You want to shed that weight, knowing it is harming you, but somehow don’t have the will to overcome your faulty lifestyle patterns and slip back deeper into them because they are comforting. Besides, the world doesn’t appreciate you for even the tiny effort you make. Sounds familiar. That’s because the fight against obesity cannot be successful unless it begins in the mind.
Global studies have shown that obesity is directly associated with a significant psychosocial burden. The obese struggle with issues related to their mood, self-esteem, quality of life and body image. Often the pressure of societal disdain for the overweight and even the sneers they get for not meeting their goals soon enough push patients over the edge. This emotional distress plays an important role in poor outcomes in treatment. That’s why obesity treatment is becoming multi-disciplinary with mental health experts being included in therapy protocols.
First, why is obesity a cause of concern, especially among Indians, and why does it need to be attended to immediately?
Obesity raises the risk of a number of serious and potentially life-threatening illnesses, including diabetes, heart disease, and some malignancies. This is due to a complex interplay of hormonal and inflammatory responses. “Obesity is strongly linked to various chronic conditions, including heart disease, Type 2 Diabetes, high blood pressure, stroke, certain types of cancer and respiratory problems. These conditions can significantly reduce the quality and length of life,” says Dr Sharad Sharma, Consultant, Robotic, Laparoscopic GI and Bariatric surgeon, Fortis Hiranandani Hospital, Mumbai.
What mental health conditions are linked to obesity?
The “obesity epidemic” and the need to follow stringent diets widen the two polarities to such an extent that there is an increased chance of having an eating problem. Indeed, some experts feel that diets for weight loss may carry more risks than benefits because the intended results take a longer time and the mind cannot process this delay. Which is why patients give up halfway and develop anxieties, self-esteem and body confidence issues. “People with bigger bodies are more likely to be stigmatised and experience bullying. It is unclear why persons with bigger bodies are more prone to suffering anxiety. One possibility is that their anxiousness is caused by weight discrimination. Then there are secondary problems like sleep apnea, which is common among patients with neuropsychiatric symptoms,” says Dr Santosh Bangar, Senior Consultant- Psychiatrist, Global Hospitals, Mumbai.
Reduced physical activity levels can lead to feelings of lethargy and a sedentary lifestyle, which may be associated with laziness. “These factors can impact overall mental well-being and quality of life. Obesity can hinder all aspects of healthy living, and in turn limit participation in activities, affecting relationships and decreasing overall satisfaction with life,” says Dr Sharma.
He also warns about atypical anorexia, which occurs when a person with anorexia is not considered underweight and is frequently misdiagnosed. “Anorexia carries a significant risk of metabolic imbalance, depression, anxiety and suicide. Parents’ lack of knowledge and awareness about obesity leads to an inability to guide their children and may sometimes lead to increased mental anxiety in both,” he says.
Dr Aparna Govil Bhasker, Consultant Bariatric and Laparoscopic Surgeon, Saifee Hospital, argues for a behavioural change within the family and their participation in battling child obesity. “Children with obesity tend to suffer from neglect and are poorly treated within family structures. Together, this can lead to increased stress, which further aggravates emotional eating behaviour, poor sleep and fatigue, in turn leading to more weight gain,” she says.
Should a weight loss regime involve a psychiatrist for better outcomes?
Studies have shown that some individuals who lose weight experience a return of pre-existing psychopathology or the development of new psychosocial issues. Those who experience weight regain, regardless of the approach to weight loss, also remain at risk for the return of unwanted psychological symptoms. That’s why Dr Bangar argues for a holistic approach to obesity treatment. In such a line of treatment, a typical team includes a nutritionist, endocrinologist, behavioural counsellor and a psychiatrist. “Cognitive Behavioural Therapy (CBT) is the cornerstone of psychological issues of obesity and its emotional effects. A psychiatrist may be required for dealing with co-morbid issues like clinical depression, body dysmorphic disorder or other anxiety disorders,” says Dr Bangar.
Why is intensive behavioural therapy recommended for obesity?
According to Johns Hopkins Medicine, intensive behavioural therapy is very goal-oriented and helps obese patients get through the stubborn phase of dropping their weight for other therapies to take effect. Its intervention protocol says, “It targets poor habits that lead to obesity. These may include unhealthy eating and not exercising. The treatment uses interventions to fix these poor habits. You will work closely with a therapist. This could be done one-on-one or in a group session. You will learn how to change your lifestyle to lose weight. Specifically, you may learn how to:
- Track your eating
- Change your environment to avoid overeating
- Increase your activity level
- Create an exercise plan
- Set realistic goals
- By making these changes, you may be able to lose a lot of weight. You are also likely to keep the pounds off. Some parts of behavioural therapy are often the same as those in other weight-loss programmes. These include self-help groups.”