Eating behaviors and the possibility of positive change By Dr Helen McCarthy

The British Psychological Society (BPS) recently published a report titled “Psychological perspectives on obesity” in which they call for professionals and policy makers to take an approach that is guided by psychology. The report argues that reversing the trend of increasing obesity rates requires an integrated evidence-based approach that recognises that behaviours are influenced by a combination of biological, psychological and social factors.

Biological Factors

The BPS report is clear that our genes play a significant role in how the appetite regulation system in our brain functions. So people’s differing interest in food, their ability to know when they are full and emotional eating all have some genetic basis. And then there are the biological effects of chronic stress, which creates changes in brain activity as well as altering the balance of appetite-regulating hormones.

Psychological Factors

Many psychological factors play a part in how and what each of us eats, and they include:

·         Some of us are more aware of and sensitive to internal feelings of hunger and fullness, whilst others are less so. If you tend to eat in response to external rather than internal cues, you’re likely to eat more when surrounded by food.

·         Emotional eating, where food is a regular mask for difficult feelings, can become a major problem in that it can lead to more negative feelings about ourselves. The worse we feel, the more emotion we may need to mask, which can lead to a cycle of regular binge eating with or without purging.

·         Most conventional diets offer meal plans or regimes which lead to you feeling deprived, so you are restraining how you want to eat. As the BPS report says, “restrained eating in the form of highly restrictive diets is heavily promoted in the media as a valued method of weight loss, (but) research suggests that this form of intervention may be psychologically and physically harmful”.

·         Mental health problems increase your risk of gaining weight, and childhood adverse experiences (ACEs) are associated with weight gain.

Stigma

The report includes a chapter on weight bias, stigma and discrimination and describes the vicious circle of weight-based stigma leading to stress which in turn leads to increased eating (because of higher levels of cortisol) resulting in weight gain and further stigma. It highlights the fact that people can experience stigmatising language and attitudes from the professionals they turn to for treatment and that this means that people may disengage from services rather than continue to expose themselves to this.

Behaviour Change

Central to the BPS report is the need for evidence-based approaches to behaviour change, both at a population level and an individual level. As the report says, “People and populations can change their behaviour, but it is not a simple process.” Psychologists have a key contribution to make at both policy and individual levels, with academic researchers providing the evidence about what does and does not work. Practitioner Psychologists (Clinical, Health and Counselling) and colleagues from other professions are then able to translate research findings into practice, to help individuals make sustainable changes to unhelpful eating patterns and ways of thinking about themselves.

Eating is complex

Eating meets a range of social and psychological needs, and for some people strategies to support weight loss and maintenance need to go beyond simply promoting new healthy behaviours. For many of us, over-eating has developed as a way to regulate emotions and cope with emotional distress.

Psychological issues can therefore be part of what led to weight gain in the first place, but they can also be part of what maintains overweight. And of course, in a society that values thinness, being overweight itself then causes problems in feeling visibly different, with all the consequences that come from that, such as social withdrawal, reduced self-esteem and for some people, additional health problems.

What psychology has to offer

What we weigh is the result of a combination of factors as well as biology, including learned habits, patterns of thinking about ourselves and how we regulate our emotions. These are what Clinical, Health and Counselling psychologists deal with all the time, so psychologists are therefore able to help formulate what caused and is maintaining weight gain. By understanding the complex interplay of environmental and psychological factors, psychologists can help people change unhelpful eating habits, discover new ways of regulating difficult emotions, challenge unhelpful thinking patterns, tackle unhelpful beliefs about themselves and help them to strengthen a positive view of themselves.

Something psychologists bring to a person in any sort of distress is an understanding that whatever has led to their current problems, they were doing the best they could to survive and manage what was happening in their lives. This means that apparently self-defeating behaviours are understood in terms of how and why they developed, and once this is understood, evidence-based strategies can be used to bring about change. Up to half of adults attending specialist obesity services have experienced trauma or adverse experiences and bringing an understanding of the role of trauma in the development of a range of symptoms and behaviours is a basic part of a psychologist’s approach.

#obsmuk invites everyone to discuss this very interesting and important topic of eating behaviours and the potential to make positive changes to them.

We will discuss the following questions.

1) What, in your view, good eating habits are in general?

2) What are the obstacles to adopting and keeping good habits?

3) How can you acquire good eating habits if you don’t have them now?

4) Do you think people with obesity should have different eating habits from people who are not affected by obesity?

5) If you’re struggling with your eating habits or you know someone who’s struggling with their eating habits, what kind of professional (and non-professional) help you would consider to be useful?