This document discusses the need for a network medicine approach to address the growing obesity epidemic. It notes that obesity is influenced by biological, psychological, social, and environmental factors. A network medicine approach utilizes multiple healthcare specialists, including endocrinologists, dietitians, psychologists, and policymakers. This collaborative approach can help treat obesity and its related conditions by addressing the multifaceted influences on weight. The document advocates that psychology has an important role to play in a network medicine team by contributing understanding of stress, cognition, and behavior.

1. The Role of Psychology in a
Network Medicine
Approach to the Obesity
Dilemma
BARRY NIERENBERG, PH.D., ABPP
ALEXIA HOLOVATYK, B.S.

2. Obesity- an Epidemic of Growing
Concern
 According to the National Institute of Health (NIH, 2012),
obesity is defined as a function of height and weight, or body
mass index (BMI) of 30 or greater.
 Approximately 65.7% of American citizens are obese or
overweight (Hedley, Ogden, Johnson, Carroll, & Flegal, 2004).
 Obese individuals are at an increased risk for cardiac disease,
stroke, and type II diabetes- some of the leading causes of
preventable death (Center for Disease Control, 2012).

3. The High Cost of Obesity
In 2008, the estimated annual cost of
obesity in the U.S. was $147 billion dollars
(CDC, 2012).
The medical costs for people who are
obese were $1,429 higher than for those
of normal weight (CDC, 2012).

4. The High Cost of Obesity
 Americans are not equal consumers of health care.
 Five percent of the population accounts for 50% of
health care costs (NIHCM, 2012).
 In 2009, $623 billion went toward the health care
expenditures of the 5% (NIHCM, 2012).
 Of “The 5%”, 66% have hypertension, 45% have high
cholesterol, and 37% have diabetes
 ALL these conditions are precipitated by obesity

5. The High Cost of Obesity
-NIHCM, 2012

6. Weight Loss Retention- The Albatross
of Obesity
 At any given time, approximately one half of the adult population is trying
to lose weight (Kruger, Blanck, & Gillespie, 2006).
 The real challenge of weight loss lies in maintenance.
 Weight loss maintenance is defined as a ten or more percent reduction in
initial body weight that is intentionally maintained over the course of a
year (Wing & Phelan, 2005)
 This marker is notable because it is associated with statistically significant
improvements in lipids ratios, blood glucose homeostasis, and lowered risk
of heart disease (National Institute of Health, 1998).
 Eighty percent of obese people fail to maintain their weight loss (Wing &
Phelan, 2005).

7. The Goal of a Network Medicine
Approach (Taken from Pain slides)
 To create a common language in order to facilitate collaboration among
physicians, care teams, and patients in order to increase positive medical
outcomes
 To address and decrease short-term and long-term financial cost
 To increase understanding of role of multidirectional role of micro and
macro systems In medical care, including biological, social networks and
psychological
 to refute Cartesian dualism in diagnosis and treatment
 To move away from “diagnose and treat” to “intercept and prevent

8. The Multilayered Approach of Network
Medicine
 Genetics & Epigenetics
 Biologists, geneticists, endocrinologists
 Interconnection of Diseases
 Primary care providers, medical specialists
 Moving away from an “organ-focused” approach to medicine
 Graph theory
 Social & Environment
 Mental health providers, registered dieticians, exercise physiologists, & policy
makers that incent healthy lifestyle choices
 Allostatic load

9. Support for a Network Medicine
Approach to Obesity
 “A multitude of factors likely contribute to obesity, from
inherent biological traits that differ between individuals
relevant to body weight; to environmental and socioeconomic
factors; to behavioral factors--which may have both molecular
and environmental influences. Thus, the diverse efforts of
many federal agencies and public and private organizations
will be valuable in working towards reducing obesity.” –NIH
(2012)

10. Support for a Network Medicine
Approach to Obesity
 The NIH recommends a combination of specialists to address the obesity
problem, including:
 An endocrinologist to treat for type II diabetes or a hormone problem, such as
an underactive thyroid.
 A registered dietitian or nutritionist to change eating habits.
 An exercise physiologist or trainer to determine fitness levels and recommend
suitable exercises
 A bariatric surgeon if weight-loss surgery is an option.
 A psychiatrist, psychologist, or clinical social worker to treat depression or
stress.

11. Support for a Network Medicine
Approach to Obesity
 Obesity is influenced by a multitude of physiological, psychological,
emotional and environmental factors
 Stress can alter brain networks that can lead to obesity (Dallman, 2010)
 Stressors can activate a neural stress–response network, bias cognition toward
increased emotional activity and degrade executive function.
 Stress can increase release of glucocorticoids, which raises craving for food and
insulin levels, which thereby promotes food intake.
 Genetic mutations have been shown to lead to obesity and pituitary
dysfunction (Clément, et al., 1998)

12. Conclusion
 Focusing on preventable conditions such as obesity
that are costly to society and detrimental to the
wellness of individuals is of the essence
 The network medicine approach is poised to be an
effective means to alleviate the growing epidemic of
obesity
 Psychology can contribute a great deal to a
collaborative team through the network medicine
approach

13. References
 Center for Disease Control. Obesity and overweight. 2012; Available at
http://www.cdc.gov/obesity/adult/index.html. Accessibility verified on April 27, 2012.
 Clément, K., Vaisse, C., Lahlou, N., Cabrol, S., Pelloux, V., Cassuto, D., ... & Guy- Grand, B.
(1998). A mutation in the human leptin receptor gene causes obesity and pituitary
dysfunction. Nature, 392(6674), 398-401.
 Dallman, M. F. Stress-induced obesity and the emotional nervous system. Trends in
Endocrinology & Metabolism, 21(3), 159-165. doi: 10.1016/j.tem.2009.10.004
 Hedley, A. A., Ogden, C. L., Johnson, C. L., Carroll, M. D., Curtin, L. R., & Flegal, K. M.
(2004). Prevalence of overweight and obesity among us children, adolescents, and
adults, 1999-2002. JAMA, 291(23), 2847-2850. doi: 10.1001/jama.291.23.2847.
 Kruger, J., Blanck, H. M., & Gillespie, C. (2006). Dietary and physical activity behaviors
among adults successful at weight loss maintenance. International Journal of
Behavioral Nutrition and Physical Activity, 3(1), 17.

14. References
 National Institute of Health (2012). How are overweight and Obesity
Diagnosed? Retrieved from http://www.nhlbi.nih.gov/health/health-
topics/topics/obe/diagnosis
 National Institute of Health (2015). About NIH Obesity Research. Retrieved
from http://www.obesityresearch.nih.gov/about/about.aspx
 National Heart Lung and Blood Institute. (1998). Clinical guidelines on the
identification, evaluation, and treatment of overweight and obesity in
adults [NIH Publication No. 98-4083]. National Institutes of Health.
 Schoenman, J., & Chockley, N. (2012). The concentration of health care
spending: NIHCM Foundation data brief.
http://www.nihcm.org/pdf/DataBrief3%20Final.pdf
 Wing, R. R., & Phelan, S. (2005). Long-term weight loss maintenance. The
American Journal of Clinical Nutrition, 82(1), 222S-225S.