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Mental Health and Obesity: Day 1



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.

AMS
Toronto, Ontario

4 Comments

  1. Are they Psychologists having fun?

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  2. Hi Doctor Sharma: As a mental health consumer and a member of a clubhouse for mental health consumers I could identify, many members who display trait A or B or C. I would like to find some obesity research on “long term low grade depression” and how that is related to obesity. I know the foolishness of lay people trying to identify mental illnesses and am going to not be able to share this information with anyone–but is neat to have. Thanks

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  3. I’ve been pondering the prevalence of Borderline disorder, which, according to most research literature I have consulted, occurs in 2% of the general population–yet according to your report, here, “slightly over” 25% of people with obesity “suffer from varying degrees of [BPD]”. My goodness, this seems like a very significant (high) percentage! In his book, The Polyvagal Theory”, Porges presents “documented evidence of autonomic nervous system differences” (p. 236) in individuals with BPD diagnosis, indicating “the autonomic nervous system is regulated to a state that supports fight or flight” even under normal conditions (“nonthreatening”). This poses an interesting question about faulty physiological processes over which these individuals have no conscious control (in this case, their body’s inability to accurately regulate its stress response). I would imagine that effective long-term treatment protocols, then, would include careful monitoring of stress hormones, particularly those that may be produced by, or indirectly influenced by, fat cells. For example, I recall one study that concluded by recommending the inclusion of Leptin as a stress hormone.

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  4. “Present data indicate that slightly over one-quarter of obese individuals may suffer from varying degrees of borderline personality disorder.”
    Source please. Are these individuals seeking mental health treatment who happen to be fat or fat people seeking treatment for obesity or data from a population-based study? Also what is meant by “varying degrees”? Do you mean traits or severity? This formerly fat, public health care clinician is intrigued.

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