Clinical experiences of working in weight management services

Obesity has become quite a topical issue and of great concern for our healthcare system, even more so since the pandemic. Psychological support is advised by NICE guidance as part of the services provided to support weight loss.

This is an area that has been of personal interest to me before it even became so topical, as it formed part of the research for my doctorate thesis. I have also done ad-hoc work for tier 3 and tier 4 services within the NHS. In brief tier 3 is the combined approach of dietary, physical activity, psychological support and medical input where needed to lose weight and the last stop before considering surgery. Whereas tier 4 is bariatric surgery which is a process of its own with a multidisciplinary team to ensure people understand exactly what's involved as there are procedures that are non-reversible and therefore can leave life changing affects.

The variation within people and their intentions and motivations in regard to weight loss is very interesting. There are some who want to use all the support available, including surgery if needed, this is as an aid to reach their weight goal and where professional support can aid them. Alternatively, there are people who just want a quick-fix and are hoping once they have surgery, they can continue with the lifestyle they had pre-surgery.

This can cause so many complications post-surgery that it can be detrimental to their life. The best outcomes come from making the appropriate lifestyle changes and then being able to sustain them in the long term. There is plenty of research that has investigated this area and one of the issues that has come to my attention is the fact that 2-5 years post-surgery is when the weight loss can start to increase again. Therefore, sustaining weight loss changes are vital and maybe even more so once people are to trying to live a form of post-surgery normality. 

Most of the tier 3 work that I was involved in was around trying to support change with their current lifestyle. The service I worked for encouraged exercise by having access to a gym that was available to use, along with psychological and medical support if needed. However, there are also people who are on medications that may offer complications to this process. These medicines either create a lot of resistance to losing weight or more directly have led to an individual's weight gain whilst on them, which consequently can limit results that can be achieved. This can create a challenging environment but being aware of this and discussing alternative treatment with their medical doctors is always a good option.

There are also people who try their best with managing their lifestyle better but can still struggle to lose weight. It is such mixed pool of people's experiences that there is no one size fits all approach. This is where services being flexible and trying to provide some tailored support is important if we are to provide the most effective support available and in return see achievable results. From a psychological perspective this could be from the basics of discussing Maslow's theory and what their daily routine is like through to trauma therapy to focus on what may have led to them using eating and drinking excessively as a form of a coping, which may contribute to their weight gain. 

For a lot of people weight-gain and falling into the categories of overweight or obese isn't just about the weight. It can also be all the other health problems that evolve around this. These can create a combination of physical and psychological effects which results in a poorer quality of life.

Overall, this is an interesting but challenging area and even though obesity is reported to be on the increase, policymakers are trying their best to create support, including providing appropriate health care. In my view it's still quite a minefield trying to consider the many factors that may lead an individual to be battling with their weight to the point that it can be life-threatening. With NICE guidance encouraging psychological support as part of the weight loss journey, I think this highlights the importance of weight-related difficulties upon our mental health and vice versa.

Dr Sindeep Lehl is a Principal Counselling Psychologist, working within the NHS. She specialises in physical health, especially in cancer & palliative care as well as obesity, and is a member of the BPS, BABCP, SIGOPAC, and the EMDR academy.