Patients suffering from morbid obesity experienced an improvement in their quality of life and significantly fewer episodes of overeating after ten weeks with a new treatment method developed at NTNU.
The current advice and treatment for obese patients is mainly to eat less, eat healthier and exercise more. In some of the more severe cases, patients undergo surgery for obesity.
We see a strong need for interdisciplinary treatment that takes into account the psychological aspects of morbid obesity much more than today. The treatment we use is based on teaching patients to make them aware of the reasons for their overeating, followed by exercise and group discussions. “
Trine Tetlie Eik-Nes, NTNU
Eik-Nes is Associate Professor in the Department of Neuromedicine and Movement Science at the Norwegian University of Science and Technology (NTNU) and led the project.
Patients who wanted help
Overeating is defined as repeated episodes in which a person eats a lot more than normal. The 42 adults who participated in the study were people who had gone to the obesity outpatient clinic at St. Olavs Hospital for help.
All of the participants had third degree obesity, which means a body mass index (BMI) of 40 or more, or second degree obesity with additional problems. The majority of the group were women. Six people had undergone surgery for obesity.
Eik-Nes thinks the understanding and treatment of obesity and overeating has been too narrow.
“The explanation is more complicated than just having a big appetite, genetic susceptibility, and ‘laziness.’ International research indicates that 30 to 50 percent of people with a high degree of overeating who seek treatment for obesity have psychological problems related to loss of control, such as overeating that lasts all day, ”she says.
Eat to numb the pain
According to the researcher, overeating is often linked to internal and external stressors. The causes can be multiple and complex: for example, childhood trauma, negative thoughts about oneself, contempt for the body, problematic relationships with parents and social difficulties.
Psychological treatment is not used enough for morbid obesity.
Many people feel stigmatized because of their large bodies – in their families, at school, at work, and elsewhere in society. Food acts to numb and help to cope with everyday life.
“If you have security, good support, decent finances, and a manageable daily life, you don’t need much to regulate your emotions with food, alcohol, or other stimuli,” says Eik- Nes.
Lack of treatment
She believes that the health service offers patients with morbidly obesity lifestyle changes when they really need a comprehensive assessment and treatment that combines mental and somatic health care. which means an understanding of what is going on internally, in their body.
“This approach will give people with eating disorders a chance to be successful. Psychological treatment is not used enough for morbid obesity and the methods are too limited for such a heterogeneous group,” says Eik-Nes.
The treatment method used in the study was developed by Eik-Nes and Kjersti Hognes Berg. An interdisciplinary team conducted the assessments and treatment, which emphasized emotional security and openness.
The participants met for 30 hours over ten weeks. After each teaching session, patients split into small groups to practice “dissecting” their own daily lives. All 42 stayed with the study until the end.
“We wanted to teach and educate patients about the link between weight and mental health. Over the ten weeks the goal was for them to become more aware of the challenges they face in daily life and the strategies that could help them. Each individual was able to receive personalized goals and measures in this way, ”explains Eik-Nes.
Transfer to own life
During the course of treatment, patients became more aware of what makes them react and triggers their overeating. For example, overeating or grazing (constant snacking) can calm the experience of being outside your comfort zone.
Many participants felt that their negative body image and shame were a barrier to physical activity and social life. Eik-Nes thinks this might explain why it’s so difficult for this group to put lifestyle measures into practice.
Less food and fuss, more social life
The researchers measured a marked improvement after ten weeks.
“Patients experienced an almost 30% reduction in the number of overeating episodes and a significant improvement in their emotional problems, such as internal disturbances, anxiety, depression and irritability. Additionally, patients reported feeling much less limited in their social life. activities, ”explains Eik-Nes.
The study did not measure weight loss, but the impression was that a good number of participants had lost weight.
According to the researcher, an important point of the study was to examine how a treatment covering both physical and mental health can work.
“Our interdisciplinary approach worked well. Just the fact that everyone completed the study is a very good result,” says Eik-Nes.
“We cannot say anything yet about the long-term effect of the treatment. We hope that this study can lay the groundwork for a larger project on morbid obesity and psychological disorders. Next, we would like to study the changes in the over time, ”said Eik-Nés.
The Stjørdal District Psychiatric Center (DPS) of the Nord-Trøndelag Health Trust collaborated on the project with the Obesity Outpatient Clinic at St. Olav Hospital in Trondheim.
Norwegian University of Science and Technology
Eik-Nes, TT, et al. (2021) A group intervention for people with obesity and comorbid binge eating disorder: results of a feasibility study. Frontiers in endocrinology. doi.org/10.3389/fendo.2021.738856.