Obesity: what mental health professionals need to know.
OBJECTIVE
Obesity is a highly prevalent condition with significant health implications. This report summarizes recent clinically relevant findings concerning the pathogenesis and treatment of obesity and considers their implications for psychiatric diagnosis and management.


METHODS
The authors conducted selective reviews of the literature from the last 10 years. Topics included the biological and behavioral factors that contribute to the onset and maintenance of obesity, the relationship between obesity and psychiatric illness and treatment, and the questions of whether and how obesity should be treated.


RESULTS
Genetic effects, some mediated by eating behavior, contribute importantly to the potential for obesity, the expression of which is promoted by environmental factors that increase the availability of calorically dense foods and discourage activity. There appear to be behaviorally distinct subsets of obese persons who display particular patterns of disordered eating and elevated rates of psychopathology. Treatment with psychotropic medications may contribute to obesity in ways that are only partly understood. Although successful obesity treatment is associated with clear health benefits and available treatments offer benefit to some, relapse remains the rule.


CONCLUSIONS
Although the presence or development of obesity is a daunting problem, it should not be ignored by mental health professionals. Treatment should address not only obesity per se, but also its effects on self-esteem in a hostile cultural climate. Ongoing developments in basic and clinical research are likely to increase the range, efficacy, and acceptability of treatment options in the years ahead.
Devlin
M J
MJ
New York State Psychiatric Institute and the Department of Physicians and Surgeons, New York, NY 10032, USA. mjd5@columbia.edu
Yanovski
S Z
SZ
Wilson
G T
GT
D014150:Antipsychotic Agents / Q000009:adverse effects / Q000627:therapeutic use; D001521:Behavior Therapy; D004435:Eating / Q000235:genetics; D004734:Energy Metabolism; D005247:Feeding Behavior / Q000502:physiology; D015870:Gene Expression; D005824:Genetics, Behavioral; D006282:Health Personnel; D006801:Humans; D001523:Mental Disorders / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology; D008605:Mental Health Services; D009765:Obesity / Q000209:etiology* / Q000235:genetics / Q000628:therapy; D015431:Weight Loss
D014150:Antipsychotic Agents