Areas of Expertise: Obesity Assessment, Treatment, and Support

What is the prevalence of weight problems and obesity among children and adolescents?

According to the Centers for Disease Control and Prevention, childhood obesity has more than tripled in the past 30 years. The percentage of children aged 7 to 11 years in the United States who are obese increased from 7% to nearly 20%. Similarly, the percentage of adolescents aged 12 to 19 years who are obese increased from 5 % to 18% during the same period. The percentage of children and adolescents aged 2-19 years who live in Virginia who are obese is 26%.

What is the prevalence of weight problems among adults?

A recent survey on weight concerns in the U.S. adult population was published in The Washington Post (2012). The Washington Post and the Henry J. Kaiser Family Foundation, a nonprofit organization that researches health care, randomly surveyed 1936 adults by telephone. Among women in the sample, 44% of white women and 44% of black women reported that they are overweight; 6% of white women and 6% of black women reported that they are underweight. Among men, 39% of white men and 25% of black men reported that they are overweight; 4% of white men and 6% of black men reported that they are underweight.

What are the medical complications of obesity?

Obese children and adolescents are more likely to have risk factors for cardiovascular disease and prediabetes. They are at greater risk for bone and joint problems, and sleep apnea. Some people are stigmatized for being obese, and develop self-esteem problems. Obesity in adulthood is associated with heart disease, stroke, osteoarthritis, type 2 diabetes, and several types of cancer.

What interventions work for people with weight problems and obesity?

Although there is ample evidence that dieting alone is not effective, lifestyle interventions that include modifications in exercise, eating patterns, and cognitions have a positive long term impact. Studies have shown that one third to two thirds of dieters regain more weight than they lose on diets. On the other hand, lifestyle changes produce sustained weight loss and are associated with improvements in diabetes, blood pressure, and /or cardiovascular risk factors. Surgical interventions offer hope for significant weight reduction. We know that calorie density of food is important in hunger, satiety and food intake, and that low-density cooking is one way to reduce calories without a feeling of deprivation. The Weight Watchers emphasis on healthy diet and exercise is an example of a program that promotes lifestyle change.

What will we do in the first session?

I discuss your weight loss goals with you at the first session, take a complete history, and go over questionnaires and tests that you will take home to complete including the Eating Problems Questionnaire, The Eating Disorder Inventory, Personal Problems Checklist, Health Problems Checklist, Incomplete Sentences Blank, Minnesota Multiphasic Personality Inventory (MMPI), and an assessment of character strengths. These assessment tools, available only to licensed clinical psychologists, are provided at no additional cost.

What do we learn from the assessment?

The results of testing, including graphs from two inventories, are reviewed in subsequent meetings, and form the basis for treatment goals and planning. For example, The Eating Disorder Inventory (EDI) identifies problems in the following areas: preoccupation with restrictive dieting, uncontrollable overeating, concern about overall body shape, global measures of eating and weight concerns, low self esteem, emotional emptiness, interpersonal insecurity, lack of trust in relationships, tendency towards mood instability, perfectionism, self sacrifice, and maturity fears. The MMPI identifies elevations in areas including depression, anxiety, need for attention, somatic concerns, reality testing, interpersonal trust, energy level, and relative tendency toward introversion or extraversion.

A character strengths assessment helps us to recognize and build on your core strengths. The “positive psychology” approach is effective when applied to challenges in managing your weight management and exercise goals. Awareness of strengths and problem areas identified in the assessment phase of treatment forms a basis for exploring the following questions:

  • How do I maintain my commitment to weight loss goals?
  • How can I maintain confidence in my ability to lose weight?
  • How can I learn to trust my body?
  • How do I retain my identity and sense of who I am as I lose weight?
  • How will my relationships with others change as I lose weight?
  • What steps can I take to be successful and happy in relationships with others as my weight changes?

How do I complete the Signature Strengths assessment online?

You can learn about your particular strengths by following the directions below, and going online to take the Signature Strengths Inventory.

  • Go to Questionnaires
  • Go to VIA Signature Strengths Questionnaire
  • You must register by logging in and identifying a password

How does testing provide a basis for establishing treatment goals?

Treatment for obesity consists of cognitive, behavioral, and insight oriented procedures designed to:

  • Engage you in treatment
  • Enhance your motivation for change
  • Replace dysfunctional dieting with a regular and flexible pattern of eating
  • Achieve weight loss goals and prevent relapse
  • Solidify your commitment to a new lifestyle that incorporates regular exercise and healthy eating practices
  • Develop trust in your body and ability to maintain a normal weight
  • Reduce isolation associated with behaviors that reinforce overeating
  • Build self esteem and self confidence as your weight changes
  • Look for support from others in healthy eating, maintenance, and exercise practices

The assessment tools reveal areas of relative strengths and weaknesses, and point to the particular aspects of treatment that should be emphasized such as building self esteem.

What are common treatment goals, and what techniques do you use?

Our discussions may focus on mindfulness when eating; self-control and self-regulation; problem solving; vigilance in areas of nutrition, diet, body image, exercise, and sleep; and stress management techniques. Social relationships are discussed within the framework of understanding how particular self-views, views of others, cognitive beliefs, perceptions of threat and vulnerabilities, strategies, and affect have an impact on the way in which people interact with one another.

Coping, decision-making, and interpersonal skills are reinforced in order to reduce self defeating behaviors; and enhance connections with others. The positive psychology approach enables you to use your unique talents, abilities, character strengths, and the insight gained through therapy sessions to resolve weight problems, and achieve greater fulfillment and happiness in life. Support from family members and your health care team are critical aspects of treatment.

Why should I seek your services for myself or a family member?

Nearly eight hundred therapists identified specialists to whom they would send a family member in the most recent Washingtonian magazine ranking of therapists Best of Issue (July, 2009). My peers recognized me as the one clinical psychologist practicing in northern Virginia whose services they would seek for a relative with an eating disorder. I am honored to be the only psychologist practicing in northern Virginia to be included in this category.