 study published in Alternative Therapies in Health and Medicine, researchers found that people of normal weight between the ages of 45 and 55 who practiced yoga regularly were less likely to gain weight over a ten-year span than non-practitioners (the yogis gained 3 pounds while most others gained about 10). The study also found that overweight people who did yoga actually lost 5 pounds over the ten years while overweight men and women who didn't do yoga gained 14 pounds. "Yoga teaches you body awareness and mindfulness, and that can help you be more sensitive to the feeling of being full and make it easier to stop eating before you've eaten too much," says the study's lead researcher, Alan R. Kristal, Dr. P.H., an associate head of cancer prevention at Seattle's Fred Hutchinson Cancer Research Center and a professor of epidemiology at the University of Washington.

We may know more about how well mindfulness works for promoting healthier eating in a few years: The National Institutes of Health is currently funding an Indiana State University study looking at the effect of mindfulness on binge eating.

Know yourself
Going inward helped Frank, Mapes, and Lugo-Perrin learn more about themselves. Frank, for instance, discovered he likes exercising. "I used to think it was boring, but now I put on my headphones so I can tune into the bank of TVs at the gym, and I actually enjoy it," he says. Mapes realized she is more likely to stick to healthy habits if she can discuss them with someone. Lugo-Perrin has learned she must plan ahead. "If I go to a family cookout, I bring my own turkey burgers so I'm not tempted by foods I shouldn't be eating," she says. "But I don't feel deprived. It's simply the way I live."