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The Psychological Approach to Weight Loss. Catherine Kissel: Psychologist. Assessment Prevalence of psychiatric comorbidities Obesity is a complex disorder of physiology, shame, negative cognitions, stigmatisation, medication effects, protective behaviours, poor sleep, pain …….
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The Psychological Approach to Weight Loss Catherine Kissel: Psychologist
AssessmentPrevalence of psychiatric comorbiditiesObesity is a complex disorder of physiology, shame, negative cognitions, stigmatisation, medication effects, protective behaviours, poor sleep, pain ……. Mental Health Comorbidities • Depression • normal weight (20–25%) • moderately obese (60%) • morbidly obese (90%) • Anxiety -24% • SUD – self and family- 8-33% • OCD • Impulse control disorder • History of Trauma • BED & night eating syndrome (sub clinical disorder) Social Comorbidities • Weight harassment, prejudice and “fatism” • studies show society has low respect for morbidly obese • Social and physical isolation become more common • Dating and marriage is less common • Avoidance of medical care • Employment discrimination • Loss of pleasure association with physical function and form • Limitations in physical activity • Sleep disturbance
Assessment Maladaptive eating & prevalence in presurgical bariatric candidates (Opolski et al., 2015):University of Adelaide. Lifetime risk of a woman in her 50s having an eating disorder is 15.3% (Treasure, Bulk et al 2017), higher for maladaptive eating Behaviour & Prevalence • Binge eating disorder (4-45%) • Grazing (20-60% ) • Night eating syndrome (2-42%) • Emotional eating (38-59%) • Food addiction (17-54%) Description • Recurrent episodes of eating large amounts of food in a discrete time period, with loss of control and distress • Continuous consumption of small amounts of food over a long period of time, resulting in subjective overeating • Recurrent episodes of night eating (after waking or excessive eating after dinner), which the individual is aware of and can remember, and are distressing • A tendency to overeat in response to negative emotional states like stress or sadness • Applies criteria for other addiction disorders (e.g. alcohol, tobacco), to eating related behaviour
Drivers towards weight loss: Eating patterns & Body Image Importance & Confidence Weight loss can be achieved…..but harder to sustain 200 people with obesity dieted to loose weight (over 2 periods of time 3 months and 9 months)& followed up for 3 years. At which time both groups had regained 71% of weight lost Lancet Weight loss differences between individual named diets were small. This supports the practice of recommending any diet that a patient will adhere to in order to lose weight. JAMA. 2014;312(9):923-933.
Interventions and SupportThe big Picture: towards Persistence • Commitment • Emotional resilience • Low impulsivity • Motivation, engagement and hope • Maladaptive eating: support, information, strategies • Coexisting MH • Anxiety • Trauma • Depression • ED • Hope, success
Psychological Intervention:Cycle of binge eating “Have to loose weight” now linked to “cant control my eating” With food restriction, high calorie food becomes more appealing and if very hungry difficult to interrupt Overeating becomes new norm and difficult to distinguish satiety from feeling over full (overfull becomes the signal to stop eating Thoughts such as “I need a treat” “No one will know” “I might as well” “You cant tell me what to eat” support overeating
Psychology in understanding weight gain & interventions for weight loss • Cycle of weight gain • Impact of weight gain and impact of repeated failure • Managing cravings • Rapid success and support • Manage “lapses”
