I’ve heard many patients declare “I’m fat because I eat too much.”  Probably most of us realize that a person becoming obese is much more complicated than this.  While not denying that an individual’s genetic background and biological factors may have a strong influence on his or her body weight, a behavioral approach looks at the association between eating and exercise behaviors and environmental events.  These environmental events include time of day, presence of other people, mood, and other activities. 

A key technique to behavioral modification is self-monitoring, which involves writing down exactly what is eaten and what type of physical activity is performed.  This record allows the patient and the clinician to identify problem behaviors that might be changed.  Perhaps this sounds simple, but many of us know first hand how hard this is to do consistently for any extended period of time.

Since environmental events trigger certain behaviors, restructuring one’s home environment can help elicit the desired behaviors.  For example, one should refrain from purchasing high-calorie desserts and to store all high-calorie foods in difficult to reach places; simultaneously, buy more fruits and vegetables and keep them readily accessible.  These and similar strategies help to minimize the need for “willpower” to avoid unhealthy foods.  Planning ahead and developing a structure at a point in time when willpower is not required increase the likelihood that the desirable behavior will occur.

Samuel D. Blackwell, MD

Finally, one cannot forget the importance of positive feedback for successfully adhering to the above behavioral goals.  A reward (not food!) for avoiding old eating habits and staying active is a useful tool.  So is the frequent mental “pat on the back”  to remind oneself of the value in sticking to their weight loss goals.