Nowadays, our society is becoming increasingly aware of the distorted message we often receive about weight and body image in the media. Regarding aesthetic demands, it is increasingly common to hear dissenting voices; many well-known faces in the fashion industry renounce post-photographic touch-ups, pose without makeup, denounce health-toxic environments that promote eating disorders, or openly defend a body symmetry different from the norm as a way to make the problem visible.
At a social level, the influence of prevailing aesthetic models in each era is undeniable, which, more or less directly, have contributed to the development of irrational or over-demanding beliefs about weight, neurotic beliefs about the body, which, at their most dramatic extreme, have facilitated the pathological transition of potentially vulnerable individuals to the development of eating disorders.
It is important to note that obesity is a complex state involving the influence of genetic, physiological, behavioral, and environmental factors that vary among individuals (American Psychiatric Association, 2013). Due to this complexity, we cannot state that there are personality traits that determine obesity today, although important aspects have been indicated, such as the predisposition of obese individuals with high neuroticism and low conscientiousness (Type A personality) to experience a high probability of going through cycles of weight loss and gain throughout their lives.
Indeed, the trait of impulsivity is considered the strongest predictor of overweight, a quite logical conclusion since maintaining a healthy weight requires following a balanced diet and a consistent physical activity program, behaviors that involve commitment and moderation, and therefore, difficult for highly impulsive individuals to sustain (Sutin, Ferrucci, Zonderman, & Terracciano, 2011).
Psychological Consequences of Obesity
Obesity has undeniable medical consequences (heart disease, high blood pressure, diabetes, increased cholesterol, kidney disease, arthritis, chronic fatigue, asthma, sleep apnea, and even certain types of cancer), social consequences (stereotypes, prejudice, and unfair treatment towards individuals due to their excess weight or obesity), and psychological consequences such as depression and anxiety. In this sense, it is associated with an increase in negative affects, which is reflected in emotions such as distress, anger, disgust, fear, and shame (Pasco, Williams, Jacka, Brennan, & Berk, 2013). And this is where emotional regulation comes into play, as we know that both important life events and daily problems can trigger negative emotions, leading to emotional eating (May, 2011). This eating would be explained as a learned regulation mechanism to cope with states of boredom, frustration, or anxiety.
This dysfunctional regulation behavior is associated with the reward circuit produced by the dopaminergic system that would be activated when eating, creating a cycle that perpetuates the problem. Unfortunately, resorting to this mechanism can degenerate into serious problems such as “binge eating disorder” (DSM-V), manifested by immediate and uncontrollable desires to ingest food, generally high in caloric content and at high speed, thereby reducing the onset of satiety and resulting in feelings of guilt after the episode. If, in addition, one is involved in constant diets, long-term cycles of weight loss-regain will occur, which can lead the obese individual to the development of psychopathologies (Moral de la Rubia, 2002).
The psychological consequences of obesity produce in potential individuals the development of a negative body image, with continuous stress, shyness, and discomfort in social relationships; an overvaluation of the importance of physical appearance and a negative self-assessment that can lead to direct consequences on self-esteem (Rosen 1996). In view of the above, the most successful approach will necessarily be multidisciplinary, where the identification and treatment of psychological characteristics will be as fundamental as the other etiopathogenic factors, whether these are at the genesis of obesity, are a consequence of it, or are simply present simultaneously.
Psychotherapy for Patients in a Weight Loss Program
Here are the basic recommendations from the American Psychological Association (APA), important aspects that we should observe in consultation when a patient is starting a weight loss program:
– As a first step, it is crucial to become aware of what we eat and how we eat; monitor eating habits through self-recording, including time and estimated quantities; record feelings and thoughts and ask questions after the episode about mood, or if the behavior was contingent on a stressful episode.
It is necessary to remember that stressed people lose sleep, exercise less, and drink more alcohol, which contributes to weight gain (Harvard Health Publications, 2012; Sinha & Jastreboff, 2013).
– Make small portions of meals and more frequent intakes, this will make the weight loss process less traumatic; soon it is discovered that small portions are just as satisfying as large ones.
– Although obesity treatment sometimes leads to a decrease in previously experienced feelings of depression, weight loss is never successful if the same level of stress or negative feelings prior to slimming is still present, so it is necessary to work on these aspects before starting the weight loss program.
– Losing weight is easier with the support of family and friends. It can be a good idea to try to promote healthier eating options at home and among friends; minimal habit changes can produce great results.
– Getting support from a friend or colleague who is also on a weight loss program to help when tempted to abandon the new lifestyle is a good resource, but it is important to ensure it doesn’t turn into a competition to see who loses more weight.
– Don’t obsess over “bad days” or blame yourself for losing control. It is necessary to observe the thoughts and feelings of that day that caused excessive intake, and ask how they could be managed in another way that does not involve dietary uncontrolled eating. A properly qualified psychology professional within a multidisciplinary approach can be crucial in helping to formulate an action plan to emotionally manage these episodes and achieve long-term success.