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Rapid response to:


Making progress on the global crisis of obesity and weight management

BMJ 2018; 361 doi: (Published 13 June 2018) Cite this as: BMJ 2018;361:k2538

Food for thought

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Rapid Response:

Nuancing weight management using future focused hypnosis

As highly desirable as the political and legislative changes that Lean et al (1) propose to reduce the obesogenic environment may be, it is probably unrealistic to expect a reversal of national obesity trends without those changes. Thus, for the foreseeable future, in the UK obesity prevention will ultimately remain devolved down to individuals.

Arguably, a large part of the population is unprepared for this role. The proverbial kid in a sweetshop, confused by mixture of dietary messages and limited only by the money in their pocket to act as a restraint on food purchasing behaviour is perhaps an apt stereotype.

Unfortunately, the consequences of the macroeconomic financial environment with insufficient funding and lack of appropriately trained personnel means that individual “willpower” based weight management and control will continue to be the mainstay of primary care.

However, as Lean et al (1) allude, most individuals are unable to mobilise appropriate psychophysiological building blocks to achieve a sufficient state of self-control that allows them to improve their ability to cope with exposure to the obesogenic environment.

There is, however, some tentative data that some of those building blocks or inner resources that may contribute to making better dietary choices can be developed.

Techniques such as working memory training, (2) mental imagery and meditation (3), hypnosis (4) may be useful in the development of internal resources for managing weight.

In the more hypnotisable, hypnosis may help reduce the desirability of unhealthy snack foods. The altered desirability is associated with BOLD changes in the ventro-medial Prefrontal Cortex (vmPFC) (5).

Krushwitz et al (6) have recently demonstrated that a positive view of the future, for example, being healthier in relation to making better food choices can activate stronger connectivity between areas of the brain such as the vmPFC, dorsal posterior cingular cortex and ventral striatum. These areas are linked with positive affect processing as well as with the default mode network.

The study by Bo et al (4) has shown that the success of positively framed hypnosis seems to be in the form of a dose response relationship. Those who habitually practice self-hypnosis most intensively lose the most weight over the course of a year. The adage of practice makes perfect would seem to apply to wilful-power of hypnosis for losing weight!


1) Lean MEJ, Astrup A, Roberts SB Making progress on the global crisis of obesity and weight management. BMJ. 2018 Jun 13;361:k2538. doi: 10.1136/bmj.k2538.

2) Houben K, Dassen FC, Jansen A, Taking control: Working memory training in overweight individuals increases self-regulation of food intake. Appetite. 2016 Oct 1;105:567-74. doi: 10.1016/j.appet.2016.06.029. Epub 2016 Jun 25.

3) Missbach B, Florack A and König J (2015) Mental imagery and food consumption. Front. Psychia- try 6:48. doi: 10.3389/fpsyt.2015.00048

4) Bo S, Rahimi F, Goitre I et al Effects of Self-Conditioning Techniques (Self-Hypnosis) in Promoting Weight Loss in Patients with Severe Obesity: A Randomized Controlled Trial. Obesity (2018) 26, 1422-1429. doi:10.1002/oby.22262

5) Ludwig VU, Stelzel C, Krutiak H et al. The suggestible brain: posthypnotic effects on value-based decision-making. Soc Cogn Affect Neurosci. 2014 Sep;9(9):1281-8. doi: 10.1093/scan/nst110. Epub 2013 Jul 24.

6) Kruschwitz JD, Ludwig VU, Waller L, List D, Wisniewski D, Wolfensteller U, Goschke T and Walter H (2018) Regulating Craving by Anticipating Positive and Negative Outcomes: A Multivariate Pattern Analysis and Network Connectivity Approach. Front. Behav. Neurosci. 12:297. doi: 10.3389/fnbeh.2018.00297

Competing interests: No competing interests

31 December 2018
Alan O Szmelskyj
Senior clinician
True Health Clinics
True Health Clinics, 34, Cambridge Road, Godmanchester, Huntingdon, Cambridgeshire, UK, PE29 2BT.