Best Practices: Treating the Shame of Weight Gain

Most folks that go on diets lose weight and most of the time gain it back. And often gain back more than they lost. Even bariatric surgery is wrought with substantial regains.

 Bariatric practitioners have identified a most prevalent shame based diagnosis:

Avoidant Personality Disorder, that is common to many that have weight relapses/collapses.  As the diagnosis suggests, the main coping mechanism of those with avoidant personality disorder is avoidance. They will avoid most things that elicits their deep feelings of personal shame, like weight gain.  As a result they are most vulnerable to relapse/collapse stages.

Anecdote: Julie was introduced to a group of patients seeking surgery, as a successful patient that lost and keeps off 60 pounds for over five years. Julie interrupted and said, “That’s not true”.  I gain back about 60 pounds every couple of years but instead of completely relapsing, I gain and lose 2-3 pounds about 20 times every couple of years”.

Prudent bariatric counseling had taught Julie that weight gain is a typical expectancy following weight loss and no longer avoided that expectancy and viewed her lapses as part of her recovery and not worthy of shame or guilt.

Reducing Shame Narrative for Rational Cognitive Therapy:

Most intuitive, naturally thin people, without weighing themselves, or consciously censoring their food choices stay within a weight range… they do go up and down the scale, but stay within a tight range. Using them as our index we realize that weight gain is a natural occurrence. But here lies the difference, most diet veterans or surgical patients that have intentionally lost weight eventually start regaining weight. But they do not have that compensatory intuitive mechanism that allows them to stay within a tight range of their desired lower weight. If we know in advance that weight gain is simply a typical expectancy following weight loss, why view that as a failing? Why feed into that irrational belief system of weight gain and failure? It is that very belief that can elicit shame and avoidance behaviors and that is how a manageable lapse becomes a relapse/collapse.

Learning How to Gain Weight Without Shame:

Learning how to shamelessly accept and not avoid the expectancy of weight gain is an important stage for long-term obesity recovery. When a patient does reach their desired weight goal or during the weight-loss process, asking them to surplus calories and gain a pound or two (lapse) and then reverse it, is prudent relapse prevention counseling. That is a lifelong behavioral skill they will need, long after they have left our care. When we praise patients for confronting a lapse and then reversing that lapse, they reduce both weight and shame importantly they learn to master a skill they will likely need forever. Ironically, realistic patient preparation to prevent relapse/collapse is teaching patients how to gain weight with both their and your approval.

Dr. Brené Brown: “Shame Is Lethal” | SuperSoul Sunday | Oprah Winfrey Network

The price of shame | Monica Lewinsky