Behavioral Therapy: Beyond “Eat Less, Move More”

by Zachary DeCoster

Fall 2025

Too often, people with obesity hear generic advice like “eat less and move more” or “calories in versus calories out.” This cookie cutter approach can cause people to feel discouraged, lose motivation and sometimes slip into worse health. We know weight management is far more complex and should never involve striving for “perfection.” Instead, it is a delicate balancing act that works best when we focus on progress.

Lifestyle medicine is a growing specialty that focuses on how daily habits influence long-term health. In 2024, more than 2,500 physicians in the United States earned credentials in this field, reflecting its increasing role in medical care. As more providers look at the connection between everyday choices and overall health, behavioral therapy has become a key part of this approach.

What Lifestyle Medicine Means

Lifestyle medicine treats the whole person, not just a symptom or diagnosis. It takes into account the connections between daily habits and overall well-being. This includes:

• Movement: How we move our bodies through exercise or daily activity.
• Nutrition: The food we choose and how it fuels us.
• Stress management: The ways we cope with pressure and emotional strain.
• Sleep: How we rest and recharge our bodies.
• Relationships: The support we receive from friends, family and coworkers.
• Work and purpose: The fulfillment we get from our careers or meaningful activities.
• Substances and environment: How we limit harmful substances or reduce exposure to unhealthy situations.

All these pieces are connected through behavior. Our behaviors guide our choices and those choices shape our health. The goal of behavioral therapy in lifestyle medicine is to empower individuals to make sustainable changes that improve health and reduce the risk of chronic conditions like heart disease, diabetes, cancer and obesity.

Why Behavior is the Foundation

When lifestyle medicine is shown as a pyramid, behavioral health often forms the base. This is not because it’s the least important, but because it supports everything else.

We choose how much to exercise, which foods to eat, how we relax and when we go to sleep. These choices—repeated daily—build long-term habits. A behavioral therapist helps patients see how these everyday decisions affect health. They also help identify the hurdles and pitfalls that throw people off track, and develop strategies for moving past them.

Importantly, behavioral therapists understand that there is no such thing as perfection. Everyone’s journey happens at a different pace, with peaks and valleys along the way. Therapy focuses on celebrating progress, learning from setbacks and steadily moving toward long-term goals.

How Behavioral Therapy Works

A good behavioral health program usually begins with an evaluation. This first appointment sets the stage for what to expect from a multidisciplinary approach to weight management. It focuses on connecting thoughts, feelings and actions, often using techniques such as:

• Cognitive Behavioral Therapy (CBT): Helps people identify negative thought patterns and replace them with healthier ones. For example, instead of “I failed because I skipped the gym,” a patient might learn to think, “I missed today, but I can try again tomorrow.”
• Motivational Interviewing: Encourages patients to uncover their own reasons for change. When motivation comes from within—for example, wanting more energy to play with children—it is more powerful.
• Dialectical Behavior Therapy (DBT): Balances acceptance with change while improving emotional regulation.
• Classical and Operant Conditioning: Teaches patients how to replace harmful habits with positive ones by using rewards and consequences.
• Exposure Therapy: Helps patients face fears or triggers in safe, gradual ways.
• Feedback Loops: Shows how repeated actions produce outcomes, making the cycle of habits easier to understand and change.

The goal is not to tell people what to do, but to help them discover strategies that fit their own lives and values. This patient-centered, collaborative method focuses on empowerment.

Small Steps Add Up

One of the keys to effective behavioral therapy is recognizing that change does not have to happen all at once. Trying to overhaul every part of life at the same time usually leads to burnout. Instead, therapy encourages small, sustainable changes that build over time.

• Take a 10-Minute Walk — start small and add time until you reach 30 minutes a day
• Swap the Soda — choose water at lunch, then work on portions at other meals
• Manage Stress — simple relaxation techniques can ease tension and even improve relationships at home

Some people may choose to start with stress relief or time management. Others may focus on exercise or sleep first. There’s no single plan that works for everyone, which is why goals should fit each person’s life and be updated regularly as progress builds.

Building Independence

Behavioral therapy is not designed to last forever. Therapists take pride in supporting patients as they find approaches that work for them, but the ultimate goal is independence. Throughout time, patients develop self-efficacy—a sense of confidence in their ability to manage daily choices and challenges. This allows them to continue practicing skills, adjusting goals and building on progress without relying on constant guidance. As people feel more prepared to handle changes in their routines, therapy shifts toward a transition phase, with an emphasis on maintaining momentum and continuing growth. This process helps patients move forward with stronger habits, more confidence and practical tools they can use throughout life.

Finding the Right Therapist

Choosing the right behavioral health provider is an important step. Look for professionals with the right credentials and training: Licensed Clinical Social Workers (LCSWs) and Doctors of Psychology (PsyDs) are clinically trained in therapies like CBT, DBT, motivational interviewing, exposure therapy and more. Many are also skilled in methods such as operant conditioning, stress management and feedback loops, which help patients understand and reshape habits. Some providers may have additional certifications, such as the American Board of Obesity Medicine (ABOM) or training through Healthy at Every Size (HAES). Professional groups such as the Obesity Medicine Association (OMA) and The Obesity Society also provide specialized training and resources.

The most important thing is finding a therapist who understands obesity and can provide a patient-centered approach tailored to each individual’s needs. Behavioral therapy is not just about giving advice—it’s about supporting people as they learn, practice and strengthen habits that improve health.

When combined with lifestyle medicine, behavioral therapy creates a whole-person approach that centers progress, builds confidence and helps people feel more in control of their day-to-day lives. 

About the Author:

Zachary DeCoster is a clinical exercise physiologist with more than 12 years of experience in health and wellness. He combines fitness, nutrition, and behavioral health to support whole-person care. Zach is the Lead Exercise Physiologist and Director of the Weight Loss Program at RevolutionPTWL in Chicago, where he provides biometric testing and oversees a multidisciplinary team.

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