Youth Lifestyle Psychiatry: Addressing Obesity in the Psychiatric Setting

As an expert in multiple areas like obesity medicine and lifestyle medicine, Tiffani Bell-Washington, MD, MPH, shared her expertise with Psychiatric Times on lifestyle changes and weight-management. Dr Bell-Washington emphasized the importance of compassion, connection, and manageable changes for patients working through weight-related issues. Adolescent lifestyle psychiatry is a specialty that thrives on collaboration and integrated approaches.

Psychiatric Times: How do you approach helping patients make meaningful lifestyle changes?

Tiffani Bell-Washington, MD, MPH: I focus on helping patients identify changes that align with their daily realities. Many arrive expecting that they need a complete overhaul of their routines, but that approach often leads to frustration. I guide them to choose one small, achievable behavior that they feel confident they can maintain. Early success matters. It restores a sense of capability, which is essential for long-term engagement.

As a psychiatrist quadruple board certified in adult psychiatry, child and adolescent psychiatry, obesity medicine, and lifestyle medicine, I use structured lifestyle assessments to evaluate sleep, stress, movement, nutrition, social rhythms, and mental health patterns. These data points help me partner with patients on a plan that considers their barriers, strengths, and stage of readiness.

I integrate motivational interviewing throughout treatment. When patients feel heard and supported, their willingness to experiment with change increases. I also rely on text-based coaching between visits, which allows for brief check-ins, real-time behavioral adjustments, and reinforcement of the goals we’ve created together. Many patients feel more accountable and more connected to their care, which improves adherence.

I apply this same framework in my Harvard/Massachusetts General Hospital (MGH) academic child psychiatry clinic, where lifestyle interventions offer children and adolescents structured ways to improve sleep patterns, eating habits, physical activity, and emotional regulation. Lifestyle change becomes less intimidating when it is practical, collaborative, and individualized.

PT: What should clinicians keep in mind when discussing lifestyle habits or weight with patients?

Dr Bell-Washington: The most important principle is to begin with permission and respect. Discussions about weight and lifestyle carry emotional baggage for many patients. A brief request for permission can reduce anxiety and help the patient feel safe. People-first, nonstigmatizing language is essential.

Clinicians should prioritize behaviors over numbers. Words like “healthy eating pattern,” “sleep quality,” or “activity routine” help shift the focus away from judgment and toward actionable strategies. Curiosity-based questions, such as “What feels hardest about evenings?” or “How does stress show up for you during meals?” reveal barriers and opportunities that may not be obvious.

It is also important to recognize the role of structural factors. Time constraints, food insecurity, chronic stress, caregiving demands, and work-related pressures often shape lifestyle behaviors. When clinicians acknowledge these realities, the patient feels validated rather than blamed.

Finally, tone matters. A calm, collaborative tone increases engagement and allows patients to be honest about challenges they previously felt embarrassed to share.

PT: What has been most challenging about supporting patients who experience weight gain related to psychiatric medication?

Dr Bell-Washington: One of the most challenging aspects is the emotional impact. Patients often internalize the weight gain and view it as a personal failure. They may feel discouraged, embarrassed, or hesitant to continue treatment. Addressing these emotional responses is foundational to effective care.

The illuminating part is how transformative education can be. When I explain how certain medications influence appetite regulation, metabolic rate, reward circuitry, or insulin sensitivity, patients shift from self-blaming to understanding. This reframing reduces shame and increases willingness to participate in treatment planning.

Once the biology is clear, we can explore integrated approaches. This may include adjusting psychiatric medications, adding weight-supportive agents, targeting sleep and stress, structuring movement, or optimizing nutrition. For some patients, understanding that we have options restores hope. For others, it strengthens the therapeutic alliance because they see that I recognize both their mental health needs and their metabolic concerns.

This work is especially meaningful at Harvard/MGH, where I integrate lifestyle psychiatry with evidence-informed obesity care in children and adolescents who are facing similar challenges related to medication and metabolic vulnerability.

PT: What unique challenges do you see in adolescents with lifestyle or weight-related concerns, and what approaches have been most effective?

Dr Bell-Washington: Adolescents face a constellation of challenges. They are navigating developmental changes, academic pressures, body image concerns, social comparison, shifting routines, and often significant emotional stress. Many also experience anxiety, depression, ADHD, trauma, or sleep disruption, which directly affect appetite, motivation, and consistency.

In my child psychiatry work at Harvard/MGH, I rely on short, structured visits that maintain focus and reduce overwhelm. Parents are included when appropriate, especially to support routines around sleep, meals, and movement.

I avoid restrictive or punitive approaches, which can worsen anxiety or lead to unhealthy coping patterns. Instead, I emphasize skill-building: balanced meals, emotional regulation practices, understanding hunger and fullness cues, and identifying forms of movement that feel enjoyable instead of obligatory.

Small goals work best. Teens respond strongly to early success, consistent encouragement, and clear expectations. When they feel competent, treatment adherence improves. When families participate as a team, progress accelerates.

PT: What comorbidities do you commonly see in patients who struggle with lifestyle or weight issues, and how do you address them?

Dr Bell-Washington: I frequently see depression, anxiety, trauma-related symptoms, attention deficit hyperactive disorder (ADHD), sleep disorders, insulin resistance, and chronic stress. Each of these conditions can interfere with motivation, decision-making, energy, appetite regulation, and follow-through.

I use an integrated psychiatric and lifestyle medicine approach. For example:

• Treating ADHD often improves consistency with meals and routines.
• Treating depression may reduce emotional eating and increase daily structure.
• Improving sleep quality has immediate effects on appetite, craving regulation, and mood.
• Addressing insulin resistance can stabilize energy and reduce hunger variability.

I collaborate with primary care, endocrinology, OB-GYN, and nutrition when needed. When metabolic and mental health conditions are treated together rather than separately, patients experience more meaningful and sustained progress.

PT: What current research or clinical trends in lifestyle psychiatry or obesity medicine interest you most?

Dr Bell-Washington: I am following emerging work on the relationship between chronic stress, inflammatory pathways, metabolic health, and psychiatric symptoms. The interaction between stress physiology and weight regulation is especially relevant for the populations I treat.

Research on medications that minimize metabolic side effects while maintaining psychiatric stability is also important. There is growing interest in how pharmacologic and lifestyle interventions can be combined to support both mental and metabolic outcomes.

Digital health is another area of interest. AI-supported habit change, digital monitoring tools, and text-based behavioral interventions show promise for increasing adherence and reducing barriers to care. These approaches may expand access to evidence-informed lifestyle support, especially for patients who struggle with consistency or live in areas with limited services.

PT: Are you working on any projects or initiatives you’d like to share?

Dr Bell-Washington: In my Harvard/MGH academic child psychiatry clinic, I am expanding the use of lifestyle psychiatry frameworks to support children and adolescents with anxiety, depression, ADHD, and weight-related concerns. Families appreciate having structured, evidence-informed tools they can use at home, and these approaches help strengthen daily routines, sleep, nutrition, emotional regulation, and overall functioning.

Through The Healthy Weigh MD, I provide concierge psychiatry and weight management services for adults, teens, and parents. My practice integrates psychiatric treatment, lifestyle medicine, and obesity care to build individualized, sustainable plans that address both mental health and metabolic health.

I also lead the Bell Well Joy Initiative, where I coach and consult with clinicians and professionals on burnout prevention, sustainable career design, and emotional well-being. I am developing courses and practice-building resources for clinicians who want to incorporate lifestyle psychiatry, metabolic health, and integrative care models into their own work.

In addition, I am a certified AI consultant and integrate AI into clinical workflows, education, and practice operations. I use AI to streamline documentation, enhance patient engagement, reduce administrative burden, and train other clinicians and professionals to use AI safely and effectively in their daily work.

My goal is to help both patients and clinicians experience better health, more joy, and more balance through evidence-informed, accessible, and compassionate care.

If you are a clinician who would like guidance in building an integrative, patient-centered, and sustainable practice, you are welcome to contact me at info@DrTiffaniMD.com for details about my mentorship program.

Individuals and families seeking care with The Healthy Weigh MD can request an appointment here.

Dr Bell-Washington is a child and adolescent psychiatrist and obesity medicine physician.