More than once, I’ve found myself half-joking that simply glancing at food seems sufficient to tip the scales. For the longest time, I dismissed this as idle hyperbole—a light-hearted lament echoed by many. Yet emerging scientific insights suggest this might not be as far-fetched as it sounds. According to leading experts in metabolic health and behavioural science, there’s growing evidence that supports a physiological basis for this phenomenon—ushering in the field of psychophysiopathology of obesity.
Fast forward to 2050, a mere quarter-century away, and India is projected to bear the weight—literally—of an obesity epidemic affecting nearly 450 million citizens. That’s a staggering increase of 180 million individuals from 2021, a rise that underscores the gravity of the crisis. Obesity, along with its metabolic cohorts such as Type 2 diabetes, cardiovascular disease, and neurodegenerative disorders, represents a burgeoning public health emergency that could deeply undermine the nation’s socioeconomic fabric.
Historically, our communal focus has been narrowly riveted on caloric arithmetic and physical exertion—mantras of “eat less, move more.” However, despite widespread adoption, these interventions in isolation have proved insufficient. Could it be that the elusive missing link lies not in the external—but within the intimate, dynamic interplay between how we think, how we feel, and how we physiologically respond to our environments? It is in the mind-body nexus that the science of psychophysiology offers a paradigm-shifting perspective—one that reframes obesity not merely as a failure of willpower, but as a complex biopsychosocial phenomenon demanding deeper, multidimensional inquiry.
The mind-body link
The mind-body connection has long fascinated me, and one I avidly follow the work of Deepak Chopra. In his seminal book, Creating Health, he elucidates on the intricate relationship between the mind and body, positing that this synergy plays a pivotal role in the pathogenesis of various diseases, including obesity. Notably, Dr. Chopra references groundbreaking experiments that demonstrate the phenomenon of cephalic phase responses, wherein certain individuals exhibit a pronounced metabolic reaction to mere sensory cues associated with food, such as the sight, aroma, and sounds of culinary preparation. This anticipatory response eerily mirrors the physiological changes that occur upon actual food consumption.
Furthermore, Dr. Chopra’s work reveals that, beyond sensory inputs, even the mere thought of food can trigger a cascade of neuroendocrine events. This cognitive-emotional stimulus activates the hypothalamic-pituitary-adrenal axis, culminating in the release of insulin from the pancreas. The resultant surge in insulin levels triggers a profound sensation of hunger, accelerating metabolic processes and facilitating the rapid conversion of nutrients into fat. This complex interplay between cognitive, emotional, and physiological factors underscores the notion that the mind-body connection plays a critical role in modulating metabolic function and, by extension, obesity.
Chronic stress could result in emotional or comfort eating at times. In other times, people could be replacing excessive eating or drinking of fizzy drinks to use as a placebo or as a way of managing cravings. For example, I do extensive work with people in addiction recovery. People, especially ones recovering from cocaine or alcohol, always speak about how foods high in cheese/ fat/ sugars or carbohydrates help them manage their cravings for their substance of choice. This results in overeating and obesity, although the management of recovery is on the right track. All these in tandem with recent studies indicate that chronic stress, emotional dysregulation and cognitive patterns disrupt the autonomic nervous system function, through hormonal signalling such as production of insulin or cortisol, often resulting in maladaptive eating behaviours.
Obesity as an interplay of multiple factors
Psychophysiology is rapidly emerging as a transformative lens through which to understand obesity—not merely as a metabolic imbalance, but as a dynamic interplay of biological, psychological, and social forces. This biopsychosocial model, when integrated with psychophysiological metrics like heart rate variability and neuroendocrine markers, enables researchers to identify nuanced pathways linking mental states to metabolic outcomes. This convergence is not only reshaping obesity science but also paving the way for precision interventions—ranging from cognitive-behavioral therapy to neurofeedback—that target the root causes of weight dysregulation beyond diet and exercise alone.
The pernicious consequences of obesity extend far beyond the realm of individual health, precipitating a profound impact on the economic and social fabric of societies. In India alone, the annual healthcare expenditure and productivity losses attributable to obesity are projected to surpass a staggering USD 35 billion, thereby imposing an immense economic burden on the nation. Globally, obesity is estimated to contribute to a colossal 65% of the total economic burden through indirect cost implications, including diminished workforce participation, disability, and premature mortality. This insidious phenomenon perpetuates a vicious cycle of economic stagnation and human suffering.
Moreover, the social implications of obesity are equally egregious, exacerbating existing health inequities and disproportionately affecting vulnerable populations, particularly those in the lower-income strata. The paucity of access to wholesome nutrition, safe physical activity spaces, and preventive healthcare in these communities perpetuates a cycle of disadvantage, further entrenching unhealthy behaviors. Furthermore, the stigma surrounding obesity precipitates a profound psychological toll, fueling distress, anxiety, and decreased self-esteem, which in turn exacerbates the condition, creating a self-perpetuating cycle of morbidity.
The role of identity
When tackling obesity through the lens of psychophysiology, a crucial aspect to understand is the role of identity. Similar to the paradigm of addiction recovery, individuals struggling with obesity often encapsulate their self-concept around a fixed identity, such as “a fat person.” This cognitive schema can perpetuate a self-fulfilling prophecy, where their experiences and behaviours align with their deeply-ingrained beliefs, both consciously and subconsciously. From an evolutionary perspective, the brain strives to maintain cognitive consistency, reinforcing patterns that validate one’s self-image.
In the context of obesity, individuals often grapple with body image concerns or body dysphoria, which can limit their ability to adopt healthier lifestyles. Research suggests that individuals who perceive themselves as healthy and happy are more likely to engage in health-promoting behaviors. Conversely, those who identify as “fat” or “unhealthy” may experience social consequences, such as bullying or social isolation, leading to decreased happiness and further exacerbating their health issues.
Emerging research in neurophysiology is exploring the intricate relationship between self-image and metabolic function, seeking to elucidate the correlational dynamics between these complex variables. By understanding the interplay between identity, happiness, and physiological responses, scientists may uncover novel targets for intervention, enabling more effective and sustainable.
The need for a paradigm shift in approaching obesity
To mitigate the burgeoning obesity epidemic in India, a paradigmatic shift in our approach is warranted, necessitating a synergistic, cross-sectoral response that integrates the trifecta of biological, psychological, and environmental determinants. Policymakers, healthcare professionals, and the public must converge to adopt a psychophysiopathological framework that acknowledges obesity as a complex, multifactorial disorder precipitated by the intricate interplay of genetic, neuroendocrine, and environmental factors.
Policymakers must transcend the erstwhile piecemeal approach to nutrition and fitness, instead prioritising the development and implementation of comprehensive programmes that seamlessly integrate mental health, stress management, and behavioral science into national health strategies. Flagship initiatives such as the Fit India Movement and POSHAN Abhiyaan should be augmented to incorporate psychophysiological screening tools, emotional wellness education, and community-based interventions that target the underlying etiological factors contributing to maladaptive eating behaviors.
Healthcare professionals require rigorous training in psychobehavioral diagnostics and interventions, encompassing tools such as heart rate variability monitoring, cognitive-behavioral therapy (CBT), and mindfulness-based stress reduction (MBSR). Multidisciplinary teams comprising endocrinologists, psychologists, nutritionists, and public health experts should collaborate to deliver personalised, evidence-based treatment plans tailored to individual needs, predicated on a nuanced understanding of the biopsychosocial determinants of obesity.
The public also has a vital role to play in this endeavor, necessitating empowerment through knowledge about the intricate relationships between stress, emotions, thought patterns, and eating habits, as well as their impact on metabolic health. Schools, workplaces, and digital platforms should promote emotional literacy, mindful eating, and resilience-building practices as integral components of everyday life, thereby fostering a culture of wellness and salutogenesis.
India stands at a critical juncture, poised to either succumb to the weight of the obesity epidemic or rise to the challenge by adopting a holistic, psychophysiology-informed approach that acknowledges the complex interplay between biological, psychological, and environmental factors. By doing so, we can pivot from a paradigm of blame and symptom management to one of understanding and root-cause resolution, thereby mitigating the burgeoning health crisis and promoting a culture of wellness and optimal health.
(Rashikkha is a multidisciplinary clinician working in the U.K., specialising in the delivery of clinical interventions in forensic settings. Rashikkha.RaIyer@outlook.com)
