Obesity Starts in the Brain

Michael R. Mantell, PhD, earned his doctorate at the University of Pennsylvania and his master’s degree in clinical psychology at Hahnemann Medical College, where he wrote his thesis on the psychology of obesity. He has served as chief psychologist both for Rady Children’s Hospital and Health Center of San Diego and for the San Diego Police Department. In addition to working in private practice, Mantell coaches world-class athletes and fitness enthusiasts for mental and behavioral performance enhancement. He also serves as the ACE senior fitness consultant for behavioral sciences and as a monthly contributor to Club Business International, published by the International Health & Racquet Sportsclub Association. He has served as chief behavioral scientist for Anytime Fitness® and as a faculty member of Equinox® Fitness Training Institute. A past consultant and contributor for Les Mills International and Total Gym®, Mantell has also written two best-selling books.

ACE: In your day-to-day life, how do you see the impact of the obesity epidemic in the lives of your clients, your friends and family, or just the people you pass on the street?

Michael R. Mantell: In my practice, it’s clear that people impacted by obesity are almost two times more likely than the general population to have a major mental illness. They also suffer at significantly higher rates with depression, dementia, and health problems such as hypertension, diabetes, heart failure, asthma, sleep apnea, stroke, liver and gallbladder disease, and even endometrial and colon cancers.

My obese clients and friends describe seeing themselves as unattractive. They think others are always thinking and talking badly about them, and they’re hesitant to go to parties and social events. They feel discriminated against in many business and professional settings, and they even feel uncomfortable talking with their physicians.

ACE: What misconceptions—if any—do you believe fitness professionals have about people who may be struggling with their weight? And why is it important for fitness professionals to overcome those misconceptions before they can truly help clients meet their goals?

Michael R. Mantell: Fitness professionals would be wise to abandon the notion that obese and overweight clients require [the help of] personal trainers to lose weight or become fit. They should also stop believing that a primary goal for someone impacted by obesity is always weight loss. That’s simply not true. Many times, it’s health and overall fitness. In fact, medical professionals suggest that with the chronic condition of obesity, simply halting the progression or slowing down the rate of weight gain may be considered a success. Thus, obesity management and weight loss are not necessarily the same things. Obviously, helping clients lose weight would be wonderful, but that should not be the only goal.

Personal trainers should also realize that encouraging “dieting” only builds a futile, endless cycle of failure. Only 3%–5% of dieters who lose weight actually maintain significant weight loss. Diets can lead to binge eating, overeating and chaotic eating patterns. They encourage clients to ignore the internal signals of hunger and fullness or, even worse, may lead them to become obsessed with weight.

ACE: How do you feel your life experience and work in the field of behavioral psychology have helped you better reach those impacted by obesity?

Michael R. Mantell: I grew up with an obese dad who died at age 55 of obesity-related illnesses. More than all of my studies, research, writing and nearly 40 years of clinical practice, his lifestyle and far-too-early death, along with my loving mother’s wisdom in dealing with his weight, have helped me to understand, relate and personally connect with people impacted by obesity.

Emphasizing empathy, avoiding “telling,” staying out of the arguments and debates, building self-efficacy, respecting a client’s ability to deal with discrepancies he or she can identify—all motivational interviewing strategies—appear to be among the most effective ways I’ve found to help with weight management.

When I wrote my thesis many, many years ago on the psychological aspects of obesity, the general finding was that if you wanted to understand why you’d become obese, you went into therapy. If you wanted to get healthy and achieve a healthy weight, then you turned to behavioral lifestyle change.

Adding health, not simply treating illness by taking away symptoms, appears to be a key success tool that I’ve found works quite well with obese individuals—and all clients. I’ve helped people the most by building positive emotions in them; meeting them with healthy and judgment-free relationships; and helping them find deeper meaning in their lives, find activities in which they can be fully engaged and find pride in their personal or work-related accomplishments.

Finally, helping people impacted by obesity talk to themselves more rationally, accurately and logically, and creating ready-to-use responses for them to turn to in the face of overwhelming negative thoughts, are also essential. This includes teaching the difference between emotional and physical hunger.

ACE: What advice would you give to people who may not know where to start when it comes to losing weight and changing the way they live?

Michael R. Mantell: First, the link is what you think. The way to your stomach is through your mind. Let’s start there. Thinking healthy will help pave the way to acting healthy in every arena, including weight management and exercise.

I also highly recommend that clients work with a certified health coach who can help them make intentional changes in their behaviors and thoughts. This field is rapidly growing as an integral part of overall health care, but particularly among people impacted by obesity. Using personal connections and self-enhancing strategies to promote weight management and lifestyle change underlies success for these clients.