A Strong Correlation: Obesity and Mental Illness

| May 1, 2022

by Atif Kabir, MD

Dr. Kabir focuses on lifestyle and dietary interventions in obesity medicine at Mind Body Soul Matrix, a holistic, integrative, multi-component weight loss resource in Ottawa, Canada.

Funding: No funding was provided for this article.

Disclosures: The authors report no conflicts of interest relevant to the content of this article.

Bariatric Times. 2022;19(5):20


Obesity is a complicated disease that requires personalized and ongoing treatment. When patients with obesity are also facing mental illness, treatment becomes even more complex. Numerous studies have revealed an association between obesity and depression, and it is believed there is a bidirectional relationship between the two, with depression worsening obesity and obesity worsening depression. In fact, the prevalence of mood disorders and anxiety disorders in individuals with obesity is approximately 1.3 to 1.7 times that of patients without obesity.1–3 The overlap between obesity and mental health is not just restricted to mood disorders and anxiety, but also includes eating disorders, personality disorders, body image disorders, and various sleep disorders. 

Unfortunately, mental illness is more common in patients with obesity. The lifetime prevalence of clinical depression is elevated 1.5 to 2 times in individuals with a body mass index (BMI) greater than 30kg/m2. Approximately 30 percent of patients presenting to weight loss clinics have binge eating disorder, while 10 percent of patients with overweight also experience bulimia nervosa.4–8

There are common physiological pathways between mental illness and obesity-insulin resistance, hypothalamic-pituitary-adrenal (HPA) axis dysfunction, and low-grade systemic inflammation, along with immune dysfunction. Profound complications of mental illnesses in patients with obesity can be revealed in multiple facets of life. Increased HPA axis activity caused by long-term stress might lead to increased abdominal fat and other elements of insulin resistance, such as prediabetes, Type 2 diabetes, and high blood pressure.9 Long-term stress can also affect the limbic system of the brain and cerebrum, leading to increased cravings for ultra-processed foods rich in sugar, fat, and refined carbohydrates, and difficulty with self-regulation and decision-making, especially in prioritizing health.4,10,11 

Patients with obesity and mental illness can live in a truly vicious cycle, or a chicken-egg situation, with stigma, bias, and discrimination exacerbating quality of life. As healthcare providers, we can better help patients with obesity and mental illness by understanding the complicated correlation between the two diseases and being cognizant of prevalent societal biases.  

Obesity bias is everywhere. Western society places a high value on thinness, beauty, and athleticism. Our culture is bombarded with an ever-increasing barrage of explicit and implicit messages extolling these values in social media, fashion, television, movies, sports, and other areas. As an unfortunate result, obesity is generally viewed by society—from politicians to healthcare providers—as a moral failure. Individuals with obesity are viewed as lazy, weak, a burden on society, and lacking willpower and discipline.

Unfortunately, healthcare providers are not immune to these biases. In a study1 surveying 2,400 adult women about their experience with weight bias, 69 percent reported that physicians were a source of weight bias, and 52 percent reported that they have been stigmatized by a doctor on multiple occasions. According to the Obesity Action Coalition (OAC),12 studies of self-reported attitudes among nurses indicated 31 percent, 24 percent, and 12 percent of nurses surveyed would prefer not to care for, were repulsed by, and would prefer not to touch patients with obesity, respectively. These attitudes can be psychologically devastating for patients, especially those with mental illness. 

Promoting patients’ mental health. While obesity bias is upsetting, healthcare providers have the potential to make a powerful impact on patients by focusing on mental health, and even the simplest actions can create results. For patients with obesity who are beginning treatment, it is critical that mental health issues are addressed and optimized first, or at least concurrently. 

Providers can help patients make time for their mental health as a part of their overall care plan by incorporating these daily wellness practices:  

  • Achieve adequate sleep.
  • Prioritize “me time” every day to recharge.
  • Engage in physical activity for mental health—even a 10- or 20-minute walk can help at the end of a tough day.
  • Phone a friend. Oftentimes, mental health issues make people not want to socialize, but talking with a friend, loved one, or therapist can be therapeutic for patients.
  • Aim for healthy foods in a range of colors, including fruits, vegetables, legumes, nuts, and lean protein.
  • Avoid alcohol, as it can worsen depression.
  • Talk to your doctor and ask for help when needed.

By prioritizing the balance between mental health and physical health in our treatment plans, we have the opportunity to better help our patients reach their health goals. Our knowledge of obesity continues to evolve, especially as it relates to mental illness. The Obesity Medicine Association (OMA) also offers a variety of digital tools, webinars, and educational resources for providers. To learn more about OMA or to become a member, visit https://obesitymedicine.org/join.

References

  1. Garvey WT, Mechanick JI, Brett EM, et al. American Association of Clinical Endocrinologists and American College of Endocrinology comprehensive clinical practice guidelines for medical care of patients with obesity. Endocr Pract. 2016;22 (Suppl 3):1–203.
  2. Kushner R, Lawrence V, Kumar S. Practical Manual of Clinical Obesity. 2013; Wiley-Blackwell.  
  3. Atlantis E, Goldney RD, Wittert GA. Obesity and depression or anxiety. BMJ. 2009;339:b3868.
  4. Steelman GM, Westman EC. Obesity: Evaluation and Treatment Essentials. 2010; CRC Press.
  5. Strine TW, Mokdad AH, Balluz LS, et al. Depression and anxiety in the United States: findings from the 2006 Behavioral Risk Factor Surveillance System. Psychiatr Serv. 2008;59(12):1383–1390.
  6. Petry NM, Barry D, Pietrzak RH, Wagner JA. Overweight and obesity are associated with psychiatric disorders: results from the National Epidemiologic Survey on alcohol and related conditions. Psychosom Med. 2008;70(3):288–297.
  7. De Zwaan M. Binge eating disorder and obesity. Int J Obes Relat Metab Disord. 2001;25(Suppl 1): S51–S55.
  8. Strine TW, Mokdad AH, Dube SR, et al. The association of depression and anxiety with obesity and unhealthy behaviors among community dwelling US adults. Gen Hosp Psychiatry. 2008;30(2):127–137.
  9. Mosili P, Mkhize BC, Ngubane P, et al. The dysregulation of the hypothalamic-pituitary-adrenal axis in diet-induced prediabetic male Sprague Dawley rats. Nutr Metab (Lond). 2020;17(1):104.
  10. Bays HE, McCarthy W, Burridge K, et al. Obesity Algorithm eBook, presented by the Obesity Medicine Association. www.obesityalgorithm.org. 2021. https://obesitymedicine.org/obesity-algorithm/. Accessed 20 Apr 2022.
  11. Lustig RH. Ultraprocessed food: addictive, toxic, and ready for regulation. Nutrients. 2020;12(11):3401.
  12. Obesity Action Coalition. Understanding obesity stigma brochure. https://www.obesityaction.org/get-educated/public-resources/brochures-guides/understanding-obesity-stigma-brochure/. Accessed 14 Apr 2022.

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Category: Current Issue, Medical Methods in Obesity Treatment

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