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Dealing with Weight-Loss Relapse

Give clients the psychological tools they need to avoid weight-loss relapses.

"She was doing so well! Then one day she canceled her personal training appointment, and stopped coming to the fitness center. She had been exercising for more than two months, and was careful about what she ate. She'd lost more than 10 pounds. She did say that her department was downsizing at work, and that her teenager was having some problems in school. Maybe life just ganged up on her."

We are creatures of habit, and most people find it uncomfortable to change habits. Relapse occurs for a majority of people in their behavior-change efforts, from quitting smoking to starting exercise. Lifestyle modification programs for weight loss can be especially difficult to maintain over a long period of time. Simply sticking to an exercise program is difficult for many people. Add changes in grocery shopping, cooking, meal planning and food choices, and lifestyle modification becomes a full-time job.

In addition, losing weight almost always means swimming upstream in a culture that promotes overeating and a sedentary lifestyle. Dieters are continually challenged by situations requiring self-control, and commitments that squeeze out scheduled exercise sessions. It's not difficult to understand why most people regain the weight they worked so hard to lose.

Success factors

And yet, some people do manage to lose weight and stick to their lifestyle modification programs. Psychologists have studied the factors that contribute to success. Helping your clients understand these factors, and to plan for challenges, may help them to stick to their diet and exercise programs.

High-risk situations. Many clients can tell you about situations that tend to be especially difficult for them. Parties, vacations, holidays, visitors, eating out and travel may present circumstances that disrupt the normal routine, or present irresistible temptation. Encourage clients to anticipate challenges and to plan effective coping strategies.

Negative emotional states. Mood is everything. If you feel bad, you seek comfort. Coping with stress and negative moods requires self-control, and spending energy on stress management depletes the self-control needed for behavior change - like saying "no thanks" when a coworker brings a box of donuts to a meeting. Everyone has bad days and bad moods that can jeopardize behavior-change efforts. People with mood disorders such as depression and anxiety may have extra difficulty with behavior change if these changes increase feelings of stress.

Coping skills. Clients who are successful at sticking to their behavior-change programs develop skills to cope with stress and high-risk situations. They may reduce stress with a variety of stress management techniques, such as exercise, meditation or taking time out to participate in enjoyable activities with friends. They plan ways to cope with high-risk situations.

Craving. Some clients experience bothersome cravings when they change their eating behaviors. While some clients can include small amounts of craved foods in their eating plans, others find that they overeat when craved foods are consumed. Clients should be sure they are eating enough calories, drinking plenty of fluids, getting adequate rest and staying busy enough to avoid boredom. Cravings that arise when clients are facing high-risk situations in a negative mood are difficult to resist.

Outcome expectancies. Outcome expectancies are like behavior change pros and cons. If clients think eating a big meal will make them feel better, they will be more likely to indulge. If they think exercise will make them feel tired, they'll skip the workout. Help clients create positive expectancies for their new behaviors. For example, a moderate workout might help your clients feel more energetic and less irritable.

Self-efficacy. Self-efficacy refers to a person's judgment of how well he/she can perform a certain behavior in a given situation. For example, people who believe they will be successful in sticking to their exercise programs in high-risk situations generally are. When you help clients achieve success, you increase their self-efficacy.

Abstinence violation effect. This fancy phrase describes the behavior of people who resume drinking or drug use after a period of abstinence. Once they break their rule about not using the substance, they feel self-blame and a loss of control, and fall into a relapse. Dieting can be the same way for some people. Once they "break" their diet, they continue to overeat and abandon their weight-loss programs entirely.

Social support. Friends and family can either sabotage or support clients' behavior-change efforts. Encourage clients to cultivate a helpful and supportive social network.

Brehm, B.A. Successful Fitness Motivation Strategies. Human Kinetics: Champaign, Ill., 2004.
Witkiewitz, K., and G.A. Marlatt. Relapse prevention for alcohol and drug problems: That was Zen, this is Tao. American Psychologist 59 (4): 224-235, 2004.
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