Chapter summary

Obesity presents a worldwide health problem with substantial medical, social, and economic consequences (Arterburn et al., 2005; Yach et al., 2006; Runge, 2007). Severe cases of morbid obesity can be effectively treated by a form of bariatric surgery, and pharmacotherapy, which may support the process of weight loss by regulating appetite and controlling hunger, or altering metabolic and thermic functions of the body. However, “the cornerstones of weight management are always diet and physical activity, with behaviour change underpinning both” (Cook, 2014, p. 167-168).

Most self-help treatment approaches involve some kind of dietary intervention. It is generally agreed that hypo-caloric diets do lead to weight reduction. However, extremely restrictive diets are often nutritionally imbalanced and should not be used, as they are often ineffective in the long run and can be harmful to the body (NICE, 2006). On the other hand, it seems that well-balanced regimes that re-educate eating habits and that can be permanently maintained have the capacity to induce long-term weight loss (Cook, 2014), even though the composition of macronutrients in dietary regimens remains an area of great controversy (Halton & Hu, 2004). However, maintaining specific regimes can be challenging and it has been shown repeatedly that adherence to a lifestyle change presents one of the biggest barriers to the long-term weight loss maintenance (Makris & Foster, 2011). The inclusion in the patient’s care of different health care providers, such as dietitians, psychologists, nurses, or nurse practitioners may be an efficient way of providing the support needed for behaviour change and healthy lifestyle maintenance (Aronne, 2002).

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Behavioural therapy is undoubtedly the most commonly used psychological approach to obesity treatment, and in combination with dietary intervention, it also produces the best weight loss outcomes (Wadden et al., 2007). Yet, having to face every day challenges of the obesogenic environment, most individuals treated with BT tend to regain weight after the intervention has come to end.

A relatively new form of cognitive behaviour therapy specifically designed for individuals with weight problems (Cooper & Fairburn, 2001), has attempted to address the relapse issue in patients with overweight and obesity. CBT is recognised for its successful applications to eating disorders, some of which (i.e. bulimia nervosa, binge eating disorder) share a number of maladaptive patterns with obesity. However, its effectiveness for relapse prevention has only been tested in recent years. Although some studies have shown beneficial effects of CBT on weight loss maintenance, especially when combined with dietary and/or exercise intervention (Shaw et al., 2005; Werrij et al., 2009), others have not found CBT approaches to be superior to either standard primary care (Muggia et al., 2014), or behavioural therapy (Cooper et al., 2010).

It is believed that one of the most common reasons why people fail to achieve and maintain healthy body weight is lack of motivation and poor adherence (Teixeira et al., 2012), which is why the use of motivational interviewing as part of, or in addition to a standard BT has recently become popular. A number of studies have reported significantly greater weight reductions in individuals who received MI intervention as part of their regularly scheduled appointments, or in addition to a typical treatment in primary care settings (see Barnes & Ivezaj, 2015 for a review). It seems that individuals who fully endorse their weight loss-related behavioural goals and feel not just competent but also autonomous about reaching them, are more likely to achieve a long-lasting behaviour change (Teixeira et al., 2012). Although the majority of studies fail to measure fidelity of delivery, it seems that MI may have the potential

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to facilitate change and increase patient engagement in therapy, improving the efficacy of other interventions.

Although positive psychology as a scientific discipline is less than a couple of decades old, the concept of the “good life” has been studied by ancient philosophers and religious leaders for centuries (Lopez & Snyder, 2009). The current understanding of the positive aspects of life has been greatly shaped throughout the 20^th century by a number of psychological traditions, but the most influential field that directly identified with the study of positive human experience, was humanistic psychology (Duckworth et al, 2005). The reason why positive psychology developed within just a couple of decades was because “it brought together so much existing knowledge from Aristotle’s concepts to the work of earlier humanistic psychologists” (Csikszentmihalyi, 2009, p. 203), which formed a strong foundation for a field that has now evolved into a complex analysis of human flourishing (Seligman, 2012).

Since its formal beginnings in 1999, positive psychology has been developing rapidly.

Hundreds of articles have been published in scientific and popular press, with the appearance of special journal issues and a new journal in 2006, the Journal of Positive Psychology.

Different handbooks (e.g., Linley & Joseph, 2004; Ong & van Dulmen, 2007; Snyder & Lopez, 2002) and textbooks (e.g., Carr, 2004; Compton, 2005; Peterson, 2006) on the topics of positive psychology have been emerging, and a new therapeutic movement (positive psychotherapy) has even developed within the field of positive psychology (Biswas-Diener, 2011; Seligman et al., 2005).

Perhaps the most successful development is the discipline of applied positive psychology, which focuses on improving well-being through the application of PPIs (Lomas et al., 2015). A number of studies have shown successful applications of PPIs to mental health disorders, such as depression (Sin & Lyubomirsky, 2009), addiction (Krentzman, 2013),

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alcohol misuse (Akhtar & Boniwell, 2010), eating disorders (Harrison et al., 2016), and schizophrenia (Meyer et al., 2012), some of which are known to be conditions comorbid with obesity. A number of PPIs involving positive psychological concepts of optimism, and gratitude have even been developed specifically for patients with cardiovascular disease (DuBois et al., 2016; Huffman et al., 2011), and type 2 diabetes (Huffman et al., 2015).

A growing body of literature is emerging on the application of mindfulness-based approaches to the treatment of eating disorders (Godsey, 2013; Wanden-Berghe et al., 2011) and obesity-related eating behaviours (Godsey, 2013; Katterman et al., 2014; O'Reilly et al., 2014), with some researchers even proposing that mindfulness is an essential component of holistic obesity treatment (Douglass, 2011; Kristeller & Wolever, 2011). However, the results from the application of these approaches in terms of weight loss have been somewhat inconsistent. While some studies have shown that engaging in mindfulness-based interventions leads to reductions in weight, and BMI (Alberts et al., 2010; Dalen et al., 2010; Kristeller et al., 2014; Miller et al., 2012; Netam et al., 2012; 2015), others have reported no difference or even increases in body weight after the intervention (Kearney et al., 2012; Rosenzweig et al., 2007). Furthermore, there seem to be significant differences in weight loss when other therapeutic elements, particularly self-compassion training, are applied alongside with mindfulness as opposed to mindfulness alone (Mantzios & Wilson, 2015a). Also, when mindfulness is practiced within a group setting, people seem to perform better in losing weight than when practicing it individually (Mantzios & Giannou, 2014). Although, the results from mindfulness and compassion-based interventions are promising, the application of complex PPIs to individuals with weight problems is lacking in current research. It has been shown that people who engage in weight loss attempts display a number of positive psychological assets, including life satisfaction, gratitude, strengths, optimism, and mindfulness (Robertson et al.,

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2013), suggesting that holistic approaches to obesity treatment should address the concept of well-being to aid weight loss (Robertson et al., 2015b).

Although genetic predisposition has a significant role in obesity susceptibility, the current obesity epidemic does not have a purely genetic basis. Alterations to lifestyle over the past few decades have created an obesogenic environment in which the underlying molecular genetic pathways contributing to obesity have started to be elucidated. However, despite multi-disciplinary strategies including surgery, medication and psychosocial interventions, health professionals struggle to manage the complex and costly nature of obesity. The discovery of genetic polymorphisms associated with well-being and quality of life domains could pave the way for investigations into how environmental experiences and the “obesogenic environment”

coordinate the levels of wellbeing by modulating specific molecular genetic pathways. Current advances in “-OMIC” technologies could provide insights not only into the identification of genetic variations related to obesity and psychological wellbeing but also to link these variations to brain function. “-OMIC” technologies could also identify the interactions between environmental experiences and “obesogenic environment” that affect mental health, and identify the neural and molecular correlates of these gene–environment interactions underlying genetically correlated phenotypes, such as depression, addiction, and obesity, for which the discovery of molecular genetic associations has proven elusive. Furthermore, by linking the “-OMIC” analysis to behaviour, it will be possible to explain, predict and possibly even alter human behaviour. Hence, it is likely that “-OMICS”-based psychology research will take a central place in the understanding, diagnosis, treatment, and monitoring of psychological wellbeing and quality of life domains in the near future.

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