SBS Objectives

The Psychology of Eating & Obesity

1/27/05

1. Discuss the central control of eating

-Food as a means We eat to survive

-The control of eating can be demonstrated in: a.) the list of Ps or b.) hypothalamic centers

a.)Ps of eating control:

-Psychosocial: basic drives

-Polar: one extreme to another (hunger to satiety)

-Periodic: respond to biological clocks. In the case of eating, in response to hypothalamic cues or environmental cues

-Phasic: cravingeatingsatietyinhibit eating

-Pleasurable

-Painful: caused by food deprivation

-Pathogenic & Pathological: eating disorders, metabolism problems

b.)Hypothalamic centers

-2 centers in the hypothalamus respond to blood glucose levels and other nutrients

-Hypothalamic centers also influenced by other areas of the brain control of satiety and hunger centers

2. Explain what is meant by eating as an end in itself

-Food as an end We live to eat

-Eating is our supreme pleasure (food remains pleasurable when all other pleasures die)

-Food symbolizes other areas of human existence

-Food as a relationship:

  • 1st dyad from foodpowerful expression of love, basic trust stage of development involves eating (I am fed and allowed to survive), and autonomy stage of development (I can refuse certain foods and exert power over my feeder)
  • Intimacy (food and sexualitythese two reinforce one another. For example, to be sexual would not be wanting to eat, but after sex, may want to eat)
  • Same areas of the brain influence both sexuality and eating

3-5. Define obesity, body fat & BMI

  1. Dr. Moher defined obesity as a “chronic condition characterized by excess body fat”
  2. BMI >30= Obese (30% of Americans)

-Fadem defines obesity as more than 20% over ideal weight

  1. BMI: (Body Mass Index)

-Weight in kg divided by height in meters squared

-BMI of 25-29.9= Overweight (At a BMI of 27-28, increased risk of total morality) Accounts for 60% of Americans

-BMI of 19-24.9= Normal

-Increased risk of mortality at BMI>35 of BMI<18

6. List 5 medical conditions associated with obesity

  1. Coronary artery disease
  2. Hypertension
  3. Type II Diabetes
  4. Orthopedic problems
  5. Gallbladder disease

7. Describe 3 approaches to the treatment of obesity, including non-pharmacologic & pharmacologic

Ultimate goal: Reduce body weight by 10% over 6 months and keep if off

Non-Pharmacologic:

-Dr. Moher stated one of the most important factors here is that the patient must be ready to change

-Dietary change

-Increased physical activity

-Behavioral therapy to educate on how to make healthy choices (food choices, recognize stimuli that leads to poor eating)

Pharmacologic: 2 main classes (Decrease appetite- 1 &2 or Decrease absorption-3&4)

Only recommended for BMI>30 or >27 + other risk factors

  1. Noradrenergic drugs- suppress appetite
  2. Serotonergic drugs- affect satiety
  3. Lipase inhibitors- decrease absorption of fat
  4. Thermogenic agents- increase energy expenditure

8. Discuss the indications, risks & benefits of Bariatric surgery

-Performed on those with a BMI>40 = morbidly obese

-usually also have diabetes and hypertension

-impressive weight loss after surgery is observed (enough to resolve diabetes, HTN)

-risks include those associated with general surgery

-NOTE: this issue will be talked about more with the panel on 2/3/05