The site for Professionals interested in the

Psychology & Motivation behind Behaviour Change &

Understanding the Psychology & Sabotage of Weight Loss

The evidence-based imperative to ensure best practice

Only 13%-20% of those who intentionally try to lose weight are able to lose 5% of their body weight and maintain this for 5 years. [1]  In the face of the obesity epidemic, these concerning outcome data demand a fundamental reconstruction of extant approaches to managing obesity to ensure they align with best practice. The research is clear - the therapeutic focus needs to shift from a 'physical condition resulting from a self-discipline deficiency' model of obesity to a psychologically sophisticated focus on managing motivation to bring about sustainable lifestyle change.

Psychologically focussed treatment with a longer term follow-up maintenance phase is now considered the standard for treating obesity.[2]  The exhaustive Cochrane treatment review found that increasing the intensity and duration of the psychological intervention significantly increased the weight reduction.[3]  Moreover, group therapy has proven to be the more cost-effective intervention for treating obesity and maintaining weight loss. One of the counter-intuitive findings is that those who prefer individual treatment actually do better in group therapy than those who prefer group over individual work.[4] 

A recent survey of 200 UK GPs found that 'lack of patient motivation' was the top barrier to weight loss.[5] Behavioural factors were consistently ranked as more significant than non-behavioural factors such as lack of nutritional knowledge or insufficient support from health professionals. While 93% of GPs saw behavioural change as 'very important', only 19% reported providing behavioural treatments to their patients. An extremely disconcerting 1% felt they were successful in supporting their patients' weight loss attempts. They cited a lack of resources and funding as reasons for not providing behavioural intervention.

Dr Blair-West's clinical focus - Motivation, 'Behavioural Fatigue' and Sabotage

Dr George Blair-West is a medico and psychiatrist who specialises in the psychotherapy of weight loss. His preferred mode of psychotherapy is group therapy combined with individual therapy. His therapeutic focus is on two emerging problem areas - 'behavioural fatigue' and weight loss sabotage by self and others. 

Behavioural fatigue relates to the problem of the people tiring of restricting their food intake and exercising vigorously.[2]  The issue of 'restriction' is the domain of Restraint Theory and the wealth of research[6] into this fascinating world. His book looks in detail at what Restraint Theory has to teach us about dealing with the problem of people tiring of restricting. Strategies for dealing with motivation and exercise are explored at length.

A disturbing 69% of people on a bariatric surgery waiting list have a history of childhood abuse.[7]  This population often use their weight as a form of protection and will sabotage their weight loss if these underlying issues are not addressed. With his extensive experience in also treating trauma, Dr Blair-West has a particular interest in identifying common forms of sabotage, by self and others, and treating these problems very specifically.

As well as being primarily a clinician, Dr Blair-West has a background in research and completed a three year tenure as a Senior Clinical Lecturer at the University of Queensland. Over the years his interest has evolved in this field into deconstructing and understanding the motivation of change. 

Dr Blair-West's work and his book addresses the following questions:

• Why do traditional weight loss approaches have an 80% failure rate?
• What level of compliance do people really have to traditional weight loss plans?
• What is Restraint Theory & how does recent research predict dietary sabotage? 
• What are the primary reasons for self-sabotage of a weight loss plan?
• What is 'motivation' & why is the amount of dietary self-discipline required a marker of failure?
• What does this mean we need to do very differently if people are to lose weight?
• How do I prescribe foods to avoid the problems that follow from dietary deprivation? 

If you are interested in co-ordinating a workshop in your city email Dr Blair-West on g @ blair-west.com (remove spaces) or call his consulting rooms on +61 (0)7 3878 1222.

REFERENCES

² Wadden TA, Butryn ML, & Byrne KJ. Efficacy of lifestyle modification for long-term weight control. Obes Res. 2004;12:151S–162S.

³ Shaw K, O'Rourke P, Del Mar C, Kenardy J. Psychological interventions for overweight or obesity. The Cochrane Database of Systematic Reviews 2005, Issue 2. Art. No.: CD003818.pub2. DOI: 10.1002/14651858.CD003818.pub2.

⁴ Renjilian DA, Perri MG, Nezu AM, McKelvey WF, Shermer RL, Anton SD. Individual versus group therapy for obesity: effects of matching participants to their treatment preferences. J Consult Clin Psychol. 2001;69:717–21.

⁵ Survey of 202 UK-based General Practitioners conducted by Taylor Nelson. www.medicalnewstoday.com/articles/76504.php

⁶ Ogden J. The Psychology of Eating 2003, Blackwell Publishing, Oxford.

⁷ Grilo et al. Childhood maltreatment in extremely obese male and female bariatric surgery candidates. Obes Res. 2005;13:123–130. Click here to download this paper

  Click here to visit +Dr George Blair-West's Google profile