Professional Documents
Culture Documents
A Chicken-and-Egg Problem
Karen B. Grothe, PhD, ABPP, LP
National Press Foundation
February 23, 2016
Disclosure
Relevant financial relationships
None
Off-label investigational uses
None
Objectives
Discuss psychological factors that influence:
Obesity
Treatment of obesity
Behavioral intervention
50
45
40
35
30
Percent 25
20
15
10
5
0
46.7
43.2
33
Total
36.8
32.6
Men
33.4
Women
Depression No Depression
Pratt LA, Brody DJ. Depression and obesity in the U.S. adult household population, 20052010. NCHS data brief, no 167. Hyattsville, MD:
National Center for Health Statistics. 2014.
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Floriana S. Luppino, MD; Leonore M. de Wit, MS; Paul F. Bouvy, MD, PhD; Theo Stijnen, PhD; Pim Cuijpers, PhD; Brenda W. J. H. Penninx,
PhD; Frans G. Zitman, MD, PhD. Overweight, Obesity, and Depression: A Systematic Review and Meta-analysis of Longitudinal Studies. Arch
Gen Psychiatry. 2010;67(3):220-229. doi:10.1001/archgenpsychiatry.2010.2;
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Trauma history
Extreme obesity associated with history of rape,
molestation, crime victimization, PTSD
National sample of 3,012 women
Obesity surgery samples
20-32% childhood sexual abuse
For some patients, weight is protective
Felitti, 1993; Brewerton et al., 2015 King et al, 1996; Buser et al., 2004
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Emotional eating
Affect regulation, escape, physiological
Varies by individual
Emotional eaters consume more sweet,
high-fat foods
Men: meal-type comfort foods
Women: sweet snacks, carbohydrates
Varies by emotion
Can impact entire process of ingestion
Environmental influence
Konttinen et al., 2010; Wansink et al., 2003, 2014; Evers et al., 2013
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eat more
eat less
20%
10%
0%
Macht 2008
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American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders (DSM-5), 2013.
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Binge eating
Non binge-eating
10
8
6
4
2
0
Marcus et al.,
Telch
1988
& Agra,
Wadden
1994 et al.,
Brody
1993etKuehnel
al., 1994
& Wadden,
Mussell
1994
et al., 1996
Food Addiction
Similar symptomatology to substance dependence
Behavioral and neurophysiological evidence
Brain + environment interaction
Connection with BED
24% of those with FA did not have BED
Prevalence: 11% to 57%
Koball AM, Clark MM, Collazo-Clavell M, Kellogg T, Ames G, Ebbert J, Grothe KB. The relationship among food addiction, negative mood, and
eating-disordered behaviors in patients seeking to have bariatric surgery. Surg Obes Relat Dis. 2015 Apr 22. PMID:26183302.
DOI:10.1016/j.soard.2015.04.009.
Marcus MM, Wildes JE. Disordered eating in obese individuals. Curr Opin Psychiatry 2014, 27:443-447.DOI:10.1097/YCO.0000000000000103
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Impact on Treatment
Trauma History
Attrition
Increased distress
Lose less weight in BWLP
Equivalent weight loss 2 years post surgery
Increased risk of psychiatric hospitalizations
Burmeister et al., 2012; Clark & Saules, 2013; Koball et al., 2015; Lent et al., 2013
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Year 1
Year 2
AUD
7.0%
7.9%
10.7%
Alcohol-related harm
6.1%
7.3%
9.8%
Alcohol dependence
2.6%
3.8%
6.0%
AUDIT 8
2.4%
3.6%
6.4%
Banding
VBG
GBP
12
10
8
6
4
2
0
1 2 3 4 6 8 10
Weight
Time
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Obesity Treatment
Amount of
weight loss
Increased
risks
Bariatric surgery
25-45%
Endoscopic procedures
15-20%
10-15%
Lifestyle Modification
Diet
Physical Activity
Behavior change
10%
Expert panel report: Guidelines (2013) for the management of overweight and obesity in adults.
Obesity 2014 22(S2): S41-S410
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Behavioral Intervention
Used interchangeably with lifestyle intervention
Diet
Physical activity
Behavior therapy
Techniques to replace maladaptive behaviors
with new eating and activity habits
Goal Setting
Stimulus
Control
Cognitive
Restructuring
Social
Support
Mindful
Eating
Wadden et al. Circulation 2012
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Self-monitoring
15
10
5
0
-5
Mean weight Change (lbs) -10
-15
-20
-25
-30
1
-35
3
4
Quartiles of Monitoring
Baker, Raymond C., and Daniel S. Kirschenbaum. Self-Monitoring May Be Necessary for Successful Weight Control.
Behavior Therapy 24, no. 3 (1993): 37794. doi:10.1016/S0005-7894(05)80212-6.
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Self-monitoring
Consistent predictor of weight loss
Calorie intake underestimated up to 50%
High frequency + consistency = more weight loss
Electronic tools may be better
Food, weight, physical activity
Burke LE, Wang J, Sevick MA. Self-monitoring in weight loss: A systematic review of the literature. J Am Diet Assoc 2011;
111:92; Peterson et al., Obesity 2014;22:1962-1967.
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Outcomes
Weight loss indicated and desired
Lifestyle interventions
8 kg in 6 months (~5 - 10%)
Greater than usual care
Variability
Expert panel report: Guidelines (2013) for the management of overweight and obesity in adults. Obesity 2014 22(S2): S41-S410
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P<0.001
80
60
Subjects Exercising (% )
40
20
Not Maintained
Maintained
Kayman S, Bruvold W, Stern JS. Maintenance and relapse after weight loss in women: behavioral aspects. Am J Clin Nutr 1990;52:800-807.
Wyatt H, Catenacci VA. The role of physical activity in producing and maintaining weight loss. Nat Clin Pract Endocrinol Metab 2007;3(7):518-29.
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Summary
Many psychological aspects to eating and weight
Depression can lead to obesity and vice versa
For some people, weight is protective
Self-monitoring dietary intake is best predictor of
weight loss
Physical activity is best predictor of weight loss
maintenance
Weight Bias
Negative attitudes that negatively influence
interactions
Observed in children, parents, health care
providers, media
Affects employment, education, health care
Social, psychological, physical consequences
Stigmatizing videos with online news stories
http://www.uconnruddcenter.org/media-gallery
Puhl et al. Headless, hungry, and unhealthy: A video content analysis of obses persons portrayed in online news. J
Health Comm 2013;0:1-17
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