Psychological treatment of obesity

Obesity is an abnormal or excessive accumulation of fat which can be harmful to health.

It is a multifaceted disorder in which genetic, biological, psychological, behavioral, cognitive and socio-environmental factors influence its genesis, course and maintenance.

In this article, I will address the issue of Obesity and its psychological treatment .

Due to the influence of so many factors in this disorder, for the psychological therapy intervention to be successful, several health professionals (doctors, psychologists, nutritionists, among others) have to be approached comprehensively.

He Body mass index (BMI) is an indicator of the relationship between weight and height. This indicator is frequently used to identify levels of overweight and obesity in adults. It is calculated by dividing a person's weight in kilograms by the square of his size in meters (kg / m2).

The parameters indicated by WHO to identify both obesity and overweight are as follows:

• A BMI equal to or greater than 25 determines overweight.
• A BMI equal to or greater than 30 determines obesity.

BMI provides the most useful measure of identification of overweight and obesity in the population. This index can be used interchangeably in both sexes and in adults of all ages. However, it is not a rigorous measure at all because it may not correspond to the same level of thickness in different people.

Thus, in contrast to the different degrees of obesity, more or less prolonged, intensive interventions are used, with a more lifestyle-oriented approach.

Interventions with psychological treatment for obesity first appeared in the 1960s thanks to Ferster, Nurnberger and Levitt (1962) and Stuart (1967 and 1971). In these publications, they proposed the bases to be used in the procedures to deal with the problem of obesity.

Thanks to these pioneering studies, it was possible to reduce dropout rates to 11.4%, in addition to a weight loss greater than that obtained with the treatments already used. Despite the benefits that were found in relation to the other treatments, it was not possible to address the problem in a multifaceted way.

At present, it can be said that considerable progress has been made in the systematization of treatment programs and in the seriousness with which the intervention is performed.

Before proposing to the patient a more aggressive treatment such as pharmacotherapy or bariatric surgery, he should have made at least one or two previous attempts to modify his lifestyle through changes in his eating habits and patterns of physical activity.

When determining treatment, you have to take into account both the preferences and the objections of the patient. This will influence the patient's involvement, an essential factor for the success of the therapy.

It is also important at the time of the treatment approach to assess whether the patient has the Motivation needed To be able to not only begin the treatment, but also to keep it in time with all the efforts that this entails.

If you do not have enough motivation, the treatment will be aimed directly at failure, creating discomfort and frustration in both the patient and the professional.

Patient Evaluation

For the good evaluation of the obese patient, it is necessary to have both an extensive knowledge of the patient's obesity and a detailed analysis of the attributes of the person. To do this, both a medical interview and a physical examination would be conducted with the appropriate evidence.

Physical characteristics

It is important to have at the same time, the possible risk factors that the individual can present such as hypertension, uric acid , Etc. and possible medical complications associated (cardiovascular, metabolic, etc).

Behavioral evaluation

Beyond a detailed analysis of the physical characteristics, it is essential to take into account a behavioral assessment where behavioral factors or possible psychological consequences derived from the increase of the weight in the individual will be evaluated.

This behavioral evaluation is a key piece, since if it is done in full with it, we can get information about how the patient perceives their obesity problem, their personal, psychological and social characteristics, which is the lifestyle Which is taking place at that time, and above all, to emphasize what is your motivation and expectations to start a treatment.

In order to assess the motivation for patient change, we must focus on several aspects, since these will be essential for the treatment to be effective:

1. Evaluate if the patient is aware that he has to lose weight: in case the patient is not convinced that he should lose weight, it can help the conscience to provide him with information obtained in his medical, behavioral and psychological exploration.
2. Evaluate if the present moment is an appropriate time for the patient to lose weight: taking into account both personal, work and / or family factors.
3. Assess if the patient is aware of their confidence to achieve weight reduction.
4. Value characteristic attributes for good motivation for change. Some of these attributes are: desire for weight loss for health reasons, is not currently going through stressful events that may prevent the follow-up and achievement of treatment goals, you are confident that you will achieve the goals, value positively the Benefits that you will get with the change, and finally, family and social support of your social environment.

In the process of change, people often go through several stages of motivation:

• Pre-contemplation
• Contemplation
• Preparation
• Action
• Maintenance

Evaluate motivational stage

In the process of change, the individual usually performs overt and covert activities and activities with the aim of Achieve positive and healthy behavior .

In this aspect, there is a very useful questionnaire to identify the motivational stage of the individual and to obtain information about the patient's use of processes of change for the individual. Control of your weight .

Self-reports and self-reports are also often used to assess the patient's current lifestyle in relation to diet and physical activity.

Assessing why and when abnormal food behaviors (both restrictive and disinhibited) occur in the face of hunger or external factors can be of great help in treatment planning.

There are several questionnaires useful in this regard: WALI or questionnaires such as the Restraint scale by Hernan, Polivy, Pliner, Threlkerd and Munic (1978), among others.

Conducting a global assessment of psychological functioning with the help of questionnaires can help us to know which components we should take into account and which we should not include in the treatment.

Finally, in this evaluation, precise the objectives And expectations that the patient has in relation to weight loss as well as their degree of motivation for change.

Psychological treatments of obesity

The fundamental objective of psychological intervention in obesity is a change in the eating patterns and physical activity of the subject.

Studies have shown that, with the extension of Behavioral treatments (10 weeks to 6 months) or the combination of these with very low calorie diets, weight loss is obtained higher than that obtained only with low calorie diets, in addition to recovering lost weight much faster (Wadden and Stunkard , 1986).

Next, I will describe what are the most effective and most used treatments in obesity.

Behavioral therapy

Thanks to behavioral therapy, the patient obtains a set of principles and techniques to facilitate the change of their lifestyle, enhancing adherence to positive dietary guidelines for weight loss and maintenance, in addition to continued practice of physical activity.

In behavioral therapy, the most commonly used techniques are:

• The self-registers, both of physical activity performed and of eating habits.
• The control of stimuli.
• Nutrition education.
• Contingency management.
• Cognitive restructuring.
• Social support.
• The training in strategies for the management of possible relapses.

Self-reports help the patient to become aware of behavioral patterns and habits in relation to eating, as well as physical activity that is performing and that are maladaptive. As I said before, an awareness of the problem is essential to start and maintain a process of change.

Stimulus control aims to modify the external cues of the patient's environment that precede overeating or sedentary lifestyle (an example of this may be keeping food at home out of sight).

Also a useful technique are behavioral contracts. These are usually carried out weekly and include the activities and objectives to be carried out during the week, as well as the rewards the individual will have if he or she can carry them out. In order to assess whether these objectives have been met, the criteria that must be fulfilled must be clearly specified in these contracts.

The problem solving allows to analyze the problematic areas of the individual related to the ingestion and the physical inactivity. In the treatment of obesity, the steps to follow for learning in resolution would be:

• Definition of the problem related to weight and / or inactivity.
• Generation of alternatives or solutions to this.
• Evaluation of possible solutions or alternatives as well as the selection of the most suitable alternative.
• Implementation of the new chosen behavior.
• Evaluation of results. This technique is vital for the maintenance of lost weight.

With cognitive restructuring, the patient is taught to identify negative thoughts related to their expectations and their perceived self-efficacy in relation to treatment and achievement of goals.

Due to these negative thoughts, there is a feeling of frustration in the individual which leads to permanent defeatism in the process of change. Thanks to cognitive restructuring, these negative thoughts and irrational ideas are previously identified to replace them with more adaptive and effective ones for change.

There are also self-help manuals such as LEARN (lifestyle, exercise, attitudes, relationships, nutrition), by Brownell (2000). This manual helps the patient learn to produce permanent changes in 5 areas of life (lifestyle, exercise, interpersonal relationships, and nutrition)

Cognitive-Behavioral Therapy in Obesity

This type of therapy began to be used as a consequence of the disappointing results obtained with the indicated behavioral treatments for obesity, especially when maintaining weight loss.

The objective of the Cognitive-behavioral therapy In obesity, is primarily to produce weight loss in addition to helping the patient to accept and assess the subtle changes that are achieved in weight, and, finally, to encourage the acquisition and practice of behaviors to maintain this weight loss.

This treatment will be performed individually, always adapting to the patient's personal characteristics.

Cognitive restructuring and behavioral experiments are the most commonly used techniques for working the patient to question the obstacles and barriers to weight maintenance.

Also, with cognitive-behavioral therapy, the intake of healthy foods is enhanced, which will help the patient both to lose weight and maintain this loss.

Although both treatments have proven effective in achieving weight loss, there are still difficulties in maintaining them over time.

Perhaps for this, the emphasis would be on focusing attention on the maintenance of healthy and controlled food intake behaviors, as well as maintaining physical activity at the time of physical activity.

In relation to this last aspect, it is advisable to practice low intensity physical exercise but daily in short sessions of approximately 20 for 2 times a day.

References

1. Andrés, A, Saldaña. , Gomez-Benito, J. (2009). Establishing the stages and processes of change for weight loss by consensus of experts. Obesity. 17 (9). 1717-1723.
2. Beck, A.T., Steer. A and Brown, G.K. (nineteen ninety six). Manual for the Beck Depression Inventory (2nd ed). San Antonio. TX: The Psychological Corporation.
3. Bennet, G.A (198-6). Behavior therapy for obesity: A quantitative review of the effects of selected treatment characteristics on outcome. Behavior Therapy, 17, 554-562.
4. Brownell, K. D (2000). The LEARN program for weight management 2000. Dallas, TX: American Health.
5. Brownell, K.D and Wadden, T.A (1986). Behavior therapy for obesity: Modern approaches and better results. In K.D. Brownell and J.P. Foreyt. Handbook of eating disorders (pp. 180-197). New York: Basic books.
6. Wadden, T.A and Foster G.D (2000). Behavior therapy for obesity. Medical Clinics of North America, 84, 441-461.
7. Stuart, R.B (1971). A three dimensional program for the treatment of obesity. Behavior Research and Therapy. 9, 177-186.
8. Spielberg, C.D, Gorsuch, R.L and Lushene, R.E (1970). STAI: Manual for the state-Trait Anxiety Inventory. Palo Alto, CA: Consulting Psy-Chologists Press.