Obesity: Is it a Mental Disorder?

Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15213, USA.
International Journal of Eating Disorders (Impact Factor: 3.13). 01/2014; 42(8):739-53. DOI: 10.1002/eat.20725
Source: PubMed

ABSTRACT Using Wakefield's conceptualization of mental disorder as "harmful mental dysfunction" (Wakefield, Am Psychol, 47, 373-388, 1992), we examined the evidence for including obesity as a mental disorder in DSM-V.
We searched computer databases and examined reference lists from review articles published in the last 10 years to identify empirical papers relevant to the present review.
Obesity is a condition of heterogeneous etiology that is harmful for most individuals. However, there is scant evidence that obesity, in general, is caused by mental dysfunction. Although recent work examining the neurocircuitry of energy balance has suggested that mental dysfunction may be involved in the etiology of specific obesity phenotypes, findings are too preliminary to support classification of obesity as a mental disorder. Nevertheless, there is evidence that obesity is related to mental disorder and many of the medications used to treat psychiatric illness.
There is little evidence for including obesity as a mental disorder in DSM-V. However, results confirm the importance of monitoring adiposity routinely among patients with psychiatric illness.

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    • "Our study also shows that obesity in young Lebanese university students was not associated with having PD symptoms. In fact, it is well known that mental health risks increase considerably among the obese (Marcus & Wildes, 2009), particularly the severe cases (class III) (Onyike, Crum, Lee, Lyketsos, & Eaton, 2003). Knowing that, the inadequate number of severe cases of obesity (class I: 91 students ~ 2.7%; class II: 15 students ~ .4%; "
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    ABSTRACT: Studies investigating the association between body mass index (BMI) and psychological distress (PD) have shown contradictory results. The present study examined the relationship between BMI and PD among Lebanese university students and tested its moderation by gender. A cross-sectional study was conducted using a proportionate cluster sampling of university students. Data concerning socio-demographic characteristics, body weight and height, tobacco consumption, physical activity, presence of chronic diseases and self-rated global health were collected. PD was assessed using Beirut Distress Scale (BDS-22). Students were classified as underweight (BMI <18.5 kg/m2), normal weight (BMI 18.5–24.9 kg/m2), overweight (BMI 25– 29.9 kg/m2) and obese (BMI >30 kg/m2). The association between BMI and BDS-22 differed by gender (p-value for interaction: .02). Being overweight was inversely associated with BDS-22 for females only (adjusted OR .5, 95% CI: .4–.8, p-value .02). Neither obesity nor underweight was associated with PD for both genders.
    International journal of adolescence and youth 09/2015;
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    • "Recent studies have underlined the role of the neural reward system in the development and maintenance of obesity: " dysfunction of brain reward circuitry in response to food cues may predispose some individuals to obesity via an increased likelihood of overeating, particularly excessive consumption of palatable foods " (p. 744, Marcus and Wildes, 2009). Thus some kinds of obesity may be considered an expression of food " addiction, " problem that typically requires a long-term treatment (Wang et al., 2001, 2002, 2004, 2009; Gearhardt et al., 2009, 2011a,b,c,d, 2012, 2013; Gearhardt and Corbin, 2011; Gearhardt and Brownell, 2013). "
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    ABSTRACT: Obesity is currently an important public health problem of epidemic proportions (globesity). Inpatient rehabilitation interventions that aim at improving weight-loss, reducing obesity-related complications and changing dysfunctional behaviors, should ideally be carried out in a multidisciplinary context with a clinical team composed of psychologists, dieticians, psychiatrists, endocrinologists, nutritionists, physiotherapists, etc. Long-term outpatient multidisciplinary treatments are likely to constitute an essential aspect of rehabilitation. Internet-based technologies can improve long-term obesity rehabilitation within a collaborative approach by enhancing the steps specified by psychological and medical treatment protocols. These outcomes may be augmented further by the mHealth approach, through creating new treatment delivery methods to increase compliance and engagement. mHealth (m-health, mobile health) can be defined as the practice of medicine and public health, supported by mobile communication devices for health services and information. mHealth applications which can be implemented in weight loss protocols and obesity rehabilitation are discussed, taking into account future research directions in this promising area.
    Frontiers in Psychology 06/2014; 5:559. DOI:10.3389/fpsyg.2014.00559 · 2.80 Impact Factor
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    • "The eating disorders (ED) anorexia nervosa (AN), bulimia nervosa (BN), eating disorders not otherwise specified (EDNOS) and binge eating disorder (BED) are characterised by pathological eating behaviours and body image disturbance. Obesity is a heterogeneous condition that is not classified as an ED (Marcus & Wildes, 2009). However, it is both a risk factor and a consequence of ED. "
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    ABSTRACT: Eating disorders (ED) are chronic and sometimes deadly illnesses. Existing treatments have limited proven efficacy, especially in the case of adults with anorexia nervosa (AN). Emerging neural models of ED provide a rationale for more targeted, brain-directed interventions. This systematic review has examined the effects of neuromodulation techniques on eating behaviours and body weight and assessed their potential for therapeutic use in ED. All articles in PubMed, PsychInfo and Web of Knowledge were considered and screened against a priori inclusion/exclusion criteria. The effects of repetitive transcranial magnetic stimulation (rTMS), transcranial direct current stimulation, vagus nerve stimulation (VNS) and deep brain stimulation (DBS) were examined across studies in ED samples, other psychiatric and neurological disorders, and animal models. Sixty studies were identified. There is evidence for ED symptom reduction following rTMS and DBS in both AN and bulimia nervosa. Findings from studies of other psychiatric and neurological disorders and from animal studies demonstrate that increases in food intake and body weight can be achieved following DBS and that VNS has potential value as a means of controlling eating and inducing weight loss. Neuromodulation tools have potential for reducing ED symptomatology and related behaviours, and for altering food intake and body weight. In response to such findings, and emerging neural models of ED, treatment approaches are highly unlikely to remain 'brainless'. More research is required to evaluate the potential of neuromodulation procedures for improving long-term outcomes in ED. Copyright © 2013 John Wiley & Sons, Ltd and Eating Disorders Association.
    European Eating Disorders Review 11/2013; 21(6):436-55. DOI:10.1002/erv.2256 · 2.46 Impact Factor
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