World Mental Health Day: Striking a Balance in Treatment

by Ethan Lazarus, MD, FOMA

Dr. Lazarus is the owner and physician at Clinical Nutrition Center in Greenwood Village, Colorado. He currently serves as president of the Board of the Obesity Medicine Association and represents OMA in the House of Delegates of the American Medical Association.

Funding: No funding was provided.

Disclosures: The author has no conflicts of interest relevant to the content of this article.

Bariatric Times. 2021;18(10):15

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Obesity medicine, as is true of so many modes of care, has never been about the treatment and management of a single disease. Effective care considers the whole person. Each October, World Mental Health Day reminds us that mental health is an essential consideration for each and every patient, and it can be particularly impactful for patients living with obesity.

The intersection of mental health challenges and obesity has demonstrated ramifications for patients. Research has shown obesity to be associated with a 25-percent increase in mood and anxiety disorder diagnoses, including major depression, bipolar disorder, panic disorder, and agoraphobia.¹ As healthcare providers, we cannot ignore this fact. It is imperative that we take a thoughtful approach to care that balances mental health and weight loss in patients with obesity.

To better meet the complex needs of the growing population of patients living with obesity—all of whom are potentially subject to mental health challenges—healthcare providers should consider the following information to strike a balance between weight loss and mental health.

Keep a clear view of mental health—for good and ill. Even as obesity creates mental health challenges for patients, weight loss as a result of medical intervention can create psychological benefits, including improvement of body image and other health-related quality of life measures.² Meanwhile, matters of weight can likewise factor into treatment for mental health conditions. It’s well known that many patients experience significant weight gain when psychotropic medications are used in treatment, and it will likely not come as a surprise to any working healthcare provider that excessive weight gain is the most common cause of discontinuation of medications for conditions like depression.³

Despite the classification of obesity as a disease, weight bias remains incredibly common, and the associated social stigma can create numerous challenges and risks for people struggling with obesity. These patients might avoid medical appointments altogether based on past experiences with healthcare providers who might not have received proper training in current approaches to nonbiased and evidence-based obesity treatment. Those who do seek help from obesity medicine specialists are still subject to the burden of weight bias in everyday life—often with the end result of increased eating and decreased self-regulation. Similarly, mental health problems can drive a patient to consume high caloric amounts of unhealthy foods. After a stressful day, what does one want to eat? Carrots or carrot cake? 

The toll of social stigma does not end there. Patients with obesity who experience weight bias also tend to experience higher levels of stress, which begets a host of physiological effects. In the long-term, exposure to cortisol and other stress hormones can exacerbate conditions, such as heart disease, stroke, depression, and anxiety disorders⁴—all of which already disproportionately impact people with obesity.

Create a safe space for essential care. Ultimately, better outcomes start with providers. For patients with obesity on the brink of beginning treatment, it is critical that mental health issues are addressed and optimized first, or at least concurrently. 

Even simple actions can make an impact, and providers have an opportunity to help patients make time for their mental health as a part of their overall care plan. For instance, as part of an overall strategy, help patients prioritize their mental health with the following simple practices:

• Get plenty of sleep!
• Time is extremely valuable. Be sure to set aside “Me Time” every day.
• Physical activity is great for mental health, but you don’t have to overdo it. Even a 10 or 20 minute walk can really help at the end of a tough day.
• Don’t forget to phone a friend! Oftentimes, mental health issues make people not want to be social, but talking with a friend, loved one, or counselor or therapist might be just what is needed.
• Try to eat delicious, colorful, and healthy foods, such as fruits, vegetables, legumes, nuts, and lean protein.
• Lay off the alcohol. While it might seem to make things better, alcohol typically worsens depression.
• Talk to your doctor—don’t be afraid to ask your doctor for help! 
• On a more systemic level, the sooner the healthcare community prioritizes person-first approaches to care that make every population feel safe and respected, the greater the impact we can make. This is true not just for patients living with obesity or mental health conditions, but for all patients. Creating space to recognize and accommodate for mental health in our practices and approaches to care likewise positions patients for greater overall success. By prioritizing the balance between mental health and physical health in our approach to care, we have the opportunity to help our patients strike a better balance in life.

For more information and resources to incorporate into your obesity medicine practices—including the 2021 Obesity Algorithm and Obesity Medicine Association’s Pocket Guidelines—visit https://obesitymedicine.org/. 

References

1. Simon GE, Von Korff M, Saunders K, et al. Association between obesity and psychiatric disorders in the US adult population. Arch Gen Psychiatry. 2006;63(7):824–830.
2. Lasikiewicz N, Myrissa K, Hoyland A, Lawton CL. Psychological benefits of weight loss following behavioural and/or dietary weight loss interventions. A systematic research review. Appetite. 2014;72:123–137.
3. Berken GH, Weinstein DO, Stern WC. Weight gain. A side-effect of tricyclic antidepressants. J Affect Disord. 1984;7(2):133–138. 
4. McEwen BS. Central effects of stress hormones in health and disease: understanding the protective and damaging effects of stress and stress mediators. Eur J Pharmacol. 2008;583(2–3):174–185.

Tags: Mental Health, Obesity Medicine Association

Category: Medical Methods in Obesity Treatment, Past Articles