Wednesday, August 20, 2014

Healthy Obesity: Losing Weight Won’t Make You Happy

sharma-obesity-depressionThere is ample evidence for improvements in mood and other aspects of mental health with weight loss in people with excess weight, who have these problems to begin with.

But whether or not weight loss in otherwise healthy people living with obesity is associated with any such benefits remains unknown.

This question in now addressed by Sarah Jackson and colleagues from the UK in a paper published in PLOS | ONE.

The researchers examine data from 1,979 overweight and obese adults, free of long-standing illness or clinical depression at baseline, from the English Longitudinal Study of Ageing.

Participants were grouped according to four-year weight change into those losing ≥5% weight, those gaining ≥5%, and those whose weight was stable within 5%.

The proportion of participants with depressed mood increased by almost 300% in the group that lost weight (about 15% of participants) compared to a rather modest 85% and 62% increase in mood problems in the than weight stable or weight gain groups, respectively.

Compared to the weight stable group, the weight loss group was almost 2 times as likely to report mood problems.

Similarly, individuals in the weight loss group were also more likely to report lower wellbeing.

All effects persisted in analyses controlling for demographic variables, weight loss intention, and baseline characteristics and despite adjusting for illness and life stress during the weight loss period.

Given the longitudinal nature of this study, it is impossible to determine causal relationships in these observations but the findings do suggest that the issue of psychological harm in otherwise healthy individuals undergoing weight loss may warrant closer study.

For the event that there is indeed a causal relationship between weight loss and adverse pychological outcomes, the authors have the following explanation to offer:

The poor long-term maintenance of weight loss is notorious, and in itself could be interpreted as demonstrating that the personal costs of losing weight exceed the benefits. Resisting food in environments that offer abundant eating opportunities requires sustained self-control, and given that self-control appears to be a limited resource, other areas of life may suffer as a consequence. Loss of fat stores may also initiate signals for replenishment of adipocytes, thereby stimulating hunger and appetite and making weight control progressively more difficult. These observations suggest that weight loss is a significant psychobiological challenge, and as such, could affect psychological wellbeing.”

On the other hand, weight loss could also result from adverse changes in mood:

Evidence from the clinical literature is suggestive of a causal relationship in this direction, with major depressive disorder often associated with significant weight loss, and treatment with antidepressant medication leading to weight gain. Population studies have also demonstrated longitudinal associations between depressive symptoms and weight loss. Depressed mood may cause weight loss directly or indirectly through changes in appetite or level of physical activity.”

Thirdly, these correlational findings may be entirely unrelated to each other.

Which ever the true relationship, these findings should perhaps caution us against simply advising all overweight or obese people, irrespective of whether or not they actually have weight-related health issues (or are otherwise unhappy with their weight), to try losing some weight.

@DrSharma
Edmonton, AB

ResearchBlogging.orgJackson SE, Steptoe A, Beeken RJ, Kivimaki M, & Wardle J (2014). Psychological Changes following Weight Loss in Overweight and Obese Adults: A Prospective Cohort Study. PloS one, 9 (8) PMID: 25098417

 

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6 Responses to “Healthy Obesity: Losing Weight Won’t Make You Happy”

  1. DebraSY says:

    This was the issue that prompted me to start a blog in 2010 that lasted for a year. In short, I was in a funk and needed to vent. I was never professionally diagnosed as depressed, but I would call it that. My very first entry was “The Unfairness of Weight-Loss Maintenance.” I just re-read it, and I think it still summarizes fairly how dispiriting weight-loss maintenance can be. if you’ll forgive my presumption, here’s the link: http://justmaintaining.com/2010/09/29/hello-world/

    Happily, I can say that I have reached a place that is more stoic now with regard to my maintenance. I continue to maintain at negative 55 lbs from highest established weight. I’m in my 12th year. It doesn’t get easier.

    It would be helpful if doctors set about developing coping tools. I still feel like I’m on my own most days. One of my doctors has grown more nuanced and compassionate in her views, but offers little practical assistance. The other doctor is still in the 1990s, I think, with regard to his understanding of weight-loss maintenance. He’ll say things like, “Just keep up the good work!” I tell him it’s complicated. I sense he thinks I’m a complainer. That I should accept my weight-loss maintenance as some happy gift. It’s not a gift. It’s a job I have to do for no pay. I’ve streamlined it down from quarter-time (when I wrote the blog) to about 10 hours a week. I’m okay with that most of the time.

    Thanks for your blog, Arya. Periodically, I should say that to you. I have tried to share it several times with my two doctors — my Internist and my OB. Perhaps the OB (the one who’s grown more nuanced) has visited, though she hasn’t shared that with me if she has. I’m sure the Internist just ignores me on all things related to weight-loss maintenance. It’s a non-topic for him, since it can all be reduced to the ELMM lifestyle. Grrr.

  2. Evie says:

    From the title, I was expecting this post to talk about at least one of:

    Loss of friends/family: Losing weight means changing habits which may mean forgoing food-intensive visits with family and friends. Loss of a social group leads to depression. Particularly when you learn that the people who say they love you only love you if you join them in eating the cake.

    Not being able to be small enough: You pull off a 50 pound loss and strangers still make comments because the smallest you can be still looks like a before picture to them. It’s very depressing to realize that you literally can never be good enough for the society you live in and that dimension of failure isn’t one you can hide.

    I think their study could have benefited from some participant interviews because their reasons seem really off to me.

  3. Megan Patrick says:

    Debra,
    Your blog post is spot on! Not nearly enough research has been done about how to maintain weight loss successfully over many years. And “Just keep up the good work” is probably the worst thing you can to someone who has managed to lose a significant amount of weight. It implies that they are not good enough as they are and that they won’t be until they miraculously manage to achieve a “normal” BMI. I swear weight loss is the only thing I can think of where you can be a success and a failure at the same time!

  4. DebraSY says:

    Thanks, Megan. Being “heard” goes a long way. I don’t know why that is. It is important, however.

  5. Wendy Belgard Hanawalt says:

    The issue of self-control being a limited resource is very interesting and is supported by a lot of the literature in brain science. If that’s accurate, then it would make sense that losing weight by a strict diet, requiring a lot of self-control, would result in depression. Better, then, to lose weight with small, easy changes, particularly changes in the environment.

  6. Alexie says:

    I went to a residential fitness camp where we were weighed at the beginning and the end. We were told at the beginning to focus on fitness as the marker of success. A young mother, who was very overweight, improved her performance out of sight over the week. You could literally see her becoming faster and stronger. At her final weigh in, she was told her fat/muscle ratio had improved significantly. But the scales only registered a three pound weight loss.

    She burst into tears and rang her husband to go out and buy a big bag of candy for her homecoming, because all her hard work hadn’t paid off.

    People who have ‘only’ lost 5% of their fat may have had unrealistic expectations about how much their body/life would change as a result of whatever they were doing. A lot of pain for what seems like no gain would inevitably lead to the blues.

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