“Mental health disorder” in the sense that most people think of that term? No. Some people with mental health disorders have obesity as a result of them, but not quite the same thing.
But the brain is certainly in charge of the behaviors (in response to the environment and various exposures), controlling both input (by hunger cues and other drives) and controlling not only conscious exercise but how much we move around when not consciously exercising (what gets call non exercise activity thermogenesis, or “NEAT”) and is in control of metabolism itself to no small degree.
Not things that therapy works on so well but brain controlled to be sure.
The obesity drugs that work (modestly) generally work by targeting the brain centers involved.
Now onto exercise … the introduction to this article summarizes the expert consensus on exercise and obesity quite well.
Let me highlight that.
The impact of exercise on weight loss, per se, is modest (some better evidence for its role in maintaining loss). The impact of exercise on body composition and health is HUGE. Inactivity kills.
Note: the impact of exercise may vary in different individuals and the most important impact is likely not only directly the calories burned and the maintenance or increase of muscle mass but its impact on brain centers that then control behaviors and metabolism.
So we define “mental disorder” as meaning based to a large degree on the brain, then yes, and the therapy that generally works best on treating the brain differences associated with obesity is reduced exposure to the environmental triggers (hyperpalatable low satiety foods - read “processed crap”), more moderately palatable high satiety foods (read “lots of high fiber foods like veggies, fruits and whole grains, and probably moderately higher protein”) and regular exercise. A shocking conclusion I am sure.
The cogent point of the “HAES movement” is that the scale may be less useful to focus on than are the behaviors … not as a means to move the scale but for their own sake. Once someone is obese moving the scale in a lasting dramatic fashion is rarely achieved … but changed behaviors can be achieved and maintained and are beneficial even if the weight loss that happens to occur is very modest. Moreover the focus on the scale misses those of “normal” BMI who have poor behaviors and who metabolically are as-if obese, the metabolically obese normal weight - MONW.
Some of this stuff gets talked about when one delves into what gets called the obesity paradox, which may be in part due to other factors as well, but salient to this thread is this bit from that link:
Oh, btw, that Michael Phelps 12,000 calorie thing? Not true.
It’s not about eliminating the normal stress of life; it’s about handling the normal stress of life without eating to the point of being unhealthy.
But what if you no longer wanted the KFC or the Krispy Cremes? Then you wouldn’t even need self control. I get complimented all the time on my amazing will power, but the truth is that I have no will power at all. Through therapy, I was able to get to the point where I just had no desire at all to eat the things that were bad for me (at least in the amounts that were unhealthy).
There’s nothing wrong with trying diet and exercise first. I certainly did. It’s just that I wish I hadn’t waited thirty years to try therapy, always thinking that the next diet and exercise plan would be the one that would work.
Let’s take a step back to consider the actual costs to society from the study you cite. The key indicator that the study referenced doesn’t tell the whole story is that it’s computing annual not lifetime costs (and we’re dealing with an issue where expected life isn’t constant.) It’s a gross cost study that doesn’t look at other social savings correlated to obesity.
So what are the [lifetime medical costs of obesity?](Lifetime medical costs of obesity) In the linked study they find (with my emphasis added):
You cite also includes employment economic losses due to obesity related medical issues. It doesn’t, however, control for the fact that being obese is also correlated to lower wages. How much of that gross economic cost is borne by society as an externality and how much is borne by the individuals actually making choices about how to maximize their own rewards as they see them? The gross cost tally just lumps them together. Claiming it all as a cost to people who aren’t obese is inaccurate.
What are the effects on other lifetime costs like retirement programs. An annual gross cost methodology like you cited doesn’t cover costs savings in private defined benefit retirements, societal retirement plans, or other social safety net features that are more heavily drawn on by the elderly.
Net cost research for obesity seems to be less robust than for issues like smoking. It’s not a clear case that obesity produces a net cost borne by the non-obese though. To deal with that lack of clarity, the proposal is to use a treatment where there’s no current evidence of effectiveness. That’s in the realm of conducting a societal wide research program to test the hypothesis. The clearest effect is that it adds societal spending on mental health costs. That piece does hit my wallet for something that may or may not be more effective than the placebo effect from magnet therapy.
The comparison is a group that received CBT along with lots of attention, and both their and their families (at least one parent had to also attend all but two of the ten sessions) getting guidance and follow up phone call support, such as
Compared to
Wow. You think maybe the control was different in some ways other than CBT alone? Lots of attention, family focused education and support for a diet and exercise plan, with follow up support, resulted in cutting out sodas and some modest weight loss, with no data on whether or not the weight loss, or even just the decreased soda consumption, was maintained after the study.
Also all that attention and positive reinforcement with parental involvement, and change in diet and success at achieving a goal of modest weight loss was correlated with better scores on measures of anxiety and depression. Not shocking but better evidence that losing weight and getting extra positive attention especially from your parents, has a positive impact than evidence that therapy results in weight loss.
Also be aware of what this particular CBT was. Not dealing with anxiety or depression but half focused on diet and activity and the others on problem solving as relates to these new health related behaviors.
Thank you for the advise. Winter and spring were very hectic for me, but this summer I plan to focus on getting back into good health.
The last time I had a checkup my cholesterol and everything else was good, so it appears that my bad habits haven’t had too serious of an effect yet - but I don’t think I can keep going down the same path for a long time without seeing some more serious consequences. I’ll put more effort into developing better habits and see if that does the trick - I’ll definitely keep what you are saying in mind though.
Also note they admit how tiny their sample size, but I don’t get where this fits in with your above claims at all.
Seeing as CBT is fairly good at helping with impulse control, it could completely fit in with some of these exceptions weight control strategies. Really this study does nothing to support your side of the debate.
I’ll try as soon as you provide evidence that I have claimed that mortality should be considered a disease.
Look - if you want to argue that cognitive therapy can be effective at treating certain mental disorders, fine. Start an OP to that effect and see who wants to argue the point. This OP made a statement aout OBESITY. Now, you could certainly present an argument that a large enough percentage of obesity is caused by the factors in your study that it justifies labeling all obese people . . . . whatever. (By the way, teh secnd stuy you posted offers 10-25% of morbidly obese patients considering gastric bypass have been identidied with dysfunctional eating.)
But you haven’t done that. You haven’t even tried. It’s hard not to conclude that you simply don’t understand why you should.
Dseid already addressed some of the shortcomings in your first posted study, but I will also point out that of 25 children enrolled in the CBT program only 10 completed the full 20 week program. So the statistical results being reported for CBT versus control have already elminated 60% of the students enrolled in the CBT program,
Your second study is interesting in a couple of ways. Like the first it is short-term study only, so whether any gains were sustained (the most important question when discussing obesity and long-term societal medical costs) is unexamined. I wish I could find a link to their raw data, but what I can see from summary is that a significant numbe rof participants in the study identified prior to treatment with DE, anxiety, and depression. The study is primarily concerned with those factors and the intent is expressly to measure improvement along those measurements.
There is a small improvement in BMI and weight losss after 10 weeks, but not even teh folks who ran the sudy are arguing that CBT would be sufficient for sustained weight los in this population. They see it as an addition to surgical intervention for morbidly obese patients suffering from DE, etc. From teh conclusion: “Future research should investigate whether these proximal effects are sustained and whether presurgical improvement in DE behaviors and affective symptoms do provide an additive benefit to bariatric surgery in terms of a stabilization of weight loss.”
The largest problems with using this study to support generalized statements about treatment for obesity and societal medical costs are:
[ol]
[li]Morbidly obese patients self-selected for gastric bypass surgery are not a good model for all obese people[/li][li]A 10 week study with no long-term follow up is inadequate as a guide to effective treatment of obesity.[/li][/ol]
I’m sorry that you cannot see that neither study, in fact, purports to be addressing “the cause of obesity”. Where do you believe you read such a statement in either study?
And feel free to leave the snark at home. It is not serving you well here.
I’ve no dog in the “exercise matters” fight, but are you aware that teh number of people in DSeid’s referenced study is greater than the intervention group in your first and only 12 fewer than the intervention group in your second study? The number copleting the course of intervention is more than 3X the number completing in your first study. I couldn’t find the number that dropped out of treatment for the second stuy, but if it mathced their expected 40% loss rate then that would leave fewer people in teh final analysis than DSeid’s referenced study as well.
I’m just saying that “small sample size” may not be the most consistent claim for you to press.
That absurd request mirrored your absurd request that I provide evidence that mental health treatments could help with obesity while excluding any cause of said obesity. Purely so you could hand wave away any comprehensive research, as solutions differ based on the cause of the condition.
I did not, though you are close enough for a careless reading.
[ul]
[li]From the OP: should obesity be treated initially as a mental health issue?[/li][li]From yout first post: Obesity in it’s self is not a mental disorder, but it may be a symptom of a mental disorder.[/li][li]From my post that you objected to: there is no effective mental health treatment for obesity[/li][/ul]
Notice that the OP is about obesity. In total. Not a subset f obesity that may be caused by mental disorder. So was my response. Because, you know, the thread is supposed to respond to the OP. You keep talking abou ta proper subset when I am talking abou tthe whole. Now, since the context included explicit arguments based upon soceial cost, it would certainly be reasonable to build a case that the subsets that matter to your argument represent a sufficient portion of the obese population to justify a new public health policy - I even pointed that out to you, remember?
And it gets harder with each post you make.
I didn’t ask that you exclude causes of obesity. I pointed out that addressing a cause for some fraction of obesity is not sufficient to declare a course of treatment for obesity. Full stop. You appeared to understand teh distiction in your first post, but your subsequent posts have undercut that plain textual reading.
Just as heart surgery is not sufficient to declare a course of treatment for pending death. Your position is presented in order to make it easy to destroy. I can show you that anxiety eaters who receive CBT loose weight, I can show you those who get treatment for depression lose weight. I can not show you that the same is true for EVERY cause of obesity because there are several causes and many may be co-morbid.
If you have a problem with the OP address it to them, If you sincerely think I am locked into their OP, especially when I disagreed with it you are out of luck.
As for your claim that there is no effective mental health treatment for obesity, I already disproved it, just because there are not effective mental health treatments for ALL CAUSES of obesity doesn’t matter an iota, you are the one that claimed the absolute.
Where are you getting that quote that you are attributing to me, let alone which has nothing to do with anything that I posted?
Do NOT quote me as saying something I did not say or even imply.
The post you are responding to was me linking to one article of many discussing how response to exercise varies. This new link is to a review which summarizes much data and discusses some of the possible underlaying causes of that variability, including but not limited to the the brain-based ones that I personally see as key. They even discuss psychological factors! Yes, they exist. And no argument that a few have psychological factors and/or co-morbid mental illnesses as primary factors in their obesity and that some people benefit from therapy and/or other medical treatment of those co-morbidities.
A very interesting review however about the central role of neurologic mechanisms however including but not restricted to some very fascinating work in animal models, mostly focused on weight regain after successful loss. Yes, it happens in experimental animals too … metabolism slows down and appetite increases until they regain their previous stores and then they normalize again … the set point concept. The set point however is not set in stone:
This is not rats having psychological issues that drive them to regain weight or mental illness that does. And it is not so much more so in humans.
Note: I am not arguing that there is no role for support and therapy. Psychosocial factors also come into play, in a few people may even be primary, and in many more are a secondary impact that makes change more difficult. Data though that therapy to decrease impulse control is an effective first-line treatment for any more than a very few is … sparse. The closest to it are studies like this one - weight loss by way of a very low calorie diet coupled with behavioral therapy. End of treatment all had lower disinhibition scores. Those who gained back less were the same people who continued to keep the lowered disinhibition scores. Not sure though what that shows - I cannot read that as evidence that the therapy was effective per se so much as about pre-existing temperament: those who are able to maintain discipline do and those who cannot don’t.
If you want to define sessions primarily focused on learning and supporting lifestyle interventions, encouraging exercise and a healthy eating, as “CBT” then without question that therapy is a good bet at improved outcomes, especially if we are talking about kids and involving families. In point of fact family centered behavioral intervention is one of the few effective approaches for childhood obesity.
I would not say those kids have a mental illness though.
Not to any standard of proof meaningful in logic or scientific exchange. Obesity is a condition with a specific definition. It is not the same definition as anxiety or depression. It really is simple. Maybe if we use variables instead of statements?
[ul]
[li]SM There is no A that holds for all {X}[/li][li]RA A’ holds for {Y} and {Y} is a subset of {X}[/li][li]SM I didn’t say anything about {Y}. Can you address {X}[/li][li]RA I already disproved your statement about {X}[/li][/ul]
And, of course, you really didn;t prove anything about {Y} either - the two studies you refereced both fall well short of supporting any claims for sustained weight reduction.
It does matter, because you EXPLICITLY RESPONDED TO MY STATEMENT. Quoted me and everything. And just now referenced my statement AGAIN and claimed you had disproved it.
So the content of my statement is kind of important. It forms, in fact, the specific context for our current dispute. I understand that you would like to ignore it because you have been unable to actually frame an argument to refute it. But you chose to fight that very particular battle, I didn’t seek you and throw false equivalencies at you with smug satisfaction.
