Yesterday, in my talk, at the sold-out standing-room-only Hot Topics Conference on Obesity and Mental Health here in Toronto, I pointed out that individuals presenting with obesity often also present with mental health problems ranging from mood to attention deficit or addiction disorders. In addition, they often have eating disorders, poor self-esteem and body image and other challenges that affect their eating and activity behaviours. Thus, routine assessment and management of mental health problems should be part of obesity management practice. I also presented a brief overview of the Canadian Obesity Network’s 5As of Obesity Management.
Roger McIntyre (U of Toronto) presented data showing that individuals with bipolar disorder (BD) are differentially affected by overweight, obesity, and abdominal obesity. The hazards posed by excess weight in the Bd population on illness presentation, clinical course, and outcome have underscored the need to prioritize the prevention and treatment of overweight in this vulnerable population. Emerging evidence indicates that overweight/obesity may adversely affect neurocognitive performance in individuals with BD and may also be inversely associated with other addictive behaviours (e.g. substance use disorders). The contribution of distal adversity (e.g. childhood physical, sexual abuse) as a vulnerability factor for obesity has not been sufficiently reported or characterized. He also presented results from two recently completed studies documenting the effect of obesity on white matter integrity and as well the (positive) impact of bariatric surgery on the course of BD.
Randy Sansone (Wright State University, Dayton, Ohio) spoke on the role of borderline personality disorder (an Axis II dysfunction that is characterized by inherent difficulties with self-regulation), which may coexist in syndromes that are characterized by self-regulation difficulties. Perhaps, not surprisingly, studies in various eating disorder samples clearly suggest that restrictive personality styles are associated with restrictive eating pathology whereas impulsive personality styles are associated with impulsive eating pathology. Present data indicate that slightly over one-quarter of obese individuals may suffer from varying degrees of borderline personality disorder. Obviously, this has a number of clinical implications, particularly in terms of assessment, treatment strategies, and outcome.
Allan Kaplan (U of Toronto) focussed in his presentation on the fascinating phenomenology and etiology of the two commonest recognized eating disorders, bulimia nervosa and binge eating disorder, and their relationship to obesity. Needless to say, all health professionals dealing with obesity have to be well qualified to recognise and address these eating disorders in their patients and, if necessary, refer patients to the appropriate provider for treatment.
Other talks on this first day of the meeting included presentations by York University’s Caroline Davis on ADHD, Rudy Berthoud from the Pennington Biomedical Research Centre, Baton Rouge, LA, on neural Integration of metabolic, cognitive, and emotional signals in the control of ingestive behaviour, and Alain Dagher from McGill University on the neurobiology of appetite and a discussion of whether or not hugner and appetite should be seen as addictions.
Overall, a most interesting first day complemented by great discussions and exciting poster presentations.
Today’s presentations certainly promise to be as interesting.