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Biopsychosocial Modifiers of Obesity

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Bariatric Endocrinology

Abstract

An individual with obesity experiences multiple psychological and physiological influences that not only aggravate the condition but also may impede its treatment. Stigma and shame fostered by societal and cultural norms set the stage for chronic psychological distress. The internalization or the incorporation of weight bias into one’s belief system may lead to altered mood and increased eating behavior in response. To achieve allostasis, the neuroendocrine system responds with signaling of reward and appetite circuitry that interfaces with inflammatory pathways leading to altered food intake, cravings, and overeating. Increased body weight may result in lowered self-esteem, with increased shape concerns and changes in physical and mental health. Mechanical and inflammatory factors lead to increased pain, which in turn alters coping and mood and decreases movement in a vicious cycle. Negative early childhood experiences increase of the vulnerability for weight gain and mood disorders. Impulsivity and untreated attention deficit disorder may put a person at risk for weight gain or resistance to intervention. Behavioral intervention for weight-loss results in overall improved quality of life and self-esteem. On the other hand, depression and body image may improve independent of weight loss. Some individuals postbariatric surgery, despite their newfound independence, struggle with psychological tension of a perceived altered-self and some may be at risk for suicide. We still have much to learn regarding the psycho-physiological interface of the obesity experience. Optimal treatment for the individual with obesity should include recognition of the dynamic contextual factors within that person’s domain.

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  1. Washington Center for Weight Management and Research, Arlington, VA, USA

    Domenica M. Rubino

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  1. MNCOME, Eagan, MN, USA

    J. Michael Gonzalez-Campoy

  2. Mayo Clinic, Rochester, MN, USA

    Daniel L. Hurley

  3. University of Alabama - Birmingham, Birmingham, AL, USA

    W. Timothy Garvey

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Rubino, D.M. (2019). Biopsychosocial Modifiers of Obesity. In: Gonzalez-Campoy, J., Hurley, D., Garvey, W. (eds) Bariatric Endocrinology. Springer, Cham. https://doi.org/10.1007/978-3-319-95655-8_18

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