More than half of patients with obesity using weight management services did not feel their mental health needs were met, according to a study.
People living with obesity have a 55% higher risk of developing depression, and those with depression have a 58% higher risk for clinical obesity, according to published estimates. Studies suggest that the risk for depression gets proportionately higher for each additional 5 kg/m2 in BMI above 30. Despite the well-established association between obesity and poor mental health, there continues to be limited research on effective services for people with obesity and poor mental health who need psychological support.
Tier 2 weight management services (T2 WMS) are community-based behavioral interventions that are intended for people with obesity or other comorbidities or risk factors, such as type 2 diabetes. These services provide advice on diet, physical activity, and lifestyle and behavioral changes, usually within a group setting for 12 weeks. “Integrating psychological support into T2 WMS may help alleviate psychological distress and improve emotional well-being, health-related quality of life, weight, and risk factors for related comorbidities,” says Tamara Brown, PhD. It might also help slow or prevent progression to more serious mental health conditions.
Urgent Need for Better Understanding of Mental Health in Obesity
A recent scoping review revealed there is a lack of evidence regarding the provision of psychological support within weight management. The report also showed that psychological support tended to focus on eating behaviors and weight management rather than stand-alone support for wider mental health needs. In addition, evidence is lacking on the need for and use of psychological support among men and patients who are Black, Asian, and from other minority ethnic communities. Based on these results, there is an urgent need to understand the experiences and priorities of people living with obesity and mental health problems.
For a study published in Clinical Obesity, Dr. Brown and colleagues sought to identify what psychological support was provided in T2 WMS by distributing an online survey to 27 current or recent service users with self-reported mental health needs, 9 commissioners, and 17 healthcare professionals. The survey collected quantitative data about the respondents’ views on the use of and need for such support.
Unmet Mental Health Needs Persist for Many Service Users
The study found that more than one-half of T2 WMS users (54.2%) did not feel their mental health needs were met (Figure), and 60% said they would like additional psychological support within T2 WMS. “These results highlight the lack of psychological and emotional support that is being provided at T2 WMS,” Dr. Brown says. The study also found that psychological support and behavior change techniques were mixed, and there was no clear understanding or definition of psychological support between or within service users, healthcare providers, and commissioners.
When participants were asked to reflect on how their mental health affected their ability to manage their weight, the most common responses were eating to cope with stress or emotions, low motivation to change, and reduced sleep quality.
Greater Emphasis Needed for Patient-Centered Care
For T2 WMS to be effective, it is important to determine patients’ needs at the outset and put them at the center of how the program is designed and delivered. “Our findings can inform the development of patient-centered weight management services for many people living with mental health issues and obesity,” says Dr. Brown. Screening is required to identify people who are obese with mental health needs. Once identified, it is important to then tailor psychological and emotional support interventions to the individual to optimize outcomes. Additional research is needed to further clarify the differences between psychological support and generalized behavior change support.
