Obesity in America: Implications for Clinical and Health Psychologists

The number of individuals classified as overweight and obese is increasing at alarming rates and these conditions are associated with numerous psychological and physiological health problems. Within this epidemic, there is an increasing need and demand for psychologists and other mental health professionals to participate in the care of patients with obesity, both in assessment and treatment domains. The current paper provides a review of the status of the obesity epidemic, including psychological comorbidities and treatment approaches. Throughout this review, we highlight and discuss the important roles and impact psychologists can have. These roles include serving as members of multidisciplinary obesity treatment programs, conducting assessments for bariatric surgery, and treating related psychiatric disorders, such as depression and disordered eating. Other considerations, such as weight gain associated with psychiatric medications, and directions for future involvement of psychologists in addressing the obesity epidemic are also discussed.     

Cognitive Behavioral Therapy for Bariatric Surgery Patients: Preliminary Evidence for Feasibility,Acceptability, and Effectiveness

Bariatric surgery is the most effective treatment for extreme obesity; however, 20% to 50% of patients begin to regain their weight within the first 1.5 to 2 years following surgery. Despite some psychosocial factors predicting postoperative weight loss and weight regain, psychosocial interventions are not routinely offered in bariatric surgery programs. In this paper, we describe a 6-session cognitive behavioral therapy (CBT) intervention for preoperative and postoperative bariatric surgery patients with maladaptive eating behaviors or thought patterns, which can be delivered either in person or by telephone. In addition, we describe a small pilot study (n = 8) designed to examine the feasibility and acceptability of the CBT intervention, as well as its effectiveness in improving eating pathology and psychosocial functioning. Most pilot study participants reported improvements in binge eating severity, emotional eating, and depression from pre- to posttreatment, and all participants provided positive qualitative feedback regarding the intervention.     

Nurses' attitudes toward obese persons and certain ethnic groups.

Societal attitudes toward obese persons are predominantly negative, and many health care professionals share these beliefs. This study compared attitudes toward obese persons of 67 US nurses to those of 107 Canadian nurses. Also, attitudes toward obesity were examined as a particular class of prejudice. A positive correlation was hypothesized between ethnic prejudice and prejudice regarding obese persons. Significant differences in attitudes toward obese patients were observed between the two groups on several questionnaire items, and the hypothesis was confirmed by the moderate r of .53 for US nurses. A surprising finding was a new target of ethnic prejudice: the Caucasian majority.     

Anti-fat Prejudice: The Role of Psychology in Explication, Education and Eradication

The field of psychology’s explication of anti-fat prejudice and its impact on psychological practice in the U.S. is reviewed. The medical perspective that obesity is itself a disease or a psychological disorder and that fat is the cause of various physical or mental health conditions is challenged and viewed as contributing to weight-based prejudice in the U.S. The role of psychology in educating students and future practitioners about anti-fat bias and research on the ineffectiveness of dieting is examined. Research documenting anti-fat bias in the diagnosis and treatment of fat female clients in the U.S. is reviewed, and potential solutions for eradicating anti-fat prejudice in the clinical practice of psychology, including alternatives to dieting for women, are described.     

A Screening Tool to Assess and Manage Behavioral Risk in the Postoperative Bariatric Surgery Patient: The WATCH

Bariatric surgery is increasingly recognized as a highly effective treatment for individuals who are severely obese. Amount of weight loss and resolution of comorbidities surpass those of nonsurgical approaches; however, suboptimal weight loss and weight regain are not uncommon. These outcomes, though not fully understood, are likely at least partially explained by failure to make long-term behavioral and/or cognitive changes. We are unaware of any established clinical tools to guide providers in assessing postoperative behaviors and identifying those who may require specialized treatment. The goal of this paper is to introduce a brief screening tool, The WATCH, to help clinicians assess and identify patients who may be at risk for poor or untoward outcomes post bariatric surgery. We first review the literature on postoperative outcomes, including weight loss, resolution of comorbidities, suboptimal outcomes, and development of problematic eating behaviors. We then provide an easily-recalled, five-item tool that assesses outcomes, and discuss patient responses that may necessitate further intervention or referral.     

Emotion processing and regulation in women with morbid obesity who apply for bariatric surgery

Emotional eating, the tendency to eat when experiencing negative affect, is prevalent in morbid obesity and may indicate that ways to deal with emotions are disturbed. Our aim was to compare emotion processing and regulation between 102 women with morbid obesity who apply for bariatric surgery and 102 women from the general population (control group) and to examine in the group with morbid obesity the association of emotion processing and regulation with emotional eating. The group with morbid obesity reported higher scores on difficulty identifying feelings (alexithymia, p?=?0.002) and suppression of emotions (p?=?0.003) than the control group. In the women with morbid obesity, more negative affect and a higher difficulty identifying feelings were correlated with more emotional eating (r?=?0.36 and r?=?0.35, p?相似文献   

Ethical Considerations for Assessing Parent Mental Health during Child Assessment Services

Parents play an integral role in the mental health service provision of children and adolescents, and they can have significant effects on the outcomes of youth. A growing body of research has linked parents’ own mental health status to numerous outcomes for their children, and recent guidelines have emerged recommending the assessment of parent psychopathology when treating child patients. However, these recommendations present a range of ethical considerations. Mental health professionals must determine if the assessment of a parent is empirically supported and that an assessment procedure appropriate for parents can be feasibly implemented. They must also respect the autonomy and confidentiality of parents while ensuring that assessment findings can be translated to meaningful benefits for child patients. This article details and discusses each of these concerns within the context of the relevant principles and standards of the 2016 American Psychological Association’s Code of Ethics. Further, it provides guidelines, relevant clinical examples, and an applied model for mental health professionals to consider the ethical implications of assessing parent mental health when serving child patients.     

The obesity epidemic: medical and ethical considerations

Obesity is increasingly becoming a problem for Western societies, to the extent that politicians, scientists, patient organisations and the media now refer to it as 'the obesity epidemic'. Concerns about the damaging effect of increasing body weight on public health has led to a strong growth in the amount of scientific work on the condition, with the medical professions leading the way. This article discusses that, first of all, scientific evidence for obesity-associated mortality is at best ambiguous, and proposes that at least some of contemporary medical preoccupation with obesity has a moral origin in that it seeks to correct unwanted or immoral behaviour. It then continues to reflect on the effect of the conceptual transformation of healthy children into patients, and concludes with some reflections on the ethical implications of the obesity disease for the wellbeing of children.     

Sham surgery: An ethical analysis

Surgical clinical trials have seldom used a "sham" or placebo surgical procedure as a control, owing to ethical concerns. Recently, several ethical commentators have argued that sham surgery is either inherently or presumptively unethical. In this article I contend that these arguments are mistaken, and that there are no sound ethical reasons for an absolute prohibition of sham surgery in clinical trials. Reflecting on three cases of sham surgery, especially on the recently reported results of a sham-controlled trial of arthroscopic surgery for arthritis of the knee, I present an ethical analysis that focuses on the methodological rationale for use of sham surgery, risk-benefit assessment, and informed consent.     

Sham surgery: an ethical analysis

Surgical clinical trials have seldom used a "sham" or placebo surgical procedure as a control, owing to ethical concerns. Recently, several ethical commentators have argued that sham surgery is either inherently or presumptively unethical. In this article I contend that these arguments are mistaken and that there are no sound ethical reasons for an absolute prohibition of sham surgery in clinical trials. Reflecting on three cases of sham surgery, especially on the recently reported results of a sham-controlled trial of arthroscopic surgery for arthritis of the knee, I present an ethical analysis that focuses on the methodological rationale for use of sham surgery, risk-benefit assessment, and informed consent.     

New Models for Increasing Donor Awareness: The Role of Religion

Surgical clinical trials have seldom used a "sham" or placebo surgical procedure as a control, owing to ethical concerns. Recently, several ethical commentators have argued that sham surgery is either inherently or presumptively unethical. In this article I contend that these arguments are mistaken and that there are no sound ethical reasons for an absolute prohibition of sham surgery in clinical trials. Reflecting on three cases of sham surgery, especially on the recently reported results of a sham-controlled trial of arthroscopic surgery for arthritis of the knee, I present an ethical analysis that focuses on the methodological rationale for use of sham surgery, risk-benefit assessment, and informed consent.     

The Meaning of Obesity in the Church: A Pastoral Leader’s Perspective

The purpose of this study is to highlight a unique case regarding obesity and weight loss in the Christian church that emerged when interviewing men who had experienced bariatric surgery. Thirty-four-year-old “Pastor Tom” was removed from his position in the church due to his obesity. Through critical reflection, utilizing an intrinsic case study methodology, the authors explore how this research participant constructed meaning around obesity and weight loss. In this study, two major themes emerged: (1) leading by example and (2) becoming a leader. The study includes a discussion of implications for the church as well as teaching, clinical, and research implications.     

Emotion processing and regulation in women with morbid obesity who apply for bariatric surgery

Emotional eating, the tendency to eat when experiencing negative affect, is prevalent in morbid obesity and may indicate that ways to deal with emotions are disturbed. Our aim was to compare emotion processing and regulation between 102 women with morbid obesity who apply for bariatric surgery and 102 women from the general population (control group) and to examine in the group with morbid obesity the association of emotion processing and regulation with emotional eating. The group with morbid obesity reported higher scores on difficulty identifying feelings (alexithymia, p?=?0.002) and suppression of emotions (p?=?0.003) than the control group. In the women with morbid obesity, more negative affect and a higher difficulty identifying feelings were correlated with more emotional eating (r?=?0.36 and r?=?0.35, p?<?0.001). Our study suggests that negative emotions and unhealthy emotion processing may play a role in emotional eating, and it indicates the possible relevance of emotion processing and emotional regulation as initiating or perpetuating mechanisms in morbid obesity.     

“Big eye” surgery: the ethics of medicalizing Asian features

The popularity of surgical modifications of race-typical features among Asian women has generated debates on the ethical implications of the practice. Focusing on blepharoplasty as a representative racial surgery, this article frames the ethical discussion by viewing Asian cosmetic surgery as an example of medicalization, which can be interpreted in two forms: treatment versus enhancement. In the treatment form, medicalization occurs by considering cosmetic surgery as remedy for pathologized Asian features; the pathologization usually occurs in reference to western features as the norm. In the enhancement form, medicalization occurs by using medical means to improve physical features to achieve a certain type of beauty or physical appearance. Each type of medicalization raises slightly different ethical concerns. The problem with treatment medicalization lies in the pathologization of Asian features, which is oppressive as it continues to reinforce racial norms of appearance and negative stereotypes. Enhancement medicalization is ethically problematic because cosmetic surgery tends to conflate beauty and health as medical goals of surgery, overemphasizing the value of appearance that can further displace women’s control over their own bodies. I conclude that in both forms of medicalization, cosmetic surgery seems to narrowly frame a complex psychosocial issue involving physical appearance as a matter that can be simply solved through surgical means.     

Can Ethical Ideologies Predict Prejudice?

Idealism and relativism were designed to assess different ethical ideological views. Their relation with attitudes toward a variety of outgroups has not been previously studied. Understanding how concerns over ethical principles and consequences are related to prejudiced attitudes could provide some insight into these constructs and into the nature of prejudice. In two studies totaling 311 participants, participants completed measures on ethical ideologies, right-wing authoritarianism, and attitudes toward various outgroups. The differential predictive validities of ethical ideologies, in comparison to right-wing authoritarianism, on prejudicial attitudes toward dangerous, derogated, and dissident outgroup members were examined. We found that both idealism and relativism contributed to predicting attitudes regarding outgroup members, over and above right-wing authoritarianism. As such, people’s personal moral standards and code of conduct for dealing with interpersonal problems and transgressions can partly explain their negative attitudes toward outgroup members. More research is required to determine the unique influence of ethical ideologies over other constructs previously shown to predict prejudice.     

Psychologists’ Evaluation of Bariatric Surgery Candidates Influenced by Patients’ Attachment Representations and Symptoms of Depression and Anxiety

This study examines whether patients self-reported attachment representations and levels of depression and anxiety influenced psychologists’ evaluations of morbidly obese patients applying for bariatric surgery. A sample of 250 patients (mean age 44, 84 % female) who were referred for bariatric surgery completed questionnaires to measure adult attachment and levels of depression and anxiety. Psychologists rated patients’ suitability for bariatric surgery using the Cleveland Clinic Behavioural Rating System (CCBRS), unaware of the results of the completed questionnaires. Attachment anxiety (OR = 2.50, p = .01) and attachment avoidance (OR = 3.13, p = .001) were found to be associated with less positive evaluations on the CCBRS by the psychologists, and symptoms of depression and anxiety mediated this association. This study strongly supports the notion that patients’ attachment representations influence a psychologist’s evaluation in an indirect way by influencing the symptoms of depression and anxiety patients report during an assessment interview. The clinical implications of these findings are discussed.     

Physician-assisted suicide: the role of mental health professionals

A review of the literature was conducted to better understand the (potential) role of mental health professionals in physician-assisted suicide. Numerous studies indicate that depression is one of the most commonly encountered psychiatric illnesses in primary care settings. Yet, depression consistently goes undetected and undiagnosed by nonpsychiatrically trained primary care physicians. Noting the well-studied link between depression and suicide, it is necessary to question giving sole responsibility of assisting patients in making end-of-life treatment decisions to these physicians. Unfortunately, the use of mental health consultation by these physicians is not a common occurrence. Greater involvement of mental health professionals in this emerging and debated area is advocated. Beyond describing mental health professionals' role in the assessment of patient competency or decision making capacity, other areas of potential involvement are described. A discussion of ethical principles relevant to this area follows, along with comments on the training necessary to adequately serve patient needs.     

A Cognitive-Behavioral Mindfulness Group Therapy Intervention for the Treatment of Binge Eating in Bariatric Surgery Patients

Binge eating is a negative indicator of post-surgical weight loss and health outcome in bariatric surgery patients (Hsu, Bentancourt, Sullivan, 1996). Cognitive-behavioral techniques and mindfulness-based practices have been shown to successfully treat binge eating (Agras, Telch, Arnow, Eldredge, & Marnell, 1997; Kristeller & Hallett, 1999). This report describes the development and implementation of a 10-week cognitive-behavioral mindfulness-based group intervention designed to reduce binge eating and address the specific needs of bariatric surgery patients. Posttreatment data showed improvement in binge eating symptoms, depressive symptomatology, and emotion regulation skills and increased motivation to change maladaptive eating behavior.     

Quality of Life and General Health Perception in Women with Obesity

The purpose of this study was to determine the differences in general health status and quality of life between patients who present “non-normative eating behaviours” (namely, binge eating disorder, night eating syndrome, sweet /fat food cravings and continuous nibbling) and patients without these eating behaviour characteristics. A cohort of 168 women with obesity, all candidates to bariatric surgery, aged between 15 and 65 (M = 39.04; SD = 10.86), with a body mass index ranging between 30.37 and 80.65 (M = 48.79; SD = 8.37), was studied. Participants answered to a clinical interview, to SF-36 and to ORWELL-97, after their informed consent. Results suggest that women with obesity reporting binge eating disorder, night eating syndrome and continuous nibbling show poorer general health status and worst quality of life than those who do not present these “non-normative eating behaviours”. Moreover, the general health status and the quality of life of patients with sweet/fat food cravings do not differ from those who do not report this eating behaviour. Nevertheless, patients reporting the eating behaviours studied do not differ from the others regarding their body mass index.     

Factors Associated with Suicide Ideation in Severely Obese Bariatric Surgery‐Seeking Individuals

There are high rates of suicide ideation and/or behavior in severely obese individuals. The potential contributors to suicide ideation in a sample of 334 severely obese bariatric surgery candidates was explored. Lack of college education, a history of suicide ideation and/or behavior, psychological distress, hopelessness, loneliness, history of physical and/or sexual abuse, and lifetime major depression were associated with current suicide ideation. Some of the correlates of suicide ideation in severely obese bariatric surgery‐seeking samples are similar to those found in the general community and this knowledge may serve to improve the psychological assessment and care for this group.