Psychiatry, Psychology, Obesity

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Dr. Pretlow has just returned from the World Congress of Psychiatry. As a background to discussing that, it is useful to have a sense of what the current thinking is in other parts of the world. For that purpose we look at a Vice article in which Amelia Tait dissected one of the many disputes current in the United Kingdom.

The topic is directly related to what Dr. Pretlow recently journeyed to Berlin to discuss. Tait’s piece is titled, “Is Obesity a Psychological or Physical Problem?

The article’s subhead explains in detail:

David Cameron wants to cut people’s benefits if they don’t seek treatment for their obesity, but does the NHS recognise that overeating can be caused by underlying psychological issues, rather than biological ones?

The writer defines overeating as “compulsive eating, without purging, that is usually done with discretion.” She interviewed Dr. Cary Savage, whose research has shown that children might be dangerously susceptible to advertising techniques, especially when it comes to food products. Dr. Savage reminds us that no one has perfect control over her or his behavior.

Tait references the recent demise of Britain’s fattest man, noting that many psychologists would say he “suffered from a mental illness that compelled him to eat.” In practical terms, this means that a politician’s threat of welfare benefit cutting is likely to be ineffectual in changing the behavior of people who suffer from mental illness.

The journalist interviewed a 20-year-old youth who brought his weight down from 373 pounds to just over 220 pounds in a year. His childhood was marred by the death of his brother, compounded by his mother’s endless grief. Eating became, in his own words, an addiction, and pasta was his drug of choice — like, 15 times a week.

Tait learned a very telling detail of the young man’s history:

Daniel’s brother’s disease made him extremely thin, and Daniel recalls being shocked at being able to see his bones. “I think all of this really had an impact on me,” he says. “Being a small kid and not wanting to go like him definitely helped me to binge eat.”

Dr. Jen Nash of the British Psychological Society told the reporter:

Obesity is a complex issue, and food addiction is a relatively new and controversial term. Although food addiction does have a number of similarities to other addictive behaviors, we do not yet have enough data to fully and confidently conceptualize it in this way…

The challenge we have in the NHS is that obesity is dealt with in medical settings and in a medical paradigm, and so medical causes and solutions are the primary approach.

Tait remarks on the same phenomenon that Dr. Pretlow has noticed:

The main issue with food addiction and overeating not being classified in the DSM-5, and being widely considered as biological issues, is that there is not much psychological support out there.

It seemed possible that this sorry state of affairs might change, considering that one of the four announced themes of the WPA World Congress was “Comorbidity of mental and physical diseases.” The time seems ripe to take a hard look at obesity and think about where, among the confusing plethora of terminology, it might belong.

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Source: “Is Obesity a Psychological or Physical Problem?,” Vice.com, 07/30/15
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