Managing Your Weight Using the Bio-Psycho-Social Model

After reading that title, you might be asking, “the Bio-Psycho-Social” WHAT? Don’t panic. The Bio-Psycho-Social Model is a concept that has been used in Family Medicine for years. It is a way of looking at the “whole person”, recognizing that the health of an individual results from interactions between the body, the mind, and the environment.

In order to control our weight for the long term, we need to become aware of our challenges in each area. Once we identify our individual factors, we can create a plan to address them, and move forward toward a healthier life. Let’s take a look at common challenges, breaking them down into the categories of Biological, Psychological, and Social.

1. Biological (the Body).
This category includes many factors that can affect weight: genetics, metabolism, medical conditions (insulin resistance, hypothyroidism, etc) , medications (some of which slow metabolism and promote weight gain), body type (apple or pear shape), body composition (amount of body fat vs lean muscle), genetically influenced appetite/food preference, nutritional issues including deficiencies (such as vitamin D deficiency) and imbalances which may worsen appetite or insulin resistance, etc. This category of challenge is best examined through a full medical and bariatric evaluation, including analysis of family history, personal history, medications, medical conditions, physical assessment including vital signs, measurement of BMI, body fat percentage (different from BMI), physical exam, and bloodwork.
In my practice I have found many patients with undiagnosed or undertreated hypothyroidism, insulin resistance, pre-diabetes, diabetes, vitamin D deficiency, hypertension, metabolic syndrome, depression and anxiety, among other problems, which may contribute to further weight gain and illness if not treated. I have found many patients taking medications which can lead to weight gain. Often other medications are available which do not contribute to weight gain, and may even help patients lose weight.

Some primary care physicians are trained to perform these assessments, although according to Dr. Oz and Dr. Roizen in “You On a Diet”, many primary care physicians are not prepared to be bariatricians (weight management specialists). “ Many primary care doctors aren’t specialists in weight control and often cannot devote adequate time to the issue. They have also been discouraged by talking with patients about weight loss and not feeling that they’ve made a difference…If you feel you’re not getting anywhere with your primary doc and need further medical advice, see a weight specialist (called a bariatrician).”

It is also important to learn how to control the appetite center in your brain, by making certain food and behavior choices. Eating the right foods, at the right times, can control your appetite almost like an appetite suppressant! Appetite hormones such as leptin, ghrelin, and CCK can all be affected by your choices. It can sound complicated, but is actually quite easy to put into practice. The key is to create an eating plan that is “easy and automatic”. Our nutritionist helps our patients do this every day.

2. Psychological (the Mind).
This complex area includes self-image and self-esteem; body image; mood; emotional eating; stress and skills for stress management; developing an awareness of current habits, and learning how to make and solidify new habits. Important issues include: positive self-talk versus a negative attitude (your internal dialogue); breaking the behavior chain that leads to poor choices; recognizing sabotage from friends/family/co-workers, identifying any fears (such as fear of food deprivation), and recognizing tendencies to regress to old habits when under stress. Once we become aware of these influences, we can gain control over our lives and choices.
Unfulfilled spiritual or creative outlets, lack of sense of belonging or contributing to society, loneliness, or lack of direction can also lead to overeating, and poor health. Once these issues are identified, steps can be taken to fill these needs.

3. Social (the Environment).
This vast realm includes all the influences and challenges an individual faces when interacting with the environment. The simple reality is that some environments make it easier to stay at a healthy weight than others. Negative, unhealthy environmental influences include:

a) “External cues to eat” such as food advertisements everywhere, junk food within arm’s reach, the sight/smell of junk food, lack of easy, healthy foods; co-workers or friends eating junk food; tv ads pushing unhealthy food. These can lead to almost unconscious eating. It is important to recognize, then remove or control these “eating triggers.“

b) Stressful Environments. High levels of family or work stress can lead to compensatory, “comfort” eating. Financial stress, lack of sleep/exercise/recreation/private time to recharge the batteries, overwork, the care-taker role, or lack of control in life can increase the drive to eat. Once the environmental challenges are identified, plans can be made to either change the environment, or develop healthy coping mechanisms to deal with the environment.

c) Lack of activity in daily life. In the "good ol' days" children played outdoors, while adults stayed active by hunting and gathering! In modern society, children are often locked inside for safety, tight school budgets have limited sports and activity, and adults are trapped for long hours at their desks, in their cars, and then collapse into their armchairs at night, exhausted. Each individual has slightly different circumstances, but most people now have to actively take charge of their exercise, and schedule it intentionally into their lives. Starting with 10 minutes of "heart pumping" exercise per day, and building gradually to at least 30 minutes, five or more days of the week, has been shown to be a remarkable health "pill". The trick is to find an activity that is relatively convenient and relatively enjoyable (well, at least not miserable and painful!) There are actually many options... from walking, biking (outdoors or stationary), DVD's, classes, team sports, even the new Wii Fit, there is really something for almost everyone!

d) Family, workplace, or society ideas about what is “normal”. Certain ideas about eating, relaxing, work, etc, can be carried over from childhood or teen years, and can negatively affect health behavior. Ideas such as “cleaning your plate”, starving yourself to stay thin, or other extreme, irrational, unscientific ideas can become deep rooted. As an adult, certain workplace or society “norms”, or assigned family roles and expectations may make it difficult for people to take care of themselves properly. People may be encouraged by employers to abuse themselves by overwork , rushed or poor eating, etc. People may be encouraged by families to sacrifice their own health for the “good” of others. It is important to identify these influences, challenge their flawed logic, and make plans to “fight back.”

You CAN succeed, by getting to know your challenges, setting realistic goals, and being kind and forgiving to yourself. You will need a concrete, specific, realistic plan, and LOTS of support and accountability. It is important to play to your strengths, instead of focusing on weaknesses. Progress not Perfection is the road to success!

You can read about our program at healthyweightcenter.com