DEALING WITH OBESITY: A Psychotherapist’s Perspective
From where I sit there is more right with you, than wrong with you. So how does this apply to Obesity?
For starters let’s define obesity. We define obesity using the BMI (Body Mass Index), your weight in kilograms divided by the square of your height in meters. A BMI of 30.0 or higher falls within the obese range.
By 2025, worldobesity.org estimates that 2,7 billion adults worldwide will suffer from obesity, and untreated obesity will contribute to a significant proportion of ailments including heart disease, diabetes, liver disease and many types of cancer.
So, what are the psychological factors that underpin obesity?
Obesity is as much a psychological as a physical problem, and the causes for obesity lie in some combination of environmental, psychosocial and biological attitudes. Individuals with psychological disorders such as depression, anxiety and inappropriate eating might often use food as a coping mechanism to deal with feelings like sadness, anxiety, stress, loneliness and frustration. A perpetual cycle of mood disturbance, over eating and weight gain may emerge: the resulting weight gain results in guilt and may in turn reactivate the vicious cycle.
Add to this problematic eating behavior like mindless eating or binge eating, and this may lead to Binge Eating Disorder (BED). Because BED is not associated with compensatory behavior such as purging, fasting or excessive exercise, the majority of people with BED are obese.
Obesity and eating disorders are often treated separately. In my view the co-occurrence of eating disorders, specifically BED and obesity, should be studied and examined more carefully. According to research there are high increases in the prevalence of obesity and comorbid binge eating, and this supports the need for more integrated approaches to both the prevention and treatment of obesity and binge eating.
If one doesn’t examine and assess the occurrence of BED in obese persons seeking treatment they will find it difficult to achieve a healthy BMI. Because of multiple failed attempts to lose weight, obese people are often discouraged and frustrated and may show signs of low self-esteem and learned helplessness.
With the above in mind my perspectives on how to approach BED and the resulting obesity are to:
- Establish the diagnostic criteria of BED in the patient to understand how this contributes to their obesity
- Through a non- judgmental approach employ therapy to assess the feelings that contribute to binges and interpret these with the patient
- Arrange other medical tests as appropriate
- Teach the patient mindfulness to become aware of their feelings: binge eating is about feelings and not food
- Teach patients that food is food and has no good or bad qualities as such. Depriving yourself can cause a backlash and self-destructive behaviors. Mindful eating is an important skill to manage eating behavior.
- Give nutritional advice which can help with controlling moods, by keeping blood sugar levels stable
- Explain the link between binge eating behavior and stress and how important it is to recognize triggers and to learn new ways of coping with stress and anxiety
- Introduce new coping behaviors, that do not involve eating, to deal with stress.
- Explain the role of exercise to manage anxiety and depression
- The main message is that binge eating cannot heal feelings: there is no connection between the heart and the stomach!
Dr. Annelie van Breda PhD works as a Psychologist and uses psychotherapy, hypnotherapy and mindfulness to treat clients with obesity and BED in her practice at the Health Team in Mouille Point. She also does sessions via Skype for out of town patients.