Introduction is stigmatized and viewed as the

Introduction “Youremotions are the slaves to your thoughts, and you are the slave to youremotions.” – Elizabeth Gilbert, Eat Pray Love  Asa leading preventable cause of death worldwide, obesity is the most rapidlygrowing health problem. Throughout history it was considered a symbol of wealthbut now, in the 21st century, it is stigmatized and viewed as themost serious health problem.Obesityis considered a medical condition in which a person has body fat accumulationsto the extent of having a negative impact to their health. It is characterizedby a high body mass index (BMI) – a proportional value comparing height andweight.

In western countries a BMI of 30 kg/m2 indicates obesity,while other, eastern countries use a lower limit. An increase in the risk ofserious medical conditions is linked to obesity like hypertension, heartdisease, stroke, liver disease, type 2 diabetes, asthma, sleep apnea, cancersand more. These comorbidities most commonly appear in the form of metabolicsyndrome.

Health complications are the consequence of increased fat mass orincrease in the number of fat cells. If left unsolved, the global problem ofobesity will soon replace more traditional public health concerns such asundernutrition and infectious diseases as the most significant cause of poorhealth (WHO, 2000).However,obesity does not only cause physical conditions.

Multidisciplinary efforts havebeen made to combat the increase of obesity related problems. A combination ofgenetic, biological, environmental, psychological and physiological factors contributesto the development of obesity or derive from it. Usually, it is attributed to excessivefood energy intake and a lack of physical activity.

Tosolve obesity, we must find the root cause for this behaviour. A sedentary lifestyle appears not to be an innate human trait. Most children and teenagers arequite active. Psychologist Steven Bray researched this and came to theconclusion that, after high school, only about a third of students from hisuniversity remained physically active. A third of students ceased to exerciseregularly, while the remaining third continued their old sedentary life style.Bray hypothesised that this was due to the students’ inability to cope withenvironmental and social change.

Emotional patterns are recognisable in obesepeople, which indicates strong correlation between mental condition andobesity. Psychological issues can not only foreshadow the development ofobesity, but they can also follow ongoing struggles to control weight. Theincrease of numbers of obese people raises a set of questions aimed directly atthe psychology of eating. What is the most common behavioural pattern thatleads to obesity? Is there a specific behavioural pattern which develops out ofobesity? What are the potential causal pathways? Can obesity be treated withbehavioural therapy? Do psychiatric disorders complicate such treatment?    Psychologyof obesity   Overa third of the global population is overweight or obese according to WorldHealth Organization criteria. Analysing the cause of this ongoing epidemic,strong associations between obesity and psychiatric disorders were described bynumerous scientist. According to the “National Epidemiologic Survey on Alcoholand Related Conditions” (NESARC) sample, obesity is closely related to a numberof personality disorders (Petry N.

M., Barry D., Pietrzak R. H.

, Wagner J. A.,2008). The results of the survey indicate that there is an increase in prevalenceof psychiatric disorders among obese people compared to normal-weight persons.Obsessive-compulsive disorder, paranoid personality disorder, schizoidpersonality disorder and other antisocial, avoidant disorders are examples ofdisease more commonly seen in obese patients. The survey also found that extremecases of obesity had a greater likelihood of dependent personality disorder,while women with a high BMI showed an increase of incidence in antisocialpersonality disorder (Goldstein R. B., Dawson D.

A., Stinson F. S., et al.

, 2008).Someresearch papers showed elevated rates of hyperactivity disorder in overweightchildren. Corresponding findings were made in a research which showed anincrease in body mass amongst children with disruptive behaviour disorders. Theaffected children were more likely to remain obese in adulthood. This leadscientist to link attention deficit hyperactivity disorder related impulsivityand overeating (Altfas J.

R.,2002). Effortshave been made to prove the association between schizophrenia and obesity.However, after controlling various variables, it has been disproved. Thosestudies, on the other hand, showed substantial weight gain in patients who weretreated with olanzapine and clozapine, both being antipsychotic drugs.Largenumber of multidisciplinary studies and gathered data indicate the presence ofa variety of mental health problems beside the more known, physical healthproblems. A steady increase of obese patients has been noted by psychiatrists,with a variety of psychiatric disorders. Today, a psychiatrist is likely toencounter patients whose response totherapy is weightgain.

Despitethe increase of the obese population and obese patients, evidence shows thatmost physicians, including psychiatrists, have not underwent appropriatetraining for counselling patients regarding obesity (Jay M., Gillespie C., ArkT.

et al., 2008). Anxiety disorders and obesity  Strongcorrelation between BMI and mood disorders has been found. For example, a newstudy based on data collected by NESARC shows that mood disorder symptoms aremore common in overweight and extremely overweight persons. Those symptomsinclude major depression, dysthymia and manic and hypomanic episodes.

Patientswith an increased BMI were 1.5 times more likely to report mental healthproblems, while extremely obese patients were twice as likely. An increase inincidence of mental health problems was noted even in patients who were onlymoderately overweight (Baumeister H, Härter M., 2007).Studiesalso show a higher prevalence of lifetime generalized anxiety disorder andspecific phobias. These problems were commonly accompanied with panic disorderswithout agoraphobia.

 It should be notedthat these studies have been performed in multiple countries, includingGermany, New Zealand, France and Netherlands. This rules out any location basedfactors affecting the research (Scott KM, Bruffaerts R, Simon GE, et al, 2008.).Theconnection between obesity and affective disorders seems to be more pronounced inwomen than in men.

Although some studies show a high BMI association withanxiety and mood disorders in men and women, there are studies which showobesity predicted increase in odds for mood disorders in women only (Barry D.,Pietrzak R. H., Petry N. M.

, 2008.). More studies indicate on an increase indepression incidence amongst women but not in men. Evidence exists for anincrease in likelihood of suicidal behaviour amongst women whereas obesity andoverweight in men link to decreased likelihood for suicide (Magnusson P. K.,Rasmussen F., Lawlor D. A.

, et al. 2006.).Dueto the cross-sectional nature of these studies, causal pathways between obesityand mood disorders have not been discovered. Obesity and mood disorders mighthave a bidirectional relationship, affecting each other. Social stigma followsobese persons, leading to discriminatory behaviour towards affectedindividuals. Widespread discrimination based on body weight has been associatedwith anxiety and depression (Carr D.

, Friedman M. A., 2005). Women are morelikely to be dissatisfied with their body weight than men, which might be dueto the fact that women are more likely to be on the receiving end ofweight-based discrimination. Studies confirm this, showing that BMI is not anindicator of risk of social phobia among men, while indicating an increase inrisk of social phobia in women.Onthe other hand, mental health problems like anxiety disorders can negativelyimpact healthy eating habits or regular exercise.

The anxiolytic effect ofeating has been demonstrated in studies. This research, however, showsdifferent overeating responses to stress among individuals. Women have atendency of overeating in response to stress and negative emotions more thanmen. Women suffering from mood disorders are also more likely than men toreport increased appetite as a symptom for depression (Larsen J. K., van StrienT., Eisinga R.

, Engels R. C., 2006.).Aproposed cause for the relationship between obesity and mood disorders are theeffects of stress on the hypothalamic-pituitary-adrenal axis (HPA). Thisneuronal axis responds to stress by releasing hormones, most importantlycortisol. Because cortisol affects the sympathetic nervous system, dysregulationof the HPA axis dysregulates the sympathetic nervous system.

This state isassociated with depression and anxiety as well as obesity (Bornstein S. R.,Schuppenies A., Wong M. L.

, Licinio J., 2006.). More prospective studies onthis topic are required.

  Obesity and substance use disorders Thelink between substance abuse and obesity is inconsistent. Epidemiologicalstudies show that substance disorder also varies between genders. Lifetimealcohol use was linked to obese and extremely obese persons. When examined separately,men showed association between BMI and alcoholism as opposed to women. Womendid not show a relationship between BMI and lifetime alcohol use disorder.There is, however, evidence that supports a link between BMI index in women andpast-year alcohol abuse (Barry D.

, Petry N. M., 2009.

). Some studies, performedin the United States and Germany, showed evidence of obesity being linked witha generally lower likelihood of past-year alcohol use disorder. These studieshave not been replicated in other countries (John U., Meyer C., Rumpf H. J.,Hapke U., 2005).

Correlationbetween obesity and illicit drug use disorder was not found. Insufficientevidence from clinical trials hint at a retroverted connection between presentsubstance abuse and obesity. For example, a very low rate of current substanceuse disorder was reported contrary to lifetime substance use disorder inpersons who underwent bariatric surgery. These inverse studies suggest thatabstinence from drugs promote obesity.

Inverse relationship was found between bodymass index and substance abuse in female recreational drug and alcoholconsumers. Individuals showing symptoms of bipolar disorder also show aretroverted relationship between obesity and substance use disorder (Warren M.,Frost-Pineda K., Gold M.

, 2005).Tobetter understand this correlation, it is important to look at thepsychological and physiological mechanisms behind overeating and addictions tosubstances.