Is he mentally ill?

Risk factors: low parental education, children who are seriously neglected

Associated with diabetes, joint disease, high bp, coronary artery disease, sleep apnea, CA

Role of genes

• Role of genes

• Genes assoc with leanness have been id’d in animals
• Genetic mutation assoc with binge eating
• Hormones involved in appetite and weight regulation
• Leptin acts to reduce our intake; inability to produce leptin is assoc with morbid obesity
• People who are obese tend to have high levels of leptin, but are resistant to its effects

• Sociocultural influences

• Culture encourages consumption and discourages exercise
• Time pressure: on any given day, 30% of Am kids eat fast food
• In children: peers view obesity more negatively than physical handicaps
• Peer eating behavior
• Availability of exercise facilities

Family influences

• Family influences

• Family behavior patterns
• Food availability (home, neighborhood, school)
• Parental knowledge and attitudes about food
• Eating may become an habitual way of alleviating emotional distress
• Overfeeding young children causes them to develop more adipose cells and may predispose them to weight problems in adulthood

• Stress and Comfort Food

• When under stress, people and animals eat foods high in fat or carbohydrates
• Weight gain as a function of basic learning principles
• Obese people are conditioned to eat more in response to both external and internal cues than normal-weight individuals
• Eating is reinforced—food is pleasurable and emotional tension is reduced

• Binge eating may be a predictor of later obesity

Success rates are quite low

• Success rates are quite low

• Weight loss groups—

• Many exist, but only Weight Watchers has been shown to be effective
• Groups provide support education, encourage record-keeping

• Medications

• Two types—appetite suppressants and those that prevent some nutrients from being absorbed
• Meridia—inhibits reuptake of serotonin and norepinephrine—typical weight loss 5-8%
• Xenical—reduces amt of fat that can be absorbed—not all that effective. Ditto for Alli

• Gastric Surgery

• Reduces amt that can be consumed
• Recovery is tough
• Weight loss can be dramatic—average loss of about 60% of excess weight and loss is maintained over 8 or 9 years

• Psychological tx

• Most effective—behavioral management
• CBT for binge eating
• Gradual weight loss more effective than low-calorie diets

Losing weight is contrary to biology

• Losing weight is contrary to biology

• Brownell: Public policy recommendations

• Improve opportunities for physical activities
• Regulate food advertising directed at children
• Prohibit the sale of fast food and soft drinks in school
• Subsidize the sale of healthful foods

Two key moods:

• Two key moods:

• Depression (melancholia)—great sadness, apprehension, feelings of worthlessness, guild, withdrawal, loss of sleep, appetite and sexual desire, loss of interest and pleasure in usual activities
• Often associated with other psych conditions and medical conditions
• May go 6-8 mos if untreated—tends to dissipate with time
• In kids—aggression and overactivity, irritability, somatic complaints

• Mania—emotional state of intense but unfounded elation, hyperactivity, talkativeness, flight of ideas, distractibility, impractical, grandiose plans, spurts of purposeless activity

• Rare individuals experience only mania
• Manic stream of thought—loud incessant, full of puns and jokes
• Comes on relatively suddenly, lasts a few days or months, may be irritable

Loss and the grieving process

• Loss and the grieving process

• Normal response—Bowlby—1) numbing and disbelief, 2) yearning and searching for the dead person 3) disorganization and despair, 4) reorganization
• If symptoms haven’t resolved in 2 mos, dx

• Baby Blues

• Normal response, experienced by 50-80% of women, lasts just a few days. Caused by stress, sleeplessness, radical change in hormones. Marked by tearfulness, being overwhelmed.

• Not to be confused with Postpartum depression—

• Difficulty functioning. More common in those with predisposing factors—social isolation, less family support, history of depression.

Depressed mood of mild to moderate intensity

• Depressed mood of mild to moderate intensity

• Primary hallmark is chronicity

• Average duration is 5 years (4 years in kids)

• Chronic stress increases the severity of symptoms

• Half relapse

• Lifetime prevalence of 2.5-6 %

• Two of the following—poor appetite or overeating, insomnia or hypersomnia, low energy or fatigue, low self esteem, poor concentration or difficulty making decisions, feelings of hopelessness

• Can be diagnosed with major depression—called double depression