Obesity, defined as a Body Mass Index (BMI) ≥ 30 kg/m2, represents a serious global health issue. The prevalence of obesity has dramatically increased all over the world since 1975. Comprehensive lifestyle interventions aimed at modifying diet and physical activity habits together with behavioral strategies are considered as first-line treatment for the management of obesity and its comorbid conditions. However, enduring lifestyle changes can only be achieved with a personalized approach that targets psychological well-being (PWB). Understanding the psychological aspects of weight management is crucial for long-term success. While traditional approaches often focus on dieting and exercise, incorporating a weight loss psychologist can address the underlying emotional and behavioral factors that contribute to weight gain and hinder weight loss efforts.
The Growing Need for Psychological Support in Weight Management
The traditional approach to weight loss has been focused solely on dieting and exercise. Although many people report short-term success, the research indicates that inevitably most people will regain the weight they have lost and in many cases gain even more weight. It is common for people to engage in “yo-yo dieting” for many years, finding themselves trapped in a vicious cycle. Any form of restrictive eating is known as dieting and can include weight-focused eating. Generally, about half of the people that start exercise programs stop after only 6 months. It is common for people in a western culture to use dieting as a means of weight loss and weight management. However, dieting has been found to be associated with a range of negative physical and psychological outcomes. This includes lower metabolism, reduced muscle mass and bone density, weight gain and regain and a lower sensitivity to physical hunger and fullness cues. Furthermore, dieting is also related to lower self-esteem and negative body image, higher preoccupations with food and increased external, emotional and binge eating. Many people also approach their weight loss journey with unrealistic expectations about how quickly and easily they will lose weight, what is takes to maintain weight loss, and the anticipated benefits of weight loss. They also often fail to take into account the psychological reasons for the occurrence of unhealthy eating behaviour and it goes unaddressed in their journey. An interdisciplinary approach to weight management is generally more effective than focusing on one area alone. It can be helpful to consider a combined treatment approach to address physical fitness, medical health, nutrition and psychological well-being. An interdisciplinary approach would involve the combined help of a psychologist, dietician, medical professional (GP) and exercise physiologist or personal trainer.
Understanding Psychological Well-being and Its Impact on Weight Loss
According to current literature, the construct of psychological well-being encompasses three main facets: hedonic well-being, eudaimonic well-being, evaluative well-being. The concept of hedonic well-being originates from the hedonic philosophical tradition that defines well-being as positive feelings and emotions in step with desires satisfaction. It refers to common everyday feelings or mood, such as happiness, sadness, anger, and stress. Hedonic well-being is not simply the opposite of negative feelings, as both hedonic well-being and negative feelings carry unique information about an individual's emotional state. By contrast, eudaimonic well-being advocates that well-being is achieved by realizing one's potentials in the pursuit of meaningful goals. Drawing on Jahoda's work (1958), Ryff and Keyes (1995) have operationalized eudaimonic psychological well-being according to 6 dimensions such as autonomy, personal growth, purpose in life, environmental mastery, positive relations with others, and self-acceptance. Finally, evaluative well-being refers to people's opinions about the quality or goodness of their life and to what extent they are satisfied with their lives in general.
Impaired psychological well-being and high psychological distress are associated with weight regain and may hinder healthy behavior promotion among patients with obesity. To fill the gap in the literature, the objective of the present investigation was to explore the role of psychological well-being in clinically significant weight loss following a comprehensive lifestyle intervention program for obesity. As to this purpose, we performed a broad assessment of psychological well-being in patients with obesity, before and after the lifestyle intervention.
The Role of a Weight Loss Psychologist
A psychologist can help you take a different approach towards your relationship with food by developing psychologically healthy and sustainable behaviour around food, eating, exercise and body image. By adding a psychologist to your weight management plan you can access evidence based treatment that will enhance the short-term and long-term benefits of nutrition and exercise focused interventions. To lose and maintain weight, it’s important to establish healthy lifestyle behaviors. In today's world, there are often difficult challenges that get in the way of healthy behaviors.
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At the initial evaluation session, the psychologist will assess for possible psychological contributors to weight and psychological factors relevant to weight loss treatment. The following is an outline of the services that our Weight Center psychologists offer. Please note that the number and duration of sessions listed below is approximate. The sessions with the Weight Center psychologist will be billed to your insurance. Before you schedule any appointments, you must get a referral from your primary care doctor for the psychology treatment. You will be billed for any appointments that are not covered by your insurance.
Addressing Emotional and Psychological Factors
One in every 10 people in the United States has diabetes, for example, and they are 2 to 3 times more likely to have depression than people without the disease. Psychologists often use such interventions as cognitive behavioral therapy (CBT) and psychoeducation to treat higher-weight patients struggling with chronic disease. The emphasis is on goal setting and problem-solving to lose pounds.
However, some patients will succeed with CBT and psychoeducation, but many do not: In randomized controlled studies, dieters did not lose significantly more weight than controls, and in prospective diet studies without controls, up to two thirds of dieters ended up weighing more than when they started (Hunger, J. M., et al., Social Issues and Policy Review, Vol. 14, No. “One major problem with recommending weight loss for clients is that weight-loss interventions are ineffective,” said Margit Berman, PhD, an associate professor of clinical psychology at Augsburg University in Minneapolis. “A second problem is that weight-loss efforts are not neutral or free of risk.” They can lead to yo-yo dieting and a sense of failure and raise the risk of physical and mental health problems, she said (Markowitz, S., et al., Clinical Psychology: Science and Practice, Vol. 15, No. 1, 2008; Kim, M. K., et al., Circulation, Vol. 138, No.
There is some evidence that a nondieting, weight-acceptance approach is effective at improving mental health and empowering patients to advocate for themselves in a world that stigmatizes weight (Dugmore, J. A., et al., Nutrition Reviews, Vol. 78, No.
Promoting Self-Acceptance and Body Positivity
Helping patients out of the negative cycle of ineffective dieting does not mean embracing the antidiet messaging of some large beverage, food, and supplement companies that encourages the unfettered consumption of their processed products. The World Health Organization (WHO) defines obesity-a term that proponents of body positivity say pathologizes fat people-as “abnormal or excessive fat accumulation that presents a risk to health.” Its prevalence has increased globally since the 1970s, according to the WHO. “There are a number of factors that go into the development of obesity,” said Tiffany Powell-Wiley, MD, MPH, an investigator with a joint appointment at the National Heart, Lung, and Blood Institute and the National Institute on Minority Health and Health Disparities. , Vol.
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It is important for clinicians to recognize the complexity behind variance in body weight, said Catharine Devlin, PsyD, CEDS-C, a clinical psychologist and a certified eating disorder specialist. Patients have likely already suffered adversity because of their weight. In national surveys, the Rudd Center for Food Policy and Health at the University of Connecticut found that 40% of adults with higher weight say they have experienced some form of weight stigma in their lives, whether it is unfair treatment, teasing, bullying, victimization, or discrimination, said psychologist Rebecca M. Puhl, PhD, the center’s deputy director. Weight stigma has far-reaching consequences. “It is associated with increased risk of eating disorders, anxiety, depression, death by suicide, and poorer health outcomes,” said Cheri A. , Vol. 46, No. ). , Vol. 52, No.
Facilitating Lifestyle Changes
The most studied comprehensive lifestyle interventions for weight management have been face-to-face, weekly group meetings led by teams of experts from psychology, nutrition, and kinesiology, said Hollie Raynor, PhD, RD, LDN, a clinical psychologist and registered dietitian and the executive associate dean of research and operations in the College of Education, Health, and Human Sciences at the University of Tennessee, Knoxville. Participants discuss progress in reaching dietary and physical activity goals, solve problems, and share their challenges and successes. The focus is on changing behaviors to “improve health and help individuals with their weight, be that weight loss, weight-loss maintenance, or weight-gain prevention,” said Raynor.
Addressing Weight Stigma and Bias
Patients have likely already suffered adversity because of their weight. In national surveys, the Rudd Center for Food Policy and Health at the University of Connecticut found that 40% of adults with higher weight say they have experienced some form of weight stigma in their lives, whether it is unfair treatment, teasing, bullying, victimization, or discrimination, said psychologist Rebecca M. Puhl, PhD, the center’s deputy director. Weight stigma has far-reaching consequences.
Promoting Healthy Eating Behaviors
There are many types of eating difficulty that might be experienced by someone living with obesity, which can make it difficult to manage weight. As mentioned above, food can become a coping mechanism to deal with stress, negative emotions and the many psychological issues described above. Of candidates for bariatric surgery, 5-15% present with binge-eating disorder (BED),29 characterised by excessive and uncontrollable food consumption in a brief period of time.
Encouraging Social Support
The impact of social support is varied, with a more ‘encouraging’ approach likely to improve self-efficacy by supporting healthy eating habits within a person's lifestyle and affirming one's personal capacity to make changes. This is in contrast to more ‘critically’ perceived support, which can be overly directive, more likely to be rejected and defended against by individuals as a consequence.
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Coping with Co-existing Health Issues
A diagnosis of obesity often coincides with other health issues. For example, a diagnosis of diabetes is seven times more likely in persons living with obesity,32 which provides implications for the simultaneous coping pressures of having two chronic health conditions. Diabetes has an established bidirectional relationship with mental health conditions, such as depression,33 which can create issues with self-care34 and, consequently, further health deterioration.
Understanding Individual Experiences
Ogden et al sought to disentangle and understand the complex experiences of persons living with obesity using focus groups and interviews.39 They suggest six potential dichotomies, each with a spectrum between two extremes where people might fall. Both positive and negative experiences can be found within each dichotomy, indicating the conflict and oscillating experiences plaguing this population, which can be both helpful and destructive in their lived experience. Negative experiences are associated with behavioural arrest, diminished self-efficacy, poor psychological adjustment, behavioural stasis and weight retention/gain. Positive experiences were related to feeling more informed, with empowered and adaptive behaviour coupled with greater efficacy, psychological flexibility and resilience.
Psychological Interventions for Weight Management
Direct Clinical Consultation
Direct psychological intervention might focus on supporting individuals to reflect on factors influencing their eating behaviour. This could include exploring key narratives regarding food in their formative years, identifying functions that food might have served in their life and identifying current perpetuating cycles between cognition, feelings, diet and lifestyle behaviour. Psychological intervention can support an individual to explore their readiness to change, using approaches such as motivational interviewing.49 It might also help an individual to explore the gap between positive attitudes toward behavioural change and having the knowledge about what behaviours to change, and the implementation of such behaviours. Psychological therapy can support an individual to explore the effectiveness of their responses to the internal experiences and identify alternate responses.
Cognitive Behavioral Therapy (CBT)
For example, cognitive behaviour therapy (CBT) supports individuals to challenge negative perceptions to facilitate change in their thoughts and feelings, and subsequently lead to changes in unhelpful behaviours. A CBT-trained professional would be able to work with issues concerning body image, self-esteem, anxiety and emotionally driven eating, among others.
Acceptance and Commitment Therapy (ACT)
Other third wave CBT approaches that have been found to be beneficial in supporting those living with obesity include Acceptance and Commitment Therapy (ACT). This model aims to build an individual's awareness of internal experiences, such as thoughts, feelings and physical sensations, as well as external cues, that are associated with taking actions that move them away from acting consistently with their goals and associated values regarding diet and lifestyle. Avoidance of challenging internal experiences can result in individuals taking actions that are inconsistent with their goals and associated values for diet and lifestyle change, for example eating an item non-conducive to weight management in response to a craving.
Practical Strategies for Weight Management
Self-Monitoring
Monitor your behaviors. Research is clear that people who write down what they eat in a daily log are more successful at losing weight. Record your thoughts, feelings, and information about the environment such as where you ate, when, and what you were doing. Track your activity level. This is another important aspect of self-monitoring. It includes not only how much you exercise but also the extent to which you move around during the day rather than remaining seated or inactive.
Mindful Eating
Practice “mindful” eating. Research shows that individuals with eating problems often don’t pay attention to whether they are really hungry when they eat. Understand the things you associate with food. Behaviors are habitual and learned. Sometimes people may associate certain emotions, experiences or daily activities with particular behaviors. For example, if you typically eat while watching TV your brain has made an association between food and TV. You may not be hungry, but in your mind TV and eating are paired together. So when you watch TV you suddenly feel the urge to eat.
Emotional Awareness
Identify your emotions. It’s important to figure out what is happening emotionally while snacking, overeating, or choosing unhealthy foods. Identify the feeling: is it boredom, stress, or sadness? Patients need to determine if they are really hungry or just responding to an emotion.
Modifying Unhealthy Behaviors
Modify your unhealthy thoughts and behaviors. Reinforcing healthy behaviors is important to achieving your weight management goals. Too often, people have negative thoughts and feelings about changing their health behaviors and see the process as punishment. Some people have an “all or nothing” attitude and think about weight loss in terms of being “on” or “off” a diet. Psychologists work with people to address negative feelings and find ways to reward healthy changes to their eating habits.
The Importance of an Interdisciplinary Approach
Psychological presence in multidisciplinary obesity teams has been highlighted as an important component of such teams. Although mentioned in guidelines and recommendations, there is little information regarding the extent to which this is present currently in weight management services, and in what form. Here, we discuss important ways in which psychological aspects of obesity can impact a person living with obesity and how psychology can be incorporated to provide holistic support in weight management services. There is a bidirectional relationship between psychological factors and obesity, which is reflected in guidelines pertaining to the prevention, assessment and treatment of obesity.
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