[Cognitive restraint in obesity. History of ideas, clinical description]

AN EXPLANATION OF DISAPPOINTING RESULTS: Handling obesity and moderate overweight with dietary prescriptions or cognitive and behavioral therapies gives unsatisfying results. For some, such treatments even have the drawback of aggravating eating behavioral patterns, not to mention other psychopathological disorders. We believe, on the contrary, that such disappointing results and troubles may be explained by the cognitive restraint theory. COGNITIVE RESTRAINT THEORY: After the radical questioning of a psycho-genic origin to obesity, the efforts made to lose weight have gradually been held responsible for the psychopathological troubles observed in the cases of overweight patients. Herman and Polivy thus consider that slimming diets bring about a state of cognitive restraint, i.e. a way of eating ruled by beliefs of all kinds in the various consequences on the patients' weight of alimentary habits and choices, as opposed to inner criteria of hunger and satiety. DIFFERENT STATES: A person in a state of cognitive restraint can either experience inhibition without loss of control, or a loss both of inhibition and of control. In the former case, one can distinguish: a) a voluntarist stage in which the individual deliberately chooses not to heed his hunger and satiety sensations in order to privilege rules that are supposed to allow him/her to control his/her weight; b) an unconscious stage during which physiological sensations are blurred, and eating habits ruled by unconscious cognitive processes and emotions. The individual thus ends up organising his eating behaviour around his/her fear of lacking, the frustration/guilt doublet and troubles in the comforting pattern. Such a state of inhibition is frequently interspersed with losses of control, described as hyperphagic or bulimic bouts and compulsive eating.

Certain authors, facing the necessity to bring down their patients' weight, tend nevertheless to advocate restrictive methods, or seem to consider that in spite of the above-mentioned drawbacks, cognitive restraint remains the only extant method to lose weight. An alternative therapeutic strategy is definitely worth exploring: one that consists precisely in helping the overweight patient to deliver him/herself from cognitive restraint. The first target could thus be to restore eating habits in conformity with personal tastes and with the patient's own personal hunger and satiety physiological regulation systems. This implies a questioning of dysfunctioning cognitive processes, and a thorough investigation of upholding factors such as self-esteem or emotional and relational troubles.