Obesity, Shrinking Brains, And Why Diets Don’t Work

Like most middle aged men, I struggle to balance the delights of eating with the disappointment of my waist line. I hire a personal trainer three times a week; I eat loads of fruit and veg, and am on a low saturated fat diet (to curb my concerning cholesterol levels). Despite this I continue to buy trousers that are too tight for me on the assumption that ‘at some time in the near future’, the new me, no, the real me, will return, and I will be able to fit into them. The gold standard of a washboard stomach seems as unattainable now as it ever has been.

I am not obese by the way. Nor am I fat. My body mass index shows I am ‘normal’. My point is that keeping it at ‘normal’ is something that I have to prioritise and make time for. Exercise and good eating doesn’t happen by accident. They are hard won habits that have taken years to build.

I have a real sense of empathy for my clients whose goal it is to loose weight. My weight once spiralled out of control. It happened ‘by accident’ and when I ‘wasn’t paying attention’. Suddenly I was fat, and had no real awareness of it happening. I turned my attitude around quickly to address the problem, but it still took two years to get back in shape. Of course I had a choice at that point. I saw how all too easy it would have been to rationalise being overweight, and continue with the cosy, exercise free and chocolate rich lifestyle I had been enjoying.

Over the years I have noticed that many of my overweight clients have reached this tipping point and chose to continue eating. This is a painful option, of course, as it feeds into the man’s sense of guilt and shame, poor body image and low self worth. Eating then takes on a different symbolic meaning. It becomes the way one punishes oneself and perpetuates self loathing.

Paradoxically, it seems to me that the constant health warnings about being overweight just seem to embolden this self destructive cycle of eating as self abuse. The latest one is truly shocking. Brain regions that are important to thinking processes are 6% smaller in overweight people and 8% smaller in obese people. The reports author, Paul Thomson, cited in the New Scientist claims that the brains of obese people look 16 years older than lean controls (see New Scientist, 22 August, 2009).

But what is a person to do to combat obesity? This, of course, is a huge area of academic interest. As our populations are getting heavier and heavier, and obesity costing the economy more and more, the importance of finding answers to this question is becoming more pressing.

One finding that does seem to be coming through load and clear from the research is this: diets don’t work. I see this with the clients of my personal trainer. He puts them on a low calorie diet and vastly increases their expenditure of energy through exercise. Very often the strategy is successful in the short term. He often beams with pride as he tells me of a client who has lost 15 pounds or even 30 pounds. But in the medium term the weight simply piles back on. One person slimmed down only to put three stone back on while on a cruise.

The bottom line with weight loss is eat less and exercise more, but why is dieting so ineffective in the medium to long term? There are lots of reasons suggested for this, some physiological some psychological. My take on this is that the body can increase the number of fat cells in order to put on weight. The trouble is fat cells cannot be destroyed by the body. Weight therefore works like a ratchet system, always building the capacity to get bigger, but never smaller. The significance of this is that when you loose weight your body ‘feels’ like it is in starvation mode (as all your fat cells are now showing as ‘not full’) and this makes cravings for high calories foods more likely.

In short, once you have been overweight, in order to keep weight off you need to radically re-thing your approach to food and how you respond to cravings. This is not an easy process, and requires time and effort. Fortunately you don’t have to use a therapist to start along this process. Some of my clients have gained great benefit from an online course called Food Philosophy. It aims to educate you in food psychology so you are armed with the tools you need to change the way you think about food.

My approach to working with clients is similar. I start with understanding the person’s relationship to food. I don’t even like starting with a target weight loss. By changing the assumptions and habits of the person, I hope to bring about lasting and sustainable weight loss through subtle behavioural change. In an industry that thrives on quick fixes, my approach can seem long winded. I firmly believe, though, that sustainable weight loss in people with chronic obesity cannot be achieved without this kind of patient work.

Dr Phil Tyson is a Men’s Psychotherapist based in Manchester in the UK.  He offers counselling in Manchester, psychotherapy in Manchester, cognitive behavioural therapy in Manchester and telephone counselling nationally and internationally.