The Psychological Approach to Weight Loss Catherine Kissel: Psychologist

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

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

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):923-933. 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

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

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

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”

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