Does obesity affect Mental Health?

[Diana Young, RD, LD/N, CDE]

In a study of 9,125 individuals, the researchers found that people who are clinically obese have a 25% higher risk of developing psychiatric disorders, such as depression, bipolar disorder and panic disorder.
The link is strongest among people of European heritage, people with more education and those with higher incomes - the risk was 44% higher, when compared to people of normal weight.

Research on obesity usually examines the physical consequences, such as hypertension, heart disease, type 2 diabetes, arthritis and cancer. This is the first major study to look at an association with psychiatric consequences.

The obvious question is whether depression and other psychiatric illnesses and their treatments, lead to obesity or the other way round. It is most likely that the connection goes both ways.

Obese people are 25% likely to have a substance abuse disorder at some time during their lives when compared to people of normal weight.

While the average American has a 30% chance of being obese, a depressed person has a 40% chance of becoming obese.

20% of US people suffer from depression at some time in their lives - the figure is 28% for obese people. Is this because of social pressure? Is it just that heavy people feel badly about themselves because of the constant pressure to be of normal weight? Or is it something else entirely? The connection seems to be more complex than that, and perhaps to involve some physical mechanisms.

It is particularly important to screen for psychiatric problems in overweight people.

The research team is now engaged in research into three other questions:

-- How difficult is it for depressed people to become more physically active?

-- Do depressed people have different diets from people who are not depressed?

-- Are structured weight-loss programs less successful for a depressed person, and would it make a difference if weight-loss programs were designed specifically for depressed people?

Source: Psychiatric Resource Forum

Thoughts?

[DR]

This really is a chicken or egg kind of dilemma.

Depressed people are unlikely to WANT to exercise and people who aren't physically active are more likely to be depressed.

Personally, I work with a variety of people who suffer from mild to moderate depression. They are all unable to work because of their depression. Their employer pays for them to participate in a 12 week structured fitness program in which a personal trainer provides 1 on 1 fitness training designed to help reduce their symptoms of depression.

After 4 years of doing this program, we have a 68% remission rate

Of the 32% that don't go into remission, only a very low number don't see any improvement

[Metroknow]

DR, I'd be really interested to know if treating depression successfully contributes to weight loss - I think if there is clinical evidence of that it would be a huge step. I know for me I battle with depression and weight, and they are definitely fundamentally linked in the chicken-and-egg terms you use. I can't tell which causes the other, but I know they both contribute to perpetuating the other, if that makes sense.

[James Hubbard, M.D., M.P.H.]

I am a little surprised about the bipolar and panic disorders, but not the depression. Symptoms of depression include lethargy, sleep loss, eating more in some, less in others. On the other hand, obesity can lead to social isolation, poor self-esteem and resultant depression.

It can be a vicious cycle no matter if depression leads to weight gain or vice versa.

[David]

Exactly Dr. It's a vicious cycle. No matter which comes first, depression or weight gain, it's like the chicken and egg theory.

[Email Support From a Registered Dietitian]

Here are the statistics:

compared with people who are not obese, obese people are:

* 21% more likely to suffer major depression
* 47% more likely to suffer bipolar disorder
* 27% more likely to suffer panic disorder or fear of open places

[Aran]

Is the obesity the external manifestation of other digestive problems or a result of the industrial processing of our foods? How free from hormones is our water supply? What about pesticides? Are even organic foods truly free from contamination and does the contamination affect our bodies. Do the additives to our food cause depression and bi-polar disease? Does breathing in pollutants effect our metabolism in ways that we have not discovered yet?
Are our homes too warm, do we wear too many clothes? Do we rely too much on our cars? Are clever people too easily bored and eat too much as compensation?

[Passionate Green]

Does obesity affect mental health? Yes.

I am considered "morbidly obese" by clinical standards. I'm about 100 lbs overweight and I don't think I look anything close to morbidly obese.

I have struggled with both weight and depression all my life, so to me the two go hand-in-hand. It's a horrible cycle: eat because you're depressed, and then get depressed because you ate and gained weight. It does not end without help. I haven't found the right help yet. When I first started taking Prozac it ended my compulsion to overeat, but it stopped being effective after about six months. My anxiety issues keep me from going to a gym or even just exercising regularly.

I watch tv shows such as You Are What You Eat , I Eat 33,000 Calories a Day, The 750 Pound Man, and Big As Life: Obesity in America . These shows reinforce the obesity-mental health connection time and time again. Not only do you get a sense of how depressed the person is while they are overweight, but you can see an obvious difference in their attitude and the way they carry themselves after significant weight loss.

Do depressed people have different diets from people who are not depressed? In my experience, not necessarily. I eat a fairly balanced diet, statistically better than most people my age and in my community, and yet I still struggle with depression. However, I have known many people who eat only junk (white flours and sugars, saturated fats, etc.) and are not depressed.

[David]

Thank you for sharing your moving feelings and thoughts. I understand
completely what you're saying because after my most serious surgery,
I wasn't sure if I was going to walk again, and I really didn't want to live
at that time because I became so depressed thinking about it.

I know the two are unrelated, but hopefully for those that are depressed
because of being overweight and obese--know that there are many
things you can do and resources to use.

To be sure--I'm preaching to the choir, but this discussion has become so very
interesting.

[Lisa Newton]

In yesterday's Wall Street Journal:

Depression Leads to Internal Body Fat in 70-Somethings, Study Suggests

To summarize:

Older people who are depressed are much more likely to develop a dangerous type of internal body fat -- the kind that can lead to diabetes and heart disease -- than people who aren't depressed, a disturbing new study found.

People with depression were twice as likely as others to gain visceral fat -- the kind that surrounds internal organs and often shows up as belly fat. It raises the risk for heart disease and diabetes.

Both groups, depressed and nondepressed, were overweight on average at the start of the study, with approximately the same average body mass index. When the researchers took into account other risk factors for obesity, including the depressed group's higher visceral fat levels in the beginning, they still found a connection between depression and visceral fat gain.

It looks like, at least in this case, weight gain is caused by depression.

[Email Support From a Registered Dietitian]

Also, of interest:

Unfortunately, recent research shows that you can crunch until you crumble and diet till you're drained of energy, but if your days are full of stress, the perfect six-pack--or even a flatter midsection--will continue to elude you.

That's because fat in the abdominal area functions differently than fat elsewhere in the body. It has a greater blood supply as well as more receptors for cortisol, a stress hormone. Cortisol levels rise and fall throughout the day, but when you're under constant stress, the amount of the hormone you produce remains elevated. With high stress and, consequently, high cortisol levels, more fat is deposited in the abdominal area since there are more cortisol receptors there.

[Metroknow]

Thank you so much for this specific explanation - that makes so much sense!

[David]

This guy likes to work out with his belly: