Psychotherapy-lite: obesity and the role of the mental health practitioner

Obesity is a chronic medical disorder that is the result of a complex interaction of genetic, environmental, neuro-endocrinological, psychosocial, and behavioral factors. There are treatment algorithms, depending on the severity of obesity, and a multi-component approach, including attention to psychological issues, is recommended regardless of the level of obesity. Cognitive-behavioral therapy is beneficial in assisting with stimulus control, self-monitoring of lifestyle changes, goal-setting, and restructuring negative and self-defeating thoughts, and psychodynamic (insight-oriented) psychotherapy is useful in assisting with conflicts regarding excessive weight, body image, relationship to food and disordered patterns of eating, and dealing with the prejudice and overt discrimination obese patients may experience. Neither therapy is particularly effective alone and either and/or both may need to be continued indefinitely to avoid inevitable weight regain. Psychological intervention before and during the difficult process of dieting, as well as before and after bariatric surgery, is essential for some vulnerable patients. Since psychological factors are neither primarily etiological nor even necessarily predominant in obesity, the mental health professional plays an important, though adjunctive--"psychotherapy-lite" role--in treating obese patients.