Can a Therapist Help You Lose Weight?
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Weight loss is, of course, largely about diet and exercise.
But what’s critical when you want to make and stick with those behavior changes — and deal with all the other stuff a weight loss journey can bring up — is to take care of your emotional health, too.
Research has shown, for instance, that people whose mental health remained stable or improved over a yearlong weight loss pursuit were more likely to drop and keep off pounds than those whose mental health worsened.
“Anytime you’re trying to make a change in your life, it’s related to how you view yourself,” says Allison Young, MD, a board-certified psychiatrist in private practice in New York City and a medical reviewer for Everyday Health.
In an Everyday Health survey of 3,144 U.S. adults who had attempted weight loss in the past six months, more than half of respondents cited a lack of motivation — not practical factors like access to healthy food or gyms — as the leading obstacle to success.
RELATED: Everyday Health’s Survey and Special Report: Weight Loss Reframed
A weight loss effort can bring up a lot of difficult feelings and emotions. According to the survey, feelings of guilt, as well as a preoccupation with weight and body image, increased after people attempted to lose weight. After starting a weight loss journey, 53 percent of people reported feeling guilt or shame around food choices (compared with 46 percent beforehand); and 42 percent reported being preoccupied with either their food choices, body image, or weight (compared with 35 percent beforehand).
That’s why therapy or counseling can be a key, albeit often overlooked, element of weight loss success.
Dr. Young says working with a therapist before attempting weight loss is a good idea, in case there are underlying — and serious — disordered eating or body image issues that should be addressed.
Here’s what else Young, who is also an adjunct professor of psychiatry at the NYU Grossman School of Medicine in New York City, says about how mental health practitioners can support your weight loss journey whatever your goals are.
Everyday Health: A lot of people don’t even think about seeking out a therapist for weight loss support, especially if they consider their mental health to be in good shape. How can a therapist still help them?
Allison Young: An interesting paper came out this past year showing that people who had an intention to exercise still started exercise routines at a chance rate; it was kind of 50/50. So even the people who said, “I understand physical exercise is important and I intend to exercise,” only followed through about half the time.
I think that really shows that there’s a lot more that goes into making changes than just “I understand and I want to.” Clearly, knowledge is a piece of it, as the Everyday Health survey showed, but it is only one piece. There’s all these other factors, and I think a therapist can help go through all those factors with people.
EH: For people who do have mental health concerns, as well as weight loss goals, how can a therapist help them know where to begin — with their body or their mind?
AY: Usually when you meet with a mental-health professional, you’ll have a lengthier first appointment where they’ll take your whole history. That’s a really important part of determining the relationship between your mental health and your weight (for those who want to talk about weight or weight loss). For instance, do you have a history of mental health symptoms that preceded the weight gain? Have you taken medicines that preceded weight gain?
Ultimately though, what’s important is what the person seeking treatment cares about. And if weight is important to them, it can be addressed — even if mental health symptoms are also present. They can be treated simultaneously — and often both are enhanced by working on them simultaneously.
EH: The survey found motivation is a leading obstacle to weight loss. Can a therapist help someone with weight loss motivation? How much does motivation even matter when it comes to weight loss?
AY: Motivation is sometimes misunderstood. In the book Atomic Habits, James Clear talks about how often what people think is a lack of motivation is really a lack of clarity.
I see this a lot. Do you really struggle with motivation? Or is your struggle actually around not knowing what steps you need to take (and therefore not taking the steps you ultimately need to succeed)?
Maybe you’ve internalized the message that you should lose weight — but you’re not clear on why that’s important to you or how it will enhance your life. Again, these are things therapists can help you with, especially if it’s clarity about how your goals support your values over the long term.
EH: What’s another common barrier to weight loss that people may mistake for a lack of motivation?
AH: When I see people who are struggling to make a change — whether it’s weight loss or starting physical activity, stopping smoking, or reducing alcohol use — usually the issue isn’t really motivation. It’s that substance or behavior is still serving a purpose in their life and they haven’t figured out what purpose that is and how they can replace it.
For example, if you eat when you’re stressed and you haven’t found a different way to manage that stress, it’s going to be very hard for you to stop that habit. So if somebody is trying hard and feeling like they’re failing, the next question should be: “How is this serving me and how can I replace it?”
EH: A large majority (78 percent) of people in Everyday Health’s survey said they believe weight loss will make them happier. What do we know about whether or not they’re right? What actually does make people happier?
AY: When it comes to external factors — physical appearance, weight, money — people are pretty bad at knowing what will make them happy. It’s more about internal factors and how you relate to those external factors that makes the biggest difference.
EH: Can you elaborate? How, for example, might a therapist help someone identify what may really make them happy, and whether or not weight loss plays into that?
AY: Let’s say your goal is weight loss. A therapist could help you understand: Why is that your goal? What is it about weight loss that is important?
If you existed in a vacuum, would weighing less matter? Maybe it’s, “I have knee pain and I can’t do X, Y, and Z,” or, “Longevity is really important to me and I’m worried that I’m cutting my life short at my current weight.” It’s all about finding what values drive you and then figuring out how you can support those values.
A lot of times, there are things people can do to support those values even as they’re trying to achieve their weight loss goal. A mental health professional can help you live in a way that supports your values while you’re working on that other goal (weight loss or something else), instead of putting off other things that might contribute to happiness.
So, if being physically active is important to you and you feel like your weight is inhibiting that, what are comfortable ways you can be more active now while you might be working on that other goal? A lot of people put happiness on hold, like, “I need to lose this much weight until I let myself be happy, until I do these other things that I enjoy, until I socialize with friends or go on another job interview.”
EH: Guilt, shame, and anxiety came up a lot in the survey, especially once people started on their weight loss journeys. How can a therapist help people cope with these emotions?
AY: First, a therapist can help make sure there’s not something else going on or an underlying cause of those feelings. Guilt is a core feature of depression, for example.
Outside of that, a therapist can help make sure you’re setting realistic expectations for yourself. Even when people are losing weight, they might still feel guilt or shame for not achieving their goal “fast enough.” So it’s important to start small and build that self-efficacy and make sure you’re starting at a reasonable goal.
A therapist can help you recognize harmful thought patterns when they start. For example, I used to run a lot. I ran a marathon. But I haven’t run in a long time, and when I started again, I was like: “This is so hard.” Then all those other secondary thoughts come: “You didn’t prioritize your self-care” and “You’re out of shape.” And those types of thoughts and stories only make you feel worse and worse.
A therapist can also arm you with tools (like meditation and mindful breathing and others) that can help you cut short whatever narrative you’re telling yourself to just focus on what’s in front of you.
Whether it’s shaming someone else into doing something, or shaming yourself into doing something, I’ve never seen shame be the successful motivator.
EH: About a third of respondents said they’ve felt stigmatized because of their weight by someone they know. How do you help people deal with all the societal messages around weight?
AY: Therapists can help people identify their own definitions of healthy body image and weight — and abide by those messages rather than someone else’s. What does health look like to you personally? What does being at a healthy weight look like to you personally?
If you’re living your life according to other people’s definitions, even if you succeed, you’re much less likely to feel fulfilled or happy.
Then we can work on minimizing exposure to channels that might be reinforcing harmful messages. If you find social media is negatively impacting you and your attitudes about weight and body image, we work on being really mindful about how you use it. If family members are constantly making you feel bad about your weight, what can you say to them or what can you do to help yourself when you’re in their presence?
The goal is that, ultimately, you don’t need that boundary. You can hang out with someone who has their own definition and you can say: “Agree to disagree.”
EH: How can people find the right mental health professional for weight loss?
AY: Research shows that when searching for a therapist for a specific reason, the best thing to do is to look for someone with experience and success in that particular area.
So in this case, it matters much less whether someone’s degree is licensed clinical social worker or PhD or certified therapist. What matters more is that they have experience working with people who are either struggling with what you’re struggling with or are interested in what you’re interested in.
But do look for someone with professional credentials, because usually they’re part of a professional network that has an ethical code. That could be LCSW (licensed clinical social worker), PsyD or PhD-level psychologists, or MD (which psychiatrists are). By contrast, a “health coach” can mean so many different things. There’s no board or admitting body of health coaches or anything.
And practically speaking, a big part of finding a therapist might be: Who will your insurance cover, if anyone, and what’s their availability?
EH: Once someone finds a therapist, how can they make the most out of that relationship in order to best support their weight loss goal?
AY: Just be open with what you’re experiencing, what your current habits are, and what you’re hoping to achieve. A lot of people think they have to come into a therapy session and ask the right question or say the right thing, but that’s what the therapist is there for.
If you feel like you can’t be open, that’s a sign that maybe the provider is not the right fit.
Everyday Health‘s Weight Loss Reframed Survey queried 3,144 Americans nationwide ages 18 and older who have tried losing weight in the past six months. The study was fielded between July 10 and August 18, 2023, across demographic groups, genders, and health conditions. Survey recruitment took place via an online portal, in-app, and email. The margin of error for the sample size of 3,144 is +/–1.7 percent at a 95 percent confidence level.
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