Presentation on theme: "Psychological Considerations for Obese People with Diabetes Geraldine Abbatiello, PhD, GNP, PMHNP, RN Complex Illness Management."— Presentation transcript:
Psychological Considerations for Obese People with Diabetes Geraldine Abbatiello, PhD, GNP, PMHNP, RN Complex Illness Management
Psychological Aspects of Food and Eating Psychological Aspects of Disease Obesity Diabetes Disordered thinking Psychological Considerations in Treatment Overview
Over one’s lifetime, we grow with food like a beautiful leather glove. Alas, sometimes, with age or lifestyle the glove gets tight or doesn’t fit the needs. A change needs to occur to our relationships. The same is true with food. Let’s look at this. Psychology and Food
Psychological Aspects of Obesity Discussing Weight Control Psychological Considerations in Treatment Challenges Overview
Hunger > Repletion > Satiety > Depletion > Hunger Versus Eating Disorders: Disruption in this process Biological Aspects of Eating versus Psychosocial/Cultural
Nutrition… life preservation Safety, security, comfort Cultural and social role Self-esteem Celebratory role Reward and punishment Coping strategy Food serves a purpose… Correct?
Childhood? Relationship with Mother? Relationships? Education? Job? Friends? Mood?
Feel better > Improve health Increased self-worth > Improve mental health Do more > Improve quality of life What else …? Why are we talking about this?
Attitudes toward Obesity Negative Psychological Social Environmental Employment Medical Positive Psychological Family Cultural Society Financial
You did well You did badly You deserve this You don’t deserve this You feel guilty You need to give this up It’s OK to eat extra sometimes You have large bones… everyone in family is fat Fat is beautiful Thin is in and you’re not Messages over lifetime
Reflected in Mood problems Eating disorders Thought disorders …what and why I am eating Bodily changes…messages about me and food Relationships with others Cause and effect of distorted thinking
Is a complex chronic disease Multifactorial Impressions associated with weight Cute (roly-poly) Pudgy Distracting Disgusting Hopeless Obesity
Biologic Genetic Emotional Social Cultural Obesity is multifactorial
Am I feeling helpless or hopeless about food - Can I change my mind? Does the thought of exercise overwhelm me? - Can I chose one exercise and feel empowered?. Can I see myself healthier looking? Change the way we look at our weight
Measured improvements Modest reductions (5%) Quality of life Self-esteem Higher energy levels Best weight vs Ideal weight Goal of Weight Change
Risk of Depression Increases with Obesity Severity Onyike et al. Am J Epidemiol 2003; 158:1139-47.
Most studies are cross-sectional Longitudinal studies Depression Obesity (adolescents) Obesity Depression (adults) Potential 3 rd variables Medication usage Affect dysregulation/coping deficits The Question of Causation Berkowitz & Fabricatore. Psychiatr Clin N Am 2005; 28:39-54.
There is no evidence to support that obesity is the result of unconscious, unresolved drives or issues, unconscious anger, depression, sexual abuse, or a need for love! Stereotypical Misconceptions
Etiology is multifactorial Many develop dysfunctional behavior as a consequence of their obesity Certain eating and lifestyle issues may not be conducive to a good outcome after surgery Behavioral Health Evaluation
Role models Reinforce a sense of belonging and camaraderie Can see other members’ surgical results; good and/or bad Teleconferencing Bring family/friends Support Groups - Key to Success
Improvement in body image/ less negatively self- conscious Improved energy Improved mobility (can exercise) Better mood and self-esteem; fewer mood swings Increased ability to explore social and vocational activities Psychological & Physical Changes
Thoughts and behaviors about food change Relationship with food will change Relationship with others may change Grieving & Loss
Almost all programs in the US require a mental health consultation pre-op Typical contraindications: active substance abuse, active psychosis, bulimia nervosa, and severe, uncontrolled depression Bariatric Surgery & Psychiatric Assessments
Over the Counter Anti-diabetics Anti-psychotics Anti-convulsants Pharmacologic Uses in Bariatrics
What is this double message Sexy weight loss = Ten percent?
Biological Psychological Environmental Nutritional Evaluation Psychological Assessment Prior to Bariatric Surgery
Crisis of adjustment Ongoing motivation Changes in patterns of thinking Changes in patterns of eating Changes in patterns of socializing Post Bariatric Surgery
Studies show 6 months for attitude changes Body Image Notion of food Socializing over food How long does it take to change?
Mind is very powerful Watch your thoughts Use your resources in own psyche Use your family and friend network as well Community resources Learning new skills for coping Coping with food Coping with being thinner Conclusion of the psychosocial/cultural aspect of weight loss
Summary of Diabesity Goals: Enhance quality of life using interdisciplinary team: Ask, Assess, Advise, Agree, Assist Personal, family, and community changes in food choices and energy expenditure can result in decreased diabetes, comorbid illnesses and improved health ( Shadi Chamany, MD, MPH ) Achieve and maintain healthy eating habits while preserving the pleasure of eating ( Lorena Drago MS, RD, CDN, CDE ) Reduction of diabetes and comorbid illnesses using bariatric surgery as a treatment modality ( Bradley Schwack, MD ) Understanding how the mind, body, and culture interact to effect choices for diabetes management in obese patients ( Geraldine Abbatiello, PhD, NP )