Is Obesity Part of the Mental Health Epidemic?Friday, April 3, 2009
Readers of these pages are probably well aware of the emphasis I place on identifying mental health factors that either promote weight gain or pose significant barriers to weight management. Indeed, I have previously proposed that the rise in obesity is more closely related to the mental health epidemic (in kids and adults) than to any other aspect of health status.
Thus, although the public and political focus remains on improving nutrition and promoting physical activity, I maintain that failure to acknowledge the importance of mental health as a major determinant of ingestive and activity behaviours ignores a significant part of the problem. Certainly anyone involved in an obesity clinic is keenly aware of the importance of having psychologists and psychiatrists on the interdisciplinary bariatric care team.
Anyone who still doubts the close relationship between obesity and mental health may be interested in the latest study on this issue just out in this month’s issue of the Journal of Psychosomatic Research.
In this paper, Amber Mather and colleagues from the University of Manitoba, Winnipeg, MB, Canada, examined the relationship between obesity and mental health in the over 36,000 participants in the nationally representative Canadian Community Health Survey.
Even after adjustment for sociodemographic factors and physical illness, obesity was associated with a 25-50% increased risk of lifetime psychiatric disorders (depression, mania, panic attacks, social phobia, agoraphobia), any lifetime mood or anxiety disorder, suicidal ideation, and suicide attempts. The only negative association was with past-year drug dependence (50% reduced risk). Most of these associations were specific to women, although some were also present in men.
In an earlier study, published in Psychosomatic Medicine, the same Canadian investigators reported a two-fold higher risk of paranoid, antisocial or avoidant personality disorders in overweight and obese women.
It is clearly time to fully acknowledge the close link between obesity and psychiatric disorders. Although it is not clear from this work which comes first, I have no doubt that a full assessment for obesity (particularly in women) must routinely include a comprehensive assessment of mental health status and that in many cases, targeting weight management without also addressing underlying or comorbid mental health problems is unlikely to prove effective.
All health professionals dealing with obese clients require at least a minimum competency in recognising mental health problems and should familiarize themselves with the adequate management and/or referral of these clients for appropriate interventions.