Maite Pérez Reyes: the psychology of obesity
We interviewed Maite Pérez Reyes, psychologist and expert in obesity and eating problems.
Obesity is a reality that affects millions of people, especially in Western countries.
But beyond the aspects of this health problem that have to do with physical complications, we must not forget that there is a psychological side to this form of overweight. To learn more about it, we talked to Maite Perez Reyes, Health Psychologist based in Las Palmas de Gran Canaria and with wide experience treating cases of overweight and Eating Disorders.
Interview with Maite Pérez Reyes: the psychological implications of obesity.
Maite Pérez Reyes, expert in Health Psychology, talks to us about obesity and its relationship with psychological aspects.
Is obesity a disease of this century?
It is not a disease exclusive to this century, but it may become the disease of the 21st century due to its prevalence. The change in habits, sedentary lifestyles, the increase in the availability of food, especially sugar derivatives and other factors, mean that this disease is more likely to develop at an earlier age.
What is the relationship between emotions and obesity?
As in any disease, emotions play a fundamental role and in the case of obesity, there are some that are predisposing to suffer it and others that are generated as a consequence of having problems with weight.
So much so that the Spanish Society of Community Nutrition includes the concept of "emotional balance" in the pyramid of healthy eating.
How can emotions predispose or influence the development of obesity?
There is more and more scientific evidence of the relationship between obesity and certain basic emotions with unpleasant affective experience, such as sadness, fear, anger... but the problem is identified when these emotions generate behaviors of abandonment towards oneself, ignoring healthy eating, physical exercise...
So, are there certain emotions such as sadness that induce us to eat more or differently?
Yes, there are emotions that produce physiological consequences in the body and to counteract them we often seek the pleasurable effects of certain foods and over time an addiction to them is generated.
Addiction to some foods?
Yes, it is true. This is what is considered a "food addiction" disorder and includes the selection of so-called "comfort" foods that provide a feeling of reward and relief from discomfort.
And how can this be dealt with?
When the patient already suffers from addiction, specific techniques should be used in the consultation room, such as de-addiction to certain foods associated with moods, among others. But the important thing is to act to prevent these addictions.
That is why it is essential not to use food as a positive reinforcement, especially in childhood, which is where eating patterns are acquired. In our culture, celebrations always revolve around food and the discomfort is relieved by offering a chocolate or similar.
Why is it that in these emotional states people do not choose to eat healthy foods, but rather those that are more harmful?
This happens because there are a number of foods, such as sugars and refined carbohydrates that generate pleasurable effects because they produce more serotonin, dopamine, opioids and endorphins in the brain, with the consequent relief of negative emotional states.
And what happens if we do not intervene in this food addiction?
This food addiction can also lead to eating disorders, such as Bulimia, Anorexia, Binge Eating Disorder, because sometimes the guilt after eating leads to purgative and self-injurious behaviors.
What are the psychological consequences of suffering from this disease?
Obesity is one of the most stigmatized diseases that exist today, where the patient is blamed, which generates social rejection. This can affect personal relationships, with the consequent isolation, depression and of course low self-esteem.
What does the work done in the psychology area of an Obesity Unit consist of?
Detection, diagnosis and treatment of those psychological variables related to obesity are carried out. For this purpose, the patients' relationship with their own body, the distortion of their image, their behavior with food, their self-esteem, their personal relationships, and their lifestyle are studied in depth.
It is also essential to rule out the existence of possible disorders and to understand the role that obesity may play in each patient, whether it is the consequence of personal situations or the cause of others. The psychologist's work is carried out in conjunction with endocrinology and nutrition, addressing aspects such as motivation, interoception and psychoeducation, among others.
How does one intervene at the psychological level with an obese patient?
First of all, a good rapport must be created with the patient, emotional discharge is encouraged, and work is done on the establishment of an alliance and adherence to the program that will be prescribed for the patient. The aim is to make him aware that he is somewhat "deaf to himself" and that it is necessary to start listening to his body.
And how do you work to increase this self-awareness?
The objective is to reconnect the patient with his body, first from the most basic, which are the perceptions of the environment to gradually work on interoception. This will allow the patient to better recognize and differentiate whether he/she is hungry or "craving for food" and to better regulate food intake.
There are many guidelines and general recommendations such as chewing slowly, not eating while watching TV, etc. Do these psychological "tricks" work?
There are recommendations that are used and that work in general, such as nutritional education, self-monitoring, the establishment of small steps based on the Kaizen philosophy...but the ideal is to use a very personalized approach. First of all, we always take into account the patients' tastes and eating habits, but above all their previous ideas about food, diets, the body....
As we work at a cognitive and belief level, a personalized action plan is elaborated, because, as an example, "leaving food on the plate" is not the same for one person as for another.
When setting up the plan, individual differences must also be considered, taking into account factors such as where meals are taken, work schedules, the possibility of doing one's own food shopping, etc.
Given that affective variables are also addressed, emphasis is placed on stress management work and unpleasant emotional states that generate behaviors towards food.
In addition to this, a system of "personalized challenges" is always designed, in which things like giving up a harmful food for good, introducing or increasing a physical activity, giving up habits such as nail biting, etc. are included.
So, in the work of the obesity psychologist, weight is not the only objective. What is really interesting about these challenges is that they are part of a personal project that is set in motion with the patient from the moment he/she arrives at the consultation and that includes changes in almost all spheres. This generates on the one hand, discarding the idea that the only goal is weight reduction and on the other hand generates more motivating elements for change.
And if dieting does not work... then is it necessary to resort to surgery?
Bariatric surgery or surgery for obesity is one of the resources used to face this disease, however, it is not exempt of risks and the need to have a permanent accompaniment of psychologists, nutritionists and endocrinologists.
In bariatric surgery, what aspects are worked on from the psychology office?
The psychology office works both preoperatively and postoperatively.
The patient who is a candidate for bariatric surgery requires a careful psychological evaluation, but, as the aim is for obese patients to lose weight and not regain it and for psychological problems prior to surgery not to be accentuated, it is essential to carry out, in addition to the evaluation, a preparation and follow-up of the patient.
It is necessary to assess eating habits and if there are eating disorders, the patient's ability to understand what the surgery consists of, the risks involved and the lifelong care that will be required, and to rule out the existence of mental disorders and pathological personality traits.
In the postoperative period it is necessary to work on fears and ideas and to establish a new relationship with food.
(Updated at Apr 12 / 2024)