Obesity Treatment 199state such as health status and psychological morbidity, and a series of
studies have shown significant improvements, particularly in those patients
who show sustained weight loss. For example, cross-sectional research has
illustrated improved quality of life in surgical patients compared to control
subjects (De Zwann et al., 2002; Ogden et al., 2005) which has been sup-
ported by studies using either retrospective or longitudinal designs. In
particular, in a large-scale follow-up of the SOS patients, Karlsson, Sjostrom,
and Sullivan (1998) reported an improvement in health-related quality of
life operationalized in terms of mood disorders, mental well-being, health
perceptions, and social interaction. Bocchieri, Meana, and Fisher (2002a)
carried out a comprehensive review of much of the literature examining
the impact of obesity surgery on psychosocial outcomes and concluded that
in general, “the empirical evidence...seems to be pointing in a positive
direction” (p. 164). Ogden et al. (2006) carried out a qualitative study to
explore patients’ experiences of obesity surgery. In line with patient exp-
eriences of taking obesity medication (see above), although surgery is con-
sidered a form of medical management, the results from this study suggest
that it also has some profound effects upon the individual’s psychological
state. In particular, as well as resulting in all the improvements associated
with weight loss as described by the quantitative studies on health status
and quality of life, the patients also described some changes in their cog-
nitive state which were specific to the process of surgery. Specifically, many
patients reported a reduction in hunger and feeling less preoccupied with
food. In addition, the authors described a process labeled “the paradox of
control”: By imposing control and limited choice upon how much and what
they could eat, surgery and the process of making their stomach much smaller
paradoxically made them feel more in control of their weight and eating
behavior. In other words, handing over control to their stomach size made
them feel more in control of their behavior.
Learning psychological lessons from
nonpsychological interventions for obesityResearch, therefore, indicates that although dietary interventions can bring
about large weight losses in the shorter term, longer term weight loss main-
tenance is difficult to achieve. As a result, exercise is often included to sup-
plement a focus on diet and seems to be effective at facilitating changes in weight
which can be sustained. In addition, obesity is also managed using drugs
and surgery which can both promote weight loss and weight loss maintenance.