Progressively acknowledged as a multifactorial illness, weight problems needs a method that includes several health care experts. For psychologist Andréa Levy, coordinator and creator of the nongovernmental organization Obesity Brazil, resolving the patient’s “psychological weight” is crucial.In an interview with Medscape, Levy, who was among the speakers at the International Congress on Weight Problems in 2024, emphasized the significance of incorporating psychological and behavioral elements into treatment, because these factors typically influence eating routines and weight gain.She also highlighted the essential partnership between endocrinologists, nutritional experts, psychiatrists, and psychologists, who must collaborate to provide extensive and reliable care to patients.
How do psychological factors affect the treatment of obesity?Psychological aspects are very important triggers for weight gain. As the degree of weight problems increases, so does the predisposition to mental illness such as stress and anxiety, state of mind conditions, character disorders, and eating conditions. Understanding these aspects is very important because precise psychodiagnosis is important for reliable illness treatment.Without a proper medical diagnosis, the treatment may be incomplete and omit pertinent elements. For example, a person with undiagnosed depression who is beginning treatment for weight loss may feel discouraged and low on energy. She or he might wrongly attribute these signs to the diet or surgery. Similarly, somebody going through bariatric surgical treatment may confuse poor nutrition symptoms with anxiety, leading to insufficient treatment with antidepressants and possible iatrogenic complications.Furthermore, psychiatric therapy and mental follow-up are essential to help the private organize much better and comprehend the treatment and the illness itself. This is particularly important in stigmatized diseases and those based on bias such as weight problems, where understanding and approval are frequently challenging, which impacts treatment adherence.Is the partnership between psychologist and psychiatrist constantly necessary?Often, it is necessary to have the support of both a psychologist and a
psychiatrist. The process typically starts with a great psychodiagnosis. At first, there might
not be a case that needs treatment, but it is necessary to perform this evaluation to eliminate any issues.The follow-up, unlike weekly psychiatric therapy, can be monthly or at an interval agreed on with the client. It is important to assist him or her browse the numerous phases of weight problems treatment. For example, the client may be going through a duration of mourning or separation, or a better moment, such as the beginning of a relationship or the birth of a kid in the family. These minutes impact consuming practices and need to be well managed.Depending on the degree of the pathology, such as depression, severe binge-eating condition, or character conditions, the psychologist operates in conjunction with the psychiatrist.
When we discuss obesity, we are perhaps also talking about a psychiatric population due to the fact that it is an illness that, besides being extremely persistent, includes numerous other elements, such as the look of others, problem with dressing, body discomforts, mobility, and relationships. For that reason, having this disease alone is already a trigger for disorders such as depression.What is the primary proof concerning the mental follow-up of patients with obesity?Several studies have actually examined the relationship between obesity and psychological health. Research suggests that the greater the obesity, the higher the possibility of a positive diagnosis for a psychiatric condition. Additionally, there is evidence of the benefits of
psychological treatment for clients with obesity.A research study released in The Journal of Clinical Endocrinology and Metabolism resolved the effect of cognitive-behavioral treatment (CBT), which helps clients handle objectives and treat maladaptive habits such as binge-eating conditions. CBT has a modest effect on weight reduction, but its integration as part of a lifestyle adjustment magnifies the results of this loss.Recent research study likewise reveals that weight loss through bariatric surgical treatment uses significant mental benefits. In the past, it was thought that this treatment might trigger depression and other extreme psychiatric disorders, but it is now more than shown that weight reduction, when done effectively and without misbehavior or malnutrition, enhances psychological and psychiatric issues.How does psychological follow-up impact the use of medication throughout obesity treatment?Many people who take medications, such as corticosteroids for chronic discomfort or psychiatric medications, might experience weight gain. It is essential to discuss these issues with the psychiatrist due to the fact that if the patient already has a predisposition to weight gain, medication X need to be selected rather of medication Y, or the dose needs to be changed. The psychiatrist requires
to understand weight problems to medicate correctly. Other kinds of medication, such as chemotherapeutics, may
also cause weight gain, often resulting in more abdominal obesity.There is likewise lipedema, a hormone-dependent illness that is different from weight problems. In this disease, the individual puts on weight primarily in the legs and arms. In this case, bariatric surgical treatment may result in weight loss only in particular areas, triggering disproportionality and trouble in comprehending for the client. Therefore, when treating weight problems, it is important to analyze the patient from all angles: psychological, physiologic, and physical, thinking about the diversity of the body,
its functioning, and hormonal reactions.Additionally, although psychologists do not prescribe medications, they frequently discuss their operating to the patient. For example, if a client is taking a glucagon-like peptide 1 analog and experiences initial nausea, they may stop utilizing the treatment since the wrong dose had been started. In this case, the psychologist can explain how the medication works and motivate the client to talk about adjustments with the doctor, preventing premature discontinuation.How has the psychological health follow-up of patients with weight problems evolved over the years?I started working with people with weight problems 25 years earlier, when I myself went through bariatric surgery. At that time, surgeons were used to “resolving”the issue and sending out the individual home. Frequently, the patient did not even return for surgical follow-up since, in theory, the problem was solved.Over time, I believe that cosmetic surgeons learned to talk to the patient, comprehending that there is a whole process that even involves creating a bond with the individual who went through the surgical procedure.
Within this procedure, the value of the psychological health of clients was acknowledged, and how common it is to confuse a degree of malnutrition with a psychological disorder.Even though I am not a nutritionist, I need to know the distinction in between a case of malnutrition and depression. So, it is an entire set of aspects that needs to be worked on like an orchestra. It is not necessary for this work to be performed in
the very same physical space, but dialogue is important.Of course, there are things that the client will only show the psychologist or with the cosmetic surgeon, but there are likewise pieces of information that require to be shared for favorable management. I have actually had patients who hesitated to go back to the nutritionist because they did not slim down. If they are afraid, it is because the professional is directing them incorrectly.What pointers would you give to clinicians regarding the psychological approach to people with obesity?Accessibility is important. When somebody informs me they are dealing with weight problems and depression, I typically ask,”Did you know you have two chronic diseases? “It is necessary to describe these concepts due to the fact that the client may frequently believe they are totally free after an effective diet plan and weight-loss, which is not true since of the high relapse related to obesity. Depression and stress and anxiety follow comparable patterns. If the same individual uses prescription glasses, I engage by stating,”Did you know you have three persistent diseases?”This question typically triggers surprise.” I had not thought about that. “It is essential to use accessible language for the client to comprehend the functioning of the disease. More crucial than selecting a treatment approach is comprehending the pathophysiology of obesity and its psychological impact. This avoids a one-size-fits-all method for all patients.For example, the impact on somebody who established weight problems in youth after suffering physical, moral, or sexual assault will probably be much deeper than on somebody in a healthy family who put on weight after ending up being sedentary. Each life story requires a tailored approach.Sometimes, a client with moderate weight problems(grade 1)might not seem to need particular interventions at first glimpse, but it is important to listen to his/her story. Likewise, patients with extreme weight problems (grades 3 or 4)who withstand surgical treatment are entitled to other treatment choices, and this is perfectly valid. Therefore, it is always important to ask,”Who is this person? What does obesity represent in their story?”Then propose the most appropriate treatment.Levy reported having no pertinent monetary relationships.This story was translated from the Medscape Portuguese edition utilizing a number of editorial tools, consisting of AI, as part of the process. Human editors evaluated
this material before publication. Dealing with weight problems requires an individualized method that incorporates psychology and psychiatry, according to one expert.
