Academic journal article American Journal of Psychotherapy

Psychotherapy-Lite: Obesity and the Role of the Mental Health Practitioner

Academic journal article American Journal of Psychotherapy

Psychotherapy-Lite: Obesity and the Role of the Mental Health Practitioner

Article excerpt

Obesity is a chronic medical disorder that is the result of a complex interaction of genetic, environmental, neuro-endocrinological, psychosocial, and behavioral factors. There are treatment algorithms, depending on the severity of obesity, and a multi-component approach, including attention to psychological issues, is recommended regardless of the level of obesity. Cognitive-behavioral therapy is beneficial in assisting with stimulus control, self-monitoring of lifestyle changes, goal-setting, and restructuring negative and self-defeating thoughts, and psychodynamic (insight-oriented) psychotherapy is useful in assisting with conflicts regarding excessive weight, body image, relationship to food and disordered patterns of eating, and dealing with the prejudice and overt discrimination obese patients may experience. Neither therapy is particularly effective alone and either and/or both may need to be continued indefinitely to avoid inevitable weight regain. Psychological intervention before and during the difficult process of dieting, as well as before and after bariatric surgery, is essential for some vulnerable patients. Since psychological factors are neither primarily etiological nor even necessarily predominant in obesity, the mental health professional plays an important, though adjunctive-"psychotherapy-lite" role-in treating obese patients.

INTRODUCTION: DEFINITIONS OF OBESITY

There are various, and even divergent, frameworks for studying obesity. Some people, quite simplistically and incorrectly, continue to view "obe- sity as a drama of temptation versus discipline" (Hirsch, 2003, p. 1). Others, such as those in the National Association for the Advancement of Fat Acceptance (NAAFA), claim that obesity is merely an example of body diversity, analogous to racial or sexual diversity, which should be cele- brated rather than pathologized (Saguy & Riley, 2005). Still others focus on the huge contribution of our environment so that obesity is seen as "inadequate adaptation" to our sophisticated twenty-first-century world, which provides fewer opportunities for physical activity and enormous varieties of enticing food choices (Power & Schulkin, p. 11, 2009).

Most researchers and clinicians in the field, however, believe that obesity is a chronic medical disorder that results from complex interac- tions of genetic, environmental, neuro-endocrinological, psychosocial, and behavioral factors (Levin, 2004). Even early on, obesity was not seen as a "single disease with a single etiology" (Stunkard, 1959, p. 293), but rather "the end stage of a variety of different conditions with different etiologies" (p. 294). Most who study obesity also assert that the overwhelming majority of obese people will develop serious physical and psychological morbidity, including metabolic disorders such as diabetes, dyslipidemias, and hypertension, cardiovascular disease, certain cancers, sleep apnea, osteoarthritis, gall bladder disease, and even psychiatric symptoms, such as depression and anxiety (see Karasu & Karasu, 2010, pp. 30-39). Kreier (2010, p. 214) has called obesity "the most urgent unsolved medical problem, with the threat of a decreased life expectancy rate for the first time in medical history." The more severe the obesity, the more likely there will be morbidity and mortality.

Simply defined, obesity is an accumulation of excess adipose (fat) tissue due either to increased consumption and/or decreased expenditure of energy. In other words, it is an energy imbalance that is a function of the First Law of Thermodynamics: when we take in more calories (i.e., food) than we use, those extra calories are converted to fat (Bray, 2004). Obesity is defined somewhat arbitrarily as a "threshold" (Friedman, 2003, p. 856) based on body mass index (BMI), i.e., our weight in kilograms divided by our height in meters squared. With the classifications now in standard practice, clinicians and researchers define obesity as a BMI of 30 kg/m2 or greater (with further Class I, II, III, and IV subdivisions as BMI increases) and those who are overweight as a BMI of 25 kg/m2 to 29. …

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