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Obesity must be treated in GGZ

Obesity is generally perceived to be mainly a biomedical and societal problem. But this is a misconception, according to six FPN researchers (Prof. Anita Jansen, PhD, Dr. Chantal Nederkoorn, Dr. Anne Roefs, Dr. Carolien Martijn, Dr. Remco Havermans and Dr. Sandra Mulkens). In an article in the GZ-Psychologie magazine, they describe obesity as above all a behavioural problem, and behavioural problems must be treated within the GGZ (the Dutch association for mental health and addiction care). To this end, cognitive behavioural therapy aimed at reducing impulsive behaviour offers interesting treatment possibilities. Recent research by the FPN group shows that treatment by dieticians combined with cognitive therapy by behaviour therapists helps to prevent patients from falling back into old habits after dieting. Only people who learn to think differently about food have less chance of relapse.

At present, approximately half of the Dutch population is considered to be too heavy. About 40% are classed as overweight (i.e. with a BMI between 25 and 30), and around 11% are obese (BMI above 30). Obesity is currently primarily treated by health professionals such as dieticians and doctors, and it is mostly studied by biologists, medical professionals and epidemiologists. Psychologists, however, have virtually ignored the problem. 

This flies in the face of recent research, which shows that obesity is a behavioural problem characterised by the poor regulation of eating behaviour. Obese people are impulsive and extremely sensitive to immediate rewards, while at the same time being relatively insensitive to prolonged negative consequences. 

Research into food preferences and eating behaviour further shows that obese people attribute a high reward value to fatty foods with a high calorie count. And because they also have lower self-control and self-regulation, it is difficult for obese people to control themselves. Cognitive behavioural therapists should therefore be the obvious therapists to help change their dysfunctional behaviour and thought patterns. ‘Cue exposure’ combined with response prevention, for example, is an effective method to decrease excessive appetite, and inhibition training could decrease impulsiveness.

About half of the people who are obese also suffer to some extent from depression: they are troubled by their body weight and ashamed of their bodies. In turn, their mood swings lead to overeating. For obese people who suffer from only mild depression, cognitive restructuring – which deals with their feelings of shame about their own bodies, their lack of self-esteem and their mood swings – appears to be highly successful.

Obesity goes unmentioned in the diagnostic ‘bible’ Diagnostic and Statistical Manual of Mental Disorders, and is therefore not recognised as a psychological problem. At present, there is no Diagnosis Treatment Combination (DTC) to treat obesity within the GGZ. This means that health insurances will not pay for cognitive behavioural therapy – a state of affairs that needs to change. One option suggested by the FPN researchers is to temporarily add cognitive behavioural therapy to the DTC system under the diagnosis ‘eating disorder NAO’ (Not Otherwise Specified).