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Nutrition and Behavior > Psychology of obesity and weight management > Flashcards

Psychology of obesity and weight management Flashcards

1
Q

brief history of how to treat obesity and weight management
- 4 steps

A
  1. psychoanalytic (Freud) 1930-40-50
  2. behavioural: 1950-60
  3. COGNITIVE BEHAVIOR THERAPY
  4. BIOBEHAVIOURAL:
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2
Q

what are the 6 domains of psychology relevant to obesity and weight management?

A
  • social
  • personality
  • neuro
  • clinical
  • developmental
  • cognitive
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3
Q

explain psychoanalytic + behavioural ways to treat obesity

A
  1. PSYCHOANALYTIC (1930-40-50s)
    - psychosomatic –> turning psychological pain (ie unconscious problems) into physical condition like hunger, craving and insatiability
    - oral fixation (earliest stage) –> due to a problem in early mother-child relationship (feeding, nurturing)
    OR addiction also looked at as an oral level fixation
    - hard to prove, never scientifically supported
  2. BEHAVIOURAL (1950-60s):
    - no one cares what you’ve thinking but about what you’re doing –> behavior related to your environment
    - learned habits
    - operant and respondent conditioning (Pavloving vs Skinner)
    - stimulus control, self control through rearranging contingencies
    - Stuart: analyze behaviors and help them reshape their patterns = successful at decreasing weight
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4
Q

Describe CBT + biobehavioural way to deal with obesity

A
  1. COGNITIVE BEHAVIOR THERAPY:
    - we care what ppl think + their behavior
    - how do they motivate themself to do an action
    - perception of problem + self-regulation
  2. BIOBEHAVIOURAL:
    - externality: appetite system based on neurological systems driving hyperreactivity to food cues
    - behavioural susceptibility theory
    - regulation of cues
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5
Q

examples of research questions relating to obesity from:
- social
- personality
- neuro
psychology

A

SOCIAL:
- why do people eat more when they eat with others?
- distracted eating, more available food, more time spent at table
PERSONALITY
- do some personality traits (ie borderline personality, negative affectivity/have more negative emotions) create a risk for weight gain and obesity?
- do some traits make it difficult to succeed in weight management?
NEURO:
- are some people more likely to overeat due to heightened response to food in brain “reward centers”?
- are there other brain processed controlling eating, activity, weight?

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6
Q

examples of research questions relating to obesity from:
- clinical
- developmental
- cognitive
psychology

A

CLINICAL:
- are obese people more likely to suffer from emotional disorders? (not really, you can see some correlation for morbid obesity/end of spectrum)
- are those disorders cause or effect of the weight problem?
DEVELOPMENTAL:
- what are risk factors for child and adolescent obesity? (if parents are overweight)
- should we focus on prevention or treatment on children/adolescents OR families?
COGNITIVE:
- do overweight people process information about food, exercise and weight differently than normal weight people?
- are there differences in knowledge?
*cognitive = knowledge structure: the way you perceive/pay attention to things

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7
Q

what are 3 basic concepts about behaviour?

A
  1. behaviour is motivated
  2. behaviour is learned
  3. behaviour occurs in a particular context which includes internal and external environment
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8
Q

what motivates behaviour? what motivates eating, PA, weight management?

A
  • hunger
  • feeling of pleasure/reward
  • health
  • it’s time to eat/schedule
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9
Q

what behaviour is related to obesity and weight management?
- how is this behavior learned?
- how can it be unlearned or replaced?

A

eating too much, binge eating
- from parents as a baby, from friends/environment
*didn’t answer last question

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10
Q

behaviour occurs in internal and external environment context
- define internal and external environment
- what are the physiological, physical and social influences?

A
  • internal = hunger, brain, thinking
  • external: food available or not
  • hormones, types and amounts of food present, others’ attitudes, modeling…
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11
Q

what are people and health professionals thinking when they seek/or offer help with obesity?
- general categories (4) + examples of thoughts

A
  • thinking about EACH OTHER (feel hopeless, professionals reject me, don’t like obese patients…)
  • think about TREATMENT STRATEGIES (need better habits, need to lose fat, should love yourself as you are, should exercise…)
  • thinking about BIOLOGY (always hungry, slow metabolism, eat 6 times a day…)
  • thinking about EMOTIONS (too stressed/anxious, emotional, go treat emotional problems first with psychologist)
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12
Q

explain psychological and emotional factors/distress related to weight
*figure with balance!

A

socioeconomic disadvantage
- negative emotions, low self-worth, stress, depression, low education, anxiety, financial insecurity, food insecurity, abuse and neglect
VS
socioeconomic advantage: high self-worth, high resilience, social support, positive coping, higher education…

socioeconomic disadvantage weighs heavier on left of seesaw –> seesaw points on HIGH psychological and emotional distress
- right side of seesaw has socioeconomic advantage (weights lighter) –> points higher = higher BMI
THEREFORE: socioeconomic disadvantage leads to high psychological and emotional distress + high BMI

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13
Q

explain mechanisms linking changes in psychological variables and outcomes
- well delineated?

A
  • psychology (how you think, your ideas, your strategies) affect motivation
  • motivation affects behaviour (eating and exercise)
  • behaviour has effect on weight change (behaviour = closest influence to weight)
  • weight change <—> satisfaction (psychological emotion)
  • motivation <—-> satisfaction
    *therefore, there is a loop btw motivation –> behaviour –> weight change <–> satisfaction <–> motivation
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14
Q

define restraint
- vs restriction

A

restraint is defined as the desire and intention to follow a set of eating rules in order to limit food intake, with the goal of weight loss or prevention of weight gain
- ie going on a diet, not eating breakfast, no fat, increase PA

RESTRICTION: actual action VS RESTRAINT = mental attitude of wanting to restrict

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15
Q

examples of questions on a restraint scale?

A
  • how often are you dieting?
  • max weight you have ever lost in 1 month?
  • max weight gain in a week
  • how does your weight fluctuate in a week
  • do you eat sensibly in front of others and splurge alone?
  • do you give too much time and thought to food?
  • do you have feelings of guild after overeating
  • how conscious are you about what you are eating?
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16
Q

will unrestrained or restrained eaters eat more if they had no milkshake preload vs low cal preload vs high cal preload?

A

RESTRAINED! no preload ate less then low cal preload, who ate less than high cal preload
- high cal preload ate the most! similar to binge-eating and disinhibition –> off diet anyways so might as well eat more

VS unrestrained: no preload ate the most vs low and high cal preload ate similar (lower than no preload)

17
Q

explain the boundary model of weight regulation
- dieter vs nondieter

A

DIETER:
- very big space between hunger and satiety –> that big space = physiological indifferent to hunger/satiety (ie not hungry or full) bc they’re used to delaying eating, or binge eating… –> influenced by psychological factors in brain
- but when they do get in that real “hunger” zone, they could start eating a lot
NONDIETER:
- small space between hunger and satiety
- that space = neutral, not hungry or full, no physiological force

18
Q

what is the relationship between restraint and disinhibition (overeat)?
- before
- vs today

A
  • early research saw them as 2 sides of the same coin –> if you restrain, you don’t overeat. if you disinhibit, you don’t restrain
  • later research suggests there may be independent dimensions –> can be low restraint + low disinhibition OR low + high OR high + low OR high + high (ie bulimic)
19
Q

CBT promotes which restraint and disinhibition combination?
- what does research show?

A
  • CBT explicitly or implicitly promotes a HIGH RESTRAINT and LOW DISINHIBITION combination
  • make people more disciplined and planned + decrease emotional eating
  • studies show that restraint increases and disinhibition decreases during treatment –> amount of these changes appears to be correlated with outcome
  • high restraint and low disinhibition could be maintained
20
Q

describe flexible vs rigid restraint
- is everyone at least a little bit restrained?

A

FLEXIBLE:
- you have principles (not rules) and you follow principles but allow yourself some deviation
- better maintenance of weight if you’re flexibly restrained
RIGID:
- you have rules and have to follow them

*yes! because of our current environment. if not restrained at all, would just buy the most palatable foods (cookies, candy, …) all the time!

21
Q

what is the non-dieting approach to obesity treatment?

A
  • non-dieting approach has its central premise that dieting does not work and may even be hazardous
  • eat when you’re hungry and strop when you’re full
  • first proposed by Herman and Polivy in the early 80s
22
Q

explain the self-regulation process and its 3 influences

A
  1. goal: need an outcome you want to achieve
  2. planning: plan to achieve your goals
  3. self-monitor –> monitor behaviour and outcomes you’re achieving
  4. self-evalution and emotional response –> feel smtg to succeeding or not
  5. problem solving: rethink plan or rethink another goal if goal was achieved
  6. cycle back to goal!

INFLUENCES:
- physiology: could make goal harder or easier (placed physiology btw goal and planning)
- social environment: placed btw self-monitoring and self-evaluation
- personality: placed btw emotional response and problem solving

23
Q
  • define weight self-regulation
  • not only __________ control
  • example
A

weight outcomes are partly determined by the effects of intentional (voluntary) goal directed activity –> you have some control over your weight
- NOT only physiological control
- ex: patient is too depressed to organize his eating or to exercise –> doesn’t really care, more pessimistic –> depression affects self-regulation

24
Q

guest lecturer’s study: focused on which 5 themes + ex of statements

A
  • WEIGHT CONCERN (+ cognitive engagement): happy with my weight VS weight is causing me physical problems
  • SELF-EFFICACY: very confident about controlling my weight vs doubt
  • RESTRAINT: try to eat less than i really want, count calories, always follow my eating rules
  • MODERATION: listen carefully to signs of hunger and fullness, eating slowly and consciously
  • INTERNALIZATION OF LIFE CHANGES: eating healthy comes naturally to me, at peace with relationship with food
25
Q

guest lecturer’s study
- who did he question?

A
  • college dieters and nondieters
  • ED: active vs partially recovered vs recovered
  • pre-bariatric surgery vs post-bariatric surgery (2 years)
  • starting weight management program
26
Q

guest lecturer’s study:
describe schéma order and which pathways lead to
- preparation
- moderation
- helpless
- disengaged
- rigid restraint
- flexible restraint

A
  1. weight concern
    - no = DISENGAGED
    - yes = continue
  2. self-efficacy:
    - no = HELPLESS
    - yes = continue
  3. restraint:
    - no = go to moderation1
    - yes = go to moderation2
    4a. moderation1:
    - no = PREPARATION (no restraint and no moderation)
    - yes = go to internalization = MODERATION
    4b. moderation2:
    - no = rigid restraint (yes restraint and no moderation)
    - yes = go to internalization = flexible restraint
27
Q

guest lecturer’s study:
- out of ___group_________ which “type” was the most frequent?
1. pretreatment (surgical and non-surgical group)
2. surgical follow up

A
  1. helpless! 65.7% –> they have just enough weight concern to ask for help but don’t have self-efficacy = still have doubt
    - but some manage to still go down the tree of choices
  2. 18.6% helpless, 31% flexibly restrained and internalized, 22.8% moderate (no restraint, yes moderation), yes internalized)
28
Q

what are the 6 stages model of weight regulation proposed by Stotland (guest lecturer)?
- what is the issue for people who are unsuccessful at weight management?

A
  1. unconcerned: not motivated to control weight or believes will be controlled automatically
  2. HOPELESS: is concerned about own-weight but sees weight as externally controlled
  3. HELPLESS: is concerned about own weight but lacks self-efficacy
  4. RIGID RESTRAINT: believes weight can be controlled through strict rule-based self regulation (often leads to relapse)
  5. FLEXIBLE RESTRAINT: still rule-based not more adaptable to situations and less disturbed by deviations
  6. MODERATION: self-regulation based on mindfulness and balancing wants and needs
    *underlying arrow: internalization of life changes –> increasing autonomy and automization
  • issue is that they don’t follow the curve. go directly from unconcerned to rigid restraint –> relapse
  • ALSO need to internalize behavior and get past rigid restraint to have successful weight loss
29
Q

is the treatment of obesity a technical or an interpersonal process?
- what (2) is needed? (form the landmark study based on principles of operant and respondent conditioning)

A
  • even if the “formula” for weight management is pretty simple, the success of implementation is very much influenced by the nature of the interaction btw client and therapists
  • REASSURANCE was given as an antecedent to each new step and PRIASE was given for success!
30
Q

most researchers on obesity treatment focuses on _________ rather than ____________
- ie?

A

focus on outcomes rather than process!
- ie weight loss and impacts on medical morbidity and mortality, comparison of weight loss for different types of treatment
- even research on lifestyle approaches focus mostly on weight loss outcomes

31
Q

what is process research?

A
  • looks at how the change takes place over time
    ie how do changes in weight relate to changes in eating habits, self-efficacy, emotional states and coping strategies?
32
Q

what 3 are key to the treatment process?

A

the formation, maintenance and (sometimes) repair of the THERAPEUTIC RELATIONSHIP/ALLIANCE

33
Q

what is a therapeutic alliance?
- typically defined by 3 interdependent dimensions

A
  • refers to the general quality of the interaction btw client and therapist
    1. creation of an emotional bond
    2. agreement on goals
    3. agreement on plans and tasks
34
Q
  1. is the alliance important in all forms of treatment?
  2. what are the effects of quality of alliance in obesity treatment?
  3. how does alliance affect outcomes?
A
  1. seen across all forms of psychotherapy, as well as in primary medical care, cancer treatment
  2. we don’t know much –> need to research obesity and personality/attachment styles/ stigma in health care settings, stereotypes and discrimination
  3. good alliance is associated with improvements in behavioural and emotional variables (ie psychological state), which predict weight change –> effect of alliance is INDIRECT, but ESSENTIAL
35
Q

describe the graph connecting patient and practitioner –> allowing patient empowerment

A
  • patient characteristics (scepticism, gender, motivation) COMBINED with practitioner characteristics (willing and able to explain, weight status, lifestyle) –> leads to collaboration (perceived power, openness) –> leads to trust (relational, informational, credible)
  • trust leads to GOAL OWNERSHIP and PERCEIVED UTILITY OF CHANGES
  • both goal ownership and perceived utility of changes = patient enpowerment and are related
36
Q
  • what is a rupture in therapeutic alliance?
  • causes?
  • reaction of patients/practitioners?
A
  • when alliance suffers a deterioration
  • due to disagreement in the goals or tasks of treatment, or a problem with emotional bond
  • people are hesitant to express disagreements and dissatisfaction –> study suggests that 65% keep their negative thoughts about the process to themselves
37
Q
  • what are 2 markers of alliance ruptures?
  • if not dealt with, rupture can lead to (2)
A
  1. withdrawal: patient is less talkative, becomes quiet
  2. confrontation: patient goes from collaborative to negative and critical about what you say
    - can lead to dropout OR poor results
38
Q

how to improve the alliance? (3)

A
  1. think of process as bi-directional –> therapist and client EQUALLY invested, responsible and collaborative
  2. pay attention to client’s perceptions, expectations, subjective/emotional responses –> make sure client feels you have a good understanding of their point of view before suggesting changes
  3. therapists need to develop capacity to detect small ruptures in alliance and learn ways to heal them (in gentle way) –> communicate with client to understand and hopefully correct the problem
39
Q

CONCLUSIONS:
- what is central to obesity treatment process? why?
- all members of the multidisciplinary team are engaged in a kind of _______ ________ –> must understand what?
- important to remember what? (lightbulb quote)

A
  • PSYCHOLOGY! –> helps us understand what is going on inside client, in environment and in the consulting room
  • kind of behavioural therapy –> must understand processes of change, within client and therapeutic interaction
  • “it takes only one psychologist to change a lightbulb, but the lightbulb has to really want to change” –> you can’t make someone, but you can make conditions favorable for them

Nutrition and Behavior (4 decks)

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