The video below is the section for Obesity from Part 6 of TSM’s lecture series on DSM-5 and the EPPP, followed by a transcript. This lecture series aims to equip those preparing for the EPPP with everything you need to know about the impact DSM-5 will be having on the EPPP. To watch all of Part 6, click HERE. To watch earlier lectures in this series, or register for our webinar series on DSM-5 and the EPPP, click HERE.
Transcript of DSM-5 EPPP Lecture Video: Obesity
NARRATIVE DEFINITION:
Obesity is a medical condition in which excess fat has accumulated to the extent that it may have an adverse impact on health. It is measured by Body Mass Index (BMI), a calculation that quantifies body fat based on height. An adult is considered to be overweight when he or she has a BMI of 25 to 29.9, and obese if his or her BMI is 30 or more (World Health Organization).
Obesity has reached epidemic levels globally (WHO). In the United States, the overall prevalence of Obesity has been steadily increasing over the past 20 years (WHO).
From 2005 and on, Obesity was the number two preventable disease in the United States, second only to tobacco use (Centers for Disease Control).
Many factors influence a person’s likelihood of becoming obese, including genetics, cultural standards, socio-economic level, and mental health. The initial treatment for Obesity is diet and exercise. This may be followed by counseling, pharmacological therapy, and surgery.
Although associated with a number of psychological and social issues that may benefit from counseling or psychological support and interventions, obesity is a medical condition and not considered a psychiatric disorder. This, is is not a diagnosis included in the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, 5th edition).
Theories abound as to the psychological causes of Obesity, and one of the most influential is the “externality hypothesis.” Based on the work of Schachter (1974), it is believed that obese individuals are more responsive to external stimuli than they are to internal stimuli. Schachter hypothesized that obese individuals are more likely to eat when presented with the sight, smell, and taste of food, even though they may not be experiencing the physiological signals of hunger. According to his theory, the best way for an obese individual to lose weight is to manipulate external cues to limit their temptation to eat.
Other researchers are not convinced that the externality hypothesis accounts for Obesity and look instead to physiological causes. Set point theory is a popular alternative perspective which purports that each person has a genetically predetermined “set point” weight that is controlled by metabolic hormones and fat cell enzymes.
The set point varies from person to person and drives the level of food intake. It is thought to compensate for an individual’s level of exercise, nutritional requirements, and stress (Nisbett, 1972). Set point theory conceptualizes Obesity as entailing a metabolic defect, or a higher “set point” that functions as a homeostatic mechanism. This higher “set point” in obese individuals is supposed to result in a slowing down of metabolic rate when the individual loses weight.
The resulting reduction of energy expenditure is said to be responsible for why the individual increases his/her food intake, regains weight, and thereby returns to the original “set point” weight.
Scientific support for the set point theory is waning. Modern research methods have shown that the metabolic slowdown can occur when patients are experiencing active weight loss, but tails off when they reach healthy target weight, and their bodies switch into weight maintenance mode. Differences in physical activity (lower daily energy expenditure) now appear to be the key issue in determining who will maintain or regain their body weight.
It should be noted that socio-economic factors influence body weight as well. In the United States, lower economic classes have greater proportions of overweight people. The American Obesity Association attributes this to the abundance of cheap, high-calorie foods.
The most common nutritional problem in the elderly population in the U.S. is Obesity.
FLASHCARD:
Definition
1. A medical condition in which excess fat has accumulated to the extent that it may have an adverse impact on health
Statistics
1. An adult is considered to be overweight when he or she has a BMI of 25 to 29.9 and obese if his or her BMI is 30 or more
2. Obesity has reached epidemic levels globally
3. In the United States, the overall prevalence of Obesity has been steadily increasing over the past 20 years
4. From 2005 and on, Obesity was the number two preventable disease in the United States, second only to tobacco use
5. Most common nutritional problem in the elderly population is Obesity in the U.S
Factors that influence a person’s likelihood to become obese
1. Genetics
2. Cultural standards
3. Socio-economic level
4. Mental health
Treatment
1. Exercise
2. Diet
3. Counseling
4. Drug-therapy
5. Surgery
Externality Hypothesis (Schachter)
1. Obese individuals are more responsive to external stimuli than they are to internal stimuli
2. Best way for an obese individual to lose weight is to manipulate external cues to limit their temptation to eat
Set Point Theory
1. Each person has a genetically predetermined “set point” weight that is controlled by metabolic hormones and fat cell enzymes
2. Scientific support for set point theory is waning
Other Research on Causation
1. Differences in physical activity now key focus for determining who will maintain/regain body weight
2. High-caloric foods
QUESTION:
The primary treatment for obesity is:
ANSWERS:
A. Diet and Counseling
B. Exercise and Surgery
C. Surgery and Counseling
D. Exercise and Diet
RATIONALE:
The correct is D. The initial treatment for obesity is diet and exercise. However this treatment may be followed by therapy or counseling, drug therapy, and surgery.