The inquest into the death of Kim Swan, who died after having gastric band surgery so she could go on holiday with her daughters, has reignited the debate about society's views on obesity. Consultant psychiatrist Tim Rank tells health reporter SIOBHAN RYAN why there needs to be a change if people are to be helped.

When it comes to a condition like anorexia, most people recognise it as a psychological problem where the patient needs help and support.

However when it comes to extreme cases of obesity, there is generally more of an attitude that it is the individual’s fault.

People are confronted every day with stick thin models as well as healthy eating health promotion campaigns.

The general feeling is often that a person should just eat less and exercise more.

But sometimes the causes run a lot deeper.

There can be physical or hormonal reasons for weight gain, or a person may be suffering from a cycle of mental health problems which is difficult to escape.

It is that attitude of disdain from outsiders that can make it extremely difficult for people with weight problems to go out and get help.

Consultant psychiatrist Tim Rank, who works at the Priory Hospital in New Church Road, Hove, believes a change of attitude would help.

He said: “There is a g rowing body of thought that suggests people with weight problems should be getting psychological support.

“It is not surprising that some people resort to using a gastric band operation because they hope that losing weight will help them feel better about themselves.

“But losing weight is hard. You are going to end up feeling hungry at times and you are going to have to exercise.

“If you are overweight and unfit, that can be a very difficult step to take.”

Dr Rank says he is now seeing people diagnosed with a condition called binge eating disorder.

It is similar to bulimia in that people are eating enormous amounts of food, but in this case they do not vomit afterwards.

He said: “It is fairly newly recognised but is probably more common than we think.

“Basically the person has lost control and eats a huge amount up until the point they feel uncomfortably full.

“It is like an addiction. They are eating things that are unhealthy and bad for them and they know they are unhealthy but they cannot stop themselves from doing it.

“Obviously the gain in weight that happens leads to a knock-on effect on their confidence.”

Dr Rank said as well as conditions like this, there can be other reasons why people gain weight, such as those suffering from depression.

He said: “When people are feeling depressed, they can lose their appetite but others may comfort eat instead.

“They gain weight and that makes them more depressed and it becomes a vicious circle.

“A person who is depressed will often withdraw socially, will become unmotivated, won't want to go out at all and will keep to themselves.

“Add in a problem with weight and they end up with some real self-esteem problems and feel disgusted with themselves.

“They are deeply unhappy and they end up eating more.

“Comments made by other people about their appearance will also have a negative effect.

“Sometimes, if we are able to tackle the depression that a person is dealing with, then we can help that person become motivated to lose weight.

“Sometimes the problems may go a lot deeper than that, especially if they have an eating disorder, and that will need specialist care and help to get them through it.

“There is evidence that gastric band surgery works and in some cases there may be no other way to tackle the problem.

“There is no doubt that being overweight is bad for you but I always feel gastric band surgery should be a last resort.

“A good way to try and lose weight is to start off with a nonimpact sport like swimming but if you are overweight, you may be too embarrassed to use a public pool.

“Regular walks are always a good start.”

Weight gain is a societal problem as well, according to Dr Rank.

He said: “There is limitless high fat and processed food available out there which is also cheap.

“A lot of it may make you feel full for a little bit but the hunger pangs will come back quickly.

“We also lead a more sedentary lifestyle than we used too – about 80% of car journeys are only a mile or two.

“It is quite interesting in that 100 years or so ago, being overweight would have been associated with people who were well off because there was a shortage of food and supplies.

“Ironically, nowadays, it tends to be people on lower incomes who have higher levels of obesity.

“This could be down to not be able to afford things like gym membership or eating healthily, although there are alternatives out there.”

Dr Rank says a change in attitude from others could help a person who is battling with their weight.

He said: “There can be a whole range of reasons why people develop a weight problem and you cannot just class them all into one group.”