Losing weight, keeping it off, is all in the mind

Overweight and obese people who manage to lose weight and then regain it – yo-yo dieters – have a problem, yet it’s not in their stomach but in their head.

Now, the Hebrew speakers among them can get help from Dr. Zipi Ha’etzni, a clinical psychologist who has written a serious, scientifically-based 290-page volume resulting from seven years of treating hundreds of such frustrated people in her private Jerusalem clinic. Called Lishkol Meihadash 2: Restart (Weighing New Options 2: Getting Back on track to Leading a Healthy and Balanced Lifestyle), it is a sequel to her first book (2009), which she meant to be a psychological handbook for weight loss and maintenance.

“It focused on the psychological aspect of weight loss,” she told The Jerusalem Post in an interview, “but it didn’t present a process on how to evade the vicious cycle of yo-yo dieting. Only the last chapter of the previous book dealt with relapse prevention. I learned so much about the subject from my clients in recent years that I decided to write the sequel. Many overweight people need to have their hand held.”

Heavy people “have such difficulty connecting the dots and understanding the process. They get stuck in a loop. I have even treated people who were alumni of weight-loss TV programs who were watched by the many viewers who saw them escape from obesity. But after all that work and detachment from normal society and home life, some of them regained the weight,” said Ha’etzni, who treats many obese patients who have undergone bariatric (stomachshortening) surgery.

The Bar-Ilan University graduate, who lectures at the University of Haifa in a program to treat the overweight using cognitive behavioral therapy, added that she has much compassion and understanding for her clients.

“I was overweight, even as a child, so I know what people who need to lose weight grapple with. Today, due to a better lifestyle, exercise and proper diet, I am within the norm.”

Born in Israel to immigrants from Romania, Ha’etzni grew up in Canada and returned to Israel when she was 18. Married and the mother of a 15 year old and an eight year old, she says that her husband is overweight but not obese.

“He struggles with it, but I respect others’ sovereignty and their choices. He has improved his lifestyle and exercises in the morning. We don’t keep junk food at home. The problem is he works a lot away from home and eats out most of the time. The ironic thing is that we first met in a health club.”

The psychologist said that when she recently removed the TV set from the living room and put it in the dining room, she noticed there was less detrimental munching by family members.

As someone who does not often stay in hotels, Ha’etzni quickly saw the effect on diet of vacationing when she and the family spent a week in Eilat this Pessah.

“I wasn’t so hungry, but I ate more. In a luxury hotel, you feel you’ve paid for the meals and are entitled to eat everything. The abundance is so overwhelming. It affected me psychologically.”

But as the days passed in the hotel, she developed “a much better eating plan for myself. It was much easier to choose what was good for me instead of trying everything. There was a lot of trial and error and a learning curve...”

The 39-year-old psychologist explained that “it certainly isn’t a sin to enjoy food. But in gaining a lot of weight, there is a personality factor. People with low conscientiousness and high impulsivity gain more than people with the opposite traits. They often eat as a coping mechanism for stresses and problems.”

HER NEW book, which at the end has a reference list of dozens of scientific books and journal articles, is clearly professional and based on proven fact, but I nevertheless found it easy to read from start to finish. Ha’etzni selected 101 cases of individuals and groups she had treated who needed psychological help to halt the cycle of weight gain, loss and re-gain.

Why 101 and not 100? Ha’etzni explains that there is a difference between a short-term habit and a long-term one. The compilation of ethical teachings and aphorisms by rabbis of the Mishnaic period called Ethics of the Fathers advocates devoting one more attempt – 101 if necessary – to study something that could not be accomplished after 100 times.

Thus she gives 101 lessons in the book’s 290 pages, utilizing the difficulties of her clients (under pseudonyms) who were yo-yo dieters, most of whom changed their way thinking and their habits, lost weight and have kept it off. Many people who lost a significant amount of weight believe they can take it off again if they need to, but this belief is mistaken, Ha’etzni writes.

“They think they don’t have to plan what they eat, consult with experts to have follow-up, make an effort or learn about new advances. Some who dieted successfully in the past forget all the efforts they invested in it and expect to succeed based on their past behavior. ‘No problem,’ they insist. ‘I already know what to do. The moment I decide, everything will work out,’ they say. The problem is that the moment arrives, and the weight keeps rising.”

Yo-yo dieters, the psychologist notes, typically suffer from a lack of self-confidence, which is no less harmful than their overconfidence that they can lose it again. Thus while sure before they diet again that they can stop eating irresponsibly, after trying to do so, they are convinced they are utter failures. This often happens to long-time smokers as well.

Avi lost 20 kilos two years ago without professional help. He joined a health club and found a girlfriend, but recently parted with her. He is stressed, and when he returns from work eats uncontrollably in front of the TV set until he falls asleep. He went to Ha’etzni in desperation after regaining some of the weight and feeling like a failure.

“I’m a mess, the world’s a mess and my future is even more so,” he told her. Avi recalled that a few days before, he was at the supermarket and saw a couple looking at him and whispering to each other that ‘it is too much.’ He thought they were saying he was obese, but in fact, upon getting closer, he heard them complaining he had put more than 10 items of groceries in his shopping cart even though he was in an express line.

Noting his lack of self-confidence, Ha’etzni asked if something good happened to him in the past week, and he remembered he had been appointed to head a new project at work and even won a small sum with a lottery ticket.

“This story illustrates a central idea in cognitive psychology, mood congruent memory, in which people tend to pull out memories that suit their current moods.”

Keren, a single mother of three, is a yo-yo dieter even though she is a clinical dietitian herself and should know better. She is well familiar with good nutrition and how to lose weight. She eats a balanced breakfast and lunch, but almost every evening, she gorges on simple carbohydrates and sweets.

“PEOPLE HAVE three brains,” Ha’etzni writes. “One is the reptilian brain whose role is to save our lives at all costs; it is responsibility for automatic functions like breathing, heartbeat and other physical activities. The second is the limbic system, responsible in all mammals for emotions, instincts, aggressiveness and eating and sexual behavior. This emotional brain is not very smart; it acts from infancy to differentiate between danger and security, pleasant and painful, attractive and repulsive and so on. This decides if we feel positive or negative emotion towards someone,” Ha’etzni writes.

The “third brain” is the neo-cortex, involved in thinking, judgment and values. Within it are hidden musical and artistic abilities as well as high cognitive functioning such as planning and organization. Scientists used to believe that this upper, rational brain uses logical thinking, is dominant and makes us able to control our eating habits.

But, she continues, experience shows that when a dieter violates his diet or otherwise acts impulsively, the limbic brain takes over and controls the other parts, causing us to act against our intentions and use the upper brain to justify our actions.

“As long as a person has negative feelings toward a healthy lifestyle, the emotional brain will disrupt his real effort to change. For a person to agree to make the effort and alter his eating habits, he must believe that the change is possible and worthwhile.”

If not, she says, the emotional brain will disrupt his efforts. Thus she suggests focusing on the enjoyable aspects of changing and losing weight.

Shira, a 42-year-old married woman and independent businesswoman, was urged by her parents and husband to lose weight. She complained to Ha’etzni that when fat started to drop off, they made such a fuss of every gram lost that she felt that her closest family members had begun to treat her like a child. In an unconscious protest and not due to hunger, she began to regain weight.

“What began as a compliment turned into a chronic problem,” wrote the psychologist. She helped Shira to investigate the effects of her feelings and regain her autonomy.

The weight-loss expert recommends keeping a daily “food diary” because many people quickly forget what they have eaten and then are surprised that they gain weight. After a week, mark in one color all eating decisions that you believe were wise and in another color those that you recognize as a mistake. Note the proportions between the two colors.

“It may be that you should have eaten something not so healthy, in moderate amounts, [which] could [have] prevent you later from gorging on the same food.”

Food can also be divided into “fuel” to keep you going and “fillers” to assuage emotional stresses.

Yoav, a researcher himself, discovered from the diary that he ate little at meals but overloaded on junk food snacks the rest of the time. He was encouraged to enter into a chart what emotions and thoughts preceded his gorging to increase his awareness of the fact that it was not hunger that pushed him to eat.

Having to say “no” to fattening food on a regular basis is too brutal for many dieters, she says. Instead, one should learn to say “not this moment,” or eat only a little bit.

Kalanit, who was able to eat properly and set a good example when having dinner at her home with her grandchildren, was determined to refrain from touching the cake they ate.

“I was very proud of myself,” she said. The next day, however, one of the kids was so unruly that in the evening, she was so upset that she took out the whole cake and ate it down to the last crumb. She should not have denied herself the small pleasure, Ha’etzni advised.

A COMPULSIVE eater should always take a moment to pin down what emotion he feels – anger, frustration, tension, annoyance, fear and so on – when about to eat yet again even though he doesn’t feel physiological hunger. And then take a walk instead to let the urge for emotional eating passes, she advises.

If a person feels so famished that he’d be willing to eat anything, it is likely that he really does need food. If he doesn’t suffer from any hunger pangs but has an urge to eat, he probably wants a specific item. Don’t eat it, is Ha’etzni’s advice.

People who really are thirsty may mistake the feeling and instead grab food. Taking a drink is advised. Not only negative feelings such as disappointment, anger, loneliness and frustration produce the urge to eat: Joy and excitement are also a trigger for hunger. Recognize these feelings and keep the refrigerator and pantry doors closed, she said.

Although losing weight, looking attractive and buying new clothes are wonderful, Ha’etzni warns that beneficial dieting does not always solve problems. People who suffer from clinical depression or other psychiatric disorders often think that if only they were thinner, all their problems will be solved. When this doesn’t come true, yoyo dieting often results. The therapist and client must be very sensitive and courageous to understand and identify the real causes.

Finally, one should choose one’s friends carefully. Anyone who has bad eating habits, is jealous of your having lost weight and goes out of his way to encourage you to have “one more bite” should be avoided as much as possible. Ha’etzni advises choosing a “true friend” who can provide emotional support as you sail over the “sea of fat” on the way to a safe harbor.