Question 1
Which area should dietitians make their primary focus in weight loss counseling: cognitive change or behavioral change, and why? Which do you think is most effective?
posted by Kalee @ 7:00 PM
32 comments
ISU Dietetic Internship Journal Club
Objective: To become familiar with current scientific literature on a variety of nutrition topics and to gain experience in gathering, organizing, critically evaluating, presenting and facilitating group discussion of the literature and the implications to practice.
Wednesday, January 10, 2007
Contributors
Previous Posts
- January 2006: Behavior Therapy and Obesity
- Conclusion: Supplement use in adolescents
- Question 3
- Question 2
- Question 1
- December 2006: Vitamin and mineral supplement int...
- Conclusion: Calcium Consumption among Adolescents
- November 2006: Calcium Intake in Adolescents
- Question #1
- Question #2
32 Comments:
This is a tough question but I do think that it depends on what the patient/client needs from the counseling sessions and what motivates the person to lose the weight. Many people have deep emotional issues attached with eating and in order to get through these I think CBT would be a good starting point. For others Behavioral Therapy would work quite nicely because they simply need to change their behaviors, because maybe they have gotten too used to the conveiences of today, and simply a little awareness of their actions through keeping a food log would help them immensely. Additionally with the effectiveness it depends on the person, some individuals will do better in a group setting and behavioral therapy is a better option, whereas CBT is technically and individual option.
I also agree that there may not be a definitive answer that suits every client. Each person may need something different from counseling in order to initiate change. I think a focus on both aspects-behavioral and cognitive would be best. Ultimately, the goal is that by changing either one (the thoughts or the actions) one will be "coerced" into changing the latter...that is if the individual is ready for change.
I believe that individuals dealing with obesity need to change the way they think about food in order to make the lifestyle changes necessary to maintain a healthy weight. It therefore seems logical to start with CBT in order to determine/change the way these individuals think and feel about food. Once the cognitive changes have been addressed, behavior changes will hopefully follow.
I feel something needs to be done with the way the rate of obesity is climbing in the United States. It seems we might be on the right track when programs are focusing on behavior therapy with obese people but I feel that more needs to be done. This can be a good start to a successful program but the program also needs to focus on other aspects of nutrition.
Since both the traditional behavioral method and cognitive behavioral therapy seem to be very similar and neither has proven to be more successful, then I feel it is more important to individualize the counseling to the specific client in question. Obesity is such a complex issue that has so many possible causes at it’s root that I think it is most effective to individualize the treatment. If that means focusing more heavily in one area or combining the two methods for best results than so be it. The similarity between the two methods is also a good argument for using a combination therapy. I think for some patients however, it might be simpler to focus simply on behavior change, while other patients may need the CBT. In general, I think it’s best to focus on what is working and to keep up on future research that might give us a better idea of which method leans more toward long-term effectiveness.
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As a result of cognitive change and behavioral change being so interchangeably linked, I couldn’t say one was superior to the other. Therefore, I do not think that dietitians should primarily focus on just one. Typically, when one change gets mentioned, oftentimes it then leads to the other, therefore, making it very important to focus on both cognitive and behavioral changes. Many times, a dietitian may want to find out what is causing the weight gain in a patient and first see if it’s a mental problem, a physical problem or both. For instance, if a patient has a very stressful life and because of that he or she has been gaining weight progressively. One might want to get to the bottom of the stressful situations and find out why they make the choices they do and help them to focus on how to deal with stress. Then decreasing the stress might cause them to change their eating behaviors then a dietitian could focus on the behavioral aspects of their changes. I do think and hope that focusing counseling on both cognitive and behavioral changes will both be very effective in the world of dietetics.
I feel to approach the weight loss epidemic via the cognitive route would be the most effective method to combat obesity. Sure one can change his or her behaviors and eat less fattening food and exercise more and thus lose weight, but how long will this new behavior last? So many people at the beginning of a new calender year follow this basic premise of being more active and eating more healthful with less than satisfactory results. Maybe if dietetic professionals could identify what cognitively drives unhealthful eating and inactivity we could work to correct this misguided thinking and in essence, attack the root of the obesity epidemic. If dietetic professional could change the way people approach and conceptualize what is health living, we could help them to see what is required to beat obesity. Understanding individual thinking and what drives individuals could help make significant advances in solving the obesity epidemic.
I really believe that both should be abehavior and cognitive therapy should be used. Dependent on the patient one type may be more effective than the other. Through counseling I believe that you can tell if a patient would be responsive to cogitive therapy. Some patients may not be willing to share emotions,give feedback on how they feel, or admit and address any problems they face. In this type of patient, I would suggest only using behavior modifications. However, those patients that are very passionate about losing weight and are self motivators would benefit from both behavior and cognitive therapy. I believe that cognitive therapy is a essential component lifestyle change. Those with cognitive therapy are able to self reflect and answer their own questions as to how they feel or how they can go about changing a behavior.
Each client has individualized needs and ultimately will need to decide which therapy will work best for them. Cognitive-Behavioral and Behavioral therapy work hand-in-hand. I think that both types need to be focused on in order to facilitate change. Cognitive may be more effective because it makes the client think about the problem and come up with various solutions to the problem. Rather than the RD naming off options, the client is allowed to fashion their own forms of solution to the problem. They are also able to weigh the pros and cons of their choices. I think that being able to look at the problem in more detail can make the problem and solving it more meaningful to the client and may make them want to change even more.
I think it is important for dietitians to apply both therapy styles during their sessions with weight-loss clients. Some clients will appeal to the Behavioral Modification strategies, while others might have deeper-rooted issues that may need to be resolved before they can start changing eating behaviors. This second client would appropriately benefit from Cognitive-Behavioral Therapy approaches. Hopefully, if dietitians use their own instincts to develop weight-loss programs for their individual clients, they will be providing the best pieces of each approach. Behavioral modification programs have shown to be helpful in the short-term, however have had little success in maintaining long-term weight loss. Cognitive-Behavioral therapies have had little research done to prove their effectiveness. Neither therapy technique has been completely successful on its own, so maybe the answer lies in a combination of the two that is tailored to each individual client’s situation and personality. Dietitians should have dynamic counseling styles to motivate each and every one of their clients, therefore maximizing the results of all of their sessions.
I believe that CBT and behavior therapy are both very important for successful weight loss. The two methods are interchangeable, but I do not think behavior therapy will be successful without CBT first. People need to learn and understand first the reasoning behind why they should change their behavior. I don't think you can expect anyone to change their behavior permanently or maybe even at all without good reasoning. Once they learn the consequences of being overweight and the benefits from eating healthier and having a healthier lifestyle they will most likely have more motivation to change their behavior. There may be some people who aren't concerned with the consequences and/or benefits and who are motivated to lose weight maybe for reasons such as emotional, image or self-esteem issues; these people may lose weight and change their behavior for a short period of time, but it probably won't last. I believe that someone who has the education and/or cognitive part will have a greater chance of the behavior change to remain permanent.
I think dietitians should focus on both Behavior Therapy and Cognitive-Behavior Therapy (CBT) equally rather than one method of intervention only. As the article states, both interventions have been shown to be effective. With weight loss counseling, each and every patient will be different, therefore it may be necessary to cater an intervention plan to each individual rather than focusing on one specific type of therapy.
I think that for the dietetic profession, both cognitive-behavioral and behavioral therapies are important tools for changing the obesity rates in the U.S. I am still a little old fashion and believe that ultimately behavioral therapies work better because many times it is a person’s behaviors (lifestyles) that lead to obesity (ex: convenience foods to save time...especially with a two income family). However, there are many times when a person has emotions tied to their eating lifestyle, which should take the modification one step further into CBT. Since both modifications are fairly new, the effectiveness is yet to be determined; due to this I think it is important to test the different modification styles every client. When consulting with a client and they don’t seem to be emotionally rooted to foods, the nutrition program should be redesigned to focus more on behavior therapy to keep focus on the problem and vice versa. No one individual is built exactly the same, therefore, no one solution will work for every person. A good dietitian will be able to try and implement one or the other modification and see either results or no results, leading them to branch out to another aspect of nutrition counseling. So, if a dietitian is just using behavioral therapy and this does not seem to be working, they may want to combine that with the cognitive aspect to conclude what is causing the emotional tie to that food.
Beth C.,
You make a great point. Attitude is extremely important for a patient’s success. If a patient doesn’t want to try, or isn’t willing to make a change, that change isn’t going to happen. I agree with your response to question 1 in that Cognitive Behavior Therapy should first be applied, followed by Behavior Therapy.
The R.D should have experience in both types of counseling in order to understand and guide the sessions for maximum success in the weight loss effort. The therapy offered will have to be individualized; if one type of counseling is not working or needs modification perhaps the other type of therapy would be better suited for the client. The Cognitive Behavioral Therapy counseling would appear to be more successful because the client is working on both the emotional battle of eating as well as changing the behavior(s) that are causing the weight gain. CBT will hopefully help identify and change the issues the client is battling with. However, behavior modification therapy would concentrate on specific situations and identify ways to change the problem by interrupting the usual routine that is sabotaging the weight loss effort.
As everyone has stated each patient/client will have different needs, and that ultimately defines how weight loss should be dealt with. I don’t think that one way is more effective than the other, as stated in the article both have been shown to be successful. However, I think that in all situations a client would benefit from behavior and cognitive changes. You need to backup the behavioral changes with a mindset that will make weight loss successful and vice versa. Once the RD has a feel for the client, hopefully they will be able to tell what the client would benefit most from, and tailor their counseling to make weight loss successful.
I think that dietitians need to focus on both aspects, cognitive and behavioral change, in order to have effective weight loss. However, I believe that cognitive change needs to happen first. It is very important for the client to be in the right state of mind. It has to be their decision to loose weight and they have to be ready and willing to work towards their goal. I believe it all starts in your head. You have to be motivated to start your new lifestyle and have the dedication to devote to it. Once the cognitive change has occurred, the behavioral change can take place and the goal of weight loss is in progress.
I definitely agree with Steph when she said: “Once the RD has a feel for the client, hopefully they will be able to tell what the client would benefit most from, and tailor their counseling to make weight loss successful.” I agree that it is a duty of the RD to get to know his/her patients and to figure out what kind of counseling they need and what will work for them. Each person is different and they need to keep in mind that different methods will work for different people.
I think they are both important when someone is trying to change something about themselves. Change is hard to deal with, espcially when you have been behaving and thinking a certain way your whole life. For the most part, the way I think influences the way I behave. So I feel that the cognitive approach would work best but that can vary from person to person. Some people react on gut instinct where others will think on things for a long time before making a decision. I think more research is necessary before any real conculsion can be made about either treatment.
Both CBT and Behavior Therapy would be very effective in weight loss counseling, although one may be more effective than the other depending on the situation and on the individual. CBT might be more effective for a client who has serious misperceptions or incorrect thinking associated with eating patterns. Behavioral modification would be helpful when the client is more motivated in group settings. However, cognitive change would be effective in correcting the root of the problem rather than just the behaviors which are more often than not a result of what this article describes as “dysfunctional thoughts”. It is important to learn client values placed on food, such as cultural/gender influences on eating patterns, emotions attached to food choices, thoughts and feelings involved when eating in social situations, etc. Moreover, cognitive change teaches the client problem-solving skills, allowing them to work through any weight-related issues and problems in food choices that arise in the future when they will not be able to rely on a dietitian for support.
I think that you as a dietitian would have to assess the patient first before making such a decision. Some people are emotional eaters while others just are not educated enough to make the right nutritious decisions. I think a majority of people though would be in the need for behavioral change. Not everyone knows about how much fiber to get or how to overall eat healthier. That is why these fad diets are so popular and why people swear by them. They need to be educated in making the right food choices and making sure that all the essential nutrients are available in their diet.
I think both areas are important and that one does not outweigh the other. Cognitive change is important because you have to want to change and feel that you can change before you take the physical action of actually changing the things you do. If you start a weight loss program and go in feeling that you are going to fail then most likely you will fail. But if you go into the weight loss program with a positive attitude then you will most likely see positive results. After you have set your mind to that you can loss weight and stick with it you are then ready to move on to actually changing the way you eat and exercise. This is where behavioral change plays an important role. You need to make a weight loss plan that involves eating right and exercising, but you need to make a plan that is going to be easy to stick with for a long time.
I think both Behavior Therapy and CBT need to be studied further in order for us to get a clearer understanding about the effects of them. However, this may be an instance where success depends on the individual patient. If I had to pick one I’d say cognitive change. There is so much to be said about the link between eating and thinking. There are a lot of obese patients that claim that emotional eating is there problems. In the US, most people opt for less healthy options, such as cookies or ice cream, as comfort food. People also tend to link their favorite foods with fond memories in their lives. I think CBT would help people who live to eat rather than eat to live. I think it would help people not feel as though they are not giving up something they love by moving to healthier food options. I also think that if CBT is successful with a patient that it will eventually lead to behavioral change as well. If there is a cognitive change, I believe the patients will be less likely to relapse and fall into their former eating habits.
Melissa,
You said "If there is a cognitive change, I believe the patients will be less likely to relapse and fall into their former eating habits." I agree with that statement in that you can change behavior but the client may not stick with it if they are not mentally ready. But at the same time they also need to make sure that they are making the right behavioral changes because just being mentally ready doesn't mean that weight loss will be successful.
In many of the comments before mine it has been mentioned that there is a need for both the Cognitive Behavioral Treatment & the Behavioral Therapy Treatment. For those of you who have stated this I completely agree. I believe that in most situations when dealing with a client both types of treatments will be used synergistically. Like Beth C mentioned, when beginning a treatment with a patient we want to make sure that the client is thinking positively and in the right mental state before moving on to more behavioral changes. Although, some patients may be more responsive to bahavioral and structured changes. This illustrates the importance of the dietitian to assess the needs of each individual and not rely on a standard program that is used for everyone.
Melissa,
I very much so agree with you that success may in fact depend on that specific individual patient. We all have different morals and reasoning that contribute to our behaviors and diet. There might not be one true right way to approach all individuals with respect to weight loss. Maybe the next question dietetic professionals should ask is how to determine what specific intervention strategy will work for a given individual.
Shanell,
I agree with you that no matter what the method is that is used, it should be focused and individualized. I also agree that it should be inspired by the client and the counselor is merely a facilitator in the process. The client should be the main determinant of what method is best for them.
Jodee,
I really liked what you said about attitude and its correlation with the outcome. I completely agree if a patient goes into a treatment/therapy program, whether it be for weight loss or for a medical issue, with a positive attitude then the patient is more likely to get everything they can out of it. These patients are probably more likely to continue with the treatment even after professional therapy is completed as well. In that respect I feel CBT is very important, but I still believe that Behavioral Therapy is just as important.
Beth C.,
I completely agree that cognitive change is the first step. If a person does not have a positive attitude and want to take the steps towards losing weight then they are not going to have much success. I also agree that if a person has a positive attitude early on they will be more likely to stick with it.
Lauren,
I completely agree with you in that we should assess the patient and their specific needs before deciding which is more important, cognitive or behavior. There is not one solution that will help everyone. That is why we as dietitians are trained on how to assess the patient and their individual needs.
Lori,
I agree what you said about us needing to access the patient before making a decision. Different people respond differently to different treatment. Education is definitely important for everyone, but there are certain people that need more than just information. Plus, there are also people who have the information, understand how to eat right, but just cannot get themselves to it. They have too strong of a relationship with food.
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