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Does Weight Loss Increase Suicide Risk?



More than 50 years ago, Albert Stunkard described “dieting depression”, a finding subsequently confirmed over the years by other investigators. In extreme cases this adverse effect of dieting or weight loss on mood can increase suicidal ideation and may well increase the risk of suicide in some individuals.

Thus, according to a new study just published in OBESITY last month, Lucy Faulconbridge and colleagues (including Stunkard!) from the University of Pennsylvania, Philadelphia, PA, weight loss in some individuals may promote depression and suicidal ideation.

This study, examined changes in symptoms of depression in 194 obese participants in a 1-yr randomized trial of lifestyle modification and sibutramine. While mean scores on the Beck Depression Inventory declined (showing improved mood) across all groups, around 14% of participants across all groups reported potentially alarming increases (5 or more points) in symptoms of depression at week 52. These patients also lost significantly less weight than the rest of the participants.

While the baseline prevalence of suicidal ideation was 3.6%, seven new cases of suicidal ideation were observed during the year, with three cases even with lifestyle modification alone.

Thus, there appears to be an important minority of obese patients, who respond adversely to weight loss with clear signs of depression and even suicidal ideation. Interestingly, increasing suicidality has also been noted in previous studies of bariatric surgery (despite a marked reduction in all cause mortality).

These findings may have important clinical implications:

– We may need to be more careful in recommending weight loss to people with depression and/or past history of suicidal ideation or attempts.

– All individuals undergoing weight loss should be carefully monitored for deterioration in mood and instructed to seek appropriate counseling immediately upon experiencing suicidal thoughts.

– Public health recommendations to lose weight should be balanced against possible negative effects of weight loss attempts on mood.

Or, as the authors conclude:

These findings suggest that careful study is needed of the behavioral, neuroendocrine, and psychological effects of weight loss in obese patients with current depressive disorders, as well as in persons with a history of these and other psychiatric conditions.

Thus, while researchers and clinicians must take care to protect the small minority of individuals who may be at risk of experiencing adverse psychiatric complications with weight loss, they must also identify the conditions under which obese individuals with significant psychiatric complications can safely undertake weight reduction.

No one ever said obesity treatment was easy!

AMS
Edmonton, Alberta

5 Comments

  1. Dr Sharma,

    Rather than the weight loss leading to depression, could the depression result from the “failure” of losing less weight than expected? Especially since this group lost less weight than other participants. I have seen many people become upset or discouraged over an inability to lose weight, it seems reasonable that in some people it could lead to full-on depression.

    Since we know that lifestyle modification has many benefits outside of weight loss (and a poor record of long-term effects on weight itself), do you think we should focus more on the healthy behaviors, rather than the outcome of body weight, which often seems to result in frustration and disappointment?

    Travis

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  2. I have heard psychologists say, when talking about eating disorders, that you cannot ask someone to cope in a different way when they really only know one way to cope. It’s like asking people to do the front crawl when they only know how to dog paddle. If they don’t know the stroke, they can’t do it. If they have only just learned the stroke, they will revert back to it, especially under times of stress. I think that for some obese persons, they do have eating disorders and this is where I draw the parallels.

    Perhaps the additional body weight being carried by some obese people is a way of coping with life stresses when they have few other ways to cope. When they lose weight, they are left with no other useful tools to help deal with the stressors of life and so feel lost and more likely to think of suicide. The weight can put them at a safe distance from hurts and insulates them from the stressors of life, as well as dealing with the stress directly by eating. I realize that these are potentially stereotypical explanations of why extra body weight or fat might actually serve useful functions. I have experienced this with some patients, though by no means all of them, in the past. Perhaps as clinicians, we need to look at how being fat is actually serving/helping these people and ensuring there are solidly able to cope in other ways before we come up with the solution of weight loss. I really like Laurel Mellin’s solution series because the program focuses on learning those other coping skills.

    http://www.thepathway.org/how_it_works.asp

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  3. As Travis said, loosing less weight than expected can cause or worsen depression.

    A similar effect could happen for other medical problems as well as obesity.

    Imagine you had a study of 194 people in bed in hospital with similar injuries from car accidents.
    Suppose at the end of a year 86% had regained their mobility. We would expect their mood to improve as their health returned.
    Suppose 14% had only partial recovery. Instead of being up and about they still needed physiotherapy and were very limited in what activities they were able to resume. The prognosis was poor for much more improvement. This 14% would very likely be depressed by their lack of progress and the prospect of no change in the future. They are suffering, they will continue to suffer, they have no more treatment options, and their life will be negatively affected. Of course that is depressing.

    The 14% of the obesity patients who had poor outcomes from treatment are in the same boat.

    Are there studies of patients with other diseases or injuries who for some reason don’t respond to treatment and don’t get better? Do they get depressed?

    As Travis says, focusing on the positive is a good approach, and probably has parallels among other people learning to cope with disappointing outcomes for other medical problems.

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  4. Hi,
    Great site!!!!! Good health is very important with the high cost of medical coverage. We need to have a healther lifestyle by taking care of our health eating and exercising. I am a cancer survivor and I know. Our health is our greatest asset. Keep up the Good Work!!!!!

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  5. I stay depressed because of my weight. I can’ t stand the hurtful jokes from people. Plus know one is willing to help.

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