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Psychological Considerations for Obese People with Diabetes Geraldine Abbatiello, PhD, GNP, PMHNP, RN Complex Illness Management.

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Presentation on theme: "Psychological Considerations for Obese People with Diabetes Geraldine Abbatiello, PhD, GNP, PMHNP, RN Complex Illness Management."— Presentation transcript:

1 Psychological Considerations for Obese People with Diabetes Geraldine Abbatiello, PhD, GNP, PMHNP, RN Complex Illness Management

2  Psychological Aspects of Food and Eating  Psychological Aspects of Disease  Obesity  Diabetes  Disordered thinking  Psychological Considerations in Treatment Overview

3 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

4  Psychological Aspects of Obesity  Discussing Weight Control  Psychological Considerations in Treatment  Challenges Overview

5 Hunger > Repletion > Satiety > Depletion > Hunger Versus Eating Disorders: Disruption in this process Biological Aspects of Eating versus Psychosocial/Cultural

6  Nutrition… life preservation  Safety, security, comfort  Cultural and social role  Self-esteem  Celebratory role  Reward and punishment  Coping strategy Food serves a purpose… Correct?

7 Childhood? Relationship with Mother? Relationships? Education? Job? Friends? Mood?

8  Feel better > Improve health  Increased self-worth > Improve mental health  Do more > Improve quality of life  What else …? Why are we talking about this?

9 Attitudes toward Obesity Negative  Psychological  Social  Environmental  Employment  Medical Positive  Psychological  Family  Cultural  Society  Financial

10 Explicit & Implicit Attitudes Characteristics:  Noncompliant  Emotionally limited  Lazy  Dishonest  Sloppy  Unpleasant – Ugly Psychological attitudes:  Low self-esteem  Poor self-worth  Limited coping skills  Mood changes  Anxiety  Depression  OCD  Victim cycle 1.Klein et al. J Fam Pract 1982; 14: Foster et al. Obes Res 2003; 11:

11  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

12 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

13  Is a complex chronic disease  Multifactorial  Impressions associated with weight  Cute (roly-poly)  Pudgy  Distracting  Disgusting  Hopeless Obesity

14  Biologic  Genetic  Emotional  Social  Cultural Obesity is multifactorial

15  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

16  Ask (permission)  Assess (causes)  Advise (risks vs benefits)  Agree (goal & plan)  Assist (reframe, remotivate, resources, reeducate)  2012 Canadian obesity network 5A's Obesity Management

17  Measured improvements  Modest reductions (5%)  Quality of life  Self-esteem  Higher energy levels  Best weight vs Ideal weight Goal of Weight Change

18 Risk of Depression Increases with Obesity Severity Onyike et al. Am J Epidemiol 2003; 158:

19  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.

20  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

21 Psychological Evaluation  Identify eating triggers  Recognize potential conflicts about weight  Somatization  Low self-esteem  Anxiety  Depression  Obsessions/compulsions  Psychoses  Paranoid ideation

22  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

23  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

24  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

25  Thoughts and behaviors about food change  Relationship with food will change  Relationship with others may change Grieving & Loss

26  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

27  Over the Counter  Anti-diabetics  Anti-psychotics  Anti-convulsants Pharmacologic Uses in Bariatrics

28

29 29

30  Non-prescription diet pills  Phentermine (Suprenza)  Orlistat (Alli)  Phentermine-topiramate (Qysmia)  Locaserin (Belviq) Drugs

31  Nutritional preparation  Psychological preparation  Smoking cessation  Exercise  Financial considerations Commitment to Change

32 What is this double message  Sexy weight loss = Ten percent?

33  Biological  Psychological  Environmental  Nutritional Evaluation Psychological Assessment Prior to Bariatric Surgery

34  Crisis of adjustment  Ongoing motivation  Changes in patterns of thinking  Changes in patterns of eating  Changes in patterns of socializing Post Bariatric Surgery

35  Studies show 6 months for attitude changes  Body Image  Notion of food  Socializing over food How long does it take to change?

36  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

37 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 )


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