The following lists some basic tasks and resources which can be used by the fat loss counsellor in exploring the psychological component of excess body fatness. More detailed therapy should be referred to a qualified professional psychologist.
Current attitudes.
1. Identify current thoughts, feelings and attitudes to fat loss: What for? Why now? How long for? What then? Ensure clients recognise that permanent fat loss means lifestyle change.
2. Clarify expectations of fat loss: What problems are anticipated that it will solve? How else could these problems be dealt with? If any of these expectations are perceived negatively, how else could the problem be managed?
3. Clearly define a lifestyle which is both acceptable and achievable, which will maintain a lower level of both fat intake and body fat level.
History.
1. Explore previous experiences of fat/weight loss: What worked, What didn’t? What lasted? How were relapses dealt with? Understand what went wrong or right and how this time is different.
2. Deal with family leftovers, experience of fatness in the family, food messages, how eating, drinking and exercise played a part in the family life and what impact these still have.
Obstacles.
1. Identify which important aspects of lifestyle keep the client from losing fat: food choices, feelings/experiences which seem associated with inappropriate eating, time pressure, stress, lack of regular exercise, food knowledge?
2. Identify times during the day/week which represent the most difficult times to control eating: Mealtimes? Snack times? Going to work? Going home? Eating out?
Knowledge.
1. How good is the client’s knowledge of what is in food? How is this used? What else is happening at times when fattier food is deliberately chosen?
2. Increase knowledge of low-fat shopping, cooking, recipe modification and food skills associated with developing palatable, low-fat foods.
Stress management.
1. Identify possible connections between perceived stress and eating behaviour.
2. Develop effective stress management techniques which do not involve the use of food, in conjunction with other regularly used ‘self-nourishing’ activities.
3. Plan and use time consistent with lifestyle aims (i.e. incorporating deliberate and incidental exercise, food choices and meal planning).
4. Develop and practice assertiveness, with self and others.
Habit management.
1. ‘Reframe’ eating habits which contribute to overfatness as ‘curious and interesting’ as opposed to ‘immoral or bad’.
2. ‘Stalk’—describe eating, drinking, exercise avoidance habits or routines and develop strategies for interrupting these. Monitor self-talk, identify triggers for over-eating and thinking patterns associated with these. Challenge beliefs about self body image.
3. Evaluate social environment for social support. Develop ways to protect self from ‘high risk’ situations.
Relapse management.
1. Identify and develop a clear strategy for dealing with relapses. This includes strategies for dealing with celebrations and festivities, times of high stress and pressure, times of boredom alone and negative mood states.
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