When Dr. Pretlow attended the World Congress of Psychiatry in October, it was with this message:
I do think we need to convince the psychology field that disordered overeating and obesity is primarily a psychological problem, and it seems to be an addictive process. Yet, even though it is not established that disordered overeating and obesity is an addictive process, this does not preclude using addiction-model methods to treat it, which appear to be highly effective. I have the goal (or at least the hope) that the psychology/psychiatry field will take on the treatment of disordered overeating and obesity.
For obesity and eating disorders, it seems self-evident that therapy is needed as a first step, because therapy acknowledges one of the huge paradoxes of human nature. Before a person can be free to change, first that person needs to be accepted for herself or himself.
However, weight loss programs of every kind and in every price range have one thing in common: They start out with the premise that something is wrong with the person, and the flaw needs to be fixed. While many people actually are open to change, nobody wants to be fixed. The implication is insulting, and gets a person’s dander up. Therapy, on the other hand, begins with, and is based on, acceptance.
Dr. Nicole Avena, who participated in the symposium chaired by Dr. Pretlow, says:
Some obese people I have talked with sound just like the anorexic patients I know, and there is a lot of data to suggest that they have underlying similarities in brain changes that occur as a result of over- or under-eating.
Before the event, she wrote what he called a brilliant analysis of why professionals in the Eating Disorder field sturdily resist considering obesity an eating disorder:
I have talked at quite a few eating disorders conferences and people did not like to hear me talking about food addiction as it might relate to eating disorders, because people typically think that if you are “addicted” the only cure is to abstain from the substance of abuse. And the last thing people who treat patients with eating disorders claim they want to do is tell them it is okay to restrict.
To put it another way, it seems that what holds them back is the fear of stirring up anorexia. But overeating can also lead to life-threatening co-morbidities, which are much more widely-spread than anorexia.
Dr. Caroline Davis, who also took part in the symposium, wrote:
In my view, it’s too broad a sweep to say that EVERYONE with a BMI greater than 30 has an “eating disorder”. That would “pathologize” about a third of adults in the Western world. I do think, however, that “compulsive overeating” is a disorder and that such a condition comprises more than just binge eating. I also agree that severe cases of all the conventional eating disorders can be modeled as an addictive process.
As we have seen, psychiatrists who do therapy are thin on the ground these days. For practitioners of the specialty, it is very much a seller market, and they mainly supply diagnoses and prescriptions.
Can the shortage of available headshrinkers be coped with? Some experts believe so, with the help of two promising solutions. One is psychiatric telemedicine, which overcomes distance and is a blessing for patients who don’t get around very well.
The other is “collaborative care in which non-psychiatrists would receive specialized training in mental health and practice based on their expertise.” A lot of that is already going on.
Your responses and feedback are welcome!