As the new class of medicines being used for weight loss, including Ozempic, Wegovy, and Mounjaro are becoming increasing popular, people ask me, “Will this put you out of business?” My answer is always the same: No! Just like antidepressant medication doesn’t eliminate the need for effective talk therapies, these medications certainly do not eliminate the need for coaching and support around weight loss and maintenance. But these medications can play a role in weight management if used correctly.
I have many clients who take one of these medications, and they have all said some version of the same thing to me: “I’m so glad I knew these CBT skills before starting on the medication.” For some people, the medication doesn’t take away the urge to overeat. It doesn’t take away the desire to eat when they’re bored or stressed; it just makes it easier for them not to do it. My clients tell me that they’re still using skills like engaging with their thinking and recognizing their sabotaging thoughts, but now they can respond to them even more effectively.
While it is true that for some people, these medications take away nearly all of their appetite and desire to eat, that is not the case for everyone. One of my clients was at the supermarket yesterday after a particularly hard day at work. She was staring at the bakery section and debating buying a large box of cookies, thinking, “I had a hard day. These cookies will make me feel better.” She was then able to say to herself, “Actually, they won’t. The evidence shows that if I bring home these cookies, I’ll end up consuming them in a way that will make me feel worse, not better. Leave the struggle at the store.” She left the store without buying them. We discussed this and she said that while it felt somewhat difficult to avoid buying the cookies, her CBT skill of “considering the evidence” in conjunction with her medication made it far easier to make a decision that was in line with her health goals.
Another client of mine recently had dinner at a Mexican restaurant with some friends. Historically, it has been very difficult for him to consume just one serving of chips and to eat only one enchilada, as opposed to the two that come with each order. This time, however, he made a plan in advance to put one serving of chips on a plate and eat them slowly. He also planned to ask for the second enchilada to be wrapped up to go before it was brought to the table. At the restaurant, he was tempted to take a second serving of chips, but he reminded himself that he got fuller faster these days and if he ate more chips, chances are he wouldn’t be able to enjoy his dinner. He told me that while he could have overridden the effects of the medicine and eaten more than he was hungry for, his CBT skills helped him respond effectively so that he didn’t.
From what I have observed, CBT skills help people navigate the sometimes enormous changes in their eating that these medications enable. In the early stages of using the medications, many people continue to eat portions or certain foods that no longer agree with them and face unpleasant consequences after the fact. Most of my clients are able to use their skills to make decisions that are both in line with their goals and in line with the way they need to eat while on these medications. Although these medications can be helpful for some, there are many people who either can’t take these types of medication due to side effects or cost, or who don’t want to. Some people are deterred by the thought of injecting the medications; others don’t like the idea that they will need to take them indefinitely to maintain their weight loss. For these people, their health and weight loss goals are still completely achievable when they learn the specific CBT skills I teach. It might be somewhat harder, and it might take extra time, but nearly everyone has the potential to learn to identify their sabotaging thinking and respond to it effectively so that, over time, they’re able to consistently make decisions that are in line with their goals.