Distress Amplifies Disability Risk in ObesityMonday, October 4, 2010
As blogged before, obesity is now one of the most common drivers of premature disability.
A new study by Genevieve Garlepy and colleagues from McGill University, Montreal, QC, published online in Social Psychiatry and Psychiatric Epidemiology, shows that the presence of psychological distress (a non-specific measure of mental health that captures negative mood states, including symptoms of depression and anxiety) can double the risk for obesity related disability.
The researchers examined 12 year longitudinal data on 8,062 adults from the representative Canadian National Population Health Survey.
After adjusting for sociodemographic and other health variables, participants with both obesity and repeated distress (n=138) had double (HR 2.8) the risk of disability compared to those with obesity (HR 1.4; n=955) or distress alone (1.8; n=1,044).
The authors conclude that recurrent psychological distress combined with obesity markedly amplifies the risk for disability normally associated with either of these conditions.
A number of factors may explain this relationship:
1) Depressive and anxious symptoms may impact self-perceived health and functional capabilities, which may subsequently affect the decision to participate in certain roles or tasks.
2) Psychological distress can intensify the perception of symptoms and pain associated with obesity, which may interfere with the ability to perform some tasks.
3) Distressed individuals tend to adopt unhealthy lifestyle, including unhealthy eating, smoking, and physical inactivity which can exacerbate the risk and severity of obesity and obesity related diseases, increasing the likelihood for disability. Psychosocial disadvantages might also impede treatment seeking and adherence to treatment.
4) Weight discrimination may limit social support, which usually acts as a buffer for the effects of ill physical and mental health on disability. Weight discrimination may also stifle employment opportunities, which can affect socioeconomic status.
Whether or not primarily targeting excess weight or helping patients better coping with recurrent distress is more effective in preventing disability in obese individuals may be an interesting question for a prospective interventions trial.
If I had to predict the outcome, I would likely pick the latter. Indeed, I would argue that in these individuals, psychological distress may well be one of the underlying factors for the development of obesity (or increasing weight gain) and would thus need to be managed first in order to prevent further weight gain or effectively reduce weight.
Simply expecting these individuals to lose weight with “diet and exercise” is unlikely to result in any meaningful sustainable weight loss.
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Gariepy G, Wang J, Lesage A, & Schmitz N (2010). Obesity and the risk of disability in a 12-year cohort study: the role of psychological distress. Social psychiatry and psychiatric epidemiology PMID: 20848077
Monday, October 4, 2010
Agree whit you. In same idea of latter and “A multi-stakeholder approach” Sassi last book is now available : OECD (2010), Obesity and the Economics of Prevention: Fit not Fat, OECD Publishing. doi: 10.1787/9789264084865-en like p 129.
Monday, October 4, 2010
Dr. Sharma, thanks for your wonderful and informative blog.
I heartily concur with your speculation regarding this post. My concurrence is based upon anecdotal evidence, but as a long time sufferer from depression and anxiety–whose weight kept increasing as I got into middle age–I learned from hard experience about the interplay of depression and anxiety with the decline in one’s physically health.
Despite having a terminal degree in the sciences–and understanding that I was at high risk for coronary artery disease and diabetes– I found that anxiety and depression basically sabotaged all of my attempts to lose weight as well as control self-destructive addictions that exacerbated the development of obesity, DM and CAD. I eventually had a heart attack at age 50 and developed full blown DM and a pancreases that essentially no longer produces insulin.
I had a hard wake-up call and it took a CABG to do the “wake up”. Had I been able to get my psychological problems under control sooner, i feel like it would have aided me in getting a handle on my physical health and in controlling my risk factors.
Controlling risk factors associated with obesity are difficult to address under the best of circumstances. Psychological issues make them almost insurmountable problems.