Will Losing Weight Make You Less Depressed?
Friday, February 25, 2011
Regular readers will appreciate the importance of mood as a driver of ingestive behaviour. While typically depression is associated with a loss of appetite, atypical depression can lead to increased cravings for “comfort” foods, especially those high in sugar and fat.
Depression is also well recognized as a major barrier to weight loss in that individuals with depression will appear less motivated, report lower energy levels, and have poor sleep patterns, all of which can in turn affect diet and physical activity.
So while depression can clearly drive weight gain and make weight management more challenging, a question often asked is whether weight loss will actually improve mood.
This question was now addressed by Anthony Fabricatore and colleagues from the University of Pennsylvania in a paper just published in the International Journal of Obesity.
The authors conducted a comprehensive meta-analyses of over 5971 articles, including 394 randomized controlled trials, regarding the relationship between weight loss and depression.
Thirty-one studies, in almost 8000 participants were included in the final analysis.
Comprehensive lifestyle modification was found to be superior for reducing symptoms of depression than control and non-dieting interventions.
Lifestyle modification was also marginally better in improving mood than dietary counseling or exercise-alone programs.
Of particular note (given my recent post on the nutritive benefits of exercise), exercise-alone programs were superior to control interventsions in reducing symptoms of depression.
Nearly all active interventions improved depression but there was no relationship between the amount of weight lost and the reduction in depression symptoms.
Health at every size (HAES) enthusiasts will likely argue that the improvement in mood has more to do with the active interventions (which include eating healthier and increasing physical activity) than with the actual weight lost – something that would be hard to argue with given that the amount of weight lost appears to have little impact on the actual improvement in mood.
Thus, rather than concluding that weight loss leads to an improvement in mood, it would perhaps be more accurate to conclude that lifestyle modifications AIMED at weight loss ALSO, on average, tend to improve mood.
This of course would not be hard to believe given the evidence that both dietary intake of certain (unhealthy) nutrients as well as increased physical activity can significantly decrease symptoms of depression.
Certainly, this study does not change my opinion that in many patients mood disorders need to be identified and addressed as a “root cause” of weight gain and that weight loss, without lifestyle change, is unlikely to improve mood.
Clearly the notion held by many of my patients, that they would be so much less depressed if only they could lose some weight, is not borne out by this data – rather I would suggest to them that a healthier lifestyle will probably improve their mood irrespective of whether or not they actually lose weight.
But of course, as always, I defer the last word on this to my readers…
AMS
Edmonton, Alberta
Fabricatore AN, Wadden TA, Higginbotham AJ, Faulconbridge LF, Nguyen AM, Heymsfield SB, & Faith MS (2011). Intentional weight loss and changes in symptoms of depression: a systematic review and meta-analysis. International journal of obesity (2005) PMID: 21343903
Friday, February 25, 2011
Wonderfully interesting again. And here’s what it makes me think – how closely are a sense of self-efficacy, or indeed self-esteem, tied to mood? Does the measure being used have anything to say about either of those? Is it possible that “lifestyle modifications aimed at weight loss” improve a sense of self-esteem due to a person having a sense of taking charge of his or her health, which could help to ameliorate mood symptoms but that the first is a short-term response, the latter one that would take more time to see?
Friday, February 25, 2011
Let me take a stab at the initial question: Will losing weight make you less depressed? I am, of course, anecdotal. I consider myself a personal scientific experiment in which n = 1. I also had no clinical diagnosis of depression. So, there’s your grain of salt. Now here’s my answer:
The effects are significant, but temporary. The introduction of vigorous exercise, especially, improves mood within a couple of weeks. For me it cured chronic insomnia too, which may have been the central catalyst in improving my mood. Diet modifications, especially if they improve the quality of food and don’t just restrict the calories, probably enhance the effect. As HAES proponents would point out, these modifications can happen without a goal of weight loss, and weight loss may be accepted as a side effect or bonus, but when weight loss is the central goal it may be more problematic than helpful. Why?
Here’s the rub: over time, the body adjusts to its new state. While it doesn’t return to a depressive state, the memory of that past-tense lowered mood fades. A new sense of “normal” has taken its place. Meanwhile, the complexity of human life persists. For someone who has lost weight too, all the mythology of weight-loss utopia crumbles. For many weight-reduced people, their relationships do not improve as they had anticipated, nor do their health conditions to the degree that they expected (were virtually promised). If joint issues were an initial problem, then they may be exacerbated by the new exercise regimen, even if the body is lighter. The reality of present joint pain may well usurp the memory of depression and cause the person to pull back on their exercise, causing weight regain, which leads to a return and worsening of depression. (I call weight regain a special “slide into Hell,” because it is layered with suggestions of failure and judgment that are reinforced every time one turns on the TV or glimpses the cover of a magazine.) If the person manages to persist with an exercise regimen that maintains weight loss, then the rewards of that loss do not necessarily exceed the cost. This realization can also be a bitter pill to swallow.
I think a sense of reality and stoicism are useful. Sadly, society keeps promoting this utopic, zippy “healthy lifestyle” imagery that is nearly impossible for most people to sustain in the “real” and complex world.
Friday, February 25, 2011
My guess (based on my own n=1 experiment) is that changes in mood are related more to nutrient intake than anything else. When I am “on track” eating whole, “real” foods with their higher intakes of vitamins (especially the fat-soluble ones) and minerals, I find my mood improves dramatically well before any significant weight loss occurs. And of course, if I slip and wind up eating SAD for more than a day or two, well, my mood pays the price!
That said, there could also be other actions at work. I suspect that ketogenic diets also improve mood (perhaps related to the idea that brain is quite happy with ketones for fuel). Again, this is actually unrelated to weight loss, but is more about feeding the brain.
Friday, February 25, 2011
I find for me personally, having lost 150lbs and having dealt with clinical depression since I was (officially) diagnosed in 1994 that while the bouts of depression are around the same in frequency, the severity of my depression is actually more now than it was when morbidly obese.
This is with both physical increase in exercise and change of eating habits. I wonder though how much hormonal imbalances play into that. Not being in the medical profession I can’t really appreciate or understand what my hormones are doing with this kind of weight loss but I can tell by physical things happening to my body that they are “out of whack” and I wonder if that could be something that is contributing to the depression.
I can say though, for me personally, that even with the change of lifestyle part of the depression comes from the physical effects of losing 150lbs, ie: saggy skin, sores on the skin, etc. It messes with the head to go from being over 300lbs to an (almost) “normal” body weight and having to deal with the issues of still feeling unattractive (if not more unattractive with the weight loss than prior to the weight loss). I was never naive enough to believe I wouldn’t have issues with my skin with massive weight loss, but I was never really prepared for just how bad it would be and how much of an effect it would have on me, mentally.
Friday, February 25, 2011
In my case, (n=1), there has been no depression since switching my lifestyle to Paleo, proportioned along the lines of Protein Power, or LoBag. No sugar, grains, lubricants or manufactured eatable products.
The website http://evolutionarypsychiatry.blogspot.com/ claims a bunch of mental improvements.
Based on the speed of depression lifting, I think it has more to do with blood sugar/insulin/hyperinsulinemia than weight loss. I used Dr. P. Maffetone’s Carbohydrate Intolerance two week test to set my carbohydrate level, and by the end of two weeks clean the depression was gone, and I knew how little carbohydrate I could tolerate.
But what do I know.
Friday, February 25, 2011
Here we go again which came first the chicken or the egg. Should an obese individual have undiagnosed depression it is very likely that a sudden change in eating paterns will make the depression symtoms more manifest. One eating less requires self-displine–which is often a challenge for an individual with depression. For those who like to eat here emotions away–dealing with emotions in a different manner is tiring–being tired is a symtom of depression. If the individual should feel powerless the food is something which he/she has power over so dieting will make the person realize his/her powerlessness–another symtom of depression. Seeing my weight go down is very enpowering and encouraging–two emtions that a depressed person often lack.
Therefore, not dealing with depression whether is shows up during weight loss or before is not very wise. many with depression are overweight or obese and there are many reasons for this–some find confort in high fat high sugar foods. While others lose interrest in physical activity. While others gain weight due to there medications. Therefore if weight lose causes depression I would think (as a mental health consumer) That the depression was already there–just that it was well buried because of other issues and coping stratigies. Thank you
Sunday, February 27, 2011
For a writeup from a psychiatrist, including a link to a study showing exercise to be as effective as Zoloft:
http://www.psycheducation.org/hormones/Insulin/exercise.htm
Monday, February 28, 2011
For me, any kind of sustained food intake limitation drives me in the end into a state very close to depression (I’m talking suicidal thoughts here, not just feeling moody), where it’s just not worth living if I have to constantly watch every morsel I eat, until I can’t stand it anymore. Then there’s a short period of “what the heck” where I regain my weight or more, until I can muster enough willpower to try again.
On the other hand, in my experience it’s next to impossible to start a diet if I’m depressed – when you lack the will to brush your teeth, food is anything just out of the fridge or the pantry, just enough to make your stomach shut up. As you can imagine, I’m the kind of person who actually gains weight when depressed.
Tuesday, March 1, 2011
I have depression and I’m overweight. Its my experience that in general increased activivity has improved my mood. But let me throw a further complication into this debate: rather than going to the gym as before, I have taken up activities that have a greater social componant and certainly a greater fun componant, like skiing, riding horses, sailing and golf. I’m wondering if the improvement in mood is due to the greater social acceptance I feel through engaging in these activities. In addition, they are all outdoor activities and I’m getting more sunlight which could be a factor too. Note I haven’t lost any weight!
Friday, March 18, 2011
great info i was not aware of this but it makes perfect sense