When we talk about obesity treatment, the conversation tends to center around food, weight, and willpower. But what if that’s just scratching the surface?
In a recent AFMC TV episode, bariatric surgeon Dr. Sam Bledsoe shared insights that go beyond the numbers on a scale. He talked about treatments like bariatric surgery and GLP-1 medications—but he also emphasized that obesity is rarely just about what you're eating. It’s also about what’s eating at you.
IN THIS BLOG:
- Can mental health issues cause weight gain?
Mental health conditions, such as depression, anxiety, and unresolved trauma may contribute to weight gain. Many people use food as a coping mechanism, leading to patterns of emotional eating and overeating that can result in obesity.
- How are trauma and grief connected to obesity?
Life events like the loss of a loved one, childhood abuse, or divorce can deeply impact emotional health. That often relates to how we eat. Recognizing and treating those emotional wounds is a crucial part of effective obesity care.
- Is mental health support part of obesity treatment?
While mental health support is not a requirement, many healthcare professionals are realizing the correlation between mental health and obesity. At Dr. Bledsoe’s clinic, psychological evaluations are built into the treatment process. Emotional well-being is closely tied to long-term weight loss success, especially post-surgery or post-treatment.
- What is the most effective obesity treatment?
Bariatric surgery is currently the most effective treatment option for significant, sustained weight loss (30–35% of total body weight). Medications like GLP-1 Agonists can also help (around 15%), but pairing any approach with mental health support and personalized care dramatically improves outcomes.
“There’s all sorts of things that can slow down your weight loss or make it more challenging to lose weight,” Dr. Bledsoe explained. “Depression and anxiety are almost endemic nowadays… and it’s pretty common for people to come in with some kind of trauma that needs to be addressed.”
While difficult at times, encouraging our patients to be honest about other co-occurring issues is a key part of treatment. Long-term weight loss treatment must consider the whole person, not just the body they’re living in.
Trauma, Grief, and the Underlying Causes of Weight Gain
Dr. Bledsoe has treated patients with obesity who have lost loved ones, gone through divorces, or experienced childhood abuse. These aren’t patients’ excuses for overeating. They reveal a deeper stressor or triggering factor that may be causing problems.
Stress causes psychological and physiological responses. Those with high stress tend to engage in emotional eating. When under stress, the body releases cortisol, a hormone that helps protect the body. If cortisol levels stay elevated for a long time, when a person eats, they store fat and gain weight more easily.
Emotional eating often has a bad connotation. For many people, however, food is a form of comfort — a way to feel safe, soothed, or even just numb. Some have lost everything, and food is the only thing they have left that doesn’t make them feel bad. That’s why successful obesity treatment often goes far beyond a meal plan or step goal.
“Sometimes you have to take a step back and look at the patient from a global perspective—what’s going on with their heart, their mental health, their support system,” Dr. Bledsoe said. “That’s how we personalize care.”
His team includes dietary counseling, exercise planning, and mental health evaluations as an essential part of the standard care path.
Personalization Is the Key
There’s no one-size-fits-all approach to treating obesity. What works for one person might not work for another, and success often depends on how well treatment is tailored to the individual.
Some patients might need to delay surgery while they work on lowering surgical risks through medication or pre-op weight loss. Others may need help strengthening their heart before they’re cleared. For many, the biggest hurdle isn’t medical—it’s emotional.
“You can go through a divorce, lose a parent, get laid off… and for a lot of people, their first instinct is to turn to their good friend—food,” said Dr. Bledsoe.
Treating obesity well means meeting people where they are. It means looking at what they’ve been through and building a plan that supports both physical and emotional healing.
Breaking the Stigma Around Obesity
Obesity results from a complicated relationship between genetics and environmental factors which are beyond an individual’s control. Despite this evidence, however, over 40% of U.S. adults of different body sizes report experiencing stigma at some point in their life. Stigma is most prevalent on social media, in movies and pop culture, and even on the news, creating a dangerous narrative that can affect a person’s desire to seek help.
Stigma lessens a person’s ability to engage in healthy behaviors and preventive care, causing decreased physical activity, health care avoidance, and weight gain. Additionally, unlike other forms of discrimination — sexism, ageism, and racism — sizeism or discrimination based on body size is legal in nearly every state. Although some people think of this as “tough love” that will motivate people to do better, research proves this is not true.
Compassion is key to breaking the stigma around obesity. Just because someone struggles with obesity does not make them lesser. Obesity is not a moral failure. It’s a complex, chronic health condition that deserves the same empathy and evidence-based care as any other disease. And part of that care is recognizing how deeply connected mental health is to the ability to lose and keep off weight.
“These are people who just struggle with their weight—just like we all struggle with certain things,” he said. “They’re not less disciplined. They’re doing the same things we’re doing, or close to it. They just need help.”
Why This Matters for Healthcare Providers, Too
If you're a provider working with patients struggling with obesity, take a moment to dig deeper with your patients. Asking about stress, grief, or past trauma isn't overstepping—it might be the key to unlocking real change. You may also take time to reflect on your own biases, preconceived ideas, or attitudes toward patients with obesity.
Progress isn't always visible on the scale. Maybe a patient isn’t losing weight quickly, but they’re finally addressing their depression. Maybe they’re healing. That counts. That’s real success, too.
A Holistic Future for Obesity Treatment
Dr. Bledsoe and others in the field are helping shift the conversation. Anti-obesity medications and surgery can be powerful tools. But if we’re not pairing those tools with mental health support, we’re missing a crucial piece of the puzzle.
So whether you're a patient or a provider, it’s important to remember that sustainable weight loss isn't just about what you eat or how much you move. It's about why you eat, and how you’re coping. And dealing with the root of the problem might just be the most powerful treatment of all.
