Karen E. Stewart

Obesity in America: implications for clinical and health psychologists.

The number of individuals classified as overweight and obese is increasing at alarming rates and these conditions are associated with numerous psychological and physiological health problems. Within this epidemic, there is an increasing need and demand for psychologists and other mental health professionals to participate in the care of patients with obesity, both in assessment and treatment domains. The current paper provides a review of the status of the obesity epidemic, including psychological comorbidities and treatment approaches. Throughout this review, we highlight and discuss the important roles and impact psychologists can have. These roles include serving as members of multidisciplinary obesity treatment programs, conducting assessments for bariatric surgery, and treating related psychiatric disorders, such as depression and disordered eating. Other considerations, such as weight gain associated with psychiatric medications, and directions for future involvement of psychologists in addressing the obesity epidemic are also discussed.

Illness Apprehension, Depression, Anxiety, and Quality of Life in Liver Transplant Candidates: Implications for Psychosocial Interventions

BACKGROUND End-stage liver disease is associated with diminished quality of life (QOL). Numerous physical and psychosocial problems that affect QOL are common in those undergoing evaluation for liver transplantation. OBJECTIVE Identifying which of these challenges are most closely associated with QOL would be helpful in developing priority targets for evidence-based interventions specific to those undergoing transplant evaluation. METHOD A total of 108 adults undergoing psychologic assessment for liver transplant completed clinical interview, neuropsychologic testing, and self-report inventories of depression, anxiety, cognitive appraisal characteristics, support resources, and QOL. RESULTS Multiple regression analyses revealed that while emotional symptoms (anxiety and depression) were primarily associated with mental QOL, illness apprehension was the only variable uniquely associated with physical QOL after accounting for severity of liver disease, cognitive status, emotional symptoms, and support resources. CONCLUSION Findings suggest that psychosocial interventions prioritizing reduction of illness-related fear and symptoms of anxiety/depression would likely have the greatest effect on QOL in persons with end-stage liver disease awaiting transplantation.

Food Cue Reactivity, Obesity, and Impulsivity: Are They Associated?

Heightened reactivity to food-associated cues and impulsive responding to these cues may be important contributors to the obesity epidemic. This article reviews the evidence for a role of food cue reactivity and impulsivity in food intake, body mass index, and weight-loss success. Inconsistencies in defining and measuring these constructs create difficulties in interpreting findings; however, evidence does support their role in obesity. The relationship between food cue reactivity and impulsivity may depend on the measurement used, but some studies have demonstrated that interactions between these constructs rather than direct effects are important in accounting for food intake pattern. Thus, multimodal assessment of both constructs is recommended. Future research would benefit from standardized definitions, measures, procedures, and reporting to enhance comparisons across studies. Implications for therapy are discussed and suggestions for further research are provided.

Readiness for behaviour change in non-alcoholic fatty liver disease: implications for multidisciplinary care models

Weight management is a cornerstone of treatment for overweight/obese persons with non‐alcoholic fatty liver disease (NAFLD). This exploratory study sought to: (i) evaluate readiness to change weight‐related behaviours; (ii) assess psychosocial characteristics that may interfere with weight loss; and (iii) evaluate how baseline psychosocial features associate with 6‐month change in weight in persons with NAFLD receiving standard medical care. The purpose of this investigation was to develop hypotheses regarding relationships between psychosocial factors and weight for use in future fully powered studies and clinical interventions

Psychological and Psychiatric Aspects of Treatment of Obesity and Nonalcoholic Fatty Liver Disease

Chronic illnesses incur a tremendous cost to American lives in dollars and quality of life. Outcomes in these illnesses are often affected by psychological, behavioral, and pharmacologic issues related to mental illness and psychological symptoms. This article focuses on psychological and psychiatric issues related to the treatment of obesity and nonalcoholic fatty liver disease (NAFLD), including available weight-loss interventions, the complex relationship between psychiatric disorders and obesity, and special considerations regarding use of psychiatric drugs in patients with or at risk for NAFLD and obesity. Recommendations for collaborative care of individuals with comorbid NAFLD and psychological disorders/symptoms are discussed.