Addressing Addiction in the Obesity Battle
For those with a significant amount of weight to lose, surgical options are a viable … and effective … weapon in the battle against obesity. Clinicians, however, are quick to add that it is simply one part of the armamentarium required to win the war. Ultimately, each person must address the underlying food and mood issues in order to achieve long term success.
Charles Ihrig, PhD, co-owner and founder of Athena Consulting and Psychological Services, Inc. has a strong working relationship with all of the bariatric centers of excellence in the Nashville area. The licensed psychologist and professional counselor, along with his colleagues, work with many Middle Tennessee patients both pre- and post-op to help ensure the tools and systems are in place to support the lifestyle changes required for weight loss and maintenance.
“The National Institutes of Health standards dictate psychological evaluations for candidates for bariatric weight loss surgery,” he explained, adding, “I can’t stress enough that it’s not designed to be a pass/fail evaluation, but it’s designed to create a plan to assist the patient before, during and after the surgery.”
Ihrig said it’s important that patients truly understand the process and recognize that even with surgical intervention, weight gain is possible for those who work to cheat the system. “The surgery itself is not the panacea. It just addresses the metabolic issue. It doesn’t address the motivation, the behaviors. It doesn’t provide new coping strategies.”
In fact, Ihrig, who is president of the Nashville Area Psychological Association, said established research has indicated between 60-80 percent of appropriate bariatric surgery candidates have clinical levels of depression. For some, the depression led to the overeating. For others, it’s a condition linked to an increasingly diminished quality of life as it becomes difficult to engage in routine activities.
“It’s almost a cliché that we think of ‘fat and happy,’” said Ihrig. “I think those are the exceptions. Most people are fat and miserable.” He added that many of the patients with whom he works see obesity as the last socially-acceptable form of discrimination. Too often, he continued, people … including some physicians … think, ‘Oh just stop it. Don’t eat so much.’ However, Ihrig said it isn’t that simple. “We really treat morbid obesity and chronic overeating in the format of an addiction,” he explained. “There are clearly medical underpinnings to the behavior like any other addiction.”
Ihrig added, “One thing that is really common that those with eating disorders share — whether it’s anorexia or chronic overeating and obesity — is obsessive behaviors around food.” For many, he continued, the compulsive behaviors surrounding eating circle back to control. “The one thing we can always control is what we put in our mouth.”
Additionally, he noted, food really can change mood by stimulating pleasure centers in the brain and making an obese person feel happier for a little while. Carbohydrates, in particular, have this impact. “For short periods of time, it changes insulin levels and serotonin levels in the brain,” he explained. “There is small relief from depressive symptoms, but it is a small window.” Ihrig added, “You can get addicted to anything that stimulates that pleasure center in the brain.”
Unfortunately, research has found the addictive behavior of chronic overeaters and the obese creates a vicious cycle by triggering hormonal responses in terms of increased levels of leptin and ghrelin. Ihrig said the increase in these hormones results in a physical evidence of hunger and drive to eat. Breaking this destructive cycle requires work on both the physical and emotional ends of the eating spectrum.
Despite the obstacles, Ihrig said achieving and maintaining significant weight loss is certainly possible. In fact, he said that when looking at the most common bariatric surgical procedure, Roux-en-Y Gastric Bypass, the majority of patients have maintained successful weight loss even 30 years post-surgery. The single biggest predictor of long term success, he continued, is attending a support group.
Athena Consulting leads the ongoing counseling groups for the Centennial Center for the Treatment of Obesity and is currently developing a similar program for Middle Tennessee Medical Center. As with Alcoholics Anonymous, those battling food addictions might find a lifelong need to tap into support in order to maintain healthy habits and behaviors. For those who are doing well, Ihrig suggested attending a counseling group once a month. For those who are struggling, weekly attendance is helpful.
Additionally, he noted that many patients initially need some individual counseling to understand the motivation behind their eating behaviors and to learn new coping strategies. For those who suffer from clinical depression or anxiety, medication might also be in order, he said.
Ultimately, Ihrig concluded, the recipe for success post-bariatric surgery comes from embracing a new lifestyle, keeping an eating journal and tapping into external support systems including family, friends and organized groups. Fighting obesity might be an uphill battle, but it’s certainly a winnable war.