Need for Mental Health Intervention

Up to now, clinical psychiatrists have generally not considered their patients' obesity their area of responsibility unless weight gain was caused by psychotropic medications, Gregory Simon, M.D., a psychiatrist and investigator at the University of Washington Center for Health Studies–Group Health, observed in a recent interview. But with the obesity epidemic now occurring in the United States, “that may be changing,” he said.

For instance, he pointed out, “because there is an association between obesity and depression, psychiatrists will certainly see lots of people in their practices who are being treated for depression and who are overweight or obese. And some will say, `I am depressed because I am overweight, and if I were not overweight, I would no longer be depressed.'”

Moreover, as more obese patients seek bariatric surgery, an increasing number of psychiatrists will undoubtedly be called in to evaluate them psychiatrically and determine whether they are suitable candidates for the procedure. For example, psychiatrists at Cedars-Sinai Medical Center in Los Angeles have set up a program with the surgical team there to do psychiatric evaluations on all patients seeking bariatric surgery. “It is quite a big program,” Jennifer McLain, M.D., a fourth-year psychiatry resident at the center and one of the program evaluators, said in an interview.

Psychiatrists are likewise being increasingly asked to evaluate obese children before they receive bariatric surgery, Gagandeep Dhaliwal, M.D., a Mobile, Ala., psychiatrist reported at APA's 2005 annual meeting in May.

And as David Herzog, M.D., a professor of psychiatry at Harvard Medical School and an eating disorder authority, told Psychiatric News, although binge-eating disorder is a provisional eating disorder in DSM-IV, “it will probably make it into DSM-V as an actual category.” Indeed, he predicted, “all the focus on obesity may ultimately create this reaction of adding more eating disorders.”▪