Obesity is a growing global health crisis, yet traditional approaches to weight management continue to focus predominantly on what patients eat rather than why they eat.
This narrow focus often undermines long-term success, leading to frustration for both patients and clinicians. To improve outcomes in aesthetic medicine and beyond, it is critical to explore the underlying psychological, hormonal, and behavioural drivers of eating.
The growing obesity concern
Since 1990, adult obesity rates have more than doubled, and adolescent obesity has quadrupled.
Approximately 43% of adults globally are overweight, and the problem extends deeply into childhood, with nearly one in five children a!ected. 1-2
Obesity is more than a cosmetic concern; it significantly increases the risk of type II diabetes, cardiovascular disease, non-alcoholic fatty liver disease, and various cancers. 3 It also places a substantial economic burden on healthcare systems, with related costs projected to surpass $2 trillion (£1.49 trillion) globally by 2025. 4
Moving beyond ‘eat less, move more’
The familiar mantra “eat less, move more” oversimplifies the complex physiology and psychology of obesity. While calorie control is important, evidence shows that over 80% of individuals who lose weight through dieting regain it within two years. 5 This high relapse rate underscores the inadequacy of focusing solely on dietary intake without addressing underlying behavioural and metabolic factors.
Obesity is now understood as a chronic, multifactorial disease involving genetic predispositions, hormonal imbalances, neurological dysregulation, and environmental influences. 6 For example, disrupted gut-brain communication and altered reward pathways contribute to overeating, while hormonal signals like insulin, leptin, and ghrelin become dysregulated, impairing hunger and satiety cues. 7,8
Why do patients eat?
Most patients know which foods are healthier, yet many struggle to maintain dietary changes.
This disconnect points to the need to address why individuals eat, particularly in ways that undermine weight management:
• Emotional triggers: Stress, anxiety, boredom, loneliness, and unresolved trauma can drive emotional eating. 9
• Habitual patterns: Unconscious routines, such as snacking while watching TV or workplace temptations, reinforce excess consumption. 10
• Environmental cues: Food marketing, social norms, and easy access to calorie-dense foods shape behaviours. 11
• Biological factors: Hormonal imbalances, insulin resistance, and gut microbiota disruptions affect appetite regulation. 7,12
• Cognitive beliefs: Negative self-talk and defeatist attitudes create barriers to sustainable change. 13
Emotional eating
Patients frequently report eating in response to stress or emotions, often feeling guilty or defeated afterwards. Recognising emotional eating as a coping mechanism rather than a character flaw is crucial for elective intervention.
Cognitive Behavioural Therapy (CBT) and motivational interviewing can help patients identify triggers and reframe unhelpful thought patterns, turning setbacks into learning opportunities. 14
A functional approach to weight management
For clinicians, integrating a holistic, patient-centred approach is essential.
This includes:
• Comprehensive initial assessment: Understanding the patient’s psychosocial context, stressors, sleep quality, and metabolic profile. 15
• Tailored nutritional plans: Focused not only on macronutrients but on sustainable lifestyle changes.
• Behavioural support: Regular consultations incorporating CBT principles and motivational tools to build healthy habits. 14
• Biological monitoring: Testing for insulin resistance, cortisol levels, leptin sensitivity, and gut health to personalise interventions. 7,12
• Interdisciplinary collaboration: Referrals to specialists such as clinical psychologists when necessary.
This approach aligns with the goal of aesthetic medicine to improve not just appearance but overall health and wellbeing.
Empowering patients for long-term success
Successful weight management requires shifting the focus from food restriction to understanding and addressing the root causes of eating behaviours.
Clinicians should guide patients through:
• Recognising emotional and environmental triggers
• Developing coping mechanisms beyond food
• Addressing hormonal and metabolic imbalances
• Changing cognitive beliefs about self-worth and capability.
By emphasising why patients eat rather than just what they eat, aesthetic practitioners can support lasting behavioural change improving patient satisfaction and health outcomes.
Conclusion
Obesity is a complex, chronic disease that demands a multifactorial approach. Sustainable weight loss is achievable when clinicians address the underlying behavioural, emotional, and biological drivers of eating.
In aesthetic medicine, where patient transformation is both internal and external, adopting this holistic model elevates care from temporary fixes to lasting wellness.
When you treat WHY a patient eats, you empower HOW they heal.
Claudia McGloin
Claudia McGloin is a registered nurse and holds dual registration in both the UK and Ireland. With more than 27 years’ nursing experience, McGloin is the clinical director and nurse practitioner at The New You Clinic in Sligo..
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