The Psychology Behind Excess Weight Patients

Carlos Grilo, PhD Professor of Psychiatry and Psychology, Director of the Program for Obesity Weight and Eating Research (POWER), Yale University School of Medicine: Obesity is something that is a prevalent problem, but even though it's so common, it's associated with a lot obesity stigma and discrimination. Many people who are obese feel and perceive they have been repeatedly treated poorly or unfairly because of their excess weight. And that actually backfires — that doesn't lead to people developing more healthful lives and eating better, and exercising more. It makes people feel badly about themselves and it often leads to them seeking less preventative care, less treatment.

So one thing is people becoming increasingly aware — at the societal level, as well as healthcare providers — of explicit and implicit biases of people with excess weight, and to counter those attitudes. The other thing with binge eating disorder is the awareness that even though a lot of the problem is described as over-eating while feeling out of control, a lot of these individuals have very significant body image disturbances, so they feel very negative.

They feel badly about their bodies regardless of their weight, and their weight and shape are amongst the most important things that they use to evaluate themselves as human beings. Because of that, they feel very badly when they can't control their eating, or they don't control their eating, or they put on weight, they feel absolutely disgusted with themselves. I realize "disgusted" is a strong word, but those are the terms that patients have shared with me.

This is a problem that greater recognition by clinicians in a variety of general health settings would be useful, because people who struggle with binge eating disorder often do so in isolation and in secrecy and alone. Their family members, their best friends often don't know they are struggling with this alone.

Recognition of these factors by health care practitioners is a useful way to make a compassionate and empathic way to begin the conversation with their patients, rather than just saying, "Go on a diet." Begin the other way, which is, "You have concerns about your weight, and we have concerns about the way you eat sometimes, or your eating patterns. Could you tell me about those?"

That kind of open, less critical and compassionate way of starting a conversation with a patient can help create a greater recognition and therapeutic relationship.