Weight Loss, Willpower, and the GLP-1 Revolution

What years in the therapy room taught me about weight management, and why I understand the appeal of weight-loss injections

By Craig Fookes | The Mind Works

When I first started my career as a therapist, I had a brilliant business idea. I was extremely pleased with it, anyway. I was a man in my mid-thirties who'd experienced more than my fair share of mental health difficulties. Anxiety, depression, addictions, relationship problems, money worries. You name it. I'd experienced plenty of the things that can make life extraordinarily difficult, and I'd spent years trying to understand and work through them.

So I thought I'd be ideally placed to work predominantly with men experiencing similar challenges.

A male therapist who understood what it was like to struggle, who could talk openly about difficult subjects and who wasn't going to judge anybody for the things they'd been through. I was rather pleased with myself. A business idea worthy of a place on Dragons' Den, I thought. There was just one small problem. Not many men were coming to therapy. At least, not to see me. So it didn't take long before I realised that if I wanted to build a sustainable business,

I'd need to broaden my appeal. I began considering the areas in which I felt I could confidently help people.

And eventually, I settled on weight loss hypnotherapy.

How difficult can weight loss be?

I knew about weight loss.

Everybody knows about weight loss.

Eat less. Move more. Count your calories.

Make sure you're burning more energy than you're consuming.

Simple. Job done, surely.

Or so I thought. Before too long, I had a steady stream of clients, predominantly women around my own age, sitting in my therapy room describing experiences that were anything but simple.

They'd tried diets. Exercise programmes. Meal replacements. Slimming clubs. Calorie counting. Cutting carbohydrates. Eating more protein. And just about every other approach you could imagine. Some had lost considerable amounts of weight, only to regain it.

Others had been trying for years without feeling they'd made meaningful progress. But the thing that struck me most wasn't necessarily their weight. It was how they felt about themselves.

"There must be something wrong with me"

I remember the desperation that so often accompanied these conversations. People would describe feeling as though they'd tried absolutely everything. Some were considering significant surgical interventions because they couldn't see another way forward.

And many had developed an extraordinarily harsh view of themselves.

They believed they were greedy. Lazy. Weak. Lacking discipline. Sometimes they used words such as disgusting to describe themselves.

Some of what I heard was heartbreaking.

Not because these people had failed at a diet, but because they'd begun to despise themselves for it. Here were intelligent, capable people who had managed careers, families, relationships and all sorts of difficult life circumstances.

Yet because they struggled with their weight, they'd come to believe that something was fundamentally wrong with them.

They weren't simply frustrated with their eating habits. Their difficulties had become part of their identity. And that was something I recognised from my own experiences.

As I've discussed in earlier articles, the things we struggle with can influence what we come to believe about ourselves. Sometimes we stop seeing a problem as something we're experiencing. And start seeing it as evidence of who we are.

The trouble with "just eat less and move more"

Around the same time, I was becoming increasingly frustrated with the messages people were encountering online.

You know the sort. A fitness influencer in their twenties, looking as though their gym clothes have been spray-painted on, recording a video at six o'clock in the morning.

Explaining how straightforward it is to develop the perfect physique. Just get up earlier. Be more disciplined. Eat more protein. Count your calories. Stop making excuses.

Physical activity matters.

Nutrition matters.

And energy intake and expenditure are relevant to changes in body weight.

But I began wondering whether we were missing something rather important. We were explaining what people needed to do without understanding why they were finding it so difficult to do it. And for some people, being repeatedly told that the answer was simple was making them feel even worse.

Because if the solution really was that straightforward, what did it say about them that they couldn't manage it?

Appetite isn't the same as craving

This became one of the most important distinctions in my work. Being hungry and wanting to eat aren't always the same experience.

Sometimes we eat because our bodies need nourishment. Sometimes we eat because food looks or smells delicious. And sometimes we find ourselves wanting something very specific, even when we're not particularly hungry. Chocolate. Crisps. Biscuits. Something sweet after dinner. Something comforting at the end of a difficult day.

Cravings can be influenced by many things, including habits, reward, stress, hormones, emotional experiences and the environment around us.

And they can be powerful.

Imagine somebody who's spent the entire day working, looking after children, managing responsibilities and trying desperately to keep everybody happy.

They finally sit down in the evening. They're exhausted. They have very little mental or emotional energy left. And they want something enjoyable. Something comforting. Something that doesn't require any more effort. Is it really helpful to tell that person they simply need more discipline?

Perhaps. But I suspect we might learn considerably more by understanding what their day has actually been like.

What I began noticing

The more people I worked with, the more I began recognising some recurring patterns. Everybody's story was different, of course. But I repeatedly encountered four areas that seemed particularly relevant.

Autopilot eating

Eating without much conscious awareness. Perhaps while watching television. Standing in the kitchen. Finishing somebody else's leftovers. Or reaching for something almost automatically because that's what we usually do at a particular time. Sometimes this involved hunger. Sometimes it didn't. Often the behaviour had become so familiar that people barely noticed themselves doing it.

Highly processed foods

Many of the foods people found most difficult to regulate were convenient, enjoyable and readily available. Foods designed to be appealing. Foods that were easy to eat quickly. Foods that required almost no preparation. This didn't mean that every processed food was harmful or that enjoying chocolate or crisps was somehow wrong. But the combination of convenience, palatability, established habits and repeated exposure could make certain eating patterns difficult to change.

Low mood and emotional pressure

Food can provide comfort. That's hardly a revolutionary observation. But I became interested in the circumstances in which people were most likely to seek that comfort. Loneliness. Frustration. Stress. Disappointment. Feeling unappreciated. Feeling that life had become a relentless series of responsibilities.

Sometimes food was one of the few reliable sources of pleasure available. Even that, became another source of pressure, the underlying belief that the food itself was "bad" and seemingly not seeing that it was providing a sense of relief from that emotional pressure.

Low energy and lack of time

This was the area I felt was particularly overlooked.

When we're exhausted, preparing nutritious meals can feel like another enormous responsibility and pressure.

Planning, shopping, cooking and washing up all require time and energy. And when we have very little of either, convenience becomes extremely appealing.

It isn't difficult to understand why. I began seeing how these factors could interact. Someone might be under considerable pressure, sleeping badly, feeling exhausted and relying on convenient food.

Eating might provide immediate enjoyment or relief. They might then feel guilty, criticise themselves and resolve to become more disciplined tomorrow. Only to wake up tired and begin the same cycle again.

The more I understood these patterns, the less useful I found it to describe people's difficulties as laziness or greed.

I thought I'd cracked it

As I became more interested in these experiences, I began studying weight management in much greater depth. And, as I described in my earlier article about ADHD, autism and my own experiences, I have a tendency to become rather absorbed in things that interest me.

So I turned my full attention towards understanding healthy, sustainable weight management. Particularly the psychological and behavioural difficulties that could make it so challenging. For my female clients (particularly in middle-age) there are further hormonal complexities - that most weight loss approaches simply ignore completely. I developed a therapeutic approach that considered not just eating habits, but the wider circumstances in which those habits developed. Sleep. Energy. Stress. Mood. Recovery. Hormones. Personal expectations.

And the ways in which food could become associated with comfort, enjoyment or relief.

Over time, I became increasingly confident in the work I was doing. And I began to feel that I had something genuinely useful to offer.

I was also becoming more frustrated with parts of the wider weight-loss industry. The promises. The pressure. The before-and-after photographs. The suggestion that everybody could achieve the same results if they simply wanted them badly enough.

And the shame that so often followed when people couldn't. So I decided to do something about it.

My revolution of the weight-loss industry

I developed a low-cost online programme based on the process I'd been using with clients.

The idea was to make the approach more accessible to people who couldn't necessarily afford individual therapy.

I put an enormous amount of work into it.

And I was delighted with the result. I genuinely felt it was one of the best things I'd ever produced.

A practical, psychologically informed alternative to so much of the advice I believed was making people feel worse about themselves. My own little revolution of the weight-loss industry. There was just one problem.

Nobody bought it.

Not exactly the revolution I'd planned.

I'd spent an extraordinary amount of time creating something I believed could be genuinely helpful.

So why wasn't anybody interested? At first, I assumed I'd simply failed to market it effectively. Perhaps I hadn't explained it properly. Perhaps I wasn't reaching the right people. Perhaps my website needed improving.

But something else was happening.

I wasn't seeing the same number of new weight-management clients in my therapy room either.

For a while, I couldn't understand it. And then I began considering a rather obvious possibility. While I was busy perfecting my grand solution, the weight-loss world had moved on.

Enter GLP-1

Weight-loss injections had become an increasingly prominent part of the conversation. Medications such as mounjaro and ozempic were offering people a treatment option that could produce substantial weight loss through biological mechanisms affecting appetite, fullness and eating behaviour.

And suddenly, the landscape looked very different.

Now, I want to be clear about something. I completely understand why people choose these medications.

Whilst I haven't personally experienced the same difficulties with weight management as many of the people I've worked with, I've had plenty of other challenges in my life. Things I've struggled to change. Things I've spent years trying to understand. Things that have caused considerable distress.

And I've sat for thousands of hours, across hundreds of conversations, listening to people describe the anguish, frustration and shame associated with their weight. So I can imagine how appealing this opportunity might be.

If somebody told me that one of the biggest difficulties in my life could be dramatically improved by taking a medication, I would certainly want to know more. And if they told me that it involved a weekly injection and a few hundred pounds a month? Well, depending on the problem, I might be crawling over broken glass to hand over my money.

I really do understand the appeal.

Particularly for somebody who's spent years trying to achieve change and repeatedly feeling that they've failed. The prospect of a treatment that makes appetite and eating easier to manage must feel enormously significant.

And for many people, it is.

But I have questions

I also have concerns.

Not because I believe everybody should manage their weight through willpower, therapy or behavioural change alone. Far from it. And not because I think medical treatments are somehow less legitimate than other approaches.

My concerns are about how we understand these treatments, how they're marketed and what expectations people may develop about them.

Weight-management medicines can offer substantial benefits, but they're not effortless solutions for everybody.

People respond differently. There can be side effects.

Treatment requires appropriate medical assessment and monitoring. And the longer-term decisions around continuing or stopping medication can be important.

I also wonder what happens to the wider experiences that may have accompanied someone's difficulties with food.

The exhaustion.

The loneliness.

The pressures of everyday life.

The self-criticism.

The belief that there's something fundamentally wrong with them.

Medication may change appetite, cravings and eating behaviour. And that may itself provide considerable relief. But what about the rest of the person's experience? Does reducing the urge to eat necessarily resolve the circumstances in which eating became comforting?

Not always, I suspect.

And perhaps that's where some of the psychological understanding I've spent years developing remains relevant.

Perhaps we were asking the wrong question

Looking back, I think there's something rather revealing about the arrival of these medications. For years, people struggling with their weight were repeatedly told that the answer was straightforward.

Eat less. Move more. Have more discipline.

And if they couldn't achieve that, they often blamed themselves. Now we have medications that can influence some of the biological processes involved in appetite, fullness and eating behaviour.

That should encourage us to reconsider some of the simplistic messages people have been receiving. Perhaps their difficulties were never adequately explained by a lack of willpower. Perhaps we should have been paying much more attention to biology, behaviour, health, environment and the realities of everyday life.

And perhaps the most useful question was never simply: Why can't you stop eating?

But: What is contributing to this experience, and what might genuinely help? That's a question that extends well beyond weight management. It's also one of the central questions behind The Mind Works.

More than a number on the scales

When I think back to the people who sat in my therapy room describing themselves as lazy, greedy or disgusting, I don't primarily remember their weight. I remember how much they were hurting. How desperately they wanted things to change. And how harshly they judged themselves when they struggled. Weight management is an important health issue, and effective treatment can make a meaningful difference to people's lives.

But I think we need to be careful that our pursuit of better health doesn't become another source of shame. Whether somebody chooses medication, behavioural support, dietary changes, surgery or a combination of approaches, they deserve to be treated with respect.

And they deserve an understanding of their difficulties that goes beyond being told to try harder. I've come a long way from the man who started his therapy career thinking weight loss was simple. I haven't stopped believing that a person's relationship with food matters. I have stopped assuming that an explanation, however good, is necessarily what they're looking to buy.

But I'm even more interested in understanding how physical health, physiology, psychology and everyday circumstances interact. Because we're rarely dealing with just one thing. And perhaps that's the biggest lesson I've taken from my little revolution of the weight-loss industry.

The numbers matter. But so does the person living with them.

Craig Fookes

Clinical Hypnotherapist | Founder of The Mind Works

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