ACT for Weight Management: An Interview with Jason Lillis
Jason Lillis, PhD, is assistant professor of research at the Alpert Medical School of Brown University, and a clinical psychologist at the Miriam Hospital in Providence, RI. He has co-authored The Diet Trap: Feed Your Psychological Needs and End the Weight Loss Struggle Using Acceptance and Commitment Therapy and is co-editor of Mindfulness and Acceptance for Treating Eating Disorders and Weight Concerns: Evidence-Based Interventions.
Jason will be among our Spring 2017 webinar line-up, presenting a webinar, Using ACT to Address Struggles with Weight Management.
Praxis: What are the main factors that set the acceptance and commitment therapy (ACT) approach apart as a weight management strategy?
JL: ACT comes from the perspective that weight management should be strongly linked to your personal values. More often than not, folks are trying to lose weight for vague health reasons and/or to avoid self shame and other shame, such as not liking their body or feeling like others judge them. Over time, these forms of motivation tend to erode.
From the start, ACT tries to undermine avoidant forms of motivation, such as, “I’d like to not feel as bad about myself.” Instead, the ACT approach aims to link the client’s health to deeply held values, such as wanting to have more energy to participate in activities with friends, or wanting to be able to play with grandkids.
Praxis: What are some of the common pitfalls you think psychotherapists trip over when working with clients struggling with their weight, and how does an ACT approach offer a way around those?
JL: These are a few tendencies that are not helpful:
Assuming the core problem with weight management is adherence
In other words, thinking that the treatment is never the problem, but instead that folks just don't adhere like they "should." This leads to an over reliance on strategies like self-monitoring weight and calories. These strategies clearly help individuals lose weight, but we have 40+ years of data that show these strategies do not help the majority of people keep it off.
Not realizing that the initial weight loss phase ends about 6-9 months in
At that point, if you have not shifted into something that is focused on maintenance and long-term sustainability, it's probably too late. It is really important to foster intrinsic motivation, connection of health behaviors to values, a lifestyle change perspective (as opposed to a weight loss perspective), a shift from food focus to activity focus, and a general understanding of the biological changes that occur as a result of losing weight.
Praxis: What environmental factors do you see as contributing to Americans’ struggle with weight, and how can ACT clinicians help clients overcome those larger issues in therapy?
JL: It’s hard to answer this in few words. There are so many.
The most important one is the proliferation of inexpensive, high calorie, highly palatable foods. On your way to work you might pass 50 or more options for obtaining tasty food that is bad for both your health and weight. That is a bombardment of food that we were just not prepared to deal with, evolutionarily speaking. And many of these foods were designed to be addictive, quite literally.
Then, add in the environmental changes promoting sedentary behavior. Leisure time is increasingly spent in front of screens (TV, computer, phone). Fewer jobs involve physical exertion. Modern city designs discourage walking and biking. The odds are really stacked against us in terms of promoting our own health via nutrition and activity.
ACT clinicians have a few tools to help with this. First, acceptance skills are important for dealing with cravings. As we will be bombarded by food and food ads, we need some way to notice and make room for cravings while still increasing the number of health eating choices we make. Values can help in this regard, realigning each food choice as a "yes or no vote" on important, identified values.
Praxis: What are some of the first skills that an ACT intervention might focus on fostering in clients who are struggling with weight management?
JL: This is still debatable. A pure ACT approach would likely start by contextualizing the weight management agenda by clarifying values and linking health behavior changes to important values. The goal here would be to set the foundation for true lifestyle change, as opposed to quick fix weight loss.
However, there is compelling data that people lose the most weight early in a program, and that losing weight early is a good predictor of long-term success. So the argument could be made that you should get weight loss started and then work on contextualizing later. This would mean focusing on the nuts and bolts first, like calorie-counting and food choices. More research is needed to clarify whether there is any benefit to front-loading ACT strategies. So right now I would say there is no right choice.
Praxis: In your book, The Diet Trap, which you co-authored with Joanne Dahl and Sandra Weineland, you talk about the “fix-me” trap which is something clients struggling with weight loss often experience. Can you share with us what that is and how you approach this trap in your work with clients?
JL: The fix-me trap is basically the idea that many individuals are losing weight in an attempt to change how they think and feel about themselves. The assumption is that if the weight comes off, then I will stop having judgments about myself and I will never feel disgusting, unsexy, or unlovable.
We identify this as a trap for a variety of reasons. First, most people will not lose all the weight they want to lose, and usually this kind of thinking is pretty absolute, for example, “I must lose 70 pounds.”
Second, we are all human beings, and as such we will all have self-judgments and feel bad some of the time. The idea that losing weight will fix all of this is a fallacy. Your mind will find something else to judge. If you talk to people who have lost a lot of weight they will very often endorse this.
And finally, the fix-me approach keeps people from engaging in their lives now. If you need to be fixed first, then why take a chance and initiate intimacy with your spouse? Or seek a promotion? Or try a new activity? Life gets put on hold.
ACT seeks to undermine this by using acceptance and defusion strategies to change the client's relationship with unwanted judgments and feelings such that they can begin living life more consistently with chosen values right now, not after they lose weight. This can help set the stage for a longer-term foundation for lifestyle change, as improvements in health will generally support values-seeking behavior.
For more about using ACT to address struggles with weight management, check out Jason’s upcoming webinar and the entire Spring 2017 webinar season pass line-up. The webinar may not be available for individual purchase as the season passes are selling fast. Purchase a season pass to guarantee admission.