Obesity all in the mind?

Hypertension, diabetes, stroke - these are just some of the many health risks involved in obesity. But even though people know the risks and the weight-loss steps to take to overcome obesity, they still fail to shed extra weight.

According to experts, many people don't address the multiple factors leading to obesity. Unhealthy eating patterns and a sedentary lifestyle are well-known causal factors, but we often ignore the crucial role that psychological factors play in obesity.

"Overeating may be part of our coping mechanisms," says Dr Clara Gerhard, obesity expert and associate professor in Family Studies at Samford University in America.

"We can, for example, try to handle stress through eating. It doesn't help us to be more successful in handling it, but it does provide comfort. Regrettably the price thereof is longer lived. This form of stress relief is often followed by guilt and as a result, a vicious cycle develops," says Gerhard.

Graham Alexander, a Cape Town clinical psychologist who specialises in treating eating disorders, agrees. In his experience, the obese often come from families with a history of addiction and which are characterised by poor conflict resolution and over- or underinvolvement. In these families, people typically overcompensate by overeating.

Sexual abuse is a common trigger for all types of eating disorders, including binge eating. "For such people, food fills the empty hole left by abuse. Fat provides a symbolic protective layer against exposure of their sexuality. Of course this is illusionary, because no-one can be protected from others," says Alexander.

The long walk to health

Permanent weight loss is extremely difficult because people are programmed to eat for survival and the satisfaction of eating is immediate. The food industry can be a friend or an enemy, depending on whether we are able to make correct choices, says Gerhard.

"Diets don't work - 90% of people fail to maintain weight loss. People might have the best intentions, but if they follow a restrictive diet they are likely to relapse because such a diet will make them feel deprived and will only lead to further binge eating and further weight gain," says Alexander.

Experts therefore suggest that, for weight-loss to be successful and long-term, it should be approached from several angles – diet, exercise and psychological support.

With regards to diet, Alexander feels that the emphasis should rather be on adopting a healthy lifestyle and achieving a sense of overall wellbeing than on weight loss. Focussing on weight loss alone is dangerous as it reinforces further pathological eating.

The role of the psychotherapist is to look at the root cause of obesity and encourage adherence to the meal plan. "When a patient begins to lose weight, anxiety is heightened because when the protective device is removed, the wounding baggage people carry is exposed. Because the defence is no longer in place, the therapist needs to assist the patient in addressing and repairing the deeper psychological wounds."

Parents should take responsibility

Gerhard says that her main message would be directed at parents.

"Parents can be very powerful role models for their children. The dieting mother becomes the first role model for her daughter to become over-focused on food (later backed up by the peer group); the family that never shares a communal meal teaches us disengagement. If we allow our children to be bombarded with food advertisements on TV, and we expose them to the seduction of fast and processed foods, overdosing them on sugar, while teaching them the coach potato lifestyle, we set them up with life habits that can be a very heavy load to carry in adulthood (both literally and figuratively).

"Let's invest in the health of our children, as well as our own health by thinking about food and exercise not in terms of a quick fix weight loss regimen, but in terms of a commitment towards maintaining a healthy lifestyle."

- (Ilse Pauw, Health24, updated December 2009)

Read more:

The obese personality
Fear makes us fat
Obesity and depression