1. The Psychological Approach to Weight Loss
Catherine Kissel: Psychologist

2. Mental Health Comorbidities Social Comorbidities
Assessment Prevalence of psychiatric comorbidities Obesity 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
No single factor would suggest that people are less likely to do well with weight loss but is a cluster effect
Depression: primary or secondary and relationship with weight loss
First 12 month vs 2 year

3. 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
Substance use
Exercise avoidance

4. Weight loss can be achieved…..but harder to sustain
Drivers towards weight loss:
Eating patterns & Body Image
Importance & Confidence
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):
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
Eating Patterns/Body Image
Importance/Confidence

5. Interventions and Support The big Picture: towards Persistence
Motivation, engagement and hope
Maladaptive eating: support, information, strategies
Coexisting MH
Anxiety
Trauma
Depression ED
Hope, success
Commitment
Emotional resilience
Low impulsivity

6. Psychological Intervention: Cycle of binge eating
Weight focus and food restriction
Access to or purchase of high calorie food
Stressed, tired, bored, happy
Decision to eat driven by permission giving thoughts
Overeat until feel physically unable to continue
Guilt & shame: cant control eating
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

7. 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”

8. Success: Developing stamina for weight loss success
Persistence
Commitment, emotional resilience, low impulsivity
Problem solving
Enhanced success
Support
Resources