Psychological Testing Before Obesity Surgery – A Myth

SmartShape Weight Loss Centre

The Great Obesity Myth

Dr David Ashton calls for an end to dangerous misconceptions about obesity

Imagine you have been listed for an operation – say a hernia repair or a hip replacement – and you then receive a letter from your doctor telling you that before they can go ahead with the surgery, you will need to see a psychiatrist. The letter also makes it clear that you can only proceed to surgery if you pass the psychiatric assessment and there is a one in five chance that you will fail. How would you feel about that?

In the USA and some European countries, this is standard practice for patients who are candidates for obesity surgery, all of whom are required to undergo pre-operative psychological/psychiatric evaluation before the surgeon is given the green light to proceed. In up to 20% of cases the patient is regarded as psychologically unfit and is thereby denied an operation which would almost certainly be life-transforming and possibly life-saving.

Obesity And Psychological Aspects

This real example illustrates the extent to which a belief in the psychological origins of obesity has become an article of faith – a dogma – among health professionals and even the lay public. This belief views people with weight problems as using food to combat feelings of depression, anxiety and low self-esteem. In other words, obesity is the consequence of an underlying psychological problem which causes them to over-eat and gain weight. It follows that the aim of treatment should be to address the mental state which caused the weight gain in the first place, thereby removing the main barrier to successful weight loss.

The problem for those who advocate this view of the causes of obesity is that there is no credible scientific evidence to support it. Psychological treatments for weight problems don’t work, precisely because obesity isn’t a psychological problem. It is, rather, a biological problem; a chronic disorder of appetite regulation which is to a large extent, genetically determined. If this is true, why then do so many health professionals and even the general public continue to believe the myth that the reason people become obese is that they are psychologically disturbed?

Obese Has Depression, Anxiety & Other Forms Of Mental iIlness

Part of the reason is that depression, anxiety and other forms of mental illness are more common in obese subjects than in the general population. The assumption is that the person’s mental state caused them to become obese. This idea feeds into the deeply prejudiced comments to which obese people are often subjected, such as, “Well you have to be a bit crazy to let yourself get into that state in the first place.” The psychological myth also supports the stereotype of the obese patient as feckless, irresponsible, weak-willed and stupid. Classifying people in this way is more convenient than thinking about it; after all, simple solutions are easier than complex ones and we all like the world to conform to our prejudices.

But for those who do think about it, the idea that excess weight or obesity is primarily psychological in origin seems highly implausible. Why?

Because if it is true, we have to accept that since 60% of the adult population is either overweight or obese, tens of millions of people are – to a greater or lesser extent – psychologically disturbed. We also have to explain why psychological treatments for obesity are so singularly unsuccessful in delivering long-term weight loss. And finally, we have to account for the fact that symptoms such as depression and low self-esteem which are so common in obese patients pre-operatively, almost invariably disappear after surgery. This strongly suggests that obesity is the cause of the psychological symptoms, not the consequence.

It has been well said that “obesity is the last socially acceptable form of prejudice”. The myth of the psychological origins of obesity underpins and sustains that prejudice and it is time we moved on to a more scientifically informed view. Perhaps then we will be less prone to apportioning blame and more focussed on providing help.