Why obesity is not a choice

Obesity is recognised as a major public health issue with Ireland having the highest rate of obesity in Europe. One in four Irish adults are obese with only 40 per cent of us a healthy weight.

Recently criticised for having the lowest EU level of public treatment for obesity, the cost of treating obesity-related diseases in Ireland is significant. It is estimated to reach an annual cost of €2.1 billion in five years, according to The Irish Society for Clinical Nutrition and Metabolism, as the links between obesity and heart disease, mental ill-health, cancers, respiratory problems, type 2 diabetes, and musculoskeletal conditions are well established. More than a million of us are living with a treatable disease.

A new report from the British Psychology Society has called on policymakers to do more than tell people to have more willpower when tackling the obesity problem. "Eat less and move more" becomes defunct advice when someone is already obese. Diet programmes may focus on what to eat more of and less of. However, focusing on portion size, fat content, protein and carbohydrates does not address the important issues surrounding weight loss. The report, Psychological Perspectives on Obesity: Addressing policy, practice and research priorities, is written by a group of expert psychologists who say obesity is a complex problem that needs an understanding of the factors that can lie beneath the condition. Recognising the psychological impact of weight gain can determine whether treatment will be a success or failure.

Fluctuate

The reason so many of us fluctuate with our weight, or struggle to lose weight, is because diet programmes do not look deeper into the whys of our eating habits and weight gain. The psychological approach in understanding our behaviour surrounding food counters the stigma that weight gain is a result of gluttony or a lack of willpower. Obesity is not a choice. It carries a complex combination of biological and psychological factors, including environmental and social elements, which affect our weight. Addressing this impact can encourage a greater weight loss.

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Counselling psychotherapist Susi Lodola says more than 90 per cent of people who lose weight regain all and often more within two years. "In my opinion, there are many contributing factors to weight gain. Our environment is one of them: fast food, ready meals, sugar-laden soft drinks, easy access to high-calorie/high-sugar foods and a lack of exercise in schools. The reason various diet and exercise programmes do not show positive long-term results in weight loss is they do not address underlying issues of why you overeat and how your mind is key to changing your relationship with food. They focus only on how to change your behaviour."

Lodola developed the Mind Over Body weight-loss programme to help people stay motivated, deal with triggers, stop the inner voice which sabotages weight loss and to put an end to emotional eating. The focus is on building mental strength, changing habits, reconditioning the brain and making changes that lead to lasting weight loss.

‘New mental skills’

“Losing weight and improving your fitness is a physical as well as a psychological process,” says Lodola, “It requires learning new mental skills and identifying thinking patterns, which have hindered your weight loss in the past. Learning those new mental skills will rewire your brain and it will make you change from the inside out.”

Lodola also stipulates that we should look at an individual holistically and not only consider the psychological factors. Looking at a person’s environment is essential to understanding the physical and emotional aspects of their habits. Having difficulties in one area of life can affect others. Genetic factors, the impact of stress, eating behaviours, food cues, emotional eating, mental health, adversity, and social and economic status all have a significant bearing on weight loss and gain.

The perceived effort to continue with a healthy weight-loss plan is greater than the perceived benefit

“If you have a very stressful job and work long hours,” says Lodola, “your emotional health may be suffering through heightened anxiety and stress. This has a knock-on effect as you don’t have any time to engage in any exercise or focus on healthy eating. This in turn leads to poor physical health. Psychological health could be further affected by unhelpful thinking, such as “I have to get everything done today or I will lose my job”. As a result, the home and work environment will be out of balance.”

For many the difficulty in maintaining a significant weight loss is affected when life factors take hold. Relapse is common. Lodola explains a possible explanation for fluctuating weight loss and gain is when weight loss plateaus. The perceived effort to continue with a healthy weight-loss plan is greater than the perceived benefit. “Identifying barriers to long term adherence to a healthy lifestyle intervention is important and low-eating self-efficacy has been identified as a barrier,” says Lodola, who underwent a significant weight loss and fitness journey herself. “Self-efficacy is defined as having the confidence in one’s ability to perform certain behaviours in the presence of challenging situations and is based on social cognitive theory. Research has demonstrated that eating self-efficacy improves with weight loss and continues to stay high when lost weight is maintained. Higher baseline levels of eating self-efficacy predict greater weight.”

Behaviour change

The authors of the British Psychology Society report determined that behaviour change is central to the prevention, management and treatment of obesity. They say reversing the trend of increasing obesity rates over the past decades requires an integrated, evidence-based approach that recognises behaviours are influenced by a combination of biological, psychological and social factors.

For the successful long-term treatment of obesity, psychosocial and psychopathological variables are important elements to consider

Lodola agrees as she says that given the failures of weight-loss methods, an understanding of the psychological variables that impact the success of weight loss is essential to help people engage in lifestyle modifications and motivate them to achieve long-term weight loss.

“For the successful long-term treatment of obesity, psychosocial and psychopathological variables are important elements to consider. This is in line with findings of correlations between obesity and psychological factors such as self-esteem, quality of life, stressful life events, eating disorders, mood problems, anxiety and personality traits.

“Psychological interventions are key to engage individuals in lifestyle modification and motivate them to achieve weight loss in a sustainable and successful manner. Psychotherapies for obesity typically could help people achieve successful weight loss by reducing dysfunctional behaviours and restructuring cognitive processes.”