Contribution of psychological intervention in the treatment of obesity.

Obesity is a chronic, complex and multifaceted illness. Its acceptance is a long process, sometimes very long indeed. It has to be an all-encompassing process because it deals with the person as a whole. It also takes in a series of different specialist areas, as various intervening parties are involved.
The role of the general practitioner is a central one, because it is around the GP that revolve the various links in the care process. The GP also provides consistency. Placed in the front line, it is the GP who assesses the patient as a whole and then refers him on to the appropriate form of intervention, both medical and paramedical. Playing a major role in this process are the nutritionists, endocrinologists, surgeons and psychologists. But others may also be required, depending on the individual profile of the patient. Then it is the GP who centralises the fine-tuning details, provides the required information to the various treating parties involved, discusses the treatment options and then monitors part of that treatment. In the long term, it is the GP who remains in touch with the patient so that the proposed treatment can be constantly re-assessed.

The role of the psychologist is part of this close-knit collaboration. It is not a question of tackling the excess weight per se, but of dealing with the associated experience. This part of the journey (submission, passivity, shame, sadness, anger, etc.) is tied to the personal story of the individual and the way he has built up the relationship with his body and his own privacy, as well as in relation to others. Apart from other determining factors (genetic, hormonal, medical, etc.), the way the patient behaves is actually based internal patterns, built up at an early age, which play a part in his pathological relationship with food and his body (gorging himself, filling a void, forgetting, consoling himself, etc.). Over time, the main function of food (eating to live) is replaced by a mainly compensatory approach (living to eat).
Each person’s experience of obesity is individual, but it is also relational (marital, familial, social, etc.) and what it brings determines the level of suffering. Talking with a psychologist is designed to make it possible to become aware of the difficulties experienced and develop an approach with the patient that enable him to overcome them. This pathway is different for each individual and depends on temperament, the ability to develop psychologically and the sheer strength of the person’s motivation.
Against this background, the approach taken to obesity cannot be standard for everyone. On the contrary, it involves individual, single-focused help to find specific solutions for overcoming the frustrations or failures. For that to happen, the person needs to define his problem himself, beyond the number of kilos to lose, and find the resources needed to manage his weight problem.

This involves working in the long term. For instance, there is the time taken for the initial assessment and diagnosis phase, then determining the psychological approach to take, and the support to provide in reinforcing success, as well as handling any setbacks and discouragement. It is important to stress the fact that willpower alone is not sufficient to resolve a weight problem. It is essential that this desire be fed by a wish to change, by a deep and recurring conviction that the stakes and the effort are worth it, because the person’s quality of life will be improved as a result. In fact, restricting the amount of food, regardless of the types of procedure used to achieve that end (surgery, endocrinology, diets, etc.), cannot be sustained if there is frustration and a constantly deprived state of mind.
To sum up, what contribution can psychological involvement have in treating obesity?

First of all, it provides a confidential space that is open and non-punitive, where the person can express himself without restraint or shame – and without taboos – on the topic of the powerful and recurring urges that have led him becoming obese. Next, it can lead to a shift in these urges towards other issues that help satisfy them.

Simply repressing these urges through willpower does not work. The person needs help in identifying the reason why he is overweight (stress, family situation, social factors, childhood, etc.) and then in maintaining his motivation in making the effort.

Psychological involvement also needs to put an end to the idea that losing weight and keeping it off will provide the key to ease and happiness, while at the same time somehow sparing him the chore and effort of having to keep at it with every new day…

The psychologist’s job is also essential in diagnosing the type of personality in order to select the most appropriate form of treatment. It is a question of identifying, where applicable, more specific pathological personality disorders that might get in the way of the treatment. For example, bulimic episodes will exclude any surgical approach, while significant and independent effects on the obesity factor may require support with medication. Taking a systemic and more interpersonal view, a difficult marital relationship would point towards discussions with the two spouses in order to understand what, in terms of the dynamics of the couple and family, might be prompting the behaviour that is at the origin of the obesity. Or again, one particular person will be better suited to a behavioural and cognitive psychological approach, whereas another will benefit more from a more neutral and attentive hearing for the unconscious elements of his personality.

In any event, acceptance of obesity is personal, differential and multiple. It involves weaving a network round the person that responds in an appropriate and specific way to his needs if the weight-loss process is to succeed. In this context, a psychological approach constitutes the most subjective link in the chain, albeit an essential one in stabilising the obese patient in the long term.


Dr Dupont Florence
Responsible for
“Psychology and Behaviour”

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