Obesity is a multifaceted issue, often oversimplified as a mere imbalance between calories consumed and calories burned. While dietary and exercise habits undoubtedly play a significant role, a deeper dive reveals the profound influence of psychological and emotional factors on weight management. This article explores the psychosomatic causes of weight loss resistance, examining how our emotions, experiences, and ingrained behaviors can create significant barriers to achieving and maintaining a healthy weight.
The Complex Relationship Between Mind and Body
Obesity is a complex health condition that not only impacts physical health but also has significant psychological consequences. Carrying excess weight can lead to a range of mental health issues, from low self-esteem and body image problems to depression and anxiety. The stigma and discrimination often faced by those with obesity can further exacerbate these psychological challenges. Additionally, the health problems associated with obesity, such as heart disease and diabetes, can also take a toll on mental well-being. Understanding the psychological effects of obesity is crucial for developing comprehensive treatment approaches that address both the physical and mental aspects of this condition.
The psychological effects of obesity can be deeply intertwined with emotional and behavioral factors, where psychological vulnerabilities may predispose individuals to obesity and vice versa. For instance, stress and emotional distress are significant contributors; individuals may turn to food as a coping mechanism for managing stress, leading to a cycle of emotional eating and weight gain. This behavior not only increases the risk of obesity but can also exacerbate feelings of guilt and shame, further impacting mental health.
The relationship between obesity and depression appears to be bidirectional and more substantial in women compared to men. In the USA, Younger individuals, non-Hispanic whites, and those with higher educational attainment show a stronger association between obesity and mood disorders. The relationship between obesity and depression is complex, with some studies finding depression as a risk factor for obesity, particularly atypical depression. In contrast, others show obesity increases the risk of depression. Adipose tissue in obese individuals secretes various hormones and signaling molecules known as adipokines, which play crucial roles in metabolism and immunity. These include anti-inflammatory adipokines in lean individuals and pro-inflammatory cytokines in obese individuals. These pro-inflammatory cytokines, such as TNF-alpha and IL-6, along with hormones like leptin, resistin, and visfatin, contribute to the development of chronic low-grade inflammation seen in obesity. Leptin, associated with appetite and energy balance, is secreted in proportion to fat storage, while adiponectin decreases in proportion to fat storage. All of these can affect mood and cognition by altering neurotransmitter function.
The Role of Emotional Eating
Emotional eating, one of the primary psychological factors influencing obesity, often occurs when individuals use food as a way to cope with stress, sadness, boredom, or other challenging emotions, rather than eating due to physical hunger. Food can have a strong and powerful emotional draw that fills the void of sadness, loneliness, and despair or nursing hard, former experiences of emotional pain.
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Chronic stress can lead to releasing cortisol, a hormone known to increase appetite and intensify cravings, particularly for high-calorie, “comfort” foods rich in fats and sugars. This physiological response likely stems from survival instincts, where calorie-dense foods provided quick energy. When individuals experience sustained stress, cortisol remains elevated, causing the body to continually seek these high-energy foods. This can create a cycle of emotional eating, where stress and negative emotions prompt repeated overeating, ultimately contributing to weight gain and obesity (Harvard Health).
Negative Self-Perception and Body Image
Negative body image and low self-esteem are also significant psychological contributors to obesity. Many people who struggle with obesity develop a negative view of their body, which can lead to feelings of hopelessness or frustration. This cycle perpetuates unhealthy habits-such as avoiding exercise and turning to food for comfort-and further exacerbates weight gain. This often reinforces negative self-perceptions, trapping individuals in a cycle of low self-esteem and unhealthy behavior patterns that can be difficult to break.
The social etiologies of the psychological effects of obesity include factors related to the environment and community infrastructure, such as geographical differences in obesity prevalence, the impact of food availability, and the quality and type of food accessible in various neighborhoods. Transportation and neighborhood walkability also significantly influence physical activity levels and weight status. Moreover, neighborhood socioeconomic status, along with perceptions of crime and safety, can affect physical activity and dietary choices, contributing to the obesity epidemic. The social etiologies of the psychological effects of obesity are further compounded by societal stigma and discrimination, as well as environmental stressors. These include not only the physical environment but also the social climate in which individuals with obesity experience marginalization and prejudice. Discrimination in healthcare, employment, and social interactions can lead to increased stress, exacerbating the psychological burden of obesity. This societal stigma can also hinder individuals from seeking medical care or participating in physical activities, reinforcing a cycle of adverse psychological effects and unhealthy behaviors.
Behavioral Conditioning and Early Life Experiences
Another major psychological factor contributing to obesity is behavioral conditioning. From a young age, many people are taught to associate food with comfort, celebration, or reward. For example, children might be given sugary treats when they perform well in school or are feeling upset. Research has shown that this type of emotional eating is influenced by reward systems in the brain, particularly the dopamine pathways that respond to pleasurable stimuli like sugary or fatty foods. These pathways can create a cycle of seeking these foods as a habitual emotional response, making behavioral conditioning around food a major factor in overeating and weight gain. This behavior can be difficult to unlearn, especially if it has been reinforced over many years. Adults may eat to soothe emotions or reward themselves for accomplishments, often leading to overeating and the consumption of unhealthy foods.
As a teenager, I spent countless hours trying to work off such tendencies, trying to outrun the calories. Even later, despite the fact that I had courses in college on nutrition and a pretty intense workout regimen, these old habits remained.
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In my example, Dr. Perhaps the last thing many of us ever ask ourselves in this country of abundance is if we feel deprived of food. As well, having immediate access to a trained expert to help do the necessary “vertical descent” work to uncover issues galvanized to food and eating is not always feasible. And in a country that promotes food 24/7 through food shows or the socialization of it (foodies), the design is to monetize desire, to want us to want more, making us emotional slaves to food.
The Impact of Deprivation and Restriction
A better place to start might be first exploring our emotional relationship with food and avoiding deprivation states. This means you can eat things you enjoy, in moderation, thus recognizing that you are still free to eat foods you like, but doing so with balance. One burger, not two, maybe a small serving of fries, and half a drink. The strength of deprivation is then appeased.
In this, renewal and reinstatement are two such ways in which conditioned responses recover, meaning, under certain conditions, we can resurrect those old habitual ways of behaving-in this case, overeating from scarcity as an example, where once initiated (renewal), the behavior may increase in frequency (reinstatement), happening with more regularity (Bouton and Swartzentruber, 1991). Renewal, reinstatement, and other relapse phenomena are now at the center of recent research inquiry because of their significance in helping understand failure rates related to extinction interventions such as dieting, weight loss strategies for eating, and more (Podlesnik et al., 2017). The recovery or re-engagement of former behaviors (i.e., former contexts and eating habits) that had been extinguished (through diets, etc.) has been studied relative to many socially significant behavioral phenomena, such as overeating, addictions, and substance abuse, to name a few (Spurlock & Lewon, 2023).
Researchers Spurlock & Lewon (2023), from their work, have described recent research that underscores how emotionally triggering events (deprivation-feeling states, celebrations, stressful situations) can function as motivating operators (MOs) and may instigate relapse both by a) triggering interoceptive (internal-emotional-biological) conditions that serve as a filtering context for relapse and, b) changes in the amount of operant responding (environmental contexts) in the presence of such stimuli. Spurlock & Lewon (2023) also conducted their own study to test this interaction with a deprivation experiment involving mice amongst food and water access. The results demonstrated the strength of response under deprivation states that might reinforce stronger postdeprivation behaviors, where such triggers can largely reignite motivation and desire to succumb (overeating).
Weight Cycling and Psychological Distress
Weight maintenance is defined as the intentional loss of weight and subsequent maintenance of that weight for at least six months [7]. Weight cycling is a cyclical cycle of weight loss (≥ 5 kg) and weight regain, affecting 20-30% of adults [7, 8]. Several studies have found that weight cycling increases weight, the metabolic burden and chances of developing chronic disease of people with obesity [9, 10].
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Depression, anxiety, and other forms of distress are referred to as psychological distress Previous studies have established a strong association between psychological issues such as anxiety and depression with weight cycling or weight regain [14, 15]. Large-sample statistical analyses have revealed that populations with weight cycling were more likely to experience depressive symptoms than non-weight cyclers and that there was a link between frequent weight cycling and depression [16]. In addition, participants with bipolar disorder and a history of weight cycling, particularly those who often regained lost weight or struggled to sustain their weight loss, experienced more frequent relapses of symptoms such as mania and depression [17]. A subsequent study discovered that adults with baseline anxiety and depression exhibited lower levels of weight maintenance over two years, were more likely to gain weight, and that depression severity had a dose-response effect with significant weight gain [18,19,20]. In contrast, some remission of major depression and dysthymia was linked to improved weight control and loss. It indicated a clear relationship between psychiatric and psychological distress, weight cycling, and weight maintenance. Mental and psychological distress have been identified as essential factors in the development of certain diseases. Psychological stress has an impact on irritable bowel syndrome. Severe mental illness and cardiovascular disease have some root causes in common, and those who have a mental illness are more likely to develop cardiovascular disease [21, 22]. Currently, studies on obesity-related diseases suggests that mental stress may influence changes in eating behavior and metabolic disorders among diseases associated with obesity. According to an increasing number of studies, independent mental diseases are closely related to the occurrence of metabolic diseases [23]. We hypothesize that reducing psychological distress in people with obesity and a history of weight cycling will lead to better weight-loss outcomes.
Eating Behavior as a Mediator
Eating behavior can also be influenced by psychological distress. Previous cross-sectional studies have discovered a link between psychological distress and emotional eating, binge eating, and external eating. Emotional eating behaviors, in general, are mediators of the effect of psychological distress on health-related quality of life [24]. Psychological distress regulation is strongly linked to problematic eating behavior in adolescents [25]. The indirect effect of psychological distress on emotional eating via emotional dysregulation was found to be significant in mediation analyses [26]. Furthermore, 25% of adults eligible for weight loss surgery exhibit food addiction and binge eating behavior, which is linked to a high prevalence of psychological distress, including depression and anxiety disorders [27].
It is important to note that eating behavior has been linked to both psychological distress and weight loss levels. Previous research has found that changes in eating habits for weight loss are associated with better outcomes [28]. The presence and severity of eating behaviors may play a role in mediating the relationship between psychological distress and weight loss levels. However, most prior studies have primarily focused on individual factors like depression, anxiety, attitudes towards healthy eating, or exercise habits, only examining their isolated impact on weight maintenance [29].
There have been few studies that look at the link between psychological distress, eating habits, and weight loss maintenance. We proposed a hypothesis that explores a sequential pathway involving psychological status, eating behavior, and weight control. This hypothesis is based on theoretical assumptions derived from existing research in the field, suggesting a complex interplay between these factors in individuals experiencing weight cycling. Our study aims to empirically test this pathway to better understand the mechanisms underlying successful weight management. This sequence is speculated to influence the effectiveness of weight loss in populations experiencing weight cycling. We used a cohort of weight loss clinic participants in this study. This study looked at the relationship between psychological distress, appetite, eating behavior, and weight loss outcomes in outpatients who had a history of weight cycling. It also examined whether the mediation effect of eating behavior between psychological status and body mass index (BMI) change found in previous studies can be replicated and whether this mediation effect is dependent on appetite. Using a structural equation model (SEM) for path analysis, we assessed the mediation and moderated mediation between psychological status, eating behavior, and weight loss. To the best of our knowledge, this is the first study to investigate the relationship between psychological distress and weight control in a cohort of participants with obesity and a history of weight cycling, as well as to mediate the role of eating behavior. This evidence will inform future improvements in psychological interventions for participants with a history of obesity and weight cycling (people experiencing weight loss difficulties), as well as provide a theoretical foundation for advancements in multi-disciplinary team (MDT) weight loss intervention strategies aimed at promoting physical and mental health.
The Anxious Brain and Metabolism
JUPITER, FL - Scripps Research scientists have published a study revealing a shared mechanism for both anxiety and weight loss. "We’ve found a relationship between anxiety and weight loss,” says Baoji Xu, PhD, professor on the Florida campus of Scripps Research and senior author of the study. Anxiety disorders are the most common types of mental health disorders in the world. Xu, a long-time obesity researcher, noticed the same phenomenon in a group of mice engineered to lack a molecule called brain-derived neurotrophic factor (BDNF). “Even on a high-fat diet, these mice were really lean,” says Xu. Answering that question required a study of how BDNF works. Normally scientists simply turn off a gene to find out what it does. There was a challenge with BDNF, though: Previous work had shown it is mandatory for brain development, learning and memory. When they deleted the BDNF gene only in the brain’s cortex, hippocampus and amygdala, their model worked as expected. With the new model, the researchers discovered that the lack of BDNF meant they could not dampen busy “excitatory” signaling in those brain circuits. Next, the researchers studied how a lack of BDNF kept the mice lean. They found that these anxious mice had an elevated basal metabolic rate, the rate of energy expended to keep the body functioning. The researchers had found a molecule-and a brain region-that link anxiety and weight loss. Xu and his team are now considering how to apply this work to help patients. No one would ever want to trigger anxiety in humans, Xu says. He also hopes to further study the neurons that BDNF targets to relieve anxiety. Xu says the environment at Scripps Research is a great place to try to answer these basic questions about the brain.
Strategies for Addressing Psychosomatic Weight Loss Resistance
While psychological factors can complicate weight management, addressing these barriers can empower individuals to regain control of their health.
- Practicing mindful eating can help individuals become more aware of their eating patterns, especially the difference between emotional hunger and physical hunger. Mindful eating encourages paying attention to the body’s hunger cues, savoring the flavors and textures of food, and recognizing when you are full (Harvard T.H. Chan School of Public Health, n.d.). Mindful eating also encourages slowing down during meals, which can help prevent impulsive eating and increase awareness of portion sizes. This practice allows individuals to become more in tune with their body’s needs, promoting healthier eating habits (Harvard T.H. Chan School of Public Health, n.d.).
- Cognitive-behavioral therapy (CBT) has proven effective in addressing the psychological factors associated with obesity, such as emotional eating, negative body image, and low self-esteem. Research shows that CBT helps patients develop healthier behaviors and coping mechanisms by restructuring dysfunctional thought patterns associated with eating and body image (Cuijpers et al., 2019). This form of therapy has been shown to effectively reduce binge eating and emotional eating by helping patients identify triggers and modify their responses to stress and emotions, ultimately supporting better weight management outcomes over time. CBT helps individuals recognize and challenge negative thought patterns, such as beliefs that they are powerless to change their eating habits.
- Stress Management: Since stress is a major contributor to emotional eating, learning how to manage stress is crucial for overcoming obesity. Incorporating stress-reducing activities like yoga, meditation, or breathwork into a daily routine can lower cortisol levels and reduce the likelihood of stress-induced eating. Developing a routine that includes moments of relaxation can prevent stress from escalating into emotional eating episodes.
- Improving Self-Esteem and Body Image: Improving self-esteem and body image is critical for long-term weight management. This can be done through therapy, self-care practices, and gradually integrating physical activity into daily routines. Additionally, focusing on non-scale victories-such as increased energy, improved mood, or better sleep-can help shift the focus away from weight and toward overall well-being.
Engage in reflection and deeper introspection. Ask questions like these: What was my relationship with food growing up? When I felt hungry, what was that like? What kinds of foods do I currently choose to consume and why? How do I engage food when I’m emotional-sad or happy? Use cognitive-behavioral therapy (CBT) self-monitoring when you eat. When you eat, once you have consumed that first plate, assuming that it’s not overfilled, and you have a strong desire to go for another, ask yourself, Why? Why do I want a second plate? Yes, it may taste good; but, you are not deprived because you have just eaten, so it must be something else at work.
I don’t diet anymore. Now that I understand my relationship with food, I am engaging in a healthier lifestyle mentally and physically. By exploring your own relationship with food, you may finally be able to unburden yourself and begin fostering balance and satisfaction.
In addition to therapy, working with an obesity doctor or joining a support group can provide the accountability and encouragement needed to stay on track. A supportive network can help individuals feel less isolated in their weight loss journey and offer practical strategies for overcoming psychological barriers. For example, have you reached your weight loss goal and are now trying to maintain that weight? A weight maintenance group may be of more help to you than one for those just starting to lose weight. Other groups may focus on the type of weight loss, such as a bariatric surgery group, as they will have very different experiences than someone who has not been through surgery. You may even find online support groups and online communities. Do not be discouraged if the first support group you try doesn't feel quite right. If you’ve had bariatric surgery, our Center for Medical and Surgical Weight Loss also offers a variety of support groups for those who have lost weight through surgical means. The National Mental Health Consumers' Self-Help Group Clearinghouse maintains a Directory of Consumer-Driven Services.
Clinical Evaluation
Evaluating the psychological effects of obesity in a clinical setting involves a comprehensive approach that addresses both the mental and physical aspects of obesity.
When evaluating individuals with obesity and assessing for its potential psychological effects, healthcare providers should obtain a complete history that includes:
- Medical history
- Psychiatric history
- Weight history
- Diet/Nutrition history
- Physical activity
- Sleep history
- Social history
A complete physical examination should be conducted and include:
- BMI
- Weight circumference
- Body habitus
- Vitals
- Mental status examination
Begin with a detailed clinical interview that includes questions about the patient's weight history, diet and exercise habits, and any attempts at weight loss. Importantly, it explores the patient's emotional and psychological well-being, focusing on body image concerns and experiences of bullying or discrimination related to weight.
Various factors, including biological, psychological, and socio-cultural influences, contribute to their weight status.
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