I think it's both. For a long time I was addicted to drugs and alcohol and so before I could even begin to try to get healthy I had to overcome those addictions first.
I also had to make some realizations. Like I can't lose 100 lbs in 6 months or even a year. It's going to take AT LEAST 1 year, but it could be 3, 4, 5 or 10, depending on my progress and the things I have to overcome. Do I want to do it as quickly as is healthy? Yes, but I understand I might stall, plateau, take breaks, gain a little back...whatever. I also know I'm struggling right now with BED, and haven't even really started losing. But I'm going to keep trying every day and that's a mental game in itself.
But I also know that when I do yoga, hula hoop, dance, walk...these physical activites perk me up and make me feel better mentally and physically. It helps. It makes the mental part easier.
I think, especially with my BED that I'm trying to beat, it's mostly mental for me.