Recently obesity is becoming one of the psychiatric disorder , we are discussing depression and ADHD associated with obesity , cognitive reconstruction and cognitive behavior therapy steps is discussed , medical therapy used in obesity

3. Obesity and Depression
obesity depression
inflammation
HPA axis
increased body dissatisfaction
low self esteem
pain
insufficient physical activity
unhealthy eating patterns
sleep disturbances
psychotropic medications
Luppino et al, 2010, Arch Gen Psychiatry, 67:220-229

4. 1. Obesity leads to ADHD
2. ADHD and obesity are expressions
of a common biological dysfunction
in a subset of patients with both
3. ADHD contributes to obesity
Cortese et al, 2008

5. Binge Eating Disorder
DSM V Diagnostic Criteria
Recurrent episodes of BE
characterized by BOTH:
 Eating large amounts of food in a
discrete period of time
 A sense of lack of control (LOC)
BE episodes are associated with ≥ 3
of:
 Eating more rapidly than usual
 Eating until uncomfortably full
 Eating large amounts when not
hungry
 Eating alone because of
embarrassed
 Feeling disgusted or guilty
Marked distress regarding BE
BE occurs at least 2 days per
week for 6 months
Not associated with
compensatory behaviors

7. • Differences between a client’s
behavior and desired goals.
• Difference between “resistance”
and the lack of motivation.
•MI requires the helper to be
reflective vs. directive.
DiLillo, V (2003). Siegfried, N.J., & West, D.S. (2003). Incorporating motivational
interviewing into behavioral obesity treatment. Cognitive and Behavioral Practice, 10,
120-130

8. Motivational Scale
How important is it for you right now to
change your behaviors?
On a scale of 0-10 what number would you
give yourself?
0…………………………………………………….10
Not at all important Important
What would need to happen
for you to go from x to y?

9. Motivational Scale
How confident are you that you could do
it?
On a scale of 0-10 what number would
you give yourself?
0……………………………………………………10
Not at all confident confident
What would need to happen for you to
go from x to y?

10. Prochaska, Norcross &
DiClemente (1994)
Maintenance Relapse
ContemplationAction
Preparation
Termination
Precontemplation
Transtheoretical Stages of Change

11. If a client answers either question between 1-4, assume
they are in pre-contemplation and consider the following
steps:
•Acknowledge the client’s control of decision
•Give your opinion on the medical benefits of
weight loss.
•Explore concerns from the client’s view
•Acknowledge possible feelings of being
pressured to change
•Validate that they are not ready and that it is
solely their decision
•State that, at this time they are not ready,
but that it is possible they may feel
differently at a future time.

12. Answers between 5-7 indicate some
continued ambivalence, assume
clients are in contemplation.
•Validate client’s experience
•Restate that the decision to change
is still completely their own
•Clarify pros and cons of changing
behavior
•Leave opportunity for continued
movement toward change

13. If answers are between 8-10,
assume they are ready to take action
and help prepare them for behavior
change.
•Praise decision to change behavior
•Identify and assist in problem
solving regarding obstacles
•Encourage small initial steps
•Help identify social supports
•Provide future follow-up
appointments to assist with
adherence

14. • Based on dysfunctional
cognitions and beliefs
• Modify behaviors by changing
antecedents and
consequences

15. 15
Behavior is controlled by its Antecedents
and Consequences

16. Face-to-face session Session description1
Behavioral therapy strategies
Session 1 Psychoeducation, goal setting, and monitoring
Session 2 Eating habits and family change
Session 3 Increasing daily activity and time management
Session 4 Food choices, shopping, and cooking
Session 5 Increasing exercise, problem solving, motivation
Cognitive behavioral therapy strategies
Session 6 Coping strategies and using helpful thoughts
Session 7 Body image
Session 8 Barriers and high-risk situations
Session 9 Maintaining change
Session 10 Maintenance and relapse prevention
Behavioral Treatment sessions

17. •Self-monitoring
•Stress management
•Stimulus control
•Problem-solving
•Contingency management
•Cognitive restructuring
•Social support

18. •Records of place and time of
food intake
•Accompanying thoughts and
feelings
• Identify the physical and
emotional settings in which
eating occurs
• Puts responsibility on the
patient

19. • Defining the eating or weight
problem.
•Generating possible solutions;
-Evaluating the solutions
-Choosing the best one.
•Trialing the new behavior;
-Evaluating outcome.
-Generating alternatives.

20. Modification of
• Chain of events preceding
eating.
• Kinds of foods .
•Consumed of satiety cues.

21. •Teaches patients to
identify, challenge, and
correct negative thoughts
•Positive self-talk

23. •Understand that drug therapy is
adjunctive to lifestyle intervention
•BMI of 30 kg/m² or more
•Have realistic expectations about
weight loss goals and outcomes
•Are unable to lose/maintain
weight with lifestyle change alone
•Have no medical or psychiatric
contraindications
NHLBI Obesity Education Initiative, Expert Panel on the Identification,
Evaluation, and Treatment of Overweight and Obesity in Adults

24. •Drugs should never be used without
continued concomitant lifestyle modifications
•Continual assessment of drug therapy for
efficacy and safety is necessary.
•If the drug is efficacious in helping the
patient to lose and/or maintain weight loss
and there are no serious adverse effects, it
can be continued.
•If not, it should be discontinued.

25. Treatment of Obesity
Name Dose Action Side Effects
•Orlistat/Xenical
•Sibutramine/Me
ridia
•Phentermine/
Adipex, Fastin
120 mg with
each meal
5-15 mg/d
15-37.5 mg
per day as a
single or split
dose
Peripheral: Blocks
absorption of about
30% of consumed
fat
Central: Inhibits
synaptic reuptake
of norepinephrine
and serotonin
Central: Stimulates
release of
norepinephrine
GI symptoms (oily
spotting, flatus with
discharge, fecal
urgency, oily stools,
incontinence)
Dry mouth,
constipation,
headache,
insomnia,
increased blood
pressure,
tachycardia
CNS stimulation,
tachycardia, dry
mouth, insomnia,
palpitations
Thomas Repas D.O
et al .2013

26. Treatment of Obesity( NOT FDA approved)
Name Usual Dose Action Side Effects
•ephedrine+/-
caffeine
"Elsinore"pill
•Bupropion/Wellb
utrin
Topiramate/Topa
max
Thomas Repas D.O et al
.2013
Varies:
usually 75-
150 mg
ephedrine
and 100-150
mg caffeine
100-300
mg/d
96-192 mg/d
Stimulates
adrenergic
receptors
Inhibits reuptake
of dopamine
norepinephrine
and serotonin
Central ?
CNS stimulation,
tachycardia, dry
mouth, insomnia,
palpitations
CNS stimulation,
dry mouth,
headache, GI
effects
Paresthesia,
fatigue, dizziness,
memory difficulty,
concentration
difficulty, and
depression