Medications and Obesity Exploring the Landscape and Advancing Comprehensive Care: Proceedings of a Workshop (2024) / Chapter Skim
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4 Mental and Behavioral Health Considerations During Obesity Treatment
4 Mental and Behavioral Health Considerations During Obesity Treatment
Pages 39-50
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From page 39... ...
(Pashby, Wilfley) • Factors that underlie the high level of comorbidity between obesity and mental health disorders include the bidirectional influence of overeating and/or underactivity on mental health symptoms, shared risk factors, stigma, and medication to treat mental health conditions.
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From page 40... ...
She focused on four mental and behavioral health considerations experienced by adults who are treated with AOMs: nonspecific mental health concerns, ED and body image, food noise, and mood and suicidal ideation (SI)
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From page 41... ...
SOURCE: Presented by Robyn Pashby, March 19, 2024. Among patients receiving AOMs in Pashby's clinical practice, common concerns include the following: • Obtaining the medication, • Managing the logistics of the medication (e.g., travel, missed doses, dosing errors)
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From page 42... ...
She has also seen increases in confusion about fullness and hunger signals and increased restriction. Pashby recommended screening for disordered eating and disordered body image cognitions or behaviors, monitoring the rate of weight loss and restriction, differentiating between "pathological" and "nonpathological" dietary restriction, and observing patients as the effects of medication attenuate or people discontinue them (Richards and Khalsa, 2024)
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From page 43... ...
Silencing food noise -- a significant psychological burden for many with and without obesity or EDs -- is a reason people take AOMs beyond weight loss and physical health. Patients on AOMs often report sentiments such as "I would stay on this medication for the rest of my life even if I never lost a pound just because of the freedom I have in my head." In her clinical practice, patients experience reduced food noise, reduced snacking, grazing, and "kitchen surfing," and heightened awareness of the previous effects of food noise.
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From page 44... ...
She discussed the co-occurrence of psychiatric disorders and obesity, mental health considerations related to RCTs of AOMs in youth, the medical complications and consequences of rapid weight loss, and strategies to support mental health through evidencebased health behavior and lifestyle treatments. She noted that researchers at UC Irvine have issued a warning that GLP-1RAs may be harmful to children, due to the unbalanced and inappropriate reductions in calorie or energy intake and -- when administered without proper supervision -- could create a host of health and emotional problems for children as they age (Cooper et al., 2023)
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From page 45... ...
Medical Complications and Consequences of Rapid Weight Loss There is increased understanding and recognition that rapid weight loss is associated with a range of medical complications and consequences, noted Wilfley. Unique medical complications of starvation may be present in children and adolescents with weight loss despite presenting at healthy or above healthy weights.
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From page 46... ...
Malnutrition can cause potentially irreversible medical complications that include negative impact on linear growth, bone deposition, and brain maturation. Bariatric surgery is also associated with mental and physical health concerns among adolescents, said Wilfley.
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From page 47... ...
She suggested including broader samples that are representative of youth with obesity and mental health comorbidities in evaluating AOMs and establishing a system for screening and monitoring all youth who receive them for possible ED and mental health safety concerns. Ongoing studies would benefit from optimized assessment tools that include comprehensive psychosocial measures collected routinely at all time points.
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From page 48... ...
Collaborative Care for Obesity Treatment To improve interprofessional collaboration around AOMs and health outcomes, Pashby recommended integrating mental and behavioral health into a range of care settings -- from obesity specialty care to primary care to hospitals -- and noted that mental health providers often have different relationships with patients than physicians do, because they tend to see patients more frequently. Wilfley commented that in Missouri, Medicaid has worked to establish a collaborative care model for individuals with obesity that includes a physician or PCP, behavioral health specialist, and registered dietitian; the provider encourages them to work together by the payer.
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From page 49... ...
She called for research on strategies to reduce internalized weight bias and implementing decision-making factors that imbue patients with confidence in evidence-based care, so they are less tempted by non-evidence-based approaches.
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