• It's common for people to start the New Year with new health goals, perhaps including losing weight or getting fitter

  • Therapist Andrew Keefe, who also works as a personal trainer, explores why our health goals are a matter of mind as much as body

  • If you struggle with disordered eating, poor body image or low self-esteem, talking to a therapist may help you achieve your goals. Find yours here

Weight is an issue of body and mind: a physical and mental issue. Physical because weight is a property of the body and losing weight involves physical activity and changes to what we take into our body as food and drink.

It is an issue of the mind because of our feelings about the weight we carry and losing and gaining weight and the pain this can cause us; because of the determination it can take to stick to a weight loss programme and the complex societal pressures which swirl around us and influence how with think about our weight. Of the mind, also because of the pain of growing up in a world which blames, bullies and belittles people who don’t conform to accepted ideas of body image, where to be overweight is equated with laziness and gluttony, ignoring the environmental, social, genetic, psychological and medical causes which influence our weight and body composition (Lawrence, 2013).

Complex reasons can create a situation where it might be considered we need to lose weight. While there are clear links between ideas of “weight” and health, decisions about where to draw the line between “healthy” and “unhealthy” size are culturally determined, to some extent. In seeking to help people lose weight and improve fitness and health, we need to guard against critical, judgemental attitudes – fat shaming “others” , marking them out as “different”, less worthy, to be blamed for their appearance and lifestyle. There is a very thin line we need to constantly observe (Orbach, 2019).

Because mental health and physical health are related, a range of health professionals from differing disciplines, can become involved: GPs, nurses, health visitors, dieticians, psychologists, psychotherapists, counsellors, physiotherapists and personal trainers: all will have their views and approaches and will use their expertise to help. It could be the person doesn’t realise or agree they need to lose weight and may not want to. They could still receive advice from some or all of the above, which may be more or less welcome.

Many of these professionals will look at the person and their weight from either a physical or psychological perspective, depending on their training and discipline, although the holistic, “whole person” approach is becoming more widely spread in healthcare.

What could happen if two of these professions – personal training and psychotherapy – combined, to look at the person, their weight, whether they need to lose weight and their experience of this, from a genuinely holistic perspective: body and mind, physical health and mental health. What might the person’s experience of this be? What could be achieved?

Personal training

A personal trainer (PT) would understand weight loss as a goal, something to be worked towards, the reason their client wants to exercise. At assessment, they would use several measures to understand their client’s weight: weighing them, calculating their Body Mass Index (BMI) and taking measurements to establish their body composition (BMI alone is not that effective a measure as it doesn’t take account of how much a client’s weight is fat and how much is muscle, which actually weighs more). Other tests include blood pressure and a range of fitness tests, with the aim of creating a picture of the client, their needs and capabilities.

The PT will use this information to design a weight loss programme, including exercise and physical activity and dietary analysis and advice. The aim will be to create an “energy imbalance”: if the client uses more calories every day than they take in, they will lose weight. Typically, if you use 500 kcal more per day than you take in, you will lose weight at a rate of 0.45 kilos per week.

The exercise and physical activity programme will aim to get the client exercising at least three times per week and up to a total of 150 minutes per week of moderate to vigorous exercise, but will also look at ways to help the client be more active during the day (so, walking or cycling to work, using the stairs not a lift, moving around more) as well as more structured sessions in a gym or park.

Dietary advice will include keeping a food diary, analysis of data and suggestions as to how to reduce calorific intake safely and to be eating more of the good calories and nutrients which our bodies need to keep healthy. A PT will understand how to calculate someone’s daily energy needs and that within this we all need carbohydrates, fats, protein and vitamins, our five-a-day fruit and veg and to drink less alcohol. They can explain the impact of exercise on your metabolism and how excessive dieting actually slows your metabolism down.

A good PT will also know that if you stick to the exercise and dietary programme, you will lose weight and that a total loss of 5-10% of starting body weight is usually achievable safely. Sticking to the programme can be challenging for many people: making significant lifestyle changes, including your diet, cutting back on foods you really like or cutting down on alcohol and taking up regular moderate to vigorous exercise, can take some doing. Many people feel too daunted even to begin or lose motivation after a few weeks. The work can be hard and people can become demoralised when they don’t see results.

PTs are trained to understand and use motivation techniques, including motivational interviewing and the cycle of change. At assessment, the PT will explore your intrinsic and extrinsic motivations for losing weight and deploy strategies to help keep you engaged.


The issue of motivation can quickly become complicated by the question of why someone feels they need to lose weight: it could be for the objective, medical reasons already mentioned: a GP has calculated your BMI and found you to be outside the healthy weight range. The GP may have advised you your weight is likely to cause serious health issues, including increasing risk of diabetes, some cancers or cardiovascular disease. 

You might be a perfectly healthy weight, shape and size but have been so bombarded by images of bodies from social media, film, television and advertising, that you feel overweight, even when you are not: we are all bombarded constantly with images of impossible shapes, bodies which don’t exist or are not achievable by natural means. We can no longer trust the images we see: air-brushing, filters, plastic surgery, are all used constantly to enhance and alter people’s shape and appearance. 

Some people who show off their ripped, toned and buff bodies on social media give the impression they look like this throughout the year when in reality, the photos were taken after a particularly intense period of training, dieting and restricting fluidsin preparation for a competition or photo-shoot: no-one can look like that all year round, but the steady drip of photos on an Instagram feed can give that impression.

The pressure to reach and maintain impossible standards of appearance which have long afflicted fashion models and film stars now impacts on “ordinary” people too, with often catastrophic results, forcing people to the extremes of diet, exercise and plastic surgery, leading to mental health disorders like eating disorders and body dysmorphia, including now even “Muscle Dysmorphia”, a condition affecting young men in particular, whereby no matter how hard they work-out and how muscly and ripped they become, they still feel themselves to be small and physically inadequate: there is always someone in the gym who is bigger than you.

There is also a link between early trauma, especially childhood sexual abuse and obesity. Childhood sexual abuse can leave the survivor with low self-esteem, poor body image and impulsive behaviour, all of which are predictors of over-eating and obesity. Survivors also talk of preferring to be “overweight” to provide a protective cushion or “de-sexualise” themselves to prevent further abuse. 

Overeating can then be a coping mechanism for the trauma the abuse has left behind or to compensate for an early loss, to fill a hole which can never be filled. A response to anxieties or troubling memories, a way of dampening down impossible feeling.

The compulsion to lose weight can arise from an eating disorder or disordered eating (often a precursor to the former and excessive exercise, restriction of calorie intake and obsessive use of scales can be signs of both conditions: with bitter irony, the first two can also be signs of a client committed to their weight loss programme and PTs need to be constantly on the look out for signals that enthusiasm for the programme isn’t crossing the line into dangerous behaviour (a risk for clients of any body shape).

Barriers to progress

Once you find motivation and arrive at a gym, if you are unfit, it is easy to feel out-of-place, judged for your appearance. Uncomfortable memories of always being the last one picked to join a team at school can resurface. Memories of feeling other children were faster, more naturally able and fitter. 

The positions people put their bodies into to perform certain exercises, can remind them of being abused when younger, especially if the PT needs to touch them while coaching (this can be necessary sometimes, but a good PT will always ask permission and explain what they are proposing to do and why – to correct posture or show the most efficient and safe way to perform an exercise.)

Agreeing you need to exercise, to get fitter and lose weight (or at least change your body composition) and to actually get to a gym and begin to work out, is far from a simple, straightforward process. What can a psychotherapist contribute?

Psychotherapy can help you achieve your health goals

If you are worried about your weight, or someone else is trying to persuade you to lose weight and this is bringing up difficult feelings, it might help to speak to a therapist.

A psychotherapist can provide the space to explore your feelings about your weight and body image and understand the sources of pressure which have led you to thinking you need to lose weight. Speaking about the difficult experiences you have lived through can help you better understand yourself and how you came to be you, psychologically and physically.

If you do have an eating disorder or again are worried you may, it can be helpful to explore this with a therapist, to better understand your feelings about and relationship with food and where this comes from. That can also help you understand your reasons for wanting to lose weight and whether these are healthy.

If your relationship with food and your weight and body composition are related to early experiences of abuse in childhood (including sexual abuse), again psychotherapy, especially a trauma-focused therapy such as EMDR, can relieve the troubling traumatic symptoms which lie beneath.

Working through these issues can help you gain a clearer understanding of your own, genuine feelings about your body and whether, if you do decide you need to make changes, these changes are driven by healthy, free choices of your own or by pressure from outside or as a response to earlier traumas.

Is there a solution?

Plato, the Ancient Greek philosopher, in his work the Symposium, tells how Socrates believed that the concept of “beauty” goes far beyond the physical and includes the idea of “beauty of the soul” (or “mind” in the more contemporary meaning of the word). An exhibition at the Archaeological Museum in Athens this summer, develops this by showing how “self-knowledge” and “inner harmony” are in themselves, part of beauty: you cannot be “beautiful” without having self-knowledge and inner-harmony.  An idea similar to the concept of “wellness”  prevalent in the fitness industry: the idea that to be truly fit, one does not just need to be physical fit but also mentally well.

The Ancient Greeks in many ways invented competitive sport and had clear ideas about what constitutes physical beauty, and might approve of the amount of time people spend working out every week, but they would also recommend time spent in reflection with a therapist and see this as part of the same endeavour.  

If you are troubled by your weight, working with a good, professional PT on an exercise and nutrition programme to create a calorie imbalance can be highly effective but it might also help to think with a psychotherapist too to explore your relationship with your body and body image and the experiences which created that relationship. This can help you find inner harmony as well as physical fitness. Beauty in body and mind.

Andrew Keefe is a verified welldoing.org therapist in Central and East London

Further reading

Meet the therapist: Andrew Keefe

Why does exercise improve mental health?

Dear body, a love letter

Is it time to ditch the diet and invest in mental wellbeing instead?

The adverse impact of early childhood trauma

10 ways to get active

The psychological costs of body shame and self-objectification


Lawrence, D. 2013. The Complete Guide to Exercise Referral. Bloomsbury. London.
Orbach, S. 2019. Bodies. Profile Books. London.