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The psychology of obesity

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Title: The psychology of obesity


1
The psychology of obesity
  • Jane Ogden
  • Professor of Health Psychology
  • University of Surrey

2
Overview
  • The causes of obesity
  • The role of behaviour
  • Obesity treatment
  • Dietary interventions
  • Medication
  • Surgery
  • What doesnt work?
  • What works?
  • How can obesity be treated effectively?

3
The rise in obesity
4
Obesity Trends Among U.S. AdultsBRFSS, 1985
(BMI 30, or 30 lbs overweight for 5 4
person)
5
Obesity Trends Among U.S. AdultsBRFSS, 1986
(BMI 30, or 30 lbs overweight for 5 4
person)
6
Obesity Trends Among U.S. AdultsBRFSS, 1987
(BMI 30, or 30 lbs overweight for 5 4
person)
7
Obesity Trends Among U.S. AdultsBRFSS, 1988
(BMI 30, or 30 lbs overweight for 5 4
person)
8
Obesity Trends Among U.S. AdultsBRFSS, 1989
(BMI 30, or 30 lbs overweight for 5 4
person)
9
Obesity Trends Among U.S. AdultsBRFSS, 1990
(BMI 30, or 30 lbs overweight for 5 4
person)
10
Obesity Trends Among U.S. AdultsBRFSS, 1991
(BMI 30, or 30 lbs overweight for 5 4
person)
11
Obesity Trends Among U.S. AdultsBRFSS, 1992
(BMI 30, or 30 lbs overweight for 5 4
person)
12
Obesity Trends Among U.S. AdultsBRFSS, 1993
(BMI 30, or 30 lbs overweight for 5 4
person)
13
Obesity Trends Among U.S. AdultsBRFSS, 1994
(BMI 30, or 30 lbs overweight for 5 4
person)
14
Obesity Trends Among U.S. AdultsBRFSS, 1995
(BMI 30, or 30 lbs overweight for 5 4
person)
15
Obesity Trends Among U.S. AdultsBRFSS, 1996
(BMI 30, or 30 lbs overweight for 5 4
person)
16
Obesity Trends Among U.S. AdultsBRFSS, 1997
(BMI 30, or 30 lbs overweight for 5 4
person)
17
Obesity Trends Among U.S. AdultsBRFSS, 1998
(BMI 30, or 30 lbs overweight for 5 4
person)
18
Obesity Trends Among U.S. AdultsBRFSS, 1999
(BMI 30, or 30 lbs overweight for 5 4
person)
19
Obesity Trends Among U.S. AdultsBRFSS, 2000
(BMI 30, or 30 lbs overweight for 5 4
person)
20
Obesity Trends Among U.S. AdultsBRFSS, 2001
(BMI 30, or 30 lbs overweight for 5 4
person)
No Data lt10 1014
1519 2024 25
21
Obesity Trends Among U.S. AdultsBRFSS, 2002
(BMI 30, or 30 lbs overweight for 5 4
person)
(BMI ?30, or 30 lbs overweight for 54 person)
No Data lt10 1014
1519 2024 25
22
Obesity Trends Among U.S. AdultsBRFSS, 2003
(BMI 30, or 30 lbs overweight for 5 4
person)
No Data lt10 1014
1519 2024 25
23
Obesity Trends Among U.S. AdultsBRFSS, 2004
(BMI 30, or 30 lbs overweight for 5 4
person)
No Data lt10 1014
1519 2024 25
24
Why this increase?
  • Genetic theories
  • One obese parent 40 risk of obese child
  • Two obese parents 80 risk of obese child
  • Twin / adoptee studies66-70 of variance
    accounted for by genetics
  • But
  • Cannot explain changes over time
  • Cannot explain migration data

25
Obesogenic environment
  • Sedentary lifestyle
  • Less manual labour
  • More car use
  • Town planning
  • Remote controls
  • Mobile phones
  • More fast food
  • Less cooking
  • More eating out
  • More snacking

26
A role for behaviour
  • Physical activity
  • Eating behaviour

27
(No Transcript)
28
Why do exercise?
  • Habit
  • Learning
  • Childhood
  • Attitudes
  • Costs and benefits
  • Peer norms
  • Social norms
  • we like it

29
  • Eating behaviour

30
(No Transcript)
31
Why do we eat what we eat?
  • Hunger?

32
The meaning of food
  • Emotional regulation
  • Social interaction
  • Habit

33
Why do we eat?
  • Habit
  • Learning
  • Childhood
  • Costs and benefits
  • Peer norms
  • Social norms
  • we like it
  • we try NOT to eat it

34
Basically ..
  • We eat because at the time the benefits of eating
    out weigh the costs

35
Therefore.
  • Good evidence for genetic basis to obesity
  • Cannot explain rapid increase
  • Role for obesogenic environment
  • Highlights role for behaviour
  • Activity and eating
  • Role of psychology
  • Obesity treatment?
  • Needs to address behaviour
  • Needs to address psychology of behaviour
  • What works / doesnt work? / why?

36
Dietary interventions
  • Traditional programmes
  • Eat less
  • Lost weight
  • but 99 regained weight
  • Multidimensional packages
  • Lifestyles changes, cognitive restructuring,
    reasonable weights, nutritional information, self
    monitoring, relapse prevention, screening
    patients, follow ups
  • 60 lose weight
  • Up to 95 regain weight in longer term

37
  • Why dont they work?

38
Dieting
  • Trying to eat less
  • But.
  • Most dieters show episodes of overeating
  • The what the hell effect

39
Why dont dietary interventions work?
  • Trying to change embedded habit
  • Rebound back to old habit
  • High effort
  • Restriction takes away function
  • Emotional regulation
  • Social interaction
  • AND imposes denial
  • Creates preoccupation with food
  • Lowers mood
  • Exacerbates benefits of eating
  • Offers no costs of eating

40
What can we learn?
  • Behaviour is difficult to change
  • Habits
  • Function of food
  • Social
  • Emotional regulation
  • Communication
  • Benefits out weigh costs
  • Dieting exacerbates benefits
  • Denial

41
  • Alternatives?...............

42
Medication
  • Orlistat (Xenical)
  • Prevents fat absorption
  • Causes unpleasant side effects
  • Qualitative study
  • The experience of taking Orlistat as a window
    into
  • Successful behaviour change
  • (Ogden and Sidhu, 2006)

43
Causes of obesity
  • Medical
  • Im not a big eater, sometimes I dont even want
    to eat but I just eat coz I have to eat coz Im
    diabetic (Frances).
  • Behavioural
  • I ate too much. I ate all the wrong foods. I
    did a static job.. And the bigger I got the more
    I ate. And thats about it really. I used to
    eat a colossal amount..it was bacon, eggs,
    sausages, chips I used to eat loads and loads of
    meat. Beef, pork. I could eat two French
    sticks in one sitting (Matthew).

44
Experiences of side effects
  • I had near misses I dont break wind unless Im
    sitting on the loo. Its a fear thing I have
    had situations where Ive had to discard a pair
    of boxer shorts (David).
  • messy, disgusting, horrible, unsafe, near
    misses, accidents, personal oil slick.

45
Behaviour change?
  • Showed behaviour change if
  • Behavioural model of causes
  • Visual side effects act as an education

46
What can we learn?
  • Drugs work by
  • Encouraging a behavioural model of obesity
  • See diet as the cause
  • Create match between cause and solution
  • Create short term costs of overeating

47
Surgery
  • Surgery
  • Reduces stomach size
  • Reduces food intake
  • Can cause dramatic weight loss
  • But has unpleasant side effects

48
Qualitative study
  • In depth interviews
  • 15 people who had had surgery
  • (Ogden et al, 2005 2006)

49
Role of food
  • I used to think about food all the time..before
    I got married Id sit in bed reading recipe books
    thinking cor I fancy thatnow I think that would
    be good and that wouldnt

50
Hunger
  • The most incredible thing that has happened is
    lack of appetite the hunger pangs have gone Im
    sated when I eat

51
Control over food
  • If someone or something didnt stop me I would
    just continue. What the operation has done for
    me is that physically because my stomach is
    smaller I can only eat smaller mealsbecause I
    know I cant I dont

52
What can we learn?
  • Surgery works by
  • Reduces function of food
  • Changes habit
  • Emotional regulation
  • Social interaction
  • Provides short term costs to overeating
  • Taking away control from individual
  • Relies upon stomach size NOT denial

53
Therefore
  • Obesity on the increase
  • Obesogenic environment
  • Behaviour
  • Behaviour difficult to change
  • Treatment alternatives
  • Have psychological implications

54
  • How can we improve weight management?

55
Need to change behaviour
  • Avoid
  • Avoid consequences of dieting
  • Avoid denial
  • Avoid making food more pleasurable
  • Avoid exacerbating benefits of eating

56
To Do.
  • Acknowledge and address the psychology of obesity
  • Address psychology of behaviour
  • AND / OR change environment
  • AND / take away control through surgery
  • AND / OR offer surgery but support people through
    it
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