There was a lot of science explained in the TLC show I mentioned. Some theories as to why some people just really let themselves go in morbid obesity were that there were some psycholgoical factors that lead to people becoming morbidly obese. These factors are being studied by psychologists in the show. Others were that the amount of leptins being released increased more & more with the ever increasing size of the fat cells in their body.
It really is a shame IMHO how little medical treatment seems to treat obesity given how much of a problem it is. It really is a complex and multidisciplinary issue and managed care, the old "give them a pill" model doesn't seem to compatible with treating it in several people.
I've considered starting something that could work with helping people lose weight, but because of the lack of managed care structure on this, that there is no real psychiatric standard saying its our field's problem, and that diet is a very broad and multifaceted aspect that we are often times not qualified to handle, I dropped the idea. All these problems open up the risks of practice not being evidenced based, opening the risk of lawsuits, and payment problems.
At the eating disorder clinic where I worked, the psychiatrist's role was at least IMHO somewhat limited. For example, very few meds work on eating disorders and with very limited benefits. The real progress was often times made with psychotherapy that could have taken months to years to create a benefit. The psychaitrist would try one pill, it was given a few weeks, it wouldn't work, and then they just tried others, without more success. Some of them were given for reasons which most would on the surface wouldn't even expect to work...e.g. "she thinks she's overweight but she's not, that's delusional, give her an antipsychotic-Stellazine". Yeah well as we know, there really isn't much of a psychotic aspect to eating disorders. The psychiatrist even knew this (believe me these psychiatrists where I worked at knew their stuff), but on their end every other med was tried. These weren't 1st, 2nd or even 3rd line. I'm talking maybe the 10th med that was tried. Managed care would also argue that meds had to be given or they weren't paying for the inpatient stay. Another irony because once these patients were discharged, they lost weight to dangerous levels, but managed care wanted them out of there the day their weight was within an ideal range.
And it was the psychologists, not the psychiatrists doing the psychotherapy. That I found odd because if the psychiatrist wass the head of the treatment team-well its really the psychologist that's making the most difference.
