Psychiatric Care in Severe Obesity provides a timely and comprehensive account of the current best practice in understanding, assessing and treating a person with severe obesity. It is a much-needed resource for professionals managing the emotional well-being of this patient group, especially given the prevalence of mental ill health within this cohort. The book acknowledges the challenges faced by health professionals when working with the complexity often presented by such individuals, and it offers evidence-based, clinically applicable examples of multidisciplinary, integrated care. The text skilfully intertwines case study examples with relevant research to ensure that the patient's voice is heard throughout, a factor which can often be missed in obesity-related texts. It is worth noting that although the focus of the book is on patients with ‘severe obesity’; the majority of the text refers to individuals with body mass indexes (BMIs) in the 30s, with little differentiation made between this cohort and individuals with a BMI of 50–60+, despite these often being clinically different.
Chapters are written by a combination of clinicians and researchers, providing a sound scientist–practitioner perspective and ensuring the book is both clinically and scientifically relevant. The material is presented in three sections covering biopsychosocial causes of obesity, considerations of key assessment domains relating to the patient's mental health, and a critical analysis of psychological and pharmacological treatment options.
Chapters covering key issues such as stigma, trauma history and body image provide important insights into the psychological experiences of individuals with severe obesity, enabling the reader to formulate a compassionate understanding of the difficulties they face. However, a dominant focus on psychiatric disorder along with the rather medicalised accounts of diagnoses within other chapters can tend to undermine the lived experience of these individuals, and could reinforce the stigma and discrimination described in the book.
Relevant nutritional, psychological and pharmacological treatment options are discussed in detail, with key approaches such as motivational interviewing, mindfulness and cognitive–behavioural interventions discussed in terms of their applicability and effectiveness for weight management. An acknowledgement of third-wave psychological therapies such as compassion-focused therapy and acceptance and commitment therapy, which are gaining research and clinical support in both health and weight management settings, would add further depth to understanding.
In line with current guidance, although not stated in the title, bariatric surgery is the treatment of choice underpinning the book and recommendations on psychological care are focused on pre-/post-surgical interventions. However, chapters on eating disorders, trauma, attachment and addiction correctly highlight the potential costs of bariatric surgery to the individual; an important reflection given the emerging evidence which highlights the potential negative psychological impact of surgery.
This is a welcome synopsis of both the literature and clinical experience. A further text focusing on the lived experience of individuals with obesity, with more qualitative accounts to better understand their emotional experiences, would be a welcome next step.
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