Key messages

1. Obesity is a complex, chronic disease influenced by biological, psychological, behavioural, and social factors.
2. Internalised weight stigma develops when patients repeatedly absorb negative societal attitudes about body weight, contributing to shame and reduced self-worth.
3. Mental health disorders and obesity have a bidirectional relationship, with each condition increasing the risk and severity of the other.
4. Depression, anxiety, ADHD, chronic stress, and psychiatric medications can all contribute to weight gain and difficulty maintaining healthy lifestyle behaviours.
5. Binge eating disorder and night eating syndrome are common in patients with obesity and are associated with increased metabolic and psychological risk.
6. Restrictive dieting may worsen overeating behaviours by increasing hunger hormones and promoting cycles of binge eating and weight regain.
7. Shame and previous negative healthcare experiences can reduce treatment engagement and lead patients to avoid seeking medical care.
8. Effective obesity management requires clinicians to assess eating patterns, emotional drivers, psychological health, medications, and environmental factors.
9. Obesity should not be viewed as a failure of willpower, as biological mechanisms such as the body’s weight set point actively resist weight loss.
10. Multidisciplinary, patient-centred care involving clinicians, dietitians, psychologists, and other healthcare professionals offers the best opportunity for sustained outcomes.

Dr Kim Ragsdale is an experienced specialist psychiatrist and therapist based in Claremont, Cape Town, with over 18-years of clinical experience in adolescent, adult, and geriatric mental health care. She obtained her MBChB from the University of Cape Town and completed her Fellowship of the College of Psychiatrists of South Africa. Following her internship at Groote Schuur Hospital, she worked in general practice for three years before specialising in psychiatry, entering private practice in 1998 with a focus on general adult psychiatry and psychotherapy. Since 2005, she has served as consultant psychiatrist to the Cape Town Bariatric Clinic team, supporting patients through the psychological aspects of bariatric surgery. Dr Ragsdale is certified in Brain Working Recursive Therapy and integrates evidence-based medication, psychotherapy, mindfulness, and lifestyle interventions. Her holistic, patient-centred approach addresses mood disorders, anxiety, psychosis, attention-deficit hyperactivity disorder, and complex trauma, while promoting empowerment and long-term wellbeing.