Obesity

Morbid obesity is a biopsychosocial problem that demands the attention of a variety of disciplines as a serious health concern. However, outcome data for existing weight management programs are notoriously poor. A variety of interventions have been researched, although none has provided a complete, effective, lasting treatment for morbid obesity as health problem.

Therefore developing a multidisciplinary model for obesity treatment that may account for the refractory nature of obesity and that may generate a sound rationale for multidisciplinary intervention is an appropriate focus for future efforts.

One promising theoretical approach is applying the notion of a set point to physiological functions such as body weight as well as to psychological functioning. As applied to obesity, the set-point theory predicts that body weight is governed at a constant level, similar to blood pressure or temperature, by a complex interaction of physiological factors. As a result, the set-point for body weight is likely to resist change; deviations from the set-point are likely to be met by regulatory, compensatory mechanisms intended to maintain that set-point.

In parallel to the set-point theory of obesity, psychological function might also be described from a homeostatic perspective, involving biological and behavioral regulatory factors. Although descriptions of the mechanisms of energy regulation from a psychological perspective are not as easily enunciated, the analogy is clearer.

Human psychological resources, regardless of theoretical definition, may be subject to a variety of fluctuations. They are likely to be available and readily mobilizable, yet may be limited in nature to obligatory costs in terms of both utilization and endurance.

Deviations from the psychological set-point also might be met by regulatory, compensatory mechanisms intended to maintain that set-point. However, just as many physiologically related variables can be shifted by manipulating contributing variables such as environmental contingencies.

It is clear that the treatment of morbid obesity must address these complex biopsychosocial issues. Lasting reductions in weight might be achieved only through alterations of both physiological and psychological set-points. This premise suggests that biological and behavioral therapies need to be integrated effectively to maximize therapeutic outcome with morbidly obese patients.

Future research might be directed toward uncovering variables that contribute to both physiological and psychological set-points in obesity and toward identifying optimum combinations of biological psychological treatment elements for altering these set-points.