Psychology and Obesity - Essay Example

Full and Number: 15 January (estimated word count 989) A Critical Review of Journal Article on Psychology and Obesity Introduction The on-going increasing trends in obesity of the overall population has now been the concern of most health care practitioners and public health policy regulators. Obesity has now been considered as an epidemic, especially among the younger generations with their changed lifestyles based on fast food menus, lack of adequate physical exercise, and carbonated drinks. Obesity can be considered as a lifestyle disease because of sedentary patterns of daily living, eating, and exercising. This can lead to a host of lifestyle diseases, the most prominent or common being diabetes, followed by heart diseases, and hypertension. This short paper is a critical review on the peer-reviewed journal article related to psychology and psychiatry, entitled as “Psychiatric Disorders and Participation in Pre- and Post-operative Counseling Groups in Bariatric Surgery Patients” by five medical doctors as part of their clinical research on obesity that was originally published on-line in the official journal Obesity Surgery of the International Federation for the Surgery of Obesity (IFSO) dated April 16, 2010. In the study, the authors sought to find out how psychological and behavioral factors can greatly influence the future success of bariatric surgery patients in their sustainable weight loss program after surgery and their related feelings of wellbeing, termed as health-related quality of life (HRQOL). As the authors had noted, bariatric surgery is the preferred treatment for obese patients with a body mass index (BMI) of more than 40, or those with a BMI of more than 35 but with a co-morbid somatic (bodily) condition like diabetes or hypertension. A problem with most bariatric surgery patients is an inability to maintain the initial weight loss. Brief Summary of the Article The article discussed the gap in the medical literature regarding the effects of various psychiatric disorders such as social phobia and avoidant personality disorder on the eventual success of bariatric surgery. These psychiatric disorders manifest themselves in personality or behavior of the surgery patient, and has a big bearing or impact on the lifestyle modifications that are required post-surgery, like eating, dieting and regularly exercising in order to benefit from bariatric surgery. The study authors had identified this gap and sought to address the gap in their research precisely to know how the aforementioned factors influence bariatric patients to participate or not in weight loss counseling, both before and after bariatric surgery. The body mass index (BMI) is an internationally-accepted measurement of the body fat of an adult person, computed by using weight and height because for most people, there is a close correlation between body fat and their body mass index (Centers for Disease Control and Prevention 1); however, there are rare instances when the BMI identified people as fat or obese although it is not the case for them, such as well-trained athletes who have more muscle mass than actual body fat. The BMI is used because it is fast, easy to use, and provides fairly accurate estimate of a persons body fat at a quick glance, although there are other methods to measure body fat and its distribution within the body, such as waist-to-hip measurement ratio, ultrasound (sonography), computed tomography (CT), or magnetic resonance imaging (MRI). The prevalence of obesity today has health care workers concerned, and they now also use the BMI on children and young teens in order to implement interventions early. The ranges for body fat using BMI figures are: 18.5 and below (underweight); 18.5-24.9 (normal); 25-29.9 (overweight); and lastly, 30.0 or above (obese). A BMI of 40 or above is considered as severely or morbidly obese already and requires immediate medical attention as it poses a serious health risk. All participants in the study had a BMI of 35 or more, in order to qualify. Discussion A person should always strive to be healthy by maintaining the ideal weight for his or her age. This can be achieved by eating the right kind of foods, the right amount of vitamins and minerals by having a balanced diet, leading a physically active life, and avoiding the risk factors for obesity, such as eating fatty or fried foods, smoking, drinking or a sedentary life. It can be said that obesity can also be caused by metabolic factors, in which what a person eats is not expended but instead, easily stored as body fat. Further to this, some health experts are of the opinion that metabolic and hormonal factors predispose some people to becoming either overweight or obese (Hu 377), using these factors as predictors of obesity. Along this line, those who believed that metabolism plays a big part in susceptibility of an individual to obesity, whether to weight gain or through weight regain after initial weight loss, think that either dietary factors or lifestyle changes have little impact on obesity, and obesity is due to biological or behavioral factors which favor weight gain. Some research studies had focused on this inherent metabolism or strong biological pressure to regain any of the lost weight, testing theories about resting metabolic rate (RMR), fat oxidation as indicated by the respiratory quotient (RQ) and close correlation of insulin sensitivity to obesity (ibid.). Obesity can also be attributed to behavioral factors, because some obese people tend to eat when they are stressed, worried, terrified, anxious, or under some emotional strain such that eating or overeating provides them some measure of comfort. Health experts term this as “emotional eating” in which people under some emotional stress tend to eat more than they should, and end up gaining weight (Lynn & Lofton 66) while others call it as food insecurity. It is also known that an estimated ten to twenty percent of all obese people suffer from depression, resulting in weight gain (Goldstein 112). No matter what the causes are, even a little weight loss produces big health benefits (Department of Health and Human Services 1). Focus of the Article – the study authors concentrated on how the prevalence of some psychiatric disorders in the patients who were selected and had qualified for bariatric surgery affected the overall outcome or potential success of a permanent weight loss. It must be also stressed that weight loss is best achieved in a multi-modal approach, and the importance of the pre-operation counseling sessions are crucial to the attainment of the surgery objectives. It tells and advices the patients who will undergo the surgery what they can expect and what the results will be, due in large part on their cooperation to participate in such group sessions. As the preceding paragraphs had discussed, obesity and binge eating disorders can be emotional in cause or etiology, other than purely physiological factors. This means behavioral approach is equally important for these bariatric patients to understand how they can help themselves. The study authors focused their research by limiting participants only to those whose BMI were 40 or over, and those whose BMI were 35 only but had somatic comorbidities; the rest of possible recruits did not qualify for general criteria for bariatric surgery, due to severe psychopathology, such as psychotic disorder, severe eating disorder, suicidal behavior, severe mood disorder, severe substance abuse or severe cognitive dysfunction. In other words, those who had severe cases of psychiatric disorders were intentionally excluded because these are people who may not be so receptive to advice, suggestions, and counseling; these people have fixed patterns of thought and rigid behaviors, hence they have less ability to make necessary lifestyle changes after their surgery (Lier, Biringer, Stubhaug, Eriksen & Tangen 732). Accepted for participation were only those morbidly obese and overweight people with serious somatic comorbid conditions. Specifically, all the participants were those found to have the milder forms of psychiatric disorders only, either social phobia (or social anxiety disorder, characterized by excessive self-consciousness, shyness, or nervousness), avoidant personality disorder, and dysthymic disorder or known as chronic depression (ibid. 735). Theoretical Coherence – the study authors had hypothesized the relationship among obese people with their psychological and psychiatric conditions as either contributory to their obesity or eventually helpful in letting them maintain their weight loss after bariatric surgery. This has some theoretical basis because as previously discussed, obesity and eating disorders are sometimes, or more often than not, caused by emotional stress and psychosocial distress of whatever nature, as the study authors themselves had pointed out in the journal article (ibid. 730); additionally, the right frame of mind is necessary to effect changes in lifestyles to make the weight loss more permanent over the long term after surgery, such as ability to assimilate coping skills, proper monitoring of lifestyle-change strategies, and having healthy habits. Logical Structure – the article followed the recommended format for a scholarly and peer-reviewed journal article, hence it has logical structure in the way it was written and also as presented. The study aims, methods (assessment of recruits, sampling, data interpretation), the gathering and presentation of the data, discussion of the initial results, as well as results or conclusions were all in accordance with generally accepted guidelines for journal writing. The authors had likewise taken the extra effort of making a proper ethical claim, regarding the use of humans as live subjects in their study by getting proper written informed consent. Relevance to Clinical Practice – the study results are highly relevant to any actual clinical practice because bariatric patients should be studied on why some of them end up with regaining the lost weight after their surgery. Considering that bariatric surgery is a major, life-threatening invasive surgery and also a big financial expense, then it is only correct that a thorough study of why such patients regain weight should be given importance and priority so their surgery is not put to waste or end up being useless. Bariatric surgery is often highly recommended as a last-resort measure to control obesity, especially in morbid cases, but this can be for nothing if people end up being overweight again due to psychiatric disorders. Recommendations for Possible Improvement – one probable improvement for further consideration by the authors is to totally segregate the participants by gender. This means that the two groups of participants (both the reference group without intervention and the control or intervention group with the counseling sessions) should contain either of one gender only. This is because co-mingling the sexes confounds the results somewhat, due to the higher or more prevalence of depression among females than males (Carey 1) with the expected results of such a better refined study more specific as to the causes of weight regain. According to noted psychologist Susan Nolen-Hoeksema, who died recently aged 53 due to complications from heart surgery, women are twice as prone to depression than men, and hence obesity. Another possible improvement is to conduct a study using subjects who have none of the psychiatric disorders, and see if they are still willing participate with counseling sessions. This will determine how the group in the present study can compare with this new group and could probably give new insights into what really works best with bariatric patients. Another option is to improve the sampling method using random sampling to preclude any of so-called “voluntary response bias” as majority of the sample population joined due to referrals. Conclusion The same group of medical doctors did another follow up study almost a year after this initial study. What they found out essentially confirmed their hypothesis on relationships between the HRQOL of patients who had preoperative counseling, those who had counseling after surgery, and also a group of patients without any of the psychiatric disorders associated with the earlier experiment. More significantly, they found out those who had the psychiatric disorders before surgery but whose disorders were resolved after surgery, had a much higher level of HRQOL almost comparable to the general population (Lier, Biringer, Hove, Stubhaug & Tangen 79). This shows how attitude contributes to the success of any bariatric surgery. Works Cited Carey, Benedict. “Susan Nolen-Hoeksema, Psychologist who Studied Depression in Women, Dies at 53.” New York Times. 13 Jan. 2013. Web. 15 Jan. 2013. . Centers for Disease Control and Prevention (CDC). “Overweight and Obesity.” National Center for Chronic Disease Prevention and Health Promotion. 27 Apr. 2012. Web. 13 Jan. 2013. . Department of Health and Human Services. “Assessing Your Weight and Health Risk.” National Institutes of Health. n.d. Web. 14 Jan. 2013. . Goldstein, David J. The Management of Eating Disorders and Obesity. New York, NY, USA: Springer Books, 2005. Print. Hu, Frank B. Obesity Epidemiology. Oxford, UK: Oxford University Press, 2008. Print. Lier, Haldis O., Eva Biringer, Bjarte Stubhaug, Hege R. Eriksen, and Tone Tangen. “Psychiatric Disorders and Participation in Pre- and Post-operative Counseling Groups in Bariatric Surgery Patients.” Obesity Surgery 21 (2011): 730-737. Print. Lier, Haldis O., Eva Biringer, Oddbjorn Hove, Bjarte Stubhaug, and Tone Tangen. “Quality of Life Among Patients Undergoing Bariatric Surgery: Associations with Mental Health – A One-year Follow-up Study of Bariatric Surgery Patients.” Health and Quality of Life Outcomes 9. 26 Sept. 2011. Web. 15 Jan. 2013. . Lynn, Kristi, and Lewis Lofton. Examining the Relationships Among Obesity, Food Insecurity, Perceived Stress, and Emotional Eating. Ann Arbor, MI, USA: Pro Quest Learning Company, 2007. Print. Read More