Course excerpt from Behavioral Strategies for Weight Loss
Perhaps the most common weight loss theory is that in order to be successful at weight loss (and arguably at health) we have to control sugar. But we also know that having self-control depends on having enough blood glucose in our system to support our willpower. The question we should be asking then is: just how do we gain self-control when we are dieting (and keeping blood sugar levels low)?
In arguably one of the most self-control deprived group of people – kids with ADHD – researchers demonstrated that the answer may lie in strengthening our executive functions. In a two-year randomized controlled trial, the researchers studied 759 children in 29 Massachusetts schools, comparing the Tools of the Mind program – a research-based educational program that uses child-directed activities and structured make-believe play to increase self-regulation (a core component of executive functioning) – to other kindergarten children not participating in the program (Blair & Raver, 2014).
When compared with their peers in control classrooms, kindergartners in the Tools of the Minds classrooms were better at paying attention in the face of distractions, controlling impulses, had better working memory and processed information more efficiently. Even more compelling, the gains were highest in children who had been given a provisional diagnosis of ADHD.
A second study (Schmidt et al., 2014) found similar results. Using a self-regulation intervention that consisted of 20-30 minute sessions every week, researchers followed 276 children ages three to five enrolled in a federally funded Head Start program for at-risk youth for eight weeks. Children were randomly assigned to either a control group or the intervention program, which used movement and music-based games that increased in complexity over time and encouraged the children to practice self-regulation skills. The game required children to listen and remember instructions, pay attention to the adult leading the game and resist natural inclinations to stop or go, and was designed to be naturally progressive, with each successive game task becoming harder.
Researchers then compared children’s self-regulation and academic achievement before and after the intervention and found that children who had received the intervention scored significantly higher on two direct measures of self-regulation. And again who the intervention was most effective with were the children considered the highest risk for struggling in school – mainly due to self-control problems.
But perhaps the question we should be asking is: Does strengthening executive functioning work for adults? Here again, to answer this question, the best place to look is a group of adults commonly considered low in self-control – those with addiction problems.
While many studies have explored techniques such as assigning a quit date, using cognitive behavioral therapy, and warning smokers of the risks of continued smoking, one recent study (Tang et al., 2015) used neuroimaging to compare the brains of non-smokers to smokers. In the region of the brain associated with self-control (and executive functioning), the prefrontal cortex, the smokers showed dramatically less activity, suggesting than when it comes to the addictive behavior of smoking, self-control is decidedly absent. Questioning if self-control training could improve smokers success at quitting, researchers from Texas Tech University and University of Oregon recruited 60 undergraduate students (27 smokers and 33 non-smokers) to participate in an integrative mind-body program designed to improve self-control. The students were then split into two groups, one receiving the self-control training and the other receiving relaxation training.
After receiving 5 hours of 30 minute sessions over the course of two weeks, researchers then compared the students’ brain scans, self-report questionnaires, and objective measure of carbon monoxide on their smoking amounts and habits, before and after the intervention. The students who had received the self-control training reduced their smoking by a whopping 60 percent (as measured by the carbon dioxide percentage in their lungs). Even more fascinating was that when researchers compared the students self-reported intention to stop smoking to their actual reduction in usage, they found no correlation (Tang et al., 2015).
What this study, and others that have replicated the results, should tell us is that when we want to change a behavior, what matters is not our intention to change, but the amount of self-control we have to actually execute the change.
And no place could this be more relevant than when trying to lose weight. In the first study ever to examine whether practicing acts of self-control during weight loss is linked to an increase in self-control and better weight loss outcomes, experts from the Miriam research team found that individuals with more willpower – or self-control – lost more weight, were more physically active, consumed fewer calories from fat, and had better attendance at weight loss group meetings. And when participants experienced an increase in self-control during a six-month behavioral weight loss treatment program, the effect was even more pronounced (Leahey et al., 2013).
Testing self-control through the use of an exercise where participants had to override aversive stimuli, such as cramping, pain, and discomfort, study lead author, Tricia Leahey explained that self-control, or willpower, is like building a muscle, “The more you ‘exercise’ it by eating a low fat diet, working out even when you don’t feel like it, and going to group meetings when you’d rather stay home, the more you’ll increase and strengthen your self-control ‘muscle’ and quite possibly lose more weight and improve your health” (Leahey, 2013).
Just how we exercise the self-control muscle, like the self-control test demonstrated, is by inhibiting impulses – especially those that threaten to derail our weight loss goals. But we may also have to inhibit who we hang around with. Self-control, it turns out, just might be contagious.
The takeaway is that self-control doesn’t just have to practiced, it has to be protected. That little trip to Starbucks that we mindlessly take with our friend known for her proclivity for venti size Frappuccino’s (which weigh in at a whopping six hundred calories and fifty grams of sugar) might go by unnoticed, but the next time we find ourselves at Starbucks, it might be us with the venti Frappuccino in our hands – and maybe one of those tasty lemon bars as well.
The more we exercise our self-control muscle – by practicing, witnessing, and surrounding ourselves with acts of self-control, such as overriding impulses – the better we get at self-control. The problem for most people, however, is that overriding impulses is a lot harder than it sounds. As we should know by now, our decisions – especially those that serve to benefit us in the long term – are plagued by a host of thought errors that don’t just make us more likely to choose the cookies over the carrot, but discount the impact it will have on our waistline, and exaggerate the pleasure of eating it.
Behavioral Strategies for Weight Loss is a 2-hour online continuing education (CE) course that exposes the many thought errors that confound the problem of weight loss and demonstrates how when we use behavioral strategies – known as commitment devices – we change the game of weight loss. While obesity is arguably the largest health problem our nation faces today, it is not a problem that is exclusive to those who suffer weight gain. For therapists and counselors who work with those who wish to lose weight, there is ample information about diet and exercise; however, one very large problem remains. How do therapists get their clients to use this information? Packed with exercises therapists can use with their clients to increase self-control, resist impulses, improve decision making and harness accountability, this course will not just provide therapists with the tools they need to help their clients change the way they think about weight loss, but ultimately, the outcome they arrive at. Course #21-13 | 2016 | 31 pages | 15 posttest questions
This online course provides instant access to the course materials (PDF download) and CE test. After enrolling, click on My Account and scroll down to My Active Courses. From here you’ll see links to download/print the course materials and take the CE test (you can print the test to mark your answers on it while reading the course document). Successful completion of the online CE test (80% required to pass, 3 chances to take) and course evaluation are required to earn a certificate of completion. Click here to learn more.
Professional Development Resources is approved to offer continuing education by the American Psychological Association (APA); the National Board of Certified Counselors (NBCC ACEP #5590); the Association of Social Work Boards (ASWB Provider #1046, ACE Program); the American Occupational Therapy Association (AOTA Provider #3159); the Commission on Dietetic Registration (CDR Provider #PR001); the Alabama State Board of Occupational Therapy; the Florida Boards of Social Work, Mental Health Counseling and Marriage and Family Therapy (#BAP346), Psychology & School Psychology (#50-1635), Dietetics & Nutrition (#50-1635), and Occupational Therapy Practice (#34); the Ohio Counselor, Social Worker & MFT Board (#RCST100501); the South Carolina Board of Professional Counselors & MFTs (#193); and the Texas Board of Examiners of Marriage & Family Therapists (#114) and State Board of Social Worker Examiners (#5678).