The Leeds Specialist Weight Management Service offer support from mental health professionals. The clinicians will be able to assess and work with you. They will discuss any psychological components which may be a barrier to your weight loss.

The psychological services available through the specialist weight management programme in Leeds include:

• 1 or 2 30-minute sessions with a Mental Health Practitioner.
• A one hour assessment with a Consultant Psychiatrist.
• One to one follow up from a Consultant Psychiatrist – the number of sessions and frequency will be based on individual need.
• One to one sessions with a Cognitive Behavioural Psychotherapist.
• A cognitive behavioural therapy group specifically for Binge Eating Disorder, delivered by a Cognitive Behavioural Psychotherapist.

Mental health practitioner assessment

At your initial screening assessment (or any other appointment), it may be advised that you could benefit from an assessment with the mental health practitioner.

What to expect from your appointment

Your first appointment will last around 30 minutes. The practitioner will make sure the space feels safe, supportive, and non-judgemental.

They will discuss your goals, challenges, and psychological background. They may ask about your eating habits, triggers for eating, and your past experiences. The aim is to get an understanding of your situation and how it connects to your weight loss journey. The practitioner will discuss a plan with you to support you moving forwards.

Psychiatry

It may be helpful for you to explore if there is a psychological component of your weight management. If you consent, you will be referred for an assessment with a Consultant Psychiatrist. You will meet our Psychiatrist via video call for around one hour. You will be asked questions around your past and current mental health and how this impacts your weight management. From this assessment, a plan will be agreed with you. This could include medication, therapy or both. If needed, follow-up appointments with the Psychiatrist will be arranged. This is to prepare you for progressing along the weight management pathway.

If you have had psychiatric treatment before or you are being treated in community psychiatric services now, these details will be included in the assessment. You may also be asked to complete an Appetite behaviour questionnaire. This will help us to understand your eating patterns.

Cognitive Behavioural Therapy

Cognitive Behavioural Therapy

We may recommend that you have some brief Cognitive Behavioural Therapy (CBT). This might be because you are experiencing low mood and/or anxiety which is directly affecting your weight management.

CBT can support you to identify unhelpful cycles of thoughts, feelings and behaviours. The therapist will work with you to help you learn some new tools and skills to break these cycles. This will hopefully support you to make steps towards your weight goals.

Up to 6 sessions can be offered on a one-to-one basis.

Binge Eating Disorder Group

It may be identified that you have symptoms of Binge Eating Disorder. This is a recognised eating disorder. It is estimated to affect 20-40% of people who are overweight. One of the main features of the condition is eating large amounts of food over a short period of time, often in secret or alone. People who binge-eat regularly may feel depressed, guilty, ashamed or disgusted afterwards.

If you have symptoms of binge eating disorder, you may be offered a place in our cognitive behavioural therapy group specifically for Binge Eating Disorder. This is a closed group which means that once the group has started, no new members will join.

These sessions tend to be weekly, spread over 15 weeks. If this is the recommended treatment for you, a separate leaflet on the group will be provided.

What to expect from the group

Going to any group for the first time can feel scary. It can be helpful to remember that everyone attending the group will be having very similar problems. Most people will feel some degree of anxiety before coming. It can be helpful to understand the sorts of things that will be covered in the group, so we have provided a basic guide for you below.

• What is binge eating disorder and programme overview.
• Cues and consequences.
• Thoughts, feelings and behaviours.
• How to challenge and re-structure your thoughts.
• Cues and chains of events.
• Impulsivity, self-control and mood enhancement.
• Body Image.
• Self-esteem.
• Stress management and problem solving.
• Assertiveness.
• Weight management.
• Relapse prevention including exposure to high-risk foods and situations, and long-term planning.

If you feel unsure about the group or have any questions before attending, please call and speak to our lead therapist.

Contact us

Should you have any questions about the psychological interventions as part of the Weight Management Service, please contact us.

What do I want to work on?

Being specific about areas that you want to focus on is important in creating a good plan that will help you with your goals.

Which of these are true for you?

Physical activity

• I set myself goals for how active I’ll be each day or week.
• I follow an exercise plan/routine.
• When I’m being active, I push myself to my limits.
• I keep track of the physical activity that I do.

Controlling cravings and mindfulness

• If I feel like eating but am trying not to, I pause and ask myself if I’m hungry.
• If I feel like eating but am trying not to, I make myself wait a certain amount of time to see if the craving passes.
• I use smaller plates and bowls when eating to help with my portion control.
• I slow down how quickly I eat in an effort to eat less.

Support and wellbeing

• I acknowledge negative emotions and can speak to somebody, use technology or specific techniques (e.g. meditation) to help with these.
• I’ve tried to get my friends and family to support me in managing my weight.
• I belong to a group of people who are trying to lose weight together (e.g. an online discussion forum).
• I use a weight loss service to help manage my weight (e.g. Weight Watchers, Slimming World, Lighter Life).

Meal and grocery planning

• When I’m grocery shopping and items of food look similar, I make my choice based on the nutritional information on the food labels.
• I plan my food shopping in advance to help me stick to my plan (e.g. use a shopping list).
• To avoid eating and drinking things that don’t fit with my plan, I don’t keep them at home.
• When I am food shopping, there are certain foods I stay away from to help me stick to my plan.

Weight loss planning and monitoring

• I use a chart, diary or app to track my progress in losing weight.
• I use a book, website, or app to look up the nutritional information and/or calorie content of the foods I eat.
• I check the portion sizes of the things I eat.
• I have a weight management plan, but I allow myself to be flexible about what I do depending on circumstances.

Adapted from OxFAB Taxonomy and questionnaire: Hartmann-Boyce et al., (2016). Development of tools to study personal weight control strategies: OxFAB taxonomy. Obesity, 24(2), pp. 314–320

Select 1 or 2 sections from above that you want to focus on for the next few weeks. Click on the sections below for useful and practical information to support you.

Tips for making it easier to be active in your home

Getting your home environment ready for activity will make it easier for you to do it every day.

• Do your activity at the same time each day. Think about the other people in your house and choose a time that is the easiest for you to fit in.
• Start small and build up. If every day is unrealistic, start with 2 or 3 times a week.
• Tell other people in your house your plan. Either ask them to join in or stay out of the way.
• If you have space in your home, you can make an area that is specifically for your activity.
• If you live alone, tell friends or family so they do not call you during this time.
• Write ‘activity’ on your calendar or in your phone, as a daily reminder.
• Find clothes that are comfortable to be active in and get them ready, e.g. if your activity is in the morning, get them out the night before.
• Celebrate every time you complete an activity! Whatever you have done is better than nothing, so congratulate yourself. Think of the positive things you would say to a friend who had just done this, now say them to yourself.
• Think about your common reasons for not doing activity and how you can avoid this ‘danger zone’. For example:

References:

Fogg, B.J. (2019) Tiny Habits. London: Virgin Books.

Otto, M. & Smits, J (2011). Exercise for Mood and Anxiety: Proven Strategies for Overcoming Depression and Enhancing Well-bring. Oxford University Press.

Pilling, S & Newman, R (2012). Braintree self help guide. London: London Strategic Health Authority.

Recommended equipment:
Resistance bands – choose multi-level bands with handles (suitable for everyone and can be bought online).
Weighing scales – choose digital ones to easily track any weight changes (can be bought online or from big supermarkets).

Intermediate Home Exercises

AT HOME WEIGHT MANAGEMENT

Numbers 1-5 are for warming up. Numbers 6,15-19 can be done with shopping bags filled with water bottles (1L = 1 KG) or tins around the house. Search YouTube for Home exercise videos. Anything that gets your heart rate up to 120bpm will be effective.

Adults – More Links

• Exercises to do at home
• Exercise video for people who are new to exercise or do not exercise very much, can be done standing or seated
• Exercise video for people who exercise regularly using items from around the house (tins of beans, bags of flour)
• 10 minute workout videos for people who exercise regularly, that do not require equipment
• 23 and ½ hours: What is the single best thing we can do for our health?
• Physical activity advice sheet
• Free 9 week exercise programme for all levels

Exercise with children and young people

• Exercise video to do with young people
• Dancing videos to do with children

Cravings and mindfulness advice

What is mindfulness?

“The awareness that arises from paying attention, on purpose, in the present moment and non-judgmentally.” Jon Kabat-Zinn

What is mindful eating?

“Using all your senses in choosing to eat food that is both satisfying to you and nourishing to your body… Becoming aware of physical hunger and satiety cues to guide your decisions to begin and end eating.” Megrette Fletcher

Benefits of mindful eating

• Helps develop a better relationship with food and body image.
• Has been shown to help with weight loss and improve food choices.
• No strict rules, no cost and can be simple to practice.
• Can help reduce stress and anxiety levels.

Mindful breathing

Try this technique on a regular basis, when you have cravings or during times of stress.

1. Sit comfortably but upright and close your eyes.
2. Focus on your breathing without changing it. Observe the feeling in the nose, rise and fall of chest, etc.
3. Thoughts will arise. Notice these but do not fight or ‘feed’ them.
4. Bring the attention back to the breath. Don’t worry if you are bringing your attention back many times – this is the practice.
5. Start with a 5 minute practice and increase gradually. Setting a timer is helpful to prevent checking the time during the practice.

Top tips!

• Use the hunger scale to rate your hunger before, halfway through, immediately after, and 20 minutes after eating.
• Create a pleasant eating environment and try to minimise distractions.
• Slow down your pace of eating by chewing more and putting your knife and fork down at regular intervals.
• Use smaller sized plates and bowls.
• Focus on the present moment whilst eating: the smell of the food, texture and the tastes. Notice how all these things change moment by moment.
• When you have a craving, try the mindful breathing exercise above and allow at least 30 minutes to see if the craving reduces.

More Links

• Tips for mindful eating
• Information and advice on mindfulness
• Mindful Eating – British Dietetic Association (BDA)

Tips on how to make a daily schedule

Making a schedule might seem like a difficult task, but it will make it easier to organise your daily life. A routine can help to break up the day, support mental wellbeing and promote healthier eating and physical activity habits. If you live with other people consider making a schedule together.

• Try to go to bed and get up at the same time. You may want to lie in, especially if you do not need to get up for work, but doing this on a regular basis can disrupt your sleep.
• Get dressed for the day, even if you’re not going anywhere.
• Set yourself small goals that are easily achieved and celebrate when you are successful at these.

In your schedule, include:

• When you will eat, go shopping, and plan meals.
• When you will do your physical activity, e.g. going for a walk or an exercise routine at home.
• When you will work (if you are working) – try to stick to your normal work times.
• When you will do your chores / household jobs.
• When you will do something that is good for your mental wellbeing e.g. speaking to friends / family on the telephone, reading, doing a jigsaw, watching a film.
• If you can, find some space where you can work if you are working from home – make it your ‘office – place for work’.
• Try to get some fresh air every day, even if it’s just a walk around the garden.
• Be flexible! The schedule is a guide; it is ok go with the flow sometimes.
• If you are spending a lot of time at home, you may find it helpful to keep things clean and tidy.

References

UNICEF (2020) How to organize time in home quarantine. [Online] Serbia: UNICEF. Available from: <How to organize time in home quarantine | UNICEF Serbia> [Accessed 30.04.2020].

Mind (2020) Coronavirus and your wellbeing. [Online] Mind. Available from: <Coronavirus – looking after your mental wellbeing | Mind, the mental health charity – help for mental health problems> [Accessed 01 May 2020].

NHS (2019) How to get to sleep. [Online] NHS. Available from: < How to get to sleep – NHS (www.nhs.uk)> [Accessed 01 May 2020].

Support and wellbeing

Reflecting on how you feel

• Take time to think about your feelings and emotions. Writing these down may help.
• Are these positive, negative or neutral?
• How often do you feel negative emotions and are there common triggers?
• When do you feel more positive and what helps with this?
• How does your mood affect your weight loss plan?
• How many hours do you sleep and is it disturbed, light or deep?

Getting the support you need

Who can support me?

• Friends and family- speak to them about your goals. What can they do to help you?
• Online weight loss groups and forums.
• Speak with your GP.
• See the links on our website under Support and Wellbeing.
• Weight loss apps and websites.
• NHS Mental Health and Wellbeing website for tips on reducing stress, anxiety and improving sleep.

Adults – More Links

• Online support groups for individuals living with obesity
• Leeds Mental Wellbeing Service
• Mindwell
• Ways to help your mental wellbeing
• Social Prescribing
• CCI – Self Help Resources for Mental Health Problems

Meal and grocery planning

Traffic light system

Look out for the food products with green, amber or red coloured labels on the front of the pack. At a glance, they show you if the product has low, medium or high amounts of fat, saturated fat, sugars and salt, helping you make a better choice.

RED – It’s fine to have this food occasionally, but think about how often you choose it and how much of it you eat.

AMBER – A better option than red and it is fine to have this in moderation. This would be an ok choice.

GREEN – This means a healthier choice.

Front of pack labelling system

• Calories, fat, saturated fat, sugar, salt
• Traffic lights
• Serving size

1. Look out for the serving size. How does this compare to your portion size?
2. The colours represent the Traffic Light System, a useful guide to help choose the healthier option.
3. The % are based on ‘reference intakes’ similar to GDA. Remember these are not accurate for everyone.
4. Energy: Lower calorie (kcal) content foods can be useful when we are trying to lose weight, but check ingredients on the back – what is it made from?
5. There is information per 100g on the back. Checking this is a helpful way to compare different products.

Top tips!

• Plan your main meals and snacks for the week ahead. It may help to put this up somewhere visible e.g. on the fridge.
• Before you go shopping, make a list using your weekly meal plan. This will help to reduce impulse buys.
• Use food labels to make healthier choices when in the supermarket.
• If you cook and shop with other people in the house, try to create the meal plan and shopping list together.
• If other people in the house have higher calorie snacks or you have these as occasional treats then put somewhere not easily visible e.g. back of the cupboard.

More links

• Recipe ideas for the whole family
• Recipe ideas for families with young children
• Information on how to read food labels

Weight loss planning and monitoring

What determines my body weight?

There is a pre-set weight at which your body will work best. This is the weight your body naturally returns to after short-term under or overeating or exercising.

This does not always fit into the healthy Body Mass Index (BMI) range that many health professionals talk about.

If your weight has been increasing for a long time, your body may forget what your natural pre-set weight is and keep returning to your higher weight. This can make it hard to lose weight and keep it off.

How can I change my weight?

The longer you have been a certain weight, the more difficult it is to ‘re-set’ your body to its natural weight. The good news is it can still be done!

It requires a lot of will power and effort. Usually, you must remain at your new weight for 6–12 months before your body agrees that it is your natural weight.

Being able to stay on track and keep motivated in the long term is really important in your journey to success.

How are your new healthy changes going? Record the following:

A healthy change you are achieving

• What is going well? e.g. getting up 5 minutes earlier is no problem and I can manage it everyday
• A healthy change you are finding difficult e.g. doing everyday activity
• What is holding you back? e.g. I have fallen out of the habit

Top tips!

• Create a sensible long-term goal e.g. between 5 and 10% weight loss in 6 months.
• Weigh yourself weekly or fortnightly.
• Track your weight changes by making a graph, use an app, or simply write down your weight in the table above.
• Write down your weight loss plan, make it specific and put it up somewhere you can see e.g. on the fridge.
• Recognise and celebrate positive changes made!

Weighing Scales

Below is a list of weighing scales that are available to buy for your own use at home.

Please note NONE of the models listed below are specifically endorsed by our service.

Before you make a purchase, we would recommend you:

• Read reviews of a product before you buy it.
• Choose digital scales if possible.
• Consider how heavy it is (in case you want to move it).
• Consider how low to the ground it is (for ease of stepping onto them).
• Consider whether the company offer a refund or guarantee.
• Consider whether it comes with batteries.

More Links

• NHS 12-week weight loss plan
• Food labelling: nutrition information – British Dietetic Association (BDA)
• Meal planning for diabetes | Diabetes UK