When we think of weight loss, we often think about what we eat. The questions we ask ourselves tend to revolve around how much fat, protein and carbs to eat, or whether beets help take off the pounds.

Diets touted in the media as optimal for weight loss abound, yet we remain a nation with an obesity problem.

What we tend to ignore, when we think of weight loss, is how we are approaching and managing the process of change. As important as it is to focus on what you eat to lose weight and keep it off, it is equally crucial to consider physical activity and maintaining lifestyle changes over time.

How to make behavioral changes, what strategies we use to adhere to new ways of eating and increasing physical activity cannot be ignored.

The problem is that making changes to your lifestyle is hard. If it weren’t, we wouldn’t have an obesity epidemic in this country, nor would estimated health care costs for physical inactivity have been $76.6 billion in 2000 (admittedly an older statistic, but unlikely to have improved significantly in recent years).

Cognitive behavioral therapy (CBT), which focuses on changing how you think about yourself, how you act, and circumstances that surround how you act, is an effective treatment for a wide range of problems, including weight loss. Key to it is its focus on making changes and sticking to them.

So, what CBT strategies help people to lose weight and change lifestyle behavior?

1. Goal setting.

If you want to meet the goals you set, consider the following three factors:

  • the more specific a goal, the more likely you are to achieve it;
  • ambitious goals are good, but overly ambitious goals can be discouraging;
  • regular feedback on progress improves outcomes.

When it comes to weight loss, then, a goal to eat fruit for dessert, rather than cake, is specific and can be clearly tracked. Specific goals around exercise or types of food you will eat — behaviors you have control over — are better than goals to improve cholesterol or glucose levels, which may fluctuate for reasons outside your immediate control.

2. Self-monitoring.

Self-monitoring requires that rather than beating yourself up for not attaining a goal, you attend to your own individual experiences. When you self-monitor, you begin to notice barriers, pay attention to physical cues and identify challenges to changing your behavior. Too often we rely on negative self-judgment to stay motivated and, in so doing, fail to recognize and plan for real barriers.

You can think of yourself as a scientist when you self-monitor. You may want to keep a log of your food intake or exercise routines, for example. Doing so will help you to problem-solve when life has gotten busy or you get off track. With greater awareness of your own experience, you are better able to find ways to maintain new behaviors when initial motivation is waning.

3. Feedback and reinforcement.

It can be helpful to get feedback from outside sources. Having a health care provider regularly check in with you can provide an external measuring stick. Feedback about your diet or exercise routine can provide motivation or help you adjust your behavior. Outside feedback also can help you keep your expectations ambitious but realistic.

4. Boosting the belief that you can do it.

When you go into any situation with the attitude that you will surely fail, you greatly reduce your odds of succeeding. It is essential to focus not just on behavior, but also on your perception of your ability to make the changes you want.

The best way to improve your belief in your ability to succeed is actually to have some success. Setting concrete and achievable goals, such as eating fruit at breakfast or replacing an after-dinner TV show with a walk, can build your confidence to set more ambitious goals.

If you’re looking to improve your sense that you can do it, it also can help to look for people in similar circumstances who have made the difficult changes you are trying to make and to surround yourself with people who will encourage your efforts.

5. Incentives.

The use of incentives to support change in behavior has been extensively studied and the concept is now being applied to regaining and maintaining physical health. Examples include companies that offer lower-priced onsite fitness facilities as an incentive to exercise, offering cash incentives and gift cards, providing free health coaching and offering insurance premium discounts to those who meet certain standards.

Adopting a healthier lifestyle isn’t simply a matter of changing the foods in your cupboards. Lifestyle changes take sustained efforts over time and whether we achieve our goals depends on how we make them, our mindset and what we put in place to maintain motivation.