• The psychological understanding of obesity has moved through several phases in recent times.

• Behaviour modification techniques were initially used widely to change habits.

• Cognitive approaches have been used to change thought patterns.

• Rational Emotive Therapy (RED is an example of a ‘pop’ psychology approach to changing thought patterns.

• Other approaches have examined the symbolic nature of fat.

• The task of a fat loss counsellor is complex and involves an understanding of a range of different causalities and interventions.

• Fat loss leaders should develop a close referral link with a qualified psychologist.

The simplistic view of obesity was that if a person ate too much, he or she got fat. The solution was: eat less and you’ll lose fat. This is the ‘diet as medicine’ approach. In reality, the issue is much more complex. Some people couldn’t eat less simply as a result of being told; some people could obey the injunction, but could not keep up the practice and some people experienced almost a panic reaction in the face of trying to control their eating. Studying the problem some researchers reported: ‘. . . it was our feeling that our patients perceived weight reduction, not as a happy end to a disabling disorder, but rather as a threat to the integrity of functioning’. Other research reported not only an increase in depression in overweight people undergoing diets, but also that the same symptoms—increased emotionality, irritability and anxiety—were seen in normal weight people subject to severe food restriction.

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Thermogenesis describes increases in the MR above RMR in response to things such as food intake, exposure to cold or heat and the body’s physiological responses to fear or stress.

Thermic effect of food. The thermic effect of food (TEF), also called diet-induced thermo-genesis, represents increases in MR above RMR resulting from the energy costs of digestion, absorption, transport, metabolism and storage of food consumed. Consumption of food produces a transient increase in MR until it is assimilated. When these processes are complete, MR returns to the pre-meal state. The TEF is the major form of thermogenesis, accounting for approximately 10-15 per cent of daily energy expenditure. Many studies have been done to examine if obesity is related to a decrease in TEF. In a recent review of all these studies it was discovered that several found a difference between the lean and obese and several found no difference. It is important to remember that even in those studies which found a difference, it was only of the order of about 1 per cent of energy expenditure.

The major factors which influence the TEF are the meal size and composition. A higher TEF is seen with a higher calorie load and a higher proportion of protein. The energy cost of processing protein is very high (~ 20% of its calories) compared to fat and carbohydrate which only cost a few per cent of its calories. Other factors which affect TEF are palatability of the food and time of the meal, as well as a person’s age, genetic factors, physical fitness and some specific foods.

Caffeine: Several studies have shown an increase in MR of up to 10-30 per cent for 1-3 hours after administering oral or intravenous caffeine. It appears that the optimal amount is the equivalent of about 2—3 cups of instant coffee per day. Caffeine use in athletes has also been shown to increase performance by increasing lipolysis and, therefore, sparing carbohydrate during endurance events. However, recent work also suggests that the effect of caffeine is not as great in the obese as in normal weight individuals.

Spicy foods: Spicy foods such as chillies and curries, which contain an ingredient known as capsaicin, have been shown to elicit small increases in TEF. The use of spices not only adds flavour to low-fat dishes therefore, but also may have a small, transient effect on increasing MR.

The importance of TEF. Most researchers do not regard TEF as a major cause of obesity.

According to Ravussin and Swinburn:

. . . one can safely state that individual differences in the thermic effect of food can only account for small differences in daily energy expenditure. This implies that a minimal weight gain will increase energy expenditure (mostly in relationship to resting metabolic rate and the energy cost of physical activity) and will therefore be sufficient to offset any impairment in the thermic effect of food.

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For most of her adult life, Cheryl maintained a healthy weight without any type of dieting. But that changed after the birth of her two daughters. A 50-pound gain during each pregnancy catapulted her out of her normal weight range. At 170 pounds, Cheryl, of Dou-glassville, Pennsylvania, was on the verge of qualifying as clinically obese.

She joined Weight Watchers. She knew that the organization’s low-fat meal plan would provide a structure for developing healthy new eating habits.

But new habits take time to form. And during those first weeks, Cheryl faced the same dilemma every day. She had no problem sticking with her meal plan at breakfast and lunch. But staying on track through dinner required more effort. By evening, her resolve sputtered and stalled. She’d get intense cravings—often for ice cream or cheese and crackers.

Cheryl’s solution? When her willpower quit for the day, so did she. Rather than cave in to her cravings, she simply went to bed. Sometimes, she turned in as early as 9 o’clock. She felt a little silly going to bed so early, but it worked.

Cheryl, now age 39, lost 40 pounds over the course of 7 to 8 months. Since her body has adjusted to her new way of eating, she doesn’t need to turn in early anymore. But she recommends it as a coping tool for anyone who is wrestling with nighttime cravings.

WINNING ACTION

Get a good night’s sleep. According to a study at Case Western Reserve University in Cleveland, there is a limit to the amount of willpower that a person can exert in a single day. That limit is highly individual. But as a general rule, when you start to hear the call of nighttime cravings, that can be your cue to turn in for the evening. You can sleep off your cravings and wake up with rejuvenated resolve.

Cheryl, now age 39, lost 40 pounds over the course of 7 to 8 months. Since her body has adjusted to her new way of eating, she doesn’t need to turn in early anymore. But she recommends it as a coping fool for anyone who is wrestling with nighttime cravings.

WINNING A C T I O N

Get a good night’s sleep. According to a study at Case Western Reserve University in Cleveland, there is a limit to the amount of willpower that a person can exert in a single day. That limit is highly individual. But as a gen¬eral rule, when you start to hear the call of nighttime cravings, that can be your cue to turn in for the evening. You can sleep off your cravings and wake up with reju-venated resolve.

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