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Is Obesity Part of the Mental Health Epidemic?



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.

AMS
Edmonton, Alberta

p.s. Mental health is a key theme of the upcoming 1st Canadian National Obesity Summit, May 7-10, Kananaskis, Alberta, hosted by the Canadian Obesity Network

4 Comments

  1. Very good article and it’s time that we (public health agency) take time to adress mental health issues as a part of the obesity problematic because clearly the message of eating well and less and move more has pass but is not enough alone. And we see in studies that has the obesity raise in the population so do psychological distress. I think that ther’s a link to do also with negative body image and obesity about this, there’s two article of interest: The relation between body size perception and change in body mass index over 13 years: the Coronary Artery Risk Development in Young Adults (CARDIA) study and I think therefore I am: perceived ideal weight as a determinant of health.
    Thanks again

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  2. Arya,
    As a psychiatrist myself, it is always refreshing when someone not directly working within mental health recognizes the need to focus on the link between mental health and obesity. Brilliant job.
    Valerie

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  3. The SSRI drugs often cause weight gain. This is a big stumbling block for weight reduction in patients with Mental Health concerns, is it not? Are there better alternatives that do not cause weight gain now? (a family member used them in 1999 and gained over 40 lb in one year).
    It would be wonderful to have effective resources for weight reduction, nobody wants to be overweight. Nobody.

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  4. Great article. I think that every weight loss programme with integrity should pay attention to mental health. I find that many of my clients are anxious and depressed (I work with overweight clients using a combination of nutrition and counselling).

    I wonder if it would be useful to undertake comprehensive blood tests to look at hormones that impact on weight and mood e.g. cortisol, oestrogen, etc to see the levels of these?

    I also think that high levels of carbs that convert to glucose cause problems. We are learning that high circulating glucose causes everything from type-2 diabetes to circulatory disease. I would be unsurprised if there was also a link with sugars and depression. I know that people with anxiety, especially panic attacks, are more balanced when on a low GI diet. I think that we need an integrated approach.

    Love your site, great stuff.

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