Why it is important to treat obesity

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1. SMD says

   March 30, 2018 at 9:07 am

   I appreciate you covering anti-obesity medications and how to use them, as well as including the fact that people don’t have to lose massive amounts of weight (only 5-10% of current weight) to gain health benefits. There is a big overlap between obesity, a disordered relationship with food and one’s body as well as with eating disorders, including BED, but BN and AN as well. Additionally, in our culture, while something like hypertension is viewed as something you have, obesity is often viewed as something you are, but wouldn’t be if you had more strength of character. Many of our overweight patients have both internalized the body shaming they have received, even from health professionals, including psychiatrists, and have tried multiple times to lose weight and maintain the weight loss. They are often ashamed of their bodies and may just be done with health professionals telling them to lose weight when they’ve already tried so hard for so long.

   How do we address the important medical implications associated with being overweight and the benefits of moderate weight loss while respecting that even mentioning it may be painful to a patient? How can we ensure that we, as psychiatrists, take a thoughtful family and individual food and body relationship history and diet history as well as do a screen for eating disorders (SCOFF Questionnaire is one option) and disordered eating in the patients whose obesity we’d like to treat? Also, if a person has “lived in a larger body”, as it is often referred to now, for much of their lives, despite efforts, often including surgery, to lose weight, how do we know when the psychological cost of the continued effort involved in trying to lose weight is more damaging to quality of life and health than the health and possible mental benefits of continuing to work to lose weight and keep it off?

   If we have a patient who dreams of losing substantial weight, despite being unable to lose or maintain loss in the past, how do we support the psychological health in the wish to be fitter and less at risk of multiple diseases, without inadvertently colluding with a belief they may have that being thin is the only way to be acceptable?
   We have to be sure that we’re not just calculating and treating the BMI, but understanding and addressing if necessary, the beliefs a person has about self, food, exercise and worthiness to exist, maybe even before treating the obesity, and anticipate with them what it will be like if they don’t lose as much weight as they hope. Without this, weight loss efforts, including surgery will be less or even ineffective. A respected dietician colleague of mine frequently says, “The Hate-Weight never stays off.” That is, weight loss motivated by body loathing is less likely to be enduring.
   Asking a patient if they’ve thought about losing weight is an important but very laden can of worms that includes much, much more than calculating a BMI and prescribing a medication.

   Thank you for writing about this important issue of treating obesity. If there is a segment in the works that addresses how to help the patient non-judgmentally accept themselves as they are, while also trying gently, consistently and self-compassionately to create a lifestyle that promotes self-care, food and exercise modifications, and possibly including medication that can lead to greater health perhaps including weight loss, I would be very interested in reading it!

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