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Obesity and Mental Health: Day 2 – ‘Stressed’ is ‘Desserts’ Spelled Backwards

On the day 2 of the Hot Topics Conference on Obesity and Mental Health, Zul Merali and Alfonso Abizaid from the University of Ottawa (working as a tag team) discussed the importance of stress as a driver of overeating. They described a a fascinating possible role of ghrelin as an important mediator that allow organisms to meet the energetic challenges of stress (which generally does require the organism to spend more energy).

Thus, ghrelin, a hormone that increases hunger and adiposity, is not only secreted when energy stores are low, but also in response to stressors. Chronic stress leads to chronically elevated levels of this hormone in tandem with increases in appetite and weight gain. These effects are prevented by pharmacological blockade of ghrelin receptors and are absent in mice with targeted mutations to the ghrelin receptor. These ghrelin receptor deficient mice, however, are more susceptible to stress-induced depressive like behaviors. Thus, although ghrelin response to stress may induce hunger and overeating, organisms that do not (or cannot) elicit this response may be more likely to develop depression like symptoms in the face of stress.

Shelly Russell-Mayhew (U Calgary) spoke on body dissatisfaction and weight and shape concern, two components of body image that have particular relevance for obesity and mental health. Body dissatisfaction is a consistent correlate of obesity in youth. While this may well be seen as a negative consequence of obesity, it is also important to recognise that body dissatisfaction often leads to dieting/unhealthy weight control practices. In youth, dietary restraint, or the vigilant restriction of caloric intake, in turn is associated with obesity and is predictive of future weight gain. Overweight children are even more concerned about weight than their normal-weight counterparts and normal-weight children with high weight and shape concern report higher body dissatisfaction and depressive symptoms. A focus on the promotion of healthy body image for children of all weight statuses could reduce the impact of multiple negative psychological outcomes. This is particularly important because of evidence that perceived weight rather than actual weight is more predictive of psychological distress and body satisfaction predicts less weight gain over time.

Ronnie Kolotkin, the developer of the Impact of Weight on Quality of Life questionnaire (IWQoL-Lite), a widely used questionnaire that assesses quality of life in obese persons and has been translated into over 60 languages, emphasized that assessing quality of life in obesity may be just as important as, or even more important than, measuring body weight or body mass index.

Other presentations on Day 2 included talks by Nick Finer, UK, on the potential role of gut hormones for treating obesity, Teodor Grantcharov (Toronto) on surgical treatments for obesity, Valerie Taylor (Toronto) on pregnancy and the post-partum period as windows for obesity and mental illness, Michael Vallis (Halifax) on the use of motivational interviewing, Anthony Fabricatore (Pennsylvania) on predictor of weight loss response in bariatric surgery, Rohan Ganguli (Toronto) on the potential and limitations of behavioural interventions for weight loss in psychiatric patients, Fannie Dagenais (Montreal) on efforts to change social standards on weight and body image, and Mary Forhan (Hamilton) on the factors that contribute to engagement in every day life of people living with severe obesity.

Overall, a most interesting a day, that ended with a plenary engagement of the participants in drafting the Toronto Charter on Obesity and Mental Health, which will be officially released in the coming days.

Toronto, Ontario


  1. Shelly Russell-Mayhew (U Calgary)
    “In youth, dietary restraint, or the vigilant restriction of caloric intake, in turn is associated with obesity and is predictive of future weight gain.”

    1. Is this why efforts to prevent obesity in children focus on their physical activity instead of what they eat?

    2. I’d like to point out that “dietary restraint, or the vigilant restriction of caloric intake” is different according to culture.

    According to my mother, we kids NEEDED desserts, and cookies for an afternoon snack, and deep fried food, and gravy on everything, and a stash of candy in the car so we’d survive a 2 hour drive, and a treat at bedtime etc etc. Anything less than that was “dietary restraint” to my mother.

    As an adult I realized that most families usually ate the way my mother would try to do when she put us all on a “diet” – smaller portions, desserts only occasionally, lower fat recepies, fruit for snacks.
    When we were “on a diet” we actually felt deprived, but really we were just eating in an ordinary healthy way.

    If people are told to “avoid dietary restraint” and “don’t vigilantly restrict calories”, be aware that those words can be interpreted very differently according to whatever diet a person considers “normal”.

    If the family who feeds kids a good diet doesn’t worry when a child has a piece of birthday cake – that’s good.

    If the family that usually eats too much decides it’s ok to keep eating lots of cakes and cookies and desserts, because to eat less would be “dietary restraint”, that’s bad.

    ps I love my Mom, other that that minor quirk, she’s wonderful!

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  2. In keeping with my comment to your article from yesterday, June 27, in which I noted the evidence for an autonomic nervous system disorder which results in faulty (overactive) stress responses in persons with Borderline Personality Disorder (BPD) (apparently a condition experienced by more than 25% of people with obesity–according to your report yesterday), I now wonder if anyone has conducted research to determine if any potential causal relationship exists between the chronic stress response (a chronic fight or flight response even under nonthreatening conditions) experienced by patients with BPD and “chronically elevated levels of ghrelin”, a hormone that may increase appetite and thus contribute to weight increase.

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