Tuesday, September 26, 2017

The Psychology of Obesity: Working together to eliminate shame and stigma

This month's blog post is written by psychologist, Robyn Osborn Pashby, PhD

Our healthcare system is failing people with obesity. Yet rather than viewing the obesity epidemic as a failure of the system, failed weight loss interventions are too often attributed to failure of will. Sadly weight bias on the part of society as a whole, and health practitioners specifically, feeds into this stigma and prevents healthy psychological support for weight loss. For patients, this weight bias and stigma fuels a sense of self as a failure, and repeated perceived failures can lead to a belief that something is wrong with oneself as a person – shame. Shame isolates people from one another at a time when support could be beneficial. Depletion of energy from this sense of failure and shame creates a cycle that can interfere with healthy cognitive, emotional, and behavioral changes.

Mired in self-blame, shame, and humiliation, people with obesity often recount failed interventions and list the ways in which they are not strong enough, good enough, or determined enough to lose weight. The same people who run businesses, care for families, serve community organizations, and make our country’s policies, laws, and regulations believe they are failures because of the number on the scale. The belief that obesity is a failure of will can cause or exacerbate eating and mood struggles, interfering with health behavior change. The constant barrage of negative self-talk results in emotional and intellectual exhaustion. This is problematic because energy for behavior change is a finite resource. The more of it that is allocated to negative self-talk criticizing oneself for a “lack of self-control,” or berating oneself for “failing” the latest diet plan, the less energy available for self-care and maintenance of healthy lifestyle changes.

Shame also interferes with a person’s likelihood of accessing support. Weight management requires support from numerous disciplines (often medical, psychological, nutrition, and/or movement) as well as from loved ones, friends, families, and coworkers. Thoughts like, “I should lose weight before I go back to my doctor,” is just one example of how shame can interfere with a person accessing the very support that is most helpful. Shame can lead a person with obesity to believe that support is something reserved for others…those who are worthy of the support. Thus, reducing shame, identifying and disempowering the shame-based beliefs, and building a core sense of worthiness are all critical in helping individuals embrace autonomy and maintain energy for long term health behavior change.


In our next Twitter chat we will discuss the psychology of obesity. Specifically, we will be addressing the following questions:


What types and sources of psychological support are most helpful for persons with #obesity?
How do stigma and shame affect eating, exercise, and even accessing treatments such as #bariatricsurgery?
In what ways can self-talk be used for making positive changes rather than reinforcing shame and stigma?
Can a goal of feeling good (rather than # on the scale) have a meaningful impact on weight management?
In what ways can health practitioners lessen the burden of stigma and shame for patients with #obesity?


We hope you will join the discussion 9:00p EST Sunday, October 8!

~The #obsm chat leadershipArghavan Salles, MD, PhD; Heather Logghe, MD; Neil Floch, MD; Amir Ghaferi, MD, MS; and Babak Moein, MD

Wednesday, September 6, 2017

#obsm: Lifestyle Changes Around Obesity: What Are They and How to Make Them Stick

Obesity is a multifactorial disease. While people commonly assume that gaining weight is a simple calculation between calories eaten and calories expended (eat less, exercise more), this is not an accurate reflection of the complexity of obesity. Other factors that contribute to obesity include genetic and environmental factors. In this month’s chat, we will focus on one factor that individuals have control over: lifestyle.
Changing unhealthy habits requires, by definition, a change in lifestyle. Whether that is quitting smoking, exercising more, or making healthier food choices, lifestyle change is hard. Indeed, one of the things often emphasized to patients undergoing bariatric surgery is the need to make significant lifestyle changes after surgery. Part of this is by necessity--the new configuration of their stomach will typically accommodate less food. Thus they will commonly eat smaller, more frequent meals in order to avoid nausea and vomiting. This is part of why caloric intake typically drops significantly after bariatric surgery. Over time, people who have had bariatric surgery can adapt to their new anatomy and potentially increase their caloric intake. To the extent that patients use bariatric surgery as a tool to help them make a more enduring lifestyle change, they are more successful in maintaining weight loss.
For those with obesity who lose weight with medical management, a similar philosophy applies. Losing weight with a diet typically results in later weight regain when one discontinues the diet. This is part of why many people are able to lose weight, even significant weight, without surgery. Unfortunately only about 5% of people are successful in maintaining this type of weight loss long term. However, to the extent that people can make a lifestyle change rather than adopting a short- term diet, they may be successful in maintaining long-term weight loss.
Photo Credit
Whether people have bariatric surgery or not, lifestyle changes are challenging to make and maintain. Establishing routines can help, but when there are logistic transitions (such as children going back to school in the fall or finishing school in the spring) these routines can get thrown off. In this month’s chat, we will discuss how to make and maintain lifestyle changes with the following questions:
  1. What is meant by "lifestyle changes" in weight management? Do patients and practitioners share the same definitions?
  2. What stumbling blocks have you (or your patients) encountered in trying to make lifestyle/habit changes? How were they overcome?
  3. It is difficult to make lifestyle changes alone. How can one succeed even if friends and family are not making changes?
  4. Fall is here. How do you (or your patients) maintain lifestyle changes in face of changes to their schedule and routine?
  5. What motivates you (or your patients) to make lifestyle changes that last?
We hope you will join the discussion 9:00p EST* Sunday, September 10!

~The #obsm chat leadershipArghavan Salles, MD, PhD; Heather Logghe, MD; Neil Floch, MD; Amir Ghaferi, MD, MS; and Babak Moein, MD

*Please note, an earlier version and incorrectly listed the time as 6 pm. The correct time is 9pm EST.

Friday, August 18, 2017

Peer-to-Peer: The role of online support for patients with obesity

Support group attendance and perceived levels of social support are associated with greater post-bariatric surgery weight loss.1,2 Unfortunately, geography and time constraints can limit participation. Therefore, online forums, Facebook groups, and tweetchats can serve to provide a sense of community while overcoming these limitations. Studies show online forums can be a useful resource for information and emotional support in obesity and bariatric surgery.3,4 The formats of online support have evolved over time from listservs to established communities such as Bariatric Pal and more recently Facebook groups and tweetchats. Some users choose to post anonymously while others share their identity and blog publicly about their experiences. While these forms of online support are shown to be beneficial, physicians may not regularly endorse their use.

Photo Credit


In our next #obsm chat, we will provide a forum for patients and health care practitioners to learn from patients and their loved ones on their personal online support experiences. Our goal is to help patients and physicians understand how online support groups can complement the care of patients with obesity, those considering bariatric surgery, and post-surgical patients. We will explore the utility, benefit, and potential pitfalls of online peer-to-peer support.


  1. What is the utility of online support for patients with #obesity and those considering #bariatricsurgery?
  2. What are the cons of online support in #obesity and #BariatricSurgery? Are there pitfalls to be aware of?
  3. What are the strengths and weaknesses of the different online platforms for people with #obesity and pre- and post- #bariatricsurgery support?
  4. Should physicians recommend online support to their patients? If so, which platforms are most useful?
  5. How do you predict (or hope) online support for those with #obesity and those undergoing #bariatricsurgery will evolve?

~The #obsm chat leadershipHeather Logghe, MD, Neil Floch, MD, Amir Ghaferi, MD, MS, Babak Moein, MD, and Arghavan Salles, MD, PhD

References:
4. Story Of Obesity Surgery - American Society for Metabolic and Bariatric Surgery. American Society for Metabolic and Bariatric Surgery. https://asmbs.org/resources/story-of-obesity-surgery. Accessed June 5, 2017.

Friday, July 7, 2017

#PlasticSurgery after #BariatricSurgery: Meeting Patients' Needs

Bariatric surgery often results in numerous health benefits, such as resolution or improvement of type 2 diabetes, hypertension, joint pain, and depression. However, the extreme and rapid weight loss after bariatric surgery may also lead to physical and emotional distress resulting from redundant, loose skin. These new skin folds require meticulous care; even so patients may suffer painful rashes and skin infections. The weight of the pendulous skin can prohibit exercise and normal daily activities. Excess skin on the upper arms, thighs, and abdomen can make it difficult to find proper fitting clothes. Patients may feel self-conscious of their atypical body contours and find the hanging skin a deterrent from their commitment to dietary changes, exercise, and continued weight loss maintenance.

“Post bariatric body contouring” is the term used for the multiple surgical procedures typically required to remove excess skin and reshape the contours of the breasts, abdomen, arms, and lower body. These procedures include the breast lift, tummy tuck, lower body and medial thigh lifts, and arm lift. Despite the medical and psychological indications for these procedures, they are largely uncovered by insurance companies. A recent study showed that after bariatric surgery, 75 percent of women and 68 percent of men were interested in plastic surgery, yet less than 6% of patients underwent any plastic surgery procedure. The failure of insurance companies to cover these medically indicated procedures results in patients either paying out of pocket or suffering the negative health and psychological consequences of the excess skin.