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The psychology of obesity

The psychology of obesity. Jane Ogden Professor of Health Psychology University of Surrey. Overview. The causes of obesity The role of behaviour Obesity treatment Dietary interventions Medication Surgery What doesn ’ t work? What works? How can obesity be treated effectively?.

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The psychology of obesity

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  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 doesn’t work? • What works? • How can obesity be treated effectively?

  3. The rise in obesity

  4. No Data <10% 10%–14% Obesity Trends* Among U.S. AdultsBRFSS, 1985 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

  5. No Data <10% 10%–14% Obesity Trends* Among U.S. AdultsBRFSS, 1986 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

  6. No Data <10% 10%–14% Obesity Trends* Among U.S. AdultsBRFSS, 1987 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

  7. No Data <10% 10%–14% Obesity Trends* Among U.S. AdultsBRFSS, 1988 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

  8. No Data <10% 10%–14% Obesity Trends* Among U.S. AdultsBRFSS, 1989 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

  9. No Data <10% 10%–14% Obesity Trends* Among U.S. AdultsBRFSS, 1990 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

  10. No Data <10% 10%–14% 15%–19% Obesity Trends* Among U.S. AdultsBRFSS, 1991 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

  11. No Data <10% 10%–14% 15%–19% Obesity Trends* Among U.S. AdultsBRFSS, 1992 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

  12. No Data <10% 10%–14% 15%–19% Obesity Trends* Among U.S. AdultsBRFSS, 1993 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

  13. No Data <10% 10%–14% 15%–19% Obesity Trends* Among U.S. AdultsBRFSS, 1994 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

  14. No Data <10% 10%–14% 15%–19% Obesity Trends* Among U.S. AdultsBRFSS, 1995 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

  15. No Data <10% 10%–14% 15%–19% Obesity Trends* Among U.S. AdultsBRFSS, 1996 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

  16. No Data <10% 10%–14% 15%–19% ≥20 Obesity Trends* Among U.S. AdultsBRFSS, 1997 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

  17. No Data <10% 10%–14% 15%–19% ≥20 Obesity Trends* Among U.S. AdultsBRFSS, 1998 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

  18. No Data <10% 10%–14% 15%–19% ≥20 Obesity Trends* Among U.S. AdultsBRFSS, 1999 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

  19. No Data <10% 10%–14% 15%–19% ≥20 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 <10% 10%–14% 15%–19% 20%–24% ≥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 5’4” person) No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

  22. Obesity Trends* Among U.S. AdultsBRFSS, 2003 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

  23. Obesity Trends* Among U.S. AdultsBRFSS, 2004 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% ≥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 studies:66-70% 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. Why do exercise? • Habit • Learning • Childhood • Attitudes • Costs and benefits • Peer norms • Social norms • ‘we like it’

  28. Eating behaviour

  29. Why do we eat what we eat? • Hunger?

  30. The meaning of food • Emotional regulation • Social interaction • Habit

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

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

  33. 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 / doesn’t work? / why?

  34. 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

  35. Why don’t they work?

  36. Dieting • Trying to eat less But…. • Most dieters show episodes of overeating • The ‘what the hell’ effect

  37. Why don’t 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

  38. 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

  39. Alternatives?...............

  40. 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)

  41. Causes of obesity Medical • ‘I’m not a big eater, sometimes I don’t even want to eat but I just eat coz I have to eat coz I’m 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 that’s 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).

  42. Experiences of side effects • ‘I had near misses… I don’t break wind unless I’m sitting on the loo. It’s a fear thing – I have had situations where I’ve had to discard a pair of boxer shorts’ (David). • ‘messy’, disgusting’, ‘horrible’, ‘unsafe’, ‘near misses’, ‘accidents’, ‘personal oil slick’.

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

  44. 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

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

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

  47. Role of food • ‘I used to think about food all the time..before I got married I’d sit in bed reading recipe books thinking cor I fancy that…now I think that would be good and that wouldn’t’

  48. Hunger • ‘The most incredible thing that has happened is lack of appetite… the hunger pangs have gone… I’m sated when I eat’

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