CBC Psychology of Obesity — Questions and Answers

Question 1: A patient reports eating large quantities of food late at night while feeling unable to stop, followed by intense guilt, but never uses compensatory behaviors like purging. Which condition does this pattern most suggest?

Binge eating disorder (Correct answer)
Bulimia nervosa
Night eating syndrome
Avoidant/restrictive food intake disorder

Correct answer: Binge eating disorder

Recurrent binges with loss of control and distress, without compensatory behaviors, define binge eating disorder.

Question 2: According to the transtheoretical model, a patient who says 'I know my weight is a problem, and I'm thinking about making changes in the next few months' is in which stage of change?

Contemplation (Correct answer)
Precontemplation
Preparation
Action

Correct answer: Contemplation

Contemplation is marked by awareness of the problem and intention to change within about six months, without concrete steps yet.

Question 3: Which psychological mechanism best explains why chronic stress often leads to increased intake of high-fat, high-sugar foods?

Cortisol-driven reward-seeking that makes palatable foods temporarily dampen the stress response (Correct answer)
Stress permanently damages satiety receptors in the stomach
Stress increases the metabolic need for glucose in muscles
Stress eliminates taste sensitivity to bland foods

Correct answer: Cortisol-driven reward-seeking that makes palatable foods temporarily dampen the stress response

Elevated cortisol enhances the reward value of palatable 'comfort' foods, which transiently blunt the stress response and reinforce emotional eating.

Question 4: A bariatric counselor notices a patient consistently describes herself as 'disgusting' and avoids mirrors and social events. These features are most characteristic of which construct?

Body image disturbance (Correct answer)
Somatic symptom disorder
Agoraphobia
Illness anxiety disorder

Correct answer: Body image disturbance

Negative self-evaluation of appearance with avoidance behaviors reflects body image disturbance, common in patients with obesity.

Question 5: Which statement best describes the relationship between depression and obesity supported by longitudinal research?

The relationship is bidirectional, with each condition increasing the risk of the other (Correct answer)
Depression only occurs after obesity develops
Obesity protects against developing depression
The two conditions are statistically unrelated

Correct answer: The relationship is bidirectional, with each condition increasing the risk of the other

Meta-analyses show a reciprocal relationship: obesity raises depression risk and depression raises obesity risk.

Question 6: In classical conditioning terms, a patient who feels strong cravings whenever she sits on her living-room couch, where she habitually snacks, is experiencing what phenomenon?

Cue-induced (conditioned) craving triggered by an environmental stimulus (Correct answer)
Negative reinforcement of hunger hormones
Operant extinction of eating behavior
Habituation to food stimuli

Correct answer: Cue-induced (conditioned) craving triggered by an environmental stimulus

The couch has become a conditioned stimulus that elicits craving through repeated pairing with eating.

Question 7: Which cognitive distortion is a patient displaying when she says, 'I ate one cookie, so my whole diet is ruined and I might as well binge'?

All-or-nothing (dichotomous) thinking (Correct answer)
Personalization
Mind reading
Emotional reasoning

Correct answer: All-or-nothing (dichotomous) thinking

Viewing a minor lapse as total failure is classic all-or-nothing thinking, a driver of the abstinence violation effect.

Question 8: A counselor using motivational interviewing hears a patient say, 'I really want to be healthier for my kids, but I love food too much.' What is the most appropriate initial response?

Reflect the ambivalence and explore the patient's own motivations for change (Correct answer)
Warn the patient about the medical dangers of obesity
Provide a strict meal plan to remove decision-making
Tell the patient she must choose between food and her children

Correct answer: Reflect the ambivalence and explore the patient's own motivations for change

Motivational interviewing responds to ambivalence with reflective listening to elicit the patient's own change talk rather than confrontation or advice.

Question 9: Which finding is most consistent with the concept of weight stigma internalization?

A patient applies negative societal stereotypes about weight to herself, worsening depression and disordered eating (Correct answer)
A patient files a discrimination complaint against her employer
A patient joins a body-positivity advocacy group
A patient loses weight in response to a physician's advice

Correct answer: A patient applies negative societal stereotypes about weight to herself, worsening depression and disordered eating

Internalized weight bias means adopting society's anti-fat stereotypes toward oneself, which is linked to poorer mental health and eating outcomes.

Question 10: A patient who was denied a job promotion says the interviewer kept glancing at her body. Research suggests experiences of weight discrimination most often lead to which behavioral outcome?

Increased eating and avoidance of exercise, promoting further weight gain (Correct answer)
Immediate sustained weight loss through motivation
No measurable effect on health behaviors
Automatic improvement in self-esteem through resilience

Correct answer: Increased eating and avoidance of exercise, promoting further weight gain

Studies show weight discrimination paradoxically increases obesity risk by triggering stress eating and exercise avoidance rather than motivating weight loss.

Question 11: Which childhood experience shows the strongest documented association with adult obesity in the Adverse Childhood Experiences (ACE) research?

Cumulative exposure to abuse and household dysfunction (Correct answer)
Attending multiple schools
Being an only child
Early bedtimes enforced by parents

Correct answer: Cumulative exposure to abuse and household dysfunction

The ACE studies found a dose-response relationship between cumulative childhood adversity and adult obesity risk.

Question 12: A patient says she eats when she is bored, lonely, or anxious rather than when physically hungry. The counselor's first skill-building target should be which of the following?

Helping her differentiate emotional triggers from physiological hunger cues (Correct answer)
Prescribing an 800-calorie liquid diet
Recommending she avoid all social situations
Teaching her to skip breakfast to reduce total intake

Correct answer: Helping her differentiate emotional triggers from physiological hunger cues

Interventions for emotional eating begin with building awareness that distinguishes emotional triggers from true hunger.

Question 13: In the dual-process model of eating behavior, obesogenic food choices are most often attributed to what imbalance?

Strong automatic/impulsive reactions to food cues overriding weaker reflective self-control (Correct answer)
Excessive reflective planning suppressing appetite
Equal strength of both systems producing paralysis
Complete absence of the impulsive system

Correct answer: Strong automatic/impulsive reactions to food cues overriding weaker reflective self-control

Dual-process theory holds that automatic impulsive responses to palatable food cues frequently overpower deliberate, goal-directed control.

Question 14: A patient reports that food is the only reliable source of pleasure in her life. Which counseling strategy directly addresses this pattern?

Behavioral activation to build alternative rewarding activities (Correct answer)
Complete elimination of all palatable foods
Extended fasting protocols
Discouraging all pleasurable activities to build discipline

Correct answer: Behavioral activation to build alternative rewarding activities

Behavioral activation expands the patient's repertoire of non-food rewards, reducing reliance on eating for pleasure.

Question 15: Six months after gastric bypass, a patient reports drinking alcohol nearly every evening despite rarely drinking before surgery. This pattern is most consistent with which recognized post-bariatric phenomenon?

Addiction transfer (cross-addiction) replacing food-related reward (Correct answer)
Normal celebratory adjustment to weight loss
Dumping syndrome
Post-surgical hypoglycemia

Correct answer: Addiction transfer (cross-addiction) replacing food-related reward

Addiction transfer describes substituting alcohol or other compulsive behaviors for food after bariatric surgery, aided by altered alcohol pharmacokinetics.

Question 16: During a pre-surgical psychological evaluation, which finding would most warrant delaying bariatric surgery for further treatment?

Active, untreated bulimia nervosa with frequent purging (Correct answer)
A remote history of mild depression treated successfully years ago
Realistic expectations about post-surgical weight loss
Mild anxiety about the anesthesia procedure

Correct answer: Active, untreated bulimia nervosa with frequent purging

Active purging-type eating disorders are a contraindication requiring stabilization before surgery, unlike treated past depression or normal procedural anxiety.

Question 17: A post-bariatric patient who lost 120 pounds still perceives herself as her pre-surgery size and turns sideways through doorways. This lag is best described as what?

Phantom fat phenomenon, a delayed updating of body image after rapid weight loss (Correct answer)
Body dysmorphic disorder requiring antipsychotics
Anosognosia from a neurological lesion
Malingering for continued disability benefits

Correct answer: Phantom fat phenomenon, a delayed updating of body image after rapid weight loss

The 'phantom fat' phenomenon refers to persistence of the larger body schema after massive weight loss, which typically improves gradually.

Question 18: Which patient behavior after sleeve gastrectomy most strongly suggests 'grazing,' a pattern linked to poorer weight outcomes?

Eating small amounts of food continuously throughout the day without planned meals (Correct answer)
Eating three structured meals with protein prioritized
Drinking water 30 minutes before meals
Taking prescribed vitamin supplements daily

Correct answer: Eating small amounts of food continuously throughout the day without planned meals

Grazing—repetitive, unplanned nibbling across the day—circumvents surgical restriction and predicts weight regain.

Question 19: A patient becomes distressed when her spouse begins criticizing her new eating habits and discouraging her gym visits after surgery. Which concept best explains the spouse's behavior?

Relationship sabotage stemming from disrupted couple dynamics as the patient changes (Correct answer)
Normal supportive caregiving
Projection of the patient's own doubts
A culturally universal mourning ritual

Correct answer: Relationship sabotage stemming from disrupted couple dynamics as the patient changes

Significant weight loss can threaten established relationship roles, leading partners to consciously or unconsciously undermine the patient's changes.

Question 20: Which psychological outcome trajectory is most commonly observed in the first two to three years after bariatric surgery?

Initial improvement in mood and quality of life, with risk of decline as weight loss plateaus (Correct answer)
Steady worsening of depression from the first month
No measurable psychological change at any point
Permanent elimination of all pre-existing mental health conditions

Correct answer: Initial improvement in mood and quality of life, with risk of decline as weight loss plateaus

Most patients experience a psychosocial 'honeymoon' that can fade around 18-36 months when weight stabilizes or regain begins.

Question 21: Research on suicide risk after bariatric surgery indicates which finding that counselors must monitor?

Self-harm and suicide rates are elevated post-surgery compared with matched controls with obesity (Correct answer)
Suicide risk drops to zero after surgery
Risk is only elevated in patients over age 70
Suicidality is unrelated to psychiatric history

Correct answer: Self-harm and suicide rates are elevated post-surgery compared with matched controls with obesity

Multiple cohort studies show increased self-harm and suicide rates after bariatric surgery, warranting ongoing mental health follow-up.

CBC Psychology of Obesity

A patient reports eating large quantities of food late at night while feeling unable to stop, followed by intense guilt, but never uses compensatory behaviors like purging.
Which condition does this pattern most suggest?

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