I have suggested that counseling be required for anyone undergoing weight loss surgery. Perhaps I should expand that to say that anyone losing a substantial amount of weight should seek counseling. Even if the weight loss is done via diet and exercise, the reasons for the initial weight gain is not being addressed. The causes of weight gain are easy to see; people eat more calories than they burn. The more difficult question is WHY do people do this?
There are some concrete answers to this question. Poor food choices, drinking empty calories, lack of exercise and portion control can all explain some weight gain. This doesn't explain why about 75% of people who lose weight gain it back. There is some science that shows that metabolism slows more than expected during weight loss, so returning to a caloric load meant to maintain weight can lead to some weight gain. This doesn't explain people who lose 50, 100, or more pounds regaining that all and sometimes even more. To gain 50 pounds, you need to eat 175,000 more calories than you burn. This does not happen overnight. Even if you're eating like it's Thanksgiving every day, it would take you at least a month to gain that much weight. Plus, you'd have to eat that much EVERY day. The reason for that behavior needs to be addressed and changed.
I think the key to losing weight and keeping it off is therapy. Turns out that there's some scientific evidence fo that belief. If you don't address the reasons why you gained the weight, it will come back. If you don't treat the issue emotionally and metally, you will treat it with food, booze, drugs or some other external item. There's also the need to address the disregard for health that is evident with a large weight gain. The same can be said for smokers or any other "progressively suicidal" behavior. Smoking won't kill you immediately, but it will eventually shorten your life span. The same can be said for alcohol abuse, drug abuse or obesity.
I was thinking of this because I saw a story of a man who lost 400 pounds through diet and exercise. He took 26 months to lose it all and 36 months to regain 75% of it. No one seemed to mention him getting any counseling at all. In an interview, he briefly mentioned needing to have a good foundation before the weight loss and that he was lacking that the first time. The story seemed to suggest that he was using his girlfriend for that foundation, though, rather than building it in himself. I hope that he is doing something to overcome his demons and build the foundation internally.