Psychology Hits the Gym

Ron Lynch, 61, of Winter Springs, Florida, is a Southern boy at stomach. He grew up with a mom who loved to feed him and a heart that couldn't turn her down. He learned early on that food is a sign of love.

"I started learning that food would help soothe me at least for a little while," says Lynch, who recently retired from the commercial insurance industry.

But what was good for his soul wasn't good for his body: Lynch has struggled with his weight most of his life, considers himself a food addict and has Type 2 diabetes. He's tried plenty of exercise programs and diets -- with little success.

That is, until about four years ago, when he went to Rosemarie "Bud" Seaman, an exercise physiologist, former Olympic swimmer and owner of Ultimate Fitness in Winter Park, Florida. The gym partners with a local psychotherapy practice to help clients address both the psychological and physical barriers to weight loss.

While not all of Ultimate Fitness's clients see Sandy Canfield, the licensed mental health counselor associated with the gym, they have the option to participate in programs and retreats that offer one-on-one counseling sessions and group therapy.

"Bud knows how to make anybody lose weight," Canfield says. "What I'm busy doing is trying to get to the original cause of everything that's going on so that they can heal that" rather than turn to unhealthy behaviors like overeating for solace, she says.

A few other fitness facilities around the country are merging mental and physical health, but it's a hard sell, says Pat Manocchia, founder and president of La Palestra, an integrative health care facility in New York that employs exercise and nutrition specialists, therapists and other health care professionals. "It's not culturally part of our language to think about behavioral intervention as part of an exercise intervention," he says.

For Lynch, who participated in Ultimate Fitness's weight-loss program that includes psychotherapy, the multifaceted approach to health helped him address underlying depression and anxiety, as well as lose about 70 pounds by better understanding what was driving him to overeat. He has also learned to appreciate the spirit-lifting effects of exercise.

"Before I would just shut down, shut in, avoid people. Now I'm much more active, I get out and enjoy interacting with people," he says. "It's given me my life back."

Treating Body and Mind

Exercise is well-known as a safe and effective treatment for mental health disorders such as depression and anxiety. But the reverse -- mental health support to improve physical health -- has generally been reserved for professional athletes.

"These guys are as fit as you can get, and they're embracing the idea of mental health and how that affects their performance, but the general population isn't, which is striking," says Manocchia, who played hockey in college and then professionally in Europe before becoming a personal trainer and founding La Palestra in 1994. "It's taboo in some ways."

Another reason therapy is rarely offered in gyms alongside nutrition counseling and personal training comes down to practicality: Legal and ethical guidelines mandate confidentiality between client and therapist -- something that's difficult to achieve in a public setting like a health club.

"It's like putting a therapy clinic in the middle of a mall," says Daniel Kirschenbaum, a clinical psychologist in Atlanta and co-founder of Wellspring, an organization with weight-loss treatment programs throughout the U.S. and U.K.

What's more, some experts like Kirschenbaum argue that treating obesity as an emotional problem rather than a physiological one is misguided. "Working out and being active is a great thing, and therapy that's scientifically-based can help a lot of people," Kirschenbaum says. "But there's not a particular need to tie the two together in the same place."

In his practice, he treats overweight clients who want to lose weight the same way he treats professional athletes who want to accomplish an unnatural feat: as people who want to achieve something their bodies resist.

"Obesity is not caused as much by overeating as people think," says Kirschenbaum, author of "Athlete, Not Food Addict," who has consulted with professional sports teams and organizations, including the Chicago Bears and the U.S. Olympic Committee. "It's caused by physiology that some people are born with and other people develop over time that is dead-set against weight loss."

Evidence-Based Fitness

Still, integrating evidence-based approaches to help people achieve their health and fitness goals is increasingly important as the population ages and chronic diseases like obesity become more common.

"We need to do something, and I think the tactics that we were taking, effectively, they're failing," says Adam Wright, a personal trainer in New York and doctoral student in sport and exercise psychology at Temple University. In his work with clients, he uses psychological techniques like motivational interviewing to help them develop sustainable goals for fitness.

"You have to look to other motivators" outside of weight loss, says Wright, whose research focuses on the psychosocial education of fitness professionals. "By taking a more psychological approach, you can continue to feed the person's sense of self-efficacy and accomplishment."

Michelle Segar, director of the University of Michigan Sport Health and Activity Research and Policy Center, agrees. In her practice, she asks clients whether exercise feels more like a chore or a gift. Most say "a chore." Her job is then to help them find activities they enjoy -- rather than those that torch the most calories -- as well as to appreciate the rewards of exercise outside of weight loss, such as increased energy and reduced stress.

"When we really take a big step back, we can understand that our relationship with any behavior is determined by our primary motivation for doing it," says Segar, author of the forthcoming book, "No Sweat: How the Simple Science of Motivation Can Bring You a Lifetime of Fitness." "So if you want to change your relationship with a behavior, you start with the reason why you're initiating it."

For clients at Ultimate Fitness, that reason usually shifts by the time they graduate from the programs that include mental health counseling, Canfield says. "They're glad they lost weight -- they lost quite a bit and they gained a lot of muscle and their [basal metabolic rate] is up -- but mostly what they talk about is the way they emotionally connected with themselves and how inspired they feel about that," she says. "That's the thrill of why we do it."