How Can Cognitive Behavioral Therapy (CBT) Help With Weight Management?

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Can your thoughts and feelings be linked to your weight? 

Experts say yes. Cognitive behavioral therapy (CBT) is a popular form of talk therapy that focuses on how your thoughts, feelings, and behaviors are connected. It’s effective for a wide range of issues. Those include helping you reach and keep a healthy weight

In the WebMD webinar “How Can Cognitive Behavioral Therapy (CBT) Help With Weight Management,” Rachel Goldman, PhD, explained to more than 2,200 attendees how CBT techniques can be key in managing your weight.

“These are also referred to as lifestyle modifications, behavioral interventions, or behavioral weight control,” said Goldman. “They provide people with a set of skills to achieve a healthier weight while learning how to handle barriers and potential challenges along the way.”

In a viewer poll during the webinar, almost half of the respondents said stress is the most likely emotional trigger for overeating. Another poll showed 28% of viewers interested in how CBT can help manage that stress and curb comfort eating. 

Question: It seems like emotional triggers that cause someone to overeat are: 

  • Stress: 47%
  • Boredom: 33%
  • Loneliness: 6%
  • Sadness: 6%
  • Something else: 5%

Question: I’m interested in how CBT can help someone:

  • Better control what they eat: 37%
  • Manage stress to avoid eating for comfort: 28%
  • Get motivated to exercise: 18%
  • Improve how they feel about their body image: 13%
  • Something else: 2%

Goldman also answered viewer questions during the webinar. Those included:

“Why do people eat out of stress?”
“How can CBT be used to stop the habit of snacking at midnight?”
How can you avoid or control snacking in social settings that revolve around food?”

Eating in response to an emotion like stress is common, Goldman explained. Maybe it became a habit to overeat or eat unhealthily on stressful days. When we eat certain foods, the reward center of our brain activates and it makes us feel good — and makes us want it again. If we’re feeling stressed, the immediate satisfaction we get from food is what we go to. This can become an issue if it’s your go-to coping mechanism for stress.

When we snack at midnight, we might think we’re hungry but we’re actually thirsty or tired. First, pause before you grab a snack. Ask yourself, are you just automatically grabbing the snack? If you’re actually hungry or if you just want to enjoy it, eat it. But first pause and identify what you’re doing. 

If you don’t need or want it, substitute the behavior. Have a glass of water, some herbal tea, hot water, or just go to bed.

Social eating may be something you want to prepare for. Don’t walk into events super hungry. It may be helpful to eat a little bit before you go somewhere. But remember, social eating is OK if you want to and if you feel in control.

“How can someone find a therapist skilled in using CBT for weight management?”
“How can you create accountability during a weight loss journey when you don’t have access to a registered dietitian?”
“How can you avoid getting discouraged during a weight loss journey?”

You can find a therapist through the Obesity Action Coalition (OAC), Psychology Today’s “therapist” button, or with a simple Google search of providers in your area, Goldman suggested. 

But if you don’t have access to a professional, you can make use of self-monitoring to stay accountable. The key, Goldman said, is to be consistent, patient, and persistent. Be kind to yourself.

You can also create a team of supportive people in your life. Find a friend who you can be accountability buddies with.

She also pointed to apps or social media experts that can provide information that’s less costly than a dietitian.

“Is weight loss possible after menopause?”
“What are the weight loss challenges associated with being postmenopausal?”

Weight is not all about calories in, calories out, Goldman said. There’s more that goes into that, like hormonal changes. During menopause, it’s first important to be mindful of your sleep.

To understand your body during menopause, she said, you might seek help from your doctor and get lab work done. This will help you understand what’s going on with your hormones. Regulating your hormones is important because they play a role in weight management. 

Another tip is to think about what worked for you when you were premenopausal, Goldman said. What did you do differently (in terms of your eating, sleeping, or other habits) when you felt good about your body and your weight?

What Is CBT for Weight Management?

Before CBT was a part of treatment for weight management, experts only focused on how your behaviors affected your weight.  But as time went on, CBT became recognized as an effective part of some weight management plans. 

Now, doctors understand that your weight is affected by many more things than just your behaviors. Today’s treatment of obesity and weight management is more complex. It focuses on many areas including your past experiences and present-day lifestyle changes.

How Does CBT Help in Weight Management?

The way you understand and think about something can affect how you feel and behave. CBT techniques shift your thoughts and emotions. 

These tools include:

Goal setting. CBT focuses on both long and short-term goals. “Define your long-term goal and then think backwards. Ask yourself how you’re going to get there,” Goldman said. Create short-term goals that lead to your main goal. Focus on small steps that relate to your behaviors.

You’ll create your goals with the “SMART” goal-setting tactic. These are:

  • Specific
  • Measurable
  • Attainable/achievable
  • Relevant/realistic
  • Timely

But it’s important that you avoid specifics like weight goals, or the words “less,” “more,” or “better,” she said. 

Self-monitoring. You can self-monitor almost anything. With CBT, you may focus on your food, emotions, activity, sleep, weight, or feeling of fullness. These are all data points that can help you in your weight management journey.

You can monitor the food you eat through a food diary. This can help keep track of the type of food you consume, the time you eat, and how much. You can do this through a diary you create or with a phone app like MyFitnessPal, FitDay, or SparkPeople.

But it’s not a good idea for everyone. “Food can be unhealthy to monitor for someone with a history of an eating disorder or disordered eating,” said Goldman.

Mindful eating habits. This can help you be more aware of food in general. Mindful eating isn’t a diet. It’s a tool that can help you learn your own habits around food. You might pay special attention to times you eat out of emotion, when you eat, the quality of your meals, or feelings you have about different foods.

Mindful eating can remind you to savor moments and slow down during meals.

Cognitive restructuring. Our thoughts are powerful. “Some thoughts are helpful, but others aren’t,” Goldman said. “The key of cognitive restructuring is that we identify, challenge, and change or tweak our unhelpful thoughts.”

With weight management, unhelpful thoughts may hold you back. Goldman pointed out some harmful thoughts:

  • “All or nothing thinking,” which makes it hard to find a happy medium. For example, if you can’t work out for a full hour, you might give up on an exercise for that day completely.
  • “Overgeneralizations,” which include defeating self-talk like “I can never reach my fitness goals,” or “I’ll never be able to lose weight.” 
  • “Jumping to conclusions” assumes things that may not be true. You might decide you’re already doomed before you even start.
  • “Should statements” might make you feel that you “should” go to the gym for a certain amount of time each day or that you “should” be able to lose a certain amount of weight. But these comments put you in a negative mindset. Focus on small steps that are doable in your life right now.

Behavior changes. Since your thoughts and emotions shape your behavior, it’s important to avoid negative ones. If you can rewire your thinking, you’ll have more success with weight management.

But this can be difficult. Maybe you’ve had negative, automatic thoughts for years. To help overcome them, Goldman suggests you:

  • Be compassionate with yourself and validate your feelings. Stay away from toxic positivity, too. Weight loss is hard and it’s OK to admit that.
  • Become more aware of your thoughts and practice mindfulness. Ask yourself if your thoughts are helpful, how they make you feel, and what purpose they serve.
  • Accept your thoughts for what they are, challenge them, and replace them with helpful thoughts. Remember, not all thoughts are facts.
  • Speak kindly to yourself. Your self-talk creates your reality. Frame your words in a healthy and realistic way. 

Future planning to avoid relapses. To continue your success with weight management, you need a plan. Find things that motivate you.

There are two types of motivation: external (like a friend’s kind comment) and internal (feeling good about your own health). 

“External motivators typically get people to make the first change,” Goldman said. “But eventually, when we make behavior changes that feel good, most people become motivated by internal feelings.”

To plan ahead, be ready to problem solve as well. There’ll be moments when weight management is hard. Expect challenges and face them with a healthy mindset. 

“We all lose sight of our goals,” she said. “When this happens, it’s important to go back to your ‘why.’ Why do you want to make these changes? Why are you going to set those goals?”

Your plan might not always work out perfectly because life happens! Outside stressors, other people’s actions, or the reactions of your peers are out of your control. But you do have control over your own reactions, thoughts, and behaviors.


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