By Krista Scott-Dixon, PhD

Let's start off by discussing how you came to write this book.

When I started seeing psychiatric patients twenty-five years ago, I would occasionally have a client who wanted to lose weight in addition to overcoming other problems such as depression or anxiety. I realized that the same tools I used to teach psychiatric patients to overcome other problems could translate into helping people to lose weight, and I developed these ideas over the years.

What makes this book different?

This one is the only one using the cognitive therapy approach (cognitive refers to thinking) to help people lose weight and most importantly, maintain the loss. It doesn't include diet plans. It says "You choose whichever healthy diet you want. Here's a six-week program in which you're going to learn a different thinking or behavioral skill each day so you can stay on your diet." The program teaches people how to motivate themselves daily, cope with hunger and craving, solve diet-related problems, get back on track when they deviate, and lots more. Because the real key here is not just losing weight; it's learning how to then maintain the loss and keep the weight off.

You say "cognitive" to refer to thinking. How is thinking involved in difficulties in dieting?

Everyone who struggles with weight has what we call "sabotaging thoughts." For example, they tell themselves, "It's okay to eat this food that isn't on my plan because...I'm happy/I'm upset/It's just a little piece/It won't matter/Everyone else is eating it/I'll start again tomorrow/I can't resist/I don't care/No one is watching/I don't want it to go to waste," etc. People need to learn exactly what to say to themselves when they have these kinds of thoughts so they can stick to their plan.

Do you find that the skills you teach in the book translate to other areas?

Oh, yes, a lot of people are emailing me, or posting on blogs or website bulletin boards, saying that they are applying what they learned in the book to other parts of their lives. They're using the same thinking, behavioral, and problem-solving skills to quit smoking, motivate themselves to look for another job, schedule their lives more effectively, and so on.

One of the biggest obstacles in working with clients is getting them to "buy in"--to have those "light bulb moments" where they say, "Aha, I realize the challenges here" or "I've just clued in to things I was doing that might not have been ideal." How do you help people have "light bulb moments"?

People have to learn how to think about things differently. For example, many people believe that they've had trouble losing weight or keeping it off before because they're weak, or a failure. A "light bulb moment" occurs when they pick up the book and realize that they just didn't know how to do it before. It wasn't their fault.

People who have read the book email us and say they find other "light bulb moments" all over the place. An important one for almost everyone is the idea that you need to eat everything sitting down. People say, "I was never aware how much I ate standing up, clearing off the kids' plates, grabbing food samples at the grocery store, nibbling on pretzels in the cabinet when I go to get something else..."

Another "light bulb moment" for many people is eating at least three meals a day, and the idea that you can't skip breakfast. Many dieters want to skip this meal because they're not terribly hungry in the morning, but research shows that if you skip breakfast you're more likely to overeat later in the day. When they start eating breakfast, and they see the benefits, that's another "light bulb moment."

One of the most important "light bulb moments" occurs when people go through the exercise (found in the book) of not eating anything between breakfast and dinner for one day. People then realize that hunger isn't all that uncomfortable, that they certainly can stand being hungry, and that hunger doesn't keep getting worse, it actually comes and goes. It's such a relief for people to find out that they don't have to worry about hunger--it gives them such a sense of freedom and control to know that hunger is mildly uncomfortable, but manageable, and that it's never an emergency.

Do you find that there are people for whom these techniques aren't effective?

The techniques aren't effective if people are simply too busy and are unable to make diet and exercise activities a priority. They're less effective if people feel they're being forced by others to diet when they themselves see no benefit. Occasionally someone will abandon the program because he or she is convinced that there's an easier way, that there's some magic bullet to be found.

How do you manage clients who have attachments to certain identities, which then guide their perceptions and behavior? For example, the guy who used to be a weight lifter or football player but is now obese yet who still carries around that identity, and says, "I'm a big guy so therefore, I should be able to eat a lot." For him, the identity as "big guy" is important and it guides his actions around food. How do you disrupt that?

We have to find out what the client is concerned about-What does he think will happen if he's not a "big guy" any more? Usually people who claim to have an attachment to an identity really have a particular concern; for example, "Uh oh, if I diet, I'll be too hungry; even if I lose weight I'm bound to regain it; if other people know I'm dieting, it'll be terrible if I fail."

Your approach, cognitive therapy, is an approach that is focused on the single person---the individual. Yet there's been some attention to what are called the "social determinants of health" recently. For example, people are researching the role that things like income, or education, or geographic location might play in ensuring people's access to healthy food, information, or resources. How do you reconcile these macro-structural concerns with your work that operates at more of a micro-level with its focus on the single person?

People with certain backgrounds may have specific problems that they need help in solving (obtaining sound nutritional advice and healthy food, dealing with family and friends who push food, etc.) but the techniques of how to stick to a healthy eating plan are the same, no matter what your background is.

OK, so let's talk about people who don't seem to have a problem with gaining weight. What makes these people unlike people who struggle with weight?

Despite what most dieters believe, most people who don't have a problem with gaining weight are still careful about what they eat-and they have different ideas from those who struggle to lose weight. For example, those without a problem may feel hungry an hour before dinner but it never occurs to them to eat. People who struggle with weight think that hunger is bad, and something to be avoided. So they load up at meals, for fear of getting hungry later. Or at the first sign of hunger, they reach for something to eat, even if their next meal is going to be fairly soon. There are lots of other differences, too. People who struggle often eat when they're upset, for example, while non-gainers don't.

I often wonder whether people who struggle with weight are more sensitive to hunger signals and less sensitive to fullness signals. It's like hunger is a volume knob, and for some people, it's turned up higher than others. Do you agree?

It's an interesting question. I don't know whether research has discovered the answer to that.

We've talked about people who are relatively healthy despite struggling with their weight. What about people with truly disordered eating, such as anorexics or binge eaters? How do you approach this and would some of the elements of your plan be useful for them?

We definitely suggest that people with eating disorders consult a therapist, and I specify that the book not be used by people who have eating disorders. They really need a full course of cognitive therapy, which might include important elements from the book. But they need to see a mental health specialist.

In the book you provide some transcripts from therapy sessions in which you identify some strategies for talking people through things. For example, you have a role-playing session in which you talk a woman through her fear of going to the beach. Are there other strategies you find work well?

I like to use a lot of analogies. For example, people often think they can return to their old way of eating after they've lost weight. One analogy I might give them is: "Think about body builders. Once they get in shape, can they stop training? Can they stop lifting weights and still stay in the same shape?" Most people can see if you want to continue making progress, you have to keep doing the same things over and over.

One key feature of the book is the focus on preparation and anticipating obstacles.

Yes, you have to expect, for example, that you're going to get hungry at times; you're going to experience craving. The book teaches you specific skills that you practice before you even need them, so you'll be ready for the more difficult times. I suggest that people take two weeks to learn the skills they need before they even start restricting their eating.

What other elements might help a plan be successful?

Support from others, and being accountable to others, is important. Dieters need to have a friend or family member to whom they can report how much weight they've lost each week and from whom they can get help when they've overeaten or are about to go into a difficult eating situation.

Any concluding thoughts?

I'd say that one thing that distinguishes the book is that it's a very honest book. It says that there's no magic bullet, but you can learn the thinking and behavioral skills you need to lose weight. The reason you weren't able to lose weight or keep it off in the past wasn't that you were weak or a failure. The reason was that you just didn't know how. But here's a program that will teach you what you need to know. People need to learn what to say to themselves so they can make not only temporary but also lifetime changes in their eating.