Many people lose weight but remain “fragile” in the sense of being at risk for regaining the weight. This article explores the reasons for this fragility, and ways to help you prevent relapse.
A glass is a great example of a stable but fragile structure. A glass may survive for a long time if you handle it with care and avoid dropping it, but it’s always a moment away from destruction. Time does not make the glass any less fragile. Let’s explore why some dieters seem to be as fragile as the glass, and the potential solution.
A central issue in weight control, as it is with every other type of behavioural problem, is how to reduce the risk of relapse. In fact, it’s not an exaggeration to say that reducing the risk of relapse is the primary task of treatment. Many methods can initiate change, such as a week at a health spa (fun!) or a 21-day diet and exercise plan (not fun!), but these short-term interventions do not fix the long-term problem. Of course, the initial focus of all treatment is symptom reduction (losing the weight, stopping drinking, recovering from depression, etc.); this is the necessary first step. You must lose the weight before you can confront the challenge of maintenance. However, you need to start preparing for maintenance before you get there and not take it for granted.
Thus, we often see people launch themselves into an intensive program – the more stringent the better – and get dramatic results. They feel happy, proud, and confident, but unfortunately, they go off course at some point, feel defeated and discouraged, lose focus, and find it difficult to get back on track. No matter how well it seems to go during the initial intensive, “boot camp” phase, these individuals remain “fragile” with respect to their risk of relapse.
The reason for the dieter’s fragility is two-fold: First, the intensive regime is not physically or psychologically sustainable and does not represent a real lifestyle change. Real lifestyle changes are built from less dramatic small shifts in daily life that add up to big changes over time. Real lifestyle change requires you to deal with all the stresses and strains and competing demands of “your” life. Second, diets do not teach people how to master the relapse crisis itself. This is another key challenge in long-term behaviour change, and where psychology plays a very important role. It’s learning to deal with, and indeed to learn from, the relapse crisis that is the key to lasting change and successful weight loss maintenance.
The most well-established model of relapse and relapse prevention was proposed about 40 years ago by a psychologist named Alan Marlatt. His initial work was with alcoholics, but the model has since been applied to all sorts of behaviour change. In the relapse prevention model, the first question is how one copes with a “high risk” situation. High risk situations are those that increase the likelihood of an initial “lapse” (a slip back to the old behaviour) for an individual; these high-risk situations often involve negative emotions and interpersonal situations, but may also involve positive events such as parties, holidays, and celebrations. When we face such a situation we are challenged to find a way to cope. If we manage to cope successfully, we gain knowledge and confidence, and reduce our future risk of relapse. On the other hand, if we fail to cope, giving in to temptation and deviating from our plans, we may lose confidence and become even more prone to relapse.
Importantly, even a failure to cope can lead to learning, as we come up with strategies to avoid or cope with similar situations in the future. Thus, it is not just the occurrence of a lapse that is important, but how it is interpreted. If a lapse is interpreted negatively (“I knew this would happen, changing my bad habits is impossible!”), it can lead to a spiral of bad behaviour and loss of motivation (“what the hell, I’ve blown it, so I may as well continue….at least I’ll have the pleasure of eating”). If one’s confidence is shaken beyond a certain point of no return, we are likely to conclude that further efforts are pointless and quit. It is as if each time we face a high-risk situation we meet a fork in the road, offering the choice between learning or quitting. We need to develop what’s called a “growth mindset,” which is thinking that we can learn through trial and error, and practice.
Most of the patients we see tell the story of having lost and regained weight many times. One of the first questions we explore is what were the causes of the weight regain? If we can pinpoint the causes of past failure we can turn them to our advantage. For example, one lady described having lost 50 pounds with a combination of better eating and regular exercise; nothing unusual or extreme in her approach and it was going great…. until she fell back into her usual pattern of caring for everyone else and not making time for herself. Thus, she reverted to her old habits of not planning or organizing her eating and not exercising, and inevitably regained the weight. In embarking on another attempt to fix her weight problem, she needed to be very clear from the start about what it will take to avoid a repetition of what happened. She will need to truly address her lifestyle issue of not making herself a priority in her own life.
In the world of business, leaders are advised to get their teams to do a “pre-mortem” before launching into a new program. The idea is to imagine that the program has failed and to think of all the reasons why it did. This is to provide insight into all the pitfalls that should be avoided. The reason this exercise is a good idea is because of the natural tendency for people to be overly optimistic when in a highly motivated state, and to ignore potential risks. We really want to achieve the outcome, so we convince ourselves that we are bound to succeed. That’s a dangerous attitude, and one which makes us more “fragile.” Better to start by facing the risks that lie ahead and using our past experiences to teach us. That is the key to relapse prevention!
Stephen Stotland, Ph.D.