For most of us, mental health and weight regulation are tightly connected. Think of them like shoelaces; they may seem like two separate things when you are getting ready to tie your shoe – after all, you can hold one in each hand, right? However, when you unlace the shoe, you realize it’s all one long cord.
How they are connected varies from person to person. Sometimes mental health issues play into weight gain. Sometimes excess weight leads to dysfunctional thinking and mental health issues.
Occasionally, they are just like two children on a playground; coexisting but unaware of each other. Most of the time, addressing our mental health improves our physical health – including excess weight. It’s not a magic solution, but it’s a lever that often needs to be pulled in order for people to lose weight. It’s even more important for long-term weight maintenance.
There is much more to treating metabolic health and excess weight than just changing the food we eat. The way we live our lives affects our metabolism, our hormones, and the way we show up in the world.
Good sleep – both in terms of quality and quantity – is associated with better weight loss outcomes and better overall health.
The habits we perform daily, often without thinking, define our long-term outcomes. Having a habit of spending every penny of your paycheck ultimately results in having no savings. Changing that behavior for a few months or a few years as part of a program is great, but if, at the end of the program, the behavior is still there, the problem hasn’t been solved. If, during the program, you are constantly thinking about how great it will be someday to be off the program and able to spend the whole paycheck again, the underlying issue hasn’t been solved.
The way we handle life’s stressors also comes into play. Most people, even those without excess weight, use food as a coping mechanism for emotional regulation. Removing the coping mechanism without dealing with the underlying problems that trigger the need for a coping mechanism in the first place rarely works. It leaves a gaping hole – and unless we have something else to plug that hole, the most obvious choice to plug it is the thing that fit in the space before – which is typically food.
Living with a disease that everyone can see – especially a disease that carries a significant amount of bias and stigma – is exhausting. It results in scars. It affects the way we look at the world and the way we make decisions. Cognitive restructuring, a technique used to change unhelpful thought processes, is often vital to the healing process as you change the way you live and function in this world.
There are so many reasons that we have to spend a great deal of time and energy working on this treatment pillar. Because it is so individual and nuanced, it’s difficult to come up with a concise summary or guide.
It’s difficult to organize psychological and emotional issues into an organized system, but what follows is our attempt at doing it. It’s by no means perfect, but it helps us create phenotypes – for pharmacologic treatment as well as behavioral.
1. External Noise
Patients with external noise are acutely affected by food cravings and impulsive eating, often responding to environmental cues like the smell or sight of food. They may feel an almost constant preoccupation with food, describing it as an “external voice” that drives their eating behaviors.
Key Aspects
- Food Cravings: Patients in this category often seek high-glycemic foods for comfort and report feeling deprived when these foods are limited.
- Impulsive Eating: Strongly influenced by food-related cues, these individuals may describe their actions as out of control, often finding themselves making impulsive food choices in settings like grocery stores or restaurants.
- Dysregulated Eating: Many of these patients have a long history of dieting and may struggle with all-or-nothing thinking. This can lead to unrealistic expectations and disappointment when immediate results are not achieved.
Strategies to Address External Noise
- Environment Control: Help patients create a controlled food environment by limiting exposure to tempting cues. For example, suggest they avoid certain aisles in the grocery store or skip visits to convenience stores.
- Prescriptive Nutrition: Emphasize a diet rich in protein and low in simple sugars to stabilize insulin and reduce cravings.
2. Internal Noise
Patients with internal noise often turn to food to manage emotions. Emotional eating is their response to feelings such as boredom, stress, or sadness, making it challenging for them to maintain a healthy diet consistently.
Key Aspects
- Emotional Eating: Food becomes a coping mechanism for these individuals, helping them manage uncomfortable emotions or rewarding themselves after a long day.
- Evening Eating Patterns: Patients may follow a healthy eating routine during the day but struggle with eating behaviors in the evening when they feel more emotionally depleted.
- Reward-Based Eating: For some, food acts as a reward system to compensate for emotional stress, similar to how others might use alcohol or other substances.
Strategies to Address Internal Noise
- Mindful Eating and Reflective Questions: Encourage patients to journal or reflect on their eating triggers. Asking questions like, “Does eating resolve your feelings, or does it leave you feeling guilty?” can promote awareness.
- Alternative Coping Mechanisms: Suggest non-food-based ways to relieve stress, such as exercise, hobbies, or social support.
- Therapeutic Interventions: Behavioral therapies, such as Cognitive Behavioral Therapy (CBT), can help address the root causes of emotional eating and introduce healthier habits.
3. Cultural and Environmental Influences
Cultural norms and social environments play a significant role in shaping eating habits. Many patients face cultural pressures to partake in food-centric social gatherings or family traditions, making adherence to dietary changes challenging.
Key Aspects
- Cultural Traditions: Some patients identify specific foods as central to their cultural identity. Declining these foods can feel like a rejection of cultural values, leading to internal conflict.
- Social Gatherings: Food is often a central theme in social interactions, especially in celebratory events. Patients may feel pressured to participate, even when doing so conflicts with their health goals.
Strategies to Address Cultural and Environmental Influences
- Encourage Positive Social Support: Help patients build a support system that respects their health goals. Encourage them to seek out friends or groups with similar health aspirations.
- Plan for Social Events: Work with patients to develop strategies for navigating social events, such as bringing their own healthy dishes or setting limits on indulgent foods.
- Focus on Personal Agency: Empower patients to make choices that align with their health goals, even in challenging social settings. This can include suggesting alternative social activities that don’t revolve around food.
A comprehensive approach to obesity treatment addresses the psychological and behavioral challenges alongside the physical aspects. By understanding the different types of behavioral barriers patients face, clinicians can provide more effective, compassionate care.
Putting these things into words can be difficult – for clinicians and patients. Having a shared language makes communicating easier.
