Tuesday, July 28, 2009

Diet for Life

For overweight and obese individuals changing their eating behaviors is often extremely challenging. As weight is lost, cravings and thoughts of "forbidden foods" can become intrusive and lead to relapse. Many people are looking for a diet approach that will help them succeed where they have failed before. This book, more than any I have read recently, seems likely to do just that. The plan outlined is based on the principles of cognitive therapy. It is not easy. It does not promise nor will it deliver short-term rapid weight loss. What it does offer is a detailed, methodical approach that, if followed, will give the reader a wide range of practical tools that will help them more effectively resist the strong forces that often frustrate and overwhelm dieters. I highly recommend this book.

The Author

Judith S. Beck has a Ph.D. in Psychology from the University of Pennsylvania, and is a Clinical Associate Professor in the Department of Psychiatry at the University of Pennsylvania. She is the daughter of the founder of cognitive therapy, the psychiatrist Aaron T. Beck. She currently serves as the Director of the Beck Institute of Cognitive Therapy. She has not published extensively on the treatment of obesity, but it is clear from her writing that she has a great deal of experience counseling real people who struggle with dieting. Dr. Judith Beck previously published two companion weight loss books: The Beck Diet Solution and The Beck Diet Solution Weight Loss Workbook. The current book updates the ideas presented in those books. While the previous books did not advocate a specific dietary plan, the new book has detailed instructions on what to eat with accompanying recipes and instruction on constructing daily menus.

The Central Concept

This is a comprehensive diet plan that grows out of the author's substantial expertise in cognitive therapy. Cognitive therapy developed in response to what Dr. Aaron Beck perceived as the shortcomings of psychodynamic psychotherapy. The treatment approach focuses on helping the patient examine thoughts and beliefs that do not align with available evidence and are not helping the person lead a happy life. The therapist works with the patient to identify, challenge and test dysfunctional beliefs then, attempting by repetition and practice, to change these beliefs.

In the context of weight loss, Dr. Judith Beck focuses on some core ideas that dieters often have that stand in the way of success including, "I'm hungry. I have to eat." "I'm upset. I need to eat." "It won't matter if I eat this unplanned food because it's only a small piece." "I can eat on the fly." and "This is too hard. I'm giving up." She encourages the reader to recognize and examine these and other thoughts that occur in the instant before they eat something that is going to get them off track with their plans to lose weight. She wants the reader to use structured exercises, simple tools and practice to replace these unhelpful thoughts with others such as, "I'm hungry. Oh well, dinner is in an hour. I'll wait." "I'm upset. If I eat, I'll feel even worse. I'll go calm myself down using the techniques I've learned." "If I want to lose weight, I have no choice. I have to take the time I need to buy food, prepare it, and eat it slowly enjoying every bite." "Dieting feels hard right at this moment, but this feeling is temporary. I'll go distract myself and in a few minutes, I'll be really glad that I did." The focus of the book is really on identifying and dealing with these core beliefs and thoughts that are so common, even natural, but that can sabotage dieting efforts.

The Diet/Program

The reader is encouraged to methodically go through five stages. In the first stage, the reader is advised to "get ready" to diet by performing a number of preparatory tasks and practicing nine "Success Skills." The author suggests that many people have trouble with diets because they are unprepared for the thoughts and challenges that they will face once they start. She advocates an extended period of skill development and practice before attempting a change in diet. In this way, the person will be prepared and practiced with specific skills that they can then implement as they take the second step, actually changing their diet. Some of the suggested exercises address fundamental issues such as creating time for diet and exercise, building a support system, addressing fears of hunger, the importance and value of weighing daily and graphing the results to name just a few. The reader is encouraged to explore the reasons that they are eating: for hunger, because they are bored, are procrastinating, are anxious or simply out of habit. Specific strategies are suggested for dealing with each. I found the approach to dealing with hunger particularly insightful.

Dr. Beck often punctuates the text with sections entitled, "Reality Check." For example, in one she writes "If you are thinking: I'll figure out how to squeeze in these diet and exercise activities when the time comes. Face reality: You're setting yourself up for failure. Extra time will not magically make itself available. You have to plan your life around diet and exercise activities--not vice versa." In another she writes, "If you are thinking: I don't feel like doing this task. Face reality: If you want to lose weight permanently, you will have to learn to do things you don't necessarily feel like doing at the moment. But the payoff is so great!" Specific tasks are suggested such as making a list of distractions that can be used when the temptation to eat is strong, making cards listing the advantages of losing weight, and cards that describe responses that the person can use in their internal conversation when a "sabotaging thought" occurs. An example of a sabotaging thought and a response that is written on a "response card" is: "Dieting should be easy and short term." To which the response might be "The only way to lose weight permanently is to learn dieting skills and practice them every day. Then dieting will get easier and easier." The reader is encouraged to practice these skills every day. A "Success Skills Sheet" is provided to be filled out each day.

In the second stage, the reader begins a structured diet program. Detailed advice is given on determining an appropriate calorie level for the diet, the timing and composition of meals and snacks and a process for introducing these changes. The diet is quite rigid and builds on the skills taught in the first section. The advice, while detailed and inflexible, seems quite reasonable with the emphasis being placed on gradual sustainable change building on the important skills taught in section 1.

In stage 3, the author provides detailed advice on dealing with difficult situations. These include weekend eating, dealing with "Food Pushers," restaurant skills, social event skills, holiday skills, and others. Here again, the overall approach strongly advocates modest, gradual and sustainable changes that constantly build on and extend the skills previously taught. In the fourth stage, the author explores ways in which the reader might introduce more flexibility into what has, to this point, been a pretty rigid program. Even when introducing flexibility, the advice given still advocates planning, monitoring and an experimental approach in which the reader will test whether the "flexibility" is actually working or not. In the final stage, the topics of long-term maintenance and relapse are discussed. Common challenges that develop during maintenance are addressed such as the question, "Is all this work really worth it?" Advice is given on adapting the strategies used earlier in the plan to this period. Specific strategies for relapse are given as well. The book contains meal plans, recipes, and food options for meals and snacks. While not extensive, these food lists have variety and contain enough examples so that the reader is likely to get the fundamental concepts advocated by the author.

The Data

This diet program has not been tested for the treatment of obesity in a randomized controlled trial. Having said that, there are a number of clinical trials that have used cognitive therapy methods in obese adults and adolescents and the general principles of cognitive therapy are used extensively in a wide variety of disorders including depression, anxiety, and eating disorders. The nutritional advice given grows out of the author's review of a large body of reasonable nutritional research and could be considered "mainstream." While this diet plan has not been tested, the principles are so straightforward and the advice so detailed that it is hard to believe that a person would not lose weight if they were able to adhere to this program.

Reviewer's Commentary

This is a terrific book. Like many others who are involved in the treatment of overweight and obese individuals, I am not trained as a psychologist or psychiatrist. I have a superficial knowledge of the basic principles of cognitive therapy but I have never been trained in this approach. While this book is not designed to train a healthcare provider in cognitive therapy, the detailed advice given certainly gives a sense of the power of this approach. Some diet books contain vague advice, some diet books contain detailed advice on what to do but not much on how to do it. This book really addresses some of the core difficulties that obese people face when they start a diet and it gives them concrete, straightforward suggestions about how to deal with these difficulties. There are only two limitations of the approach. First, it is quite labor intensive and demanding of the reader and, second, it requires a highly motivated individual. It is rigid and demands strict adherence. While many people will not be up to these demands, the reality is that weight loss is hard. The body's weight regulatory system is designed to fight against the hypocaloric state, and to strive to regain lost weight. To succeed, people have to be willing to put in a sustained effort, to cognitively override the body's regulatory system. The book is best for someone who is highly motivated and who can deal with the structure of the plan. It may be that some individuals can succeed with less structure. However, we have all seen that with less structure comes a dramatic fall in the rate of success. While difficult, the advice given here is practical and the tone of the book extremely supportive. I think the plan is "do-able" for the right person. This is one of the best diet books that I have ever read. I highly recommend it. It definitely belongs on your shelf.

--Daniel H. Bessesen, M.D.

University of Colorado Denver

Denver Health Medical Center

Denver, CO

Source Citation:Bessesen, Daniel H. "The Complete Beck Diet for Life.(Report)." Obesity Management 5.3 (June 2009): 135(3). Academic OneFile. Gale. BROWARD COUNTY LIBRARY. 28 July 2009
Gale Document Number:A202700878

Disclaimer:This information is not a tool for self-diagnosis or a substitute for professional care.

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