Why See a Psychologist for Obesity?

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Readers of this blog have no doubt noticed that I tend to highlight research evidence on psychological outcome studies, primarily those testing Cognitive-Behavioural Therapy (CBT), which tends to be very effective for many psychological issues -- often equally and sometimes superior to medication.

Well, I wanted to use this post to address psychology's role in obesity treatment. As most readers know, obesity has become a hot-button issue because the majority of people living in the US and Canada are at least overweight, with significant numbers meeting criteria for obesity (generally defined as a BMI >30). There are various treatment options available for obesity, including diet, medication and even surgery. But how do people know which are effective treatments?

Fortunately, people do not have to be left in the dark on decision-making for treatment options. There are experts in the area who can wade through the vast amounts of research, including outcome studies that examine whether various treatment strategies are effective. In 2007, the Canadian Medical Association published treatment recommendations based on the work of an expert committee. (Side Note: I had the pleasure of working at the same clinic with the lead author of this panel, Dr. David Lau from Calgary).

This expert panel recommended that psychologists be included in the treatment of obesity. Furthermore, they gave comprehensive lifestyle interventions, such as CBT, a grade A rating (this is the highest rating possible in the treatment guidelines).

Why would a psychologist be needed to help treat obesity? An entire book could be written to fully answer this question. But to give you an idea of the association between psychological variables and obesity, I offer the following research findings from recent studies:

(1) According to a recent Canadian study, obesity was associated with the following psychological problems -- depression, mania, panic attacks, social phobia, and agoraphobia without panic disorder. It was also associated with suicidal behaviour.

(2) A similar American study basically replicated most of the findings of the Canadian study.

(3) A recent US study found that 66% of obese patients undergoing bariatric surgery had a lifetime history of a psychological disorder.

Indeed, the link between psychological problems and overeating has been well-demonstrated. If you are someone thinking of making a concerted effort to lose weight, you should consider the advice of health experts and consider consulting a psychologist -- particularly one with experience in health psychology.

Dr. Roger Covin
Montreal Psychologist
www.drcovin.ca

References

Mather et al. (2009). Associations of obesity with psychiatric disorders and suicidal behaviors in
a nationally representative sample. Journal of Psychosomatic Research, 66, 277-285.

Simon et al. (2006). Association Between Obesity and Psychiatric Disorders in the US Adult Population. Archives of General Psychiatry, 63, 824-830.

Kalarkian et al. (2007).Psychiatric Disorders Among Bariatric Surgery Candidates: Relationship to Obesity and Functional Health Status. American Journal of Psychiatry, 164, 328-334.

Lau et al. (2007). 2006 Canadian clinical practice guidelines on the management and prevention of obesity
in adults and children. Canadian Medical Association Journal, 176 (Suppl. 8), Online 1-117
http://www.cmaj.ca/cgi/data/176/8/S1/DC1/1

Back Pain is Overtreated

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A very interesting story by the Associated Press was released today highlighting a disturbing trend in treatment for back pain in the United States. Although the vast majority of acute back pain subsides after 4-6 weeks, Americans are receiving way too many tests (ex: MRI; X-Rays) for back pain, and opting for unproven and unwarranted surgeries. It is estimated that Americans spend up to $86 billion every year on health care costs for back pain.

This pattern of behaviour is quite consistent with other indicators of the quick-fix mentality that has become so prevalent in North America. Pharmacology sales (particularly mental health prescriptions) and surgeries for obesity are on the rise. Advances in modern technology allow for such improvements in health care, but there tend to be at least two problems with some of these approaches.

First, the health care costs are tremendous. Second, they do not always target the problem. There is a widespread assumption that back pain must be due solely to physical tissue damage, obesity is due to genetic and biological problems (or a lack moral character -- ex: laziness) , and mental health problems reflect problems with neurochemistry. Unfortunately, things are more complicated than this, and such uni-theoretical models are often inadequate to explain complex problems.

Thus, I was very happy to see a list of recommendations posted with this story. One of the recommendations listed is that Cognitive-Behavioural Therapy be included as part of treatment. This kind of recommendation, for the inclusion of a psychologist, is now standard practice in pain treatment. Unfortunately, I rarely see mention of this fact when I read about pain in the popular press.

Do Your Brain Yoga -- Research Underscores The Value of Psychological Flexibility

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Is it more important to feel positive emotions or negative emotions? Is is healthier to suppress emotions or express them? What's more important to our mental health - the ability to experience the perceptual details of everyday moments (ex: getting immersed in our experiences) or the ability to stand back from situations to think about things objectively?

I think I can guess some of the more popular answers to these questions. Many people believe that they should always strive to feel positive emotions, and if something is bothering us, we should express it -- not suppress it.

Well, things are not always as they seem and there's a reason why psychologists conduct research -- especially on topics that appear to be based on intuitive wisdom. A recent review article in a major psychology journal inspired this post* on psychological flexibility.

First, let me start with a definition. Psychological Flexibility is somewhat difficult to define, but generally speaking, it can be understood as the ability to adapt your thinking, emotions and behaviour to various situations. When people can change and manipulate these three factors, it can lead to many psychological benefits (ex: reduced stress; fewer depression and anxiety symptoms; improved goal attainment). However, when people get stuck using the same strategies and approaches with each new situation, they are more likely to suffer psychological consequences.

Returning to my questions above, let me show how psychological flexibility works.

First, always striving for positive emotions is an inflexible strategy. There are times when negative emotions are needed and are important. For example, worry sometimes motivates us to work harder or solve a current problem. Expressing anger and frustration to others can be a beneficial communication strategy. Feeling anxiety keeps us alert and prepared to react, which is a useful state of mind in some circumstances.

Similarly, the ability to suppress emotions is often considered unhealthy and to be avoided. There is some truth to this, in that the chronic suppression of emotions has been shown to have negative consequences on physical and emotional well-being. However, sometimes suppressing emotions is useful and necessary.

For example, whenever we date or marry someone, the other person is never perfect. Your spouse probably does one or two things (or more!) that can be irritating. Should we discuss and complain about every little thing that bothers us? Sometimes we have to pick and choose our battles, and learning to suppress our annoyance and frustration over the minor irritations is necessary to maintain relationships. There will always be things about people (life, the world, our jobs,...) that bother us. If we constantly expressed how we felt about every little annoyance, we might risk pushing other people away. However, there are times when we should say something about others' behaviour. Knowing when to do this, and being able to regulate our emotions in the process can be a challenge, and certainly requires mental flexibility.

Finally, what about being immersed in the moment (as preached by mindfulness meditation advocates) or being able to stand back and analyze situations. Well, I'm guessing you can see the pattern by now. A balance between these two states of mind is optimal. Sometimes being fully focused and absorbed in something is practical and useful (ex: thinking about a work project), and sometimes it is not (ex: thinking about a work project while having supper with your family).

There are other aspects to psychological flexibility not discussed here (ex: self-control), which I will post about later. The take home message is that psychological flexibility is an important attribute that is actually predictive of happiness and well-being.

Psychological flexibility is a skill that can be improved with practice. So, we should all do ourselves a favour and practice psychological yoga on a daily basis.

Dr. Roger Covin
Montreal Psychologist
www.drcovin.ca

* Kashdan & Rottenberg (2010). Psychological flexibility as a fundamental aspect of health. Clinical Psych. Rev., 30, 467-480.