How can psychological support help with obesity?

If you have thoughts of harming yourself, contact a doctor, an emergency number or a crisis line in your country straight away.

Why is psychological support part of obesity care?

Psychological support is part of obesity care because thoughts, feelings, stress and past experiences all influence eating, activity and sleep. This does not mean that obesity is a mental illness or that it is all in your head. Obesity is a chronic disease with strong biological roots.

But living with it, and with the stigma around it, can be hard. Depression and anxiety are more common in people living with obesity, and they can make treatment more difficult. Read more about sleep, stress and mental health.

Which approaches are used?

The best-studied approach is cognitive behavioural therapy (CBT), which helps you notice and change patterns in thoughts, feelings and behaviour. Other approaches can also help.

• Cognitive behavioural therapy (CBT): you learn to recognise triggers for eating, plan regular meals, challenge unhelpful thoughts such as all-or-nothing thinking, and prevent relapse. It is often part of lifestyle treatment.
• Acceptance and commitment therapy (ACT): you learn to make room for difficult thoughts and cravings, without acting on them, and to act on what matters to you.
• Mindfulness-based approaches: paying attention to hunger, fullness and emotions, without judgement.
• Motivational interviewing: a conversation style that helps you find your own reasons and readiness for change.
• Interpersonal therapy: focuses on relationships and life events that affect mood and eating.

Support can be individual, in a group or online. It may come from a psychologist, a psychotherapist or a trained professional in an obesity team.

What does research show for each type of support?

Research shows that psychological support mainly improves eating behaviour and wellbeing, while its direct effect on weight is usually modest. The table compares the main approaches.

What do these numbers mean for you? Psychological support helps most with how you eat, feel and cope. On its own it rarely leads to large weight loss.

In the IPT and CBT trial, weight went down only slightly, and most in people who stayed free of binges. That is why support works best alongside good food, daily walking and movement at a level that suits you.

If you want to try one of these approaches, talk to your doctor first. In many countries a referral is needed, and your doctor can help you find the type of support that fits your situation.

What is binge eating disorder?

Binge eating disorder is a recognised eating disorder in which a person regularly eats an unusually large amount of food in a short time and feels a loss of control, without compensating by vomiting or extreme exercise. According to the DSM-5 diagnostic criteria, binge episodes happen at least once a week for three months and include at least three of the following:

• eating much faster than usual;
• eating until uncomfortably full;
• eating large amounts when not physically hungry;
• eating alone because of embarrassment;
• feeling disgusted, depressed or very guilty afterwards.

The episodes cause marked distress. Binge eating disorder is one of the most common eating disorders in adults. In WHO World Mental Health Surveys in 14 countries, about 1.4 percent of adults had had binge eating disorder at some point in their life. It is more common among people seeking treatment for obesity. Fewer than half of people with the condition had ever received treatment.

How is binge eating disorder treated?

Binge eating disorder is treatable, and psychological therapy is the first-choice treatment. In the UK, NICE recommends starting with guided self-help based on CBT: you work through a self-help programme with short support sessions. If that is not enough, CBT in a group or one-to-one follows, typically over about four months.

Treatment focuses on regular eating, triggers, body image and relapse prevention. It does not focus on weight loss, and strict dieting can make bingeing worse. In some countries, a medicine may also be offered. Once binge eating is under control, treatment for weight can follow.

What is emotional eating?

Emotional eating means eating to cope with feelings, such as stress, sadness, boredom or loneliness, rather than hunger. Almost everyone does this sometimes, and it is not an eating disorder in itself. It becomes a problem when it is your main way of coping. Helpful steps include:

• eating regular meals, so you are not very hungry later in the day;
• noticing which feelings or situations lead to eating;
• building other ways to cope, such as a walk, a call or a short break;
• being kind to yourself after a setback, because guilt often leads to more eating.

How does body image affect health?

A negative body image can lead to shame, avoiding exercise or social contact, and putting off medical care. Working on body image does not mean giving up on health goals. It means treating your body with respect now, whatever its size. Therapy can help you reduce constant checking or comparing, and focus on what your body can do.

How does weight stigma affect mental health?

Weight stigma harms both mental and physical health. A joint international consensus statement by 36 experts and partner organisations concluded that weight stigma damages health and that people affected are less likely to receive adequate care. When people start to believe negative stereotypes about themselves, called internalised weight bias, this is linked to shame, depression, binge eating and avoiding healthcare.

Stigma does not motivate people to lose weight. It makes treatment harder. Read more about weight stigma and stigma in healthcare.

When should you seek specialist eating disorder help?

Seek specialist help if eating feels out of control, or if your thoughts about food, weight or shape take over your life. Signs include:

• regular binges with a sense of losing control;
• vomiting, using laxatives or exercising excessively to make up for eating;
• very strict rules about food, or skipping meals for long periods;
• fast weight loss or gain, or feeling very anxious about weight;
• low mood, hopelessness or thoughts of self-harm.

Eating disorders affect people of all sizes, including people living with obesity. Tell your doctor openly what you experience, so that you can be referred to the right care. This is also important before starting weight-loss medication or bariatric surgery.