Obesity, Eating Disorder + Substance Use

Obesity def + illnesses increased risk of

“Excess body weight“

• Diabetes

• Heart disease

• Certain cancers

Most common measure of obesity

• BMI

Uses of BMI (3)

• Easy + efficient

• Reproducible

• Works for disease risk at population level

Problems with BMI

• Doesn’t work as well at individual level (ignores age, gender, muscle mass, body composition, ethnicity bc data used was based on white male population)

• Overestimates for athletes

• Limits true diagnosis of obesity

Alternative + complementary measures to BMI (4)

• Waist circumference

• Body composition

• Waist to height ratio

• Clinical assessment

Obesity as a health issue (1→3)

• Complex condition

  • Linked with other chronic illnesses (diabetes, hypertension)

  • 40-70% heritability

  • Environmental risk factors

  • Can be symptom of mental health issues/disorder

Obesity + stigma (1)

• Discrimination common in medical care, work place etc.

Negative consequences of stigma surrounding obesity (1→3)

Internalised shame can lead to:

• Depression, anxiety, low self-esteem

• Eating disorders

• Unhealthy coping strategies

CBT for obesity + low self-esteem (2)

• Replace maladaptive thoughts + behaviours w/ adaptive

• Change body image, dietary expectations, beliefs

Treatment effectivess predictors (2)

• Motivation

• Self-efficacy (belief in achieving change)

Decisional balance def

The relative balance between the perceived gains and perceived losses of engaging in a health-related behaviour, such as reducing consumption and increasing physical activity

Eating disorder def + 3 main types

Behavioural disorders characterized by an unhealthy relationship with food and an obsession with eating, exercise and / or body shape

• Binge eating disorder

• Anorexia nervosa

• Bulimia nervosa

Most common demographic eating disorders occur in

• Mostly adolescents + young adults

• Mostly females

• BUT can affect anyone

Eating disorder triggers (recognise roughly)

• Psychological: Low self-esteem, perfectionism, difficulty managing emotions, trauma.

• Social & Environmental: Bullying, peer/family pressure, unrealistic beauty standards in media, participation in body-focused activities.

• Biological & Genetic: Family history, neurochemical imbalances, genetic predisposition.

• Behavioural: Restrictive dieting, emotional eating, overexercising.

• Situational: Major life transitions, stress, social isolation, comments on weight.

Impacts on physical health (9)

• Cardiovascular: bradycardia, heart failure

• Nervous/brain: mood instability, brain matter loss

• Oral/facial

• Skeletal

• Digestive

• Endocrine + reproductive

• Immunity

• Metabolic + renal

• Death

2 main treatment types + populations used for

• Enhanced CBT (CBT-E)

  • Adults + older adolescents

• Family based treatment (FBT)

  • Children + younger adolescents

CBT-E process outline (5)

• Psychoeducation: Teaching about how eating disorders function

• Self-monitoring: Tracking eating habits, thoughts, and emotions

• Cognitive restructuring: Challenging distorted beliefs about food, weight, and self-worth

• Behavioural experiments: Testing new ways of thinking and behaving

• Relapse prevention: Building long-term strategies for maintaining recovery

FBT (1→3)

Relies of family and parents to support and take charge of recovery

• Phase 1 – Refeeding & Weight Restoration: Parents take full control of meals and eating to restore physical health

• Phase 2 – Returning Control to the Young Person: Gradual handover of eating responsibility, with continued support

• Phase 3 – Addressing Adolescent Issues: Focus shifts to identity, independence, and normal development

Remission rates for each disorder, relapse, why

Remission rates (reduction/disappearance of symptoms)

• BED: 50-75%

• BN: 45-70%

• AN: 30-50%

• AN → very high relapse rates

• Resistance to treatment: patients may not recognise/accept problem, motivated to maintain behaviours

Substance use vs substance abuse (dependence, addiction) def

• Taking of substances that have a negative impact on health

• A pattern of repeated or compulsive substance use that negatively

  interferes with health, work or social relationships.

Key characteristics of substance abuse (5)

• Regularly using more than intended.

  • Excessive effort getting, using, or recovering

  • Failing to meet responsibilities

  • Continuing use despite causing distress.

  • ‘Withdrawal' symptoms

Behavioural risk factors

• Belief that they are in control + can stop use of substance

• Unable to identify links between negative emotions and behaviours

• Going to places where the substance will be

• Hanging out will people associated with use

Illicit drugs effect, consequences, how substance starts

• All are taken to induce some form of altered mental state

• All are known to cause some type of harm, either to mental health, physical health or both, with risks of permanent damage or even death.

• Dependence/addiction is very common and often a single use → begins cycle.

Harm minimisation for addiction (3)

• Aims to reduce harm, not necessarily stop uses

• Focuses on continued users

• Moves away from punitive approaches