Obesity is considered a pandemic in Western countries. Unhealthy habits, stress, a sedentary lifestyle and poor nutrition are the most common causes of excess weight. It is a disease that comes from a work context that forces us to sit in an office and take little interest in our health.

Of course, there are several disorders that can also be the cause of obesity . Medical problems such as endocrine or hormonal disorders. These are separate cases that should be treated from a mainly medical perspective.

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The psychological and psychiatric factors of excess weight

Scientific research has focused on this disease, obesity. In the United States, more than two-thirds of adult women and up to 75% of men are overweight.

Overweight and obesity: differences

It is useful to differentiate between overweight and obesity , since they are related but not identical concepts. Both have in common that they refer to excess accumulated fat. However, people with a Body Mass Index (BMI) of 25 to 29.9 are considered overweight, being people who should reduce their weight in order to be healthier.

Obesity is a problem that is quantitatively and qualitatively more serious. Obese people exceed 30 BMI points, and their health is at significant risk.

Treating Obesity from Psychology

The causes of obesity are various and often comorbid. This means that the treatments to overcome this problem must be multifactorial : from the medical and endocrinological field, to psychology and psychiatry can help people who suffer from this problem.

Over the last few decades, a large number of therapies and treatments have been developed against this disease, mainly focused on improving eating habits and promoting physical exercise. These two factors are closely linked to the reduction of body volume.

However, professionals who treat obesity have been realizing the need to intervene in this problem with more specific and personalized approaches, through medical, nutritional, psychiatric and psychological intervention. This deployment of professionals to address this problem is motivated by the human, social and economic costs of obesity.

Risks for Obese People

Obesity is a disease that not only affects the quality of life of those affected, but also brings with it other important problems:

1. Comorbidity

Obesity is a risk factor for the development of other pathologies: hypertension, heart disease, cancer, sleep apnea, etc.

2. Social Stigma

Unfortunately, people who suffer from this health problem are strongly stigmatized both at school and in the workplace. This leads to a decline in self-concept, increasing anxiety and worsening personal relationships.

3. Psychological and psychiatric disorders

Obesity has a high rate of comorbidity with psychopathologies, such as anxiety, addictions, depression, eating disorders, among others.

Relevant psychological aspects

As I said before, obesity has biological, psychological and cultural causes. As for the psychological aspects associated with overweight, there are different approaches and studies that point to certain possible causes, although none with a high degree of consensus.

For example, since Psychoanalysis, obesity is usually attributed to the symbolic nature of eating, and overweight is usually associated with an externalization of neurosis, associated with depression, guilt and anxiety. It is also common to associate obesity with certain underlying emotional conflicts, or with another previous mental disorder.

The psychological etiology of obesity is confusing, so efforts in intervention are focused on assessing and re-educating certain beliefs of patients, in addition to knowing the affective variables (emotional management) and environmental variables (eating habits, habits, etc.). This variety of psychological processes involved in obesity raises the need to address the situation of each patient individually, evaluating their personality and their environment.

Psychological evaluation

Psychologists and psychiatrists can investigate and intervene in the beliefs and emotional states of obese patients with the aim of improving their quality of life . It is important that the therapist creates the right environment for the patient to expose and express his or her affective and cognitive conflicts. Usually, obese people experience low self-esteem and have a bad image about their own body.

Self-esteem, eating habits and intake perception

Ultimately, the therapist must not only promote changes at the level of eating habits and lifestyle, but must also find ways to reinforce the self-concept to focus on achieving weight loss. In this sense, it is important to emphasize the importance of offering the patient tools for the control of emotions, impulses, as well as anxiety management techniques.

It is noteworthy that patients with obesity tend to underestimate their caloric intake compared to people without weight problems. They minimize the amount of food they eat, not being fully aware that their intake is excessive. This is a common characteristic with people who suffer from other types of addictions. To control this, the psychotherapist must accompany the patient and carry out live records to show what amounts should be acceptable for each meal.

In short, therapy should focus not only on weight loss, but on the process of psychological maturation that allows awareness of the problem, improving quality of life and establishing healthy habits, such as physical activity, a better self-concept and perception of one’s body and healthier eating habits. It is also key c to make the patient aware that obesity is a disease , and to stress that he or she must make an effort to avoid relapses.One of the most successful treatments has been shown to be cognitive behavioural therapy.

Psychiatric aspects to consider

The role of the psychiatrist is also relevant in the treatment of people with obesity . Psychiatrists are in charge of deciding which patients are suitable to undergo surgery and which are not. Traditionally, it has been considered that patients with psychotic conditions are not suitable to undergo surgical procedures, nor are those with a history of abuse or dependence on alcohol or other drugs.

Another group of patients who have serious difficulties in following psychiatric treatment linked to excess weight are those who have a personality disorder.

Approximately 30% of obese people who come to therapy report having bulimic impulses. In addition, 50% of patients with bulimic urges also have depression, as opposed to only 5% of patients without bulimic urges.

Treating affective disorders such as anxiety or depression in obese people is key to a good outcome. It is the necessary basis for the patient’s commitment to treatment and to changing his or her life habits.


Definitely, patients with obesity require a global treatment: doctors, psychiatrists, nutritionists and psychologists must intervene to achieve a correct diagnosis and treatment of each person in a personalized way. Although there is no broad consensus on the psychological causes of obesity, we find some common points in many obese patients: low self-esteem, poor self-concept, bad eating habits and co-morbidity with other psychopathologies.

This should make us value the relevance of the role of mental health professionals in improving the quality of life and the possibilities of recovery of these patients.

Bibliographic references:

  • WHO. (2014). Fact sheet N°311
  • Banegas, J.R. (2007). The challenge of obesity for public health. I NAOS Convention. Spanish Agency for Food Safety and Nutrition. Madrid, 27 March 2007.
  • Strategy, N. A. O. S. (2005). Strategy for nutrition, physical activity and obesity prevention. Ministry of Health and Consumer Affairs. Spanish Agency for Food Safety. Madrid.
  • Stunkard, A. J. (2000). Determinants of obesity: current thinking. Obesity in Poverty: A New Public Health Challenge, 576, 27-32.
  • McRoberts, C., Burlingame, G. M., & Hoag, M. J. (1998). Comparative efficacy of individual and group psychotherapy: A meta-analytic perspective. Group Dynamics: Theory, Research, and Practice, 2(2), 101.