Individualized, whole-person, multi-disciplinary, and innovative treatment of obesity
Individualized common interventions
The composition of treatment should base on the detailed understanding of the patient’s situation including the diagnosis of the type of obesity, its metabolic consequences, any co-morbidities, as well as the medical history and personality of the patient.
For example, bariatric surgery represents an effective long-term measure for reducing weight and treating negative effects from obesity. However, the invasive procedure also poses risks of complications (Bischoff et al., 2016). For patients who are not eligible for surgery, medication may be applicable, as there is today a number of safe and effective drugs available (Henry, Chilton, and Garvey, 2013). Others like Esteghamati (2015) though are questioning the effectiveness of pharmacotherapy for obesity, and Kurylowicz (2016) is saying that “most of the available non-invasive medical therapies for obesity are non-efficient in a long-term evaluation” (p. 1). However, there seems to be a consensus that drugs are only complements to lifestyle intervention. Lenzi, Migliaccio, and Donini (n.d) see lifestyle modifications as “the cornerstone of obesity management” (p. 334), and attribute an increasing effectiveness to it, especially when individualized and integrated with cognitive behavioral therapy (CBT). Indeed, CBT increases positive overall treatment outcome if added to the program for patients with psychosocial factors, such as, e.g., family dysfunctions, and the negative perception of body satisfaction (Malkina-Pykh, 2013). Deumens, Noorthoorn, and Verbraak (2012) point to the importance of socially embedding treatments and to carefully take any psychopathological co-morbidity like depressive symptoms into account as they influence the success of interventions.
Multidisciplinary integration and innovation
Changing one’s lifestyle to reduce weight with low-calorie diet and physical activity builds the foundation of any intervention, although there are some further details to consider. Bischoff et al. (2016) found that the combined application of physical exercise, diet, and CBT is more effective than any single component alone. Khoo et al. (2015) state that exercise-induced weight loss has higher metabolic benefits than diet-induced weight loss.
To further improve the formula of lifestyle change, even in the absence of surgery and pharmacological treatment or as subsequent additions to those measures, many medical disciplines get involved in finding new ways of addressing obesity and its negative consequences. More recent suggestions are for example electro-acupuncture (Zishan, 2015), phototherapy (Sene-Fiorese, 2015), training motor responses to food (Stice, 2016), and sleep interventions (Fenton, 2014). Family-based therapy (FBT) is already more established, and current studies are comparing between individual, group, and parent-only interventions.
Conclusion
To address obesity as a complex chronic disease appropriately, a whole person and multidisciplinary approach evaluating the benefits of involving physical (e.g., surgery and medication), psychological (e.g., psychotherapy, CBT), and social (e.g., FBT) components is advised. The intervention program should logically align to prevention, treatment, recovery, and maintenance stages. Psychology is an important requirement to address obesity-related psychological disorders such as alexithymia and lowered self-esteem as coming from perfectionism and body image dissatisfaction (Malkina-Pykh, 2013).
References:
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