Psychological Factors that Affect Obesity - Essay Example

OUTLINE ESSAY Thesis: A study on the psychological factors that affect obesity Part One Introduction ment of the problem 2. Definition of terms 3. Theoretical Framework 4. Methodology – type of research 5. Hypothesis 6. Review of literature 7. scope and limitation 8. Significance of the study Part two Presentation and analysis Part three. Concluding statement ESSAY Your name Professor’s name English September 18, 2012 Are psychological factors to be blamed for obesity? There are lot of talks that link obesity to health problems and that Americans are getting heavier and heavier. Obesity is also observed by the World Health Organization as becoming doubly larger. The Media Center of WHO reports that in 2008, more than 1.4 billion adults, aged between 20 and older are overweight. Out of these, 200 million are men and 300 million are women. Furthermore, these people live in countries where obesity kills more people than underweight. It is also reported that children under age of five are overweight. According to WHO, “obesity and overweight are leading risks for global death”. It is estimated that about 2.8 million adults die because of being overweight and obese. Health related problems attributable to obesity and overweight are heart disease, diabetes, and certain cancer. Interestingly, obesity is high among Hispanics and black neighborhood. Due to these incidences, obesity has been a big concern worldwide. Fortunately, there is hope, because WHO reports obesity is preventable. Becoming obese is not a miracle, it just can’t happen overnight. Aside from the imbalance of energy intake, and energy we burn over time, are there other factors that contribute to obesity? Could psychological problems be the root cause of this problem? Obesity has been defined in the medical dictionary as the state of being well above one’s normal weight. Accordingly, a person is obese if he/she is 20 percent of his/her ideal weight. An ideal weight takes into account the person’s height, age, sex and built. The National Institute of Health defines a person as obese when he/she has a BMI of 30 and above. It is further defined by WHO as an abnormal and excessive fat accumulation that may impair health. A BMI or Body mass index is defined as a person’s weight in kilograms divided by the square of his height in meters (kg/m2). Psychological factors are described as eating disorders, anxiety and depression. Authoritative Studies are used as basis in understanding psychological factors and behaviors leading to obesity. Studies are analyzed and condensed to form a conclusion. Qualitative research and works on a literature review process of journal articles and web pages are used as sources in this essay. The literature review process imports articles, reports, explores and critiques each source. Qualitative research is about exploring issues, understanding phenomena and answering questions. Qualitative research involves the analysis of any unstructured data, literature reviews , survey responses and web pages. It is theorized that psychological problems could be the root cause of obesity. Studies along this reasoning are provided by Collins, Jennifer and Bentz, John, and other authors, wherein they reasoned out that obesity is caused by a combination of psychological factors, environment, and biological attributes. They say that psychological disorders are often found to be depression, anxiety and eating disorders. People suffering from psychological disorders, find it difficult to control consumption of food, fail to exercise regularly, and to maintain a healthy weight. A person with psychological problems turns to food as a getby mechanism. The study says that the satisfaction these persons get from eating is only temporary, but result is weight gain which may lead to “dysphoric mood”. A person with “dysphoric mood” is in a state of unhappiness. His/her condition is generally negative, irritable, and sad, and restless; but this emotion is only temporary and may vary from each person. Causes vary as well, and the mood maybe a response to the stressful environment, WiseGeek explains. Aside from depression and anxiety, Collins and Bentz pointed out problematic eating behavior such as “mindless eating”. Termed as Binge eating disorder (BED), this includes frequent snacking on high caloric foods. BED is defined as repeated events of eating quantities of food larger than most people would eat at the same period of time; a sense of lack of control during the episodes; and guilt or distress following the episodes. BED is estimated to occur in approximately 2% of the general population and between 10% and 25% of the bariatric population. Bariatric is a term associated with the branch of medicine that deals with causes, treatment, and prevention of obesity. Eric Stice, Katherine Presnell, Heather Shaw, and Rhode Paul tested in their study, whether certain psychological and behavioral variables could predict obesity. Experimenting with 496 girls, authors found out that “self-reported dietary restraint, radical weight control behaviors, depressive symptoms and perceived parental obesity are common causes. It is contrary to the belief that high food fat consumption, binge eating or not exercising frequently cause obesity. Study suggests that it is important to educate youth about effective weight control strategies, and that reduction in caloric over consumption and increase in exercise would result in decrease of obesity risk. Factors outlined in the Media Centre Report of the World Health Organization lead to the changes in the dietary and physical activity as a result of environmental and societal changes. Societal changes are those associated with “development and lack of supportive policies in sectors such as health, agriculture, transport, urban planning, environment, food processing, distribution, marketing and education”. Dietary changes are seen as the increased in-take of energy-dense foods that are high in fat, salt and sugars but low in vitamins, minerals and other micronutrients; a decrease in physical activity due to the increasingly sedentary nature of many forms of work, changing modes of transportation, and increasing urbanization. Jom Pennings (2001), a physician by profession and a Program Director of the Surgical Bariatrics Northwest, points to behavior, environment and genetic factors as factors that could affect obesity. Pennings claimed that obesity is a result of energy imbalance. It is an effect of eating too much and not getting enough physical activity; it is a result of genes, metabolism, behavior, environment, culture and socioeconomic status. Environment appears to be the prominent source of obesity. Environment causes could be toxic, or other grounds that could be present anywhere. Collins and Bentz refers to “toxic environment” as “calorically dense food” which is readily available in stores, groceries and supermarkets. It is called toxic because it decays healthy lifestyle and encourages obesity. Due to this scenario, environment plays a bigger role in the risk of being obese of an individual, In the study done by the Harvard School of Public Health, the surroundings influence what one eats. Accordingly, study said that choices of food are shaped by the world one lives in. For example, it is influenced by the kind of food parents take home for the children or by location: how far one lives from fast foods and restaurants, and even by the way of government policies in food administration. Environment also becomes a barrier to healthy eating, particularly to low income families, less educated, and to those with difficulty in language because health campaigns fail to reach them. Food environment requires a setting, and these are family setting, food barrier setting workplace and school, HSPH explained. Family greatly influences the eating habit of children. HSPH argued that taste preferences of children are developed at home and this attitude is carried up to adulthood. The food shared by families at home influences how much they eat. Food barrier. Eating healthy food becomes a barrier to low income groups because healthy foods, such as fruits and vegetables are more expensive. HSPH further countered another reasoning saying that it is more convenient for working mothers to buy from fast foods and convenience stores. Working mothers lack time to cook at home due to time pressure. HSPH theorized that the reason why there is a great deal of obesity among Hispanics and black community is due to the presence of convenience stores near schools, aside from being in the low income category. Most often they substitute expensive high caloric food to the low priced less nutritious food due to lack of knowledge of its caloric values. Workplace is also a part of the environment. Offered as reasoning by HSPH, worksites often offer quick meals in vending machines and very few choices of healthy foods. Worksite is also a source of fatigue and physical inactivity because of time devoted to work. School environment. Millions of children go to school everyday. Most of them eat breakfast, lunch, and snacks in the school cafeteria. It is supposed to be an administered food program in school, but school also sells competitive food. HSPH study shows that in 2004-2005, 40 percent of all U.S. students ate competitive foods known as junk foods that are available in vending machines, cafeteria and stores of the school. In addition, schools have a ready supply of sugar-sweetened beverages. HSPS further claimed food marketing as another consequence for obesity. Food and beverage companies spent millions in advertising and marketing promotions to invite school children to buy their food products. It is observed that many of these companies apply poor nutrition standards. Another thing that could be linked to changes in food preferences are government policies and economics. According to HSPS, change in the price supply of food has an effect on food consumption. For example, in a study done among 5,000 young adults for a period of 20 years, it was found out that lower price of soda and pizza led to high consumption and increase of weight (HSPS). Baronowski, et. al used different theories and models to understand behavioral factors that cause obesity. The study did not mention any of psychological factors that would affect obesity. It focused on interventions that would cause behavioral change. For example, authors explained the Knowledge-Attitude behavior model (KAB), wherein the lack of knowledge of food consumption of certain food consumption is related to specific health outcomes. Next is the Behavioral learning theory, wherein behaviors are performed in response to a stimuli. Authors explained the modern version of KAB which refers to cost-benefit. Study relied on secondary data, and did not perform any experiments or interviews as it deemed not necessary for the essay. Study will contribute to the existing body of literature about obesity. It sets the framework and nulls the belief that psychological factors are the root cause of obesity and overweight. As gathered from the related studies of different authors, psychological factors are not purely the root cause of obesity. Psychological factors are only mentioned in one study, wherein it is only one attribute to obesity, and the others coming from the environment and biological attributes. Environment has been found to be a major cause of obesity, as environment includes different settings, namely, family settings, workplace, schools and neighborhood. Blaming obesity of minority children on proximity of convenience stores to schools is debatable, because like the whites, they are exposed to same environment. Substitutes to low caloric food may be acceptable description for the lower income groups because it is priced lower. A person who does not know caloric values will switch to low-price food with fewer nutrients, which is reasonable. Family settings is considered a contributory factor because families, who eat a large share of food every meal time and consider eating very often, would most likely pass this habit to their children who will carry this eating habit in their lifetime. Marketing tactics of companies are carried in schools wherein they use various food campaigns to attract children; sometimes it offers large portion servings, eat all you can promo, or other merchandising activities. Perception that obesity is caused by genetic and biological factors is unfounded although it is mentioned in one study as causes. Study of Barowski, et. al agrees that biological, environmental and behavioral variables influence the act of eating. Authors concur with the energy imbalance situation, wherein “physiological and metabolic abnormalities” of energy consumption result to obesity cases, mostly because of inactivity. Accordingly, authors identified in the study that metabolic factors are found to be associated with dietary behaviors, like it is positively associated with soft drink consumption, and inversely, associated with eating breakfast, eating fruits and vegetables. It might go after behavior because behavior is also influenced by environment. Socio-economic status, for one, changes behavior in eating. When income increases, the family has more money to buy rich foods. Behavior also changes and responds to stimuli. Sedentary activities and less physical activity is the result of change. People lack physical activity because they prefer to watch TV, devote a lot of time in computers, and a lot more of sedentary activities that contribute to lack of exercise. Psychological factors such as anxiety, depression and eating disorders could be considered as behavioral patterns of obesity, because anxiety and depressions are linked to emotions and people with these behavior turn to food for comfort such as binge eating. Satisfaction they get from binge eating is only temporary, because afterwards they feel guilt as they gain added pounds. Based on the above analysis, we can now safely assume that obesity is not caused by psychological factors alone. There is a lot of host factors contributory to obesity. Understanding these factors would lead to policies and regulations that reduce the risk of weight problems. Work cited Eric Stice, Katherine Presnell, Heather, Shaw and Rhode Paul. “Psychological and risk factors for obesity onset in Adolescent Girls: A Prospective Study.” Journal of Counselling and Clinical Psychology, 2005, Vol. 73, no. 2, 195-202. Collins, Jenniferand Bentz. John E. “Behavioral and Psychological Factors in Obesity.” The Journal of Lancaster General Hospital, Winter 2009, Vol. 4 N of 4 Tom Baronowski, Karen W. Cullen, Theresa Nicklas, Deborah Thompson and Janice Baranowski. “Are Current Health Behavioral Change Models Helpful in Guiding Prevention of Weight Gain Efforts?” Obesity Research, 2003 11, 23s-43s, doi: 10.1038/oby. 2003.222 “Obesity and overweight”. Media Centre. World Health Organization. May 2012. Web. Jennings, J.L. “Factors contributing to obesity” 2000. Krem.com. NW Medical Guide. Web. wiseGeek. “What is a Dysphoric Mood?”. 19 September, 2012. Web Harvard School of Public Health. “The Obesity Prevention Source.” 19 September, 2012. web. ANNOTATED BIBLIOGRAPHY 1. Eric Stice, Katherine Presnell, Heather Shaw and Rhode Paul. Psychological and risk factors for obesity onset in Adolescent Girls: A Prospective Study. Journal of Counselling and Clinical Psychology, 2005, Vol. 73, no. 2, 195-202. Authors tested whether certain psychological and behavioral variables could predict obesity. Experimenting with 496 girls, authors found out that “self-reported dietary restraint, radical weight control behaviors, depressive symptoms and perceived parental obesity are common causes. It is contrary to the belief that high food fat consumption, binge eating or not exercising frequently causes obesity. Study suggests that it is important to educate youth about effective weight control strategies, and that a reduction in caloric over consumption and increase in exercise would result in decrease the risk of obesity. 2. Jennifer Collins and John E. Bentz. Behavioral and Psychological Factors in Obesity. The Journal of Lancaster General Hospital, Winter 2009, Vol. 4 N o. 4 Authors discussed that the basis of obesity and eating disorders is the combination of psychosocial, environmental and biological attributes. They said that psychological disorders are often found to be depression, anxiety and eating disorders. People suffering from psychological disorders, find it difficult to control consumption of food, fail to exercise regularly and to maintain a healthy weight. People with psychological problem considers food as a coping mechanism. The study said that the satisfaction these people get is only temporary, but result is weight gain which may lead to “dysphoric mood”. Aside from depression and anxiety, study points out problematic eating behavior such as “mindless eating”. Termed as Binge eating disorder (BED), this includes frequent snacking on high caloric foods. BED is defined as recurrent episodes of eating, eating quantities of food larger than most people. In addition to depression and anxiety, other risk factors include problematic eating behaviors such as “mindless eating,” frequent snacking on high calories foods, overeating, and night eating. Binge eating disorder (BED) is currently included in an appendix of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) and is characterized by: recurrent episodes of eating during a discrete period of time (at least 2 days a week over a 6 month period); eating quantities of food that are larger than most people would eat during a similar amount of time; a sense of lack of control during the episodes; and guilt or distress following the episodes. BED is estimated to occur in approximately 2% of the general population and between 10% and 25% of the bariatric population. An important differentiation between BED and bulimia/anorexia is that BED is not associated with any regular compensatory behaviors, such as purging, fasting, or excessive exercise, so the majority of individuals with BED are overweight. Discussion of psychological factors is relevant points in my research and will part of discussion. Authors are authoritative on the subject and their paper has been approved by and published by a hospital. 3.Tom Baronowski, Karen W. Cullen, Theresa Nicklas, Deborah Thompson and Janice Baranowski. Are Current Health Behavioral Change Models Helpful in Guiding Prevention of Weight Gain Efforts? Obesity Research(2003) 11, 23s-43s, doi: 10.1038/oby. 2003.222 Authors provided several theories as the basis for understanding behaviors of obese people. Study proposed to know behavioral issues such as: Why would a person want to change his, or her behavior, What are the personal or other resources that a person needs to change the behavior? What is the processes by which biological change is likely to occur, and what decisions are made in performing a behavior? What procedures encourage change in these mediators, and in turn, in behavior? The study did not mention any of psychological factors that would affect obesity. It focused on interventions that would cause behavioral change. For example authors explained the Knowledge-Attitude behavior model (KAB), wherein the lack of knowledge of food consumption of certain food consumption is related to specific health outcomes. Next is the Behavioral learning theory, wherein behaviors are performed in response to stimuli. Authors explained the modern version of KAB which refers to cost-benefit. Authors are authoritative on the issue since they belong to the Research Centers of prestigious hospitals and the study is a funded research that hopes to contribute to obesity related problems. This will form part of my analysis and will be presented in the discussions attachments 1. Are Current Health Behavioral Change Models Helpful in Guiding Prevention of Weight Gain Efforts?** Article Obesity Research (2003) 11, 23s–43S; doi: 10.1038/oby.2003.22 Obesity Research Journal, Tom Baranowski*, Karen W. Cullen*, Theresa Nicklas*, Deborah Thompson* and Janice Baranowski* *Childrens Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, Texax Correspondence: Tom Baranowski, Childrens Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, 1100 Bates Street, Room 2038, Houston, TX 77030-2600. E-mail: tbaranow@bcm.tmc.edu **Childrens Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, Texas. Obesity is a highly prevalent problem in the United States (1). Dramatic increases in prevalence started 20 years ago (2). If this trend cannot be reversed or at least halted, high levels of obesity will naturally lead to increases in the prevalence of heart disease, some cancers, type II diabetes, and other chronic diseases (3), with enormous economic and personal costs (4,5). As a result, obesity prevention has become an international priority (6). The energy balance equation proposes that increasing adiposity is the net result of inadequate energy expenditure for the energy being consumed. On the energy expenditure side, whereas physiological and metabolic abnormalities of energy expenditure (e.g., reduced resting energy expenditure) may account for some of the obesity, most seems to be caused by inadequate physical activity. Although high levels of intake of certain nutrients (e.g., dietary fat) may be more likely to result in obesity because of metabolic factors, obesity has been associated with a number of behaviors; for example, it is positively associated with soft drink consumption (7) and is inversely associated with eating breakfast (8) and increased fruit and vegetable consumption (9). Thus, this paper focuses on physical activity and dietary behaviors. Behavioral or social science theories or conceptual models provide the basis for understanding these behaviors. The mediating variable model has been proposed as a framework both for designing interventions and for understanding how interventions work to promote change in diet and physical activity behaviors (10,11). Mediating variables are in a cause-effect sequence between an intervention and an outcome. From this perspective, programs or interventions result in behavioral change due to changes in mediating variables (Figure 1). Changes in the mediating variables result in changes in the behavior, which result in changes in the desired physiological and anthropometric outcomes. The mediating variables are the influences on the behaviors of interest and come from the theoretical or conceptual models of behavior. Interventions are targeted at changing the variables from these selected models. Interventions are more likely to be effective if the mediating variables are strongly related to the behaviors of interest and if procedures for manipulating these mediating variables in desired directions are available (10,11). Thus, theoretical models of eating and physical activity behaviors provide possible mediating variables that are the foundation for effective behavioral obesity prevention programs. The term mediator or mediating variable can also be used to analyze how some of these variables are in cause-effect sequences from other cognitive or environmental effects to behaviors. xxxxxx Behavioral or social science theories or conceptual models provide the basis for understanding these behaviors. The mediating variable model has been proposed as a framework both for designing interventions and for understanding how interventions work to promote change in diet and physical activity behaviors (10,11). Mediating variables are in a cause-effect sequence between an intervention and an outcome. From this perspective, programs or interventions result in behavioral change due to changes in mediating variables (Figure 1). Changes in the mediating variables result in changes in the behavior, which result in changes in the desired physiological and anthropometric outcomes. The mediating variables are the influences on the behaviors of interest and come from the theoretical or conceptual models of behavior. Interventions are targeted at changing the variables from these selected models. Interventions are more likely to be effective if the mediating variables are strongly related to the behaviors of interest and if procedures for manipulating these mediating variables in desired directions are available (10,11). Thus, theoretical models of eating and physical activity behaviors provide possible mediating variables that are the foundation for effective behavioral obesity prevention programs. The term mediator or mediating variable can also be used to analyze how some of these variables are in cause-effect sequences from other cognitive or environmental effects to behaviors. 2. Winter 2009 - Vol.4, No.4 Behavioral and Psychological Factors in Obesity   Jennifer C. Collins, M.A., M.S. and Jon E. Bentz,Ph.D. Lancaster General Neuropsychology Specialists Introduction Obesity is as much a psychological as a physical problem. Psychological issues can not only foreshadow the development of obesity, but they can also follow ongoing struggles to control weight. Because the psychological aspects of obesity are so important, psychological assessments and interventions have become an integral part of a multidisciplinary approach to treating obesity, which includes the use of bariatric surgery. Psychological “Risk Factors” of Obesity The etiological basis of eating disorders and obesity usually lies in some combination of psychosocial, environmental, and genetic or biological attributes. Individuals who suffer from psychological disorders (e.g. depression, anxiety, and eating disorders) may have more difficulty controlling their consumption of food, exercising an adequate amount, and maintaining a healthy weight. Food is often used as a coping mechanism by those with weight problems, particularly when they are sad, anxious, stressed, lonely, and frustrated. In many obese individuals there appears to be a perpetual cycle of mood disturbance, overeating, and weight gain. When they feel distressed, they turn to food to help cope, and though such comfort eating may result in temporary attenuation of their distressed mood, the weight gain that results may cause a dysphoric mood due to their inability to control their stress. The resulting guilt may reactivate the cycle, leading to a continuous pattern of using food to cope with emotions. This pattern is particularly applicable if there is a genetic predisposition for obesity or a “toxic” environment in which calorically dense foods are readily available and physical activity is limited. Unfortunately, these circumstances are common in America. In addition to depression and anxiety, other risk factors include problematic eating behaviors such as “mindless eating,” frequent snacking on high calories foods, overeating, and night eating[1] Binge eating disorder (BED) is currently included in an appendix of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR)[2] and is characterized by: recurrent episodes of eating during a discrete period of time (at least 2 days a week over a 6 month period); eating quantities of food that are larger than most people would eat during a similar amount of time; a sense of lack of control during the episodes; and guilt or distress following the episodes. BED is estimated to occur in approximately 2% of the general population and between 10% and 25% of the bariatric population.[3] An important differentiation between BED and bulimia/anorexia is that BED is not associated with any regular compensatory behaviors, such as purging, fasting, or excessive exercise, [2] so the majority of individuals with BED are overweight. Night eating is another disorder that can lead to significant weight gain, though night eating syndrome (NES) is not currently recognized as a distinct diagnosis in the DSM-IV-TR. First identified in 1955, NES is characterized by excessive nighttime consumption (> 35% of daily calories after the evening meal), unhealthy eating patterns, “morning anorexia,” insomnia, and distress.4 NES occurs in approximately 1% of the general population and an estimated 5-20% of the bariatric population. [3] More recently, NES has been viewed as a disorder of circadian rhythm that includes a delay of appetite in the mornings and the continuation of appetite and overeating into the night. Psychological Sequelae of Obesity Society views obesity very negatively and tends to believe that people who are obese are “weak-willed” and “unmotivated”. [5] Obese individuals are often aware of these negative views, and internalize them, putting themselves at risk for disorders of mood, anxiety, and substance abuse. They perceive interpersonal and work-related discrimination, [6] often suffer from low self-esteem as a result, and feel uncomfortable with their bodies (i.e. body image dissatisfaction). [3] These feelings may lead to strain on their intimate and romantic relationships. 20-70% of obese individuals considering bariatric surgery suffer from a current and/or past psychiatric disorder, of which Major Depressive Disorder is the most prominent. Obese individuals have typically made multiple attempts to lose weight, with little or no success. Their failed attempts result in discouragement, frustration, hopelessness, and learned helplessness about the prospect of losing weight in the future on their own. For this reason, many turn to bariatric surgery as a last resort. Not surprisingly, significant weight loss confers psychological as well as medical benefits, with improved mood, self-esteem, motivation, and relationships. A meta-analysis of 40 studies focusing on psychosocial outcomes of bariatric surgery proposed that psychological health and psychosocial status including social relationships and employment opportunities improved; and psychiatric symptoms and comorbidity, predominantly affective disorders, decreased. These changes led to improved quality of life for the majority who had weight loss surgery.[7] Behavioral and Psychological Treatments for Obesity Behavioral and/or cognitive therapy can be used as part of a program of lifestyle modification with diet and exercise for individuals who do not meet criteria for or do not want bariatric surgery. Classical and operant conditioning are the two traditional behavioral therapy models, usually used in weekly sessions lasting 1-1.5 hours over a six-month period. Participants generally have lost an average of 10% of their initial weight.[8]  In classical conditioning, eating behaviors are associated with other activities. The behaviors become conditioned to occur together, as when a person eats nachos while watching the evening news. If these two behaviors are paired repeatedly, they become so strongly associated with one another that turning on the news alone triggers a craving for nachos. Behavioral intervention involves identifying and extinguishing the inappropriate psychological or environmental triggers and cues. Operant conditioning uses reinforcement and consequences. A person who uses food as a reward or to temporarily attenuate stress will associate food with a more pleasurable state, which makes it more likely to to become a repeated behavior. Although behavior therapy results in lifestyle changes and weight loss in the short-term, there is no strong evidence of its long-term effectiveness. More recently cognitive therapy and cognitive behavioral therapy (CBT) have become an important aspect of the treatment of obesity. Cognitions influence both feelings and behaviors, and they cannot be ignored when treating obesity. CBT is utilized in the treatment of obesity as a way to help individuals change their negative eating behaviors and incorporate healthy lifestyle changes.[9]  These CBT interventions are self-monitoring techniques (e.g. food and exercise journals), stress management, stimulus control (e.g. eating only at the kitchen table), social support, problem solving, and cognitive restructuring (e.g. helping patients have more realistic weight loss goals, avoidance and challenging of self defeating beliefs).[10]  The Role of Psychology in Bariatric Surgery An NIH consensus panel concluded that patients contemplating bariatric surgery should undergo pre-surgery psychological evaluation along with monitoring and addressing of psychological and behavioral factors pre- and post-surgery.[11] [12]  Many insurance companies require that patients undergo a psychological assessment prior to bariatric surgery and 88% of surgical weight loss programs require it. There are two primary reasons for this policy: (1) to identify patients who have significant psychopathology that may put them at risk for unsuccessful surgery; (2) to pre-select individuals who are psychologically stable and may have a great deal of success with bariatric surgery.[13]  The pre-surgery evaluation should address characteristics of the patient such as: (1) awareness of the procedure and capacity to give informed consent; (2) motivation for surgery; (3) awareness of and capacity for compliance with post-surgery restrictions and behavior change; (4) current stressors, behavioral and eating practices that might be barriers to the life style changes that are necessary for a successful outcome; and (5) current psychological well-being and stability, self efficacy, resiliency and coping resources to manage stress. Unfortunately, there is no single psychological characteristic or set of psychological characteristics of extremely obese individuals that is consistently predictive of success or failure following bariatric surgery, as several different psychological characteristics are likely associated with weight maintenance and relapse in obesity.Research is mixed regarding the association between co-morbid psychiatric disorders and complications after bariatric surgery.[14] One study of the outcomes of psychological evaluations of bariatric surgery candidates showed that the majority (81.5%) of individuals do not have psychological contradictions for surgery.[15] Still, although a psychiatric diagnosis may not necessarily be a contradiction for surgery, it may be an indication that additional pre- and post-surgery support may be needed for a more successful adjustment to the process of bariatric surgery.[16] Typically, a psychological assessment of bariatric surgery candidates concludes with three different types of recommendations: (1) no psychological contradiction for surgery; (2) psychological or psychiatric treatment required prior to surgery; or (3) psychological contraindication for surgery. 3. 2. Read More