Obesity and psychiatry

Food is a naturally occurring, nurturing and comforting substance that is also essential to survival. Over-consumption of food without compensatory increased activity in developed countries has led to epidemic proportions of obesity, with enormous healthcare implications. Often seen as resulting from emotional disturbance, obesity also carries huge stigma for sufferers, who are often disabled by the physical and psychiatric consequences of their condition. People who seek help for their obesity have high levels of depression, anxiety, binge eating disorder, and personality disorder. The neurological and psychological aspects of appetite and obesity are currently being explored in the fields of behavioural neuroscience and neuroimaging in an effort to understand the underpinnings of normal and abnormal eating behaviour. Traditional weight loss programmes, including psychologically based treatments for obesity, have proven disappointing in the long-term management of obesity, especially in the morbidly obese. Surgery for obesity has been recognized as the only treatment to bring about sustained weight loss, whilst also significantly reducing physical and psychiatric co-morbidity, and is recommended by National Institute for Health and Clinical Excellence guidelines in these patients. The alarming finding that suicide rates in post-operative patients is high raises questions as to how obese people cope with the absence of the emotionally regulating effect that food has in their lives.