An Interview with
Paige O'Mahoney, M.D., CHWC
Why did you write Helping Patients Outsmart Overeating: Psychological Strategies for Doctors and Healthcare Providers?
Karen and I decided to collaborate on this book to help doctors and health care professionals understand three things: why patients overeat, why our “diet and exercise” advice fails to deliver either permanent weight loss or lasting health improvement, and how eating and success psychology can help patients overcome dysregulated eating and achieve lasting, self-directed wellness. We also wanted to highlight resources and experts that health care providers can leverage to improve patient care in this area.
What is dysregulated eating, and why is it important for doctors and health care professionals to understand?
Dysregulated eating refers to eating for reasons unrelated to hunger and satiety signals. Patients with eating dysregulation will eat when not hungry or continue to eat past physiologic satisfaction or fullness. They may use food to cope, avoid or suppress feelings, distract themselves from unwanted thoughts or tasks, or simply to try to manage life. This is important for several reasons. First, patients with eating dysregulation are often living above their bodies’ preferred set point, or natural weight. Second the dieting mentality and behaviors that health care professionals are trained to prescribe for patients with “weight problems” exacerbate this pattern, putting patients at risk of restrained eating, bingeing and weight-cycling. These behaviors can promote suffering and compromise patient well-being, rather than helping patients to become healthier and improve their eating habits long-term.
What is weight stigma and why does it matter when it comes to patient care?
Weight stigma refers to negative assumptions, attitudes and/or behaviors toward a person based upon his or her weight. Weight stigma is damaging to patients and health care professionals for several reasons. First, it can prevent providers from taking a holistic view of a given patient’s health picture. For example, if the provider starts by making a negative judgment about a patient’s level of motivation or interest in his or her health based upon the patient’s size, weight or BMI, that judgment may interfere with curiosity about what is really going on with a patient, and thus appropriate evaluation and treatment. Weight stigma can also reduce every patient complaint to an issue of weight or BMI and prevent providers from searching for other possible causes. For example, shortness of breath can be attributed to excess weight, rather than being viewed as a symptom with a variety of possible causes that must be considered and investigated in order to reach an appropriate diagnosis and treatment plan. Finally, research demonstrates that patients may delay or avoid seeking needed medical care as a result of experiencing weight stigma in the health care setting. This experience is, unfortunately, all too common, for reasons that we discuss in the book.
Do some patients experience weight stigma toward themselves as well?
Yes! This is called “internalized weight stigma,” and it is particularly harmful because it undermines patients’ self-worth and self-confidence and can lead to despair. If patients attribute their weight problems to personal shortcomings, such as laziness or lack of motivation, they are less likely to consider other treatable causes, such as dysregulated eating, unexamined irrational beliefs about food, eating, weight, health and life, and inadequate self-care and life skills. This lack of awareness of important, valid contributors to their eating problems leads to stagnation, rather than progress, sometimes for decades or even a lifetime. Once internalized weight stigma is addressed in a constructive way, patients can choose a more constructive, empowered course of action, acquire learnable self-care and life skills and develop the increased self-efficacy needed for lasting change.
What 5 lessons from the book would you like patients and health care professionals to know?
- That weight and BMI are not necessarily reliable or complete indicators of health or fitness. Plenty of normal and lower weight people suffer from metabolic dysfunction, dysregulated eating and compromised health related to genetics, a poor diet, stress, or sedentary lifestyles, and many higher weight people enjoy an excellent level of fitness and health. There are many factors, besides weight and BMI, that contribute to overall health, and much that patients can do to improve their own wellness, with or without weight-loss.
- That dysregulated eating is an important, largely unrecognized contributor to weight concerns in the medical community, including “overweight,” “obesity,” and yo-yo dieting. Many eating disorders therapists and intuitive eating counselors are trained to help patients who struggle with dysregulated eating learn “normal” eating (Koenig, The Rules of Normal Eating, Gürze Books, 2005). Doctors and other health care providers can help patients by seeking out appropriately trained medical and mental health providers to work with these patients between office visits.
- That there are learnable life skills that can help patients radically and permanently improve the way they approach their health and care for themselves. These learnable skills can not only improve a patient’s level of wellness, they can also spill over into other areas of a patient’s life, leading to greater happiness and life satisfaction.
- That a weight-inclusive approach promotes health and wellness, much more than a judgmental, weight-focused approach. For more information on the Weight-Inclusive approach to Health, refer to Tracy L. Tylka, Rachel A. Annunziato, Deb Burgard, et al., “The Weight-Inclusive versus Weight-Normative Approach to Health: Evaluating the Evidence for Prioritizing Well-Being over Weight Loss,” Journal of Obesity, vol. 2014, Article ID 983495, 18 pages, 2014. doi:10.1155/2014/983495
- That health care professionals’ own food issues and weight struggles can impact patient care, and that understanding their own struggles can make professionals more effective when taking care of and advocating for patients within the medical system.
What are some of the personality traits and skills deficits of dysregulated eaters?
The most common personality traits include perfectionism, all-or-nothing thinking, and people-pleasing. We discuss these and others in the book, as does Karen in her prior books.
Interestingly, some of these traits are common to both dysregulated eaters and high achievers, including many health professionals. This may explain why some patients who struggle with overeating, higher-than-comfortable weights, and yo-yo dieting report that this seems to be the only area of their lives where they “can’t seem to reach their goals.”
How can doctors and health care professionals help?
First, doctors and health care professionals can help by being aware that weight problems are often eating problems, and that eating problems often reflect a patient’s well-intentioned attempt to cope with life or manage internal conflict. By practicing non-judgmental awareness, seeking understanding, and expressing empathy, health care professionals encourage patients to be curious and self-compassionate, which can start to move them toward healing. Taking a weight-inclusive approach (see Tylka, et. al. citation above), where the focus is on promoting overall health, rather than on a specific weight outcome, can be a great way to empower patients toward improved wellness. And, of course, referring patients to eating disorders therapists, Intuitive Eating Counselors, or appropriately trained health and wellness coaches, depending upon the patient’s individual situation and needs, can help patients make progress between medical appointments through a collaborative, interdisciplinary approach.
How can doctors and health care professionals get additional help for their patients?
- By reading the book, including the Resources section at the end of the book
- By learning about and referring patients, as appropriate, to Karen’s prior books and the other books, articles and websites in our resource list at the back of “Helping Patients Outsmart Overeating.”
- By visiting Karen’s website at www.karenrkoenig.com and Paige’s website (including the Health Care Professionals’ page, including the “Resources” section) at www.deliberatelifewellness.com.