Dr. Pretlow’s WPA World Congress Message

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In October, Dr. Pretlow went to the World Congress of Psychiatry with a handful of simple and powerful concepts.

The first is: Disordered overeating is an eating disorder. The statement is almost tautologous. Does it even need to be said? Apparently it does, because, despite its glaringly obvious nature, the point is, nevertheless, not universally acknowledged. And yet, under-eating (e.g. anorexia) is recognized as an eating disorder. That is an issue for another day.

Now, obesity: Is obesity an eating disorder? Yes, in two different ways. Obesity results from eating — from eating the wrong things, or the right things at the wrong time, or too much of the right things. There are many possible permutations of circumstance, but in the vast majority of cases, obesity and caloric intake are inextricably entwined. As for the minority of cases, the rare exceptions, those will be discussed.

In Dr. Pretlow’s view, disordered overeating is not only an eating disorder, it is a psychological malady. And if we agree to the premise that disordered overeating is a psychological problem, we pretty much have to agree that obesity, also, is a psychological malady.

Disordered overeating is almost always set in motion by psychological quirks. And without a doubt, disordered overeating almost inevitably leads to obesity. Therefore, psychological problems lead to obesity. Therefore, obesity is a psychological malady, except for when it isn’t — but that is a very small slice of the pie.

The rare exceptions

Is it possible for people who do not overeat to become obese? Yes, and psychology has nothing to do with the cause of their weight, because the problem lies elsewhere. The gigantic children who occasionally generate headlines have not had the time or opportunity to develop psychological afflictions, and even when their caloric intake is monitored, they stay big. Something else is going on, something that might be metabolic, genetic, or environmental.

Then, there are people who do undeniably and demonstrably overeat because some diseases and disorders cause unbridled appetite. Again, the basic root cause is not psychological. The disordered eating behavior originates when some other system goes haywire.

These somatic illnesses can cause obesity one way or another, for reasons that are not mental or emotional: Alström syndrome; Bardet-Biedi syndrome; certain tumors; Cohen syndrome; Cushing’s syndrome; hypothyroidism; Kleine-Levin Syndrome; and Prader-Willi syndrome. Hyperphagia (or polyphagia) is a well-known symptom of diabetes. Also, some medications for physical illnesses can start a patient down the slippery slope to obesity, and psychology has nothing to do with it.

Whether obesity results from a troubled psyche or an intractable physiological condition, here is the bottom line: Both types of obese patients need help from psychologists and psychiatrists. Folks who are coping with obesity that is not caused by their twisted psyches will more than likely progress to having twisted psyches anyway, because they really hate being fat. They definitely need and deserve therapeutic intervention that will help.

So there is no escape from the conjunction of obesity and psychology. By a direct route, or by an indirect route, as a cause or as a consequence, the emotional/mental apparatus is going to be involved too, and there is no getting around it.

Your responses and feedback are welcome!

Source: “Causes,” NIH.gov, 02/23/17
Photo by NichoDesign on Visualhunt/CC BY-SA

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