It’s not all about willpower: A clinical psychologist dispels myths about weight management  

By Katarina Fiorentino Klatzkow

“If I just tried harder I could lose weight.”  

“Why can’t I be more disciplined?”  

“My friends and family think I’m lazy.” 

As a clinical health psychologist who counsels people undergoing metabolic and bariatric surgery, Allison Holgerson, Ph.D., a clinical assistant professor in the University of Florida College of Public Health and Health Professions department of clinical and health psychology, has heard all these concerns, and more, from her patients. 

While there is increased understanding that obesity is a chronic disease that needs to be managed just like any other chronic condition, Holgerson says misconceptions remain, and dispelling them can help patients be more successful in their weight loss journey.  

“Clinical psychology is part of almost every bariatric surgery process. Weight management is multi-factorial, with medical, behavioral and nutrition education components. The goal of the psychologist is to provide a bio-psychosocial perspective to the team and support and empower patients,” said Holgerson a member of the UF Health Metabolic and Bariatric Surgery Center team and director of the bariatric/weight management service within UF Health Psychology Specialties. “We’re providing a strengths-based approach to our patients.”  

Holgerson offers her insights on the importance of psychological interventions in weight management and shares three things to know about bariatric surgery, as well as common misconceptions relating to weight management.   

Weight management is not about willpower.  

Generally, I think there’s still a misconception that weight management is all about willpower. And if people just tried harder, or if they were more disciplined, their weight would shift. I hear from patients that their own family members, spouse or partner will have these beliefs, and that’s really hard. It can also be difficult, especially for people who have never struggled with their weight, to understand that it’s so much more than that. You can be doing everything right and your weight still might not budge. So that’s not about willpower. And it’s not something that an individual just needs to try harder to achieve.  

When it comes to bariatric surgery, the main misconception is that it’s an easy way out or that people are just relying on the surgery to do the work, when in fact, it takes a lot of behavior change. Our patients can’t use straws, they must separate drinking and eating, monitor nutrition intake, exercise more than the average individual — it’s a lot of work that can sometimes be a full-time job for the rest of a person’s life.  

Education and awareness have instigated positive changes. 

In my time working in weight management, I’ve seen a shift in the understanding about obesity, and I think that’s been a positive change. People are understanding more and more that obesity is considered a disease that requires chronic management. There’s a lot that goes into it. I still think we have a long way to go, and more education and open discussion can be helpful, but there’s definitely been a shift in the right direction.  

Mindful weight management is for everyone.  

When I first started in this field, you would never see things like calorie counts on restaurant menus. Now this is normalized, where nutrition facts are easily available and accessible. Changing social infrastructure is really important and helpful. Additionally, many of my patients have an internalized stigma where they believe things about themselves like: ‘I’m lazy,’ or ‘if I just try harder,’ or ‘I’ll never be able to do it,’ so that can be one of the hardest challenges — to shift one’s mindset internally, as well as one’s relationship with food.  

Psychology tries to give people a corrective experience, where we recognize that weight and eating patterns are not the most important part about who you are. As psychologists, we want to see the bigger picture so that we can help support meaningful changes. I think this perspective helps patients feel heard about the struggles that go into managing weight or other health conditions, which allows people to feel more empowered to advocate for themselves or to make changes if they feel like they were listened to. That’s where counseling can be helpful. Our goal is to really empower our patients and be on their team.