The tangled link between obesity and mental health

It might overtly not appear to be so, but there's an inextricable connection between obesity and mental health. There's enough scientific research out there that can be used to prove the verity of this statement. For instance, in an article titled, The Psychosocial Burden of Obesity, the writers David B. Sarwer, PhD and Heather M. Polonsky, BS cite several comprehensive reviews that suggested that between 20% and 60% of persons with obesity, and extreme obesity in particular, suffer from a psychiatric illness. Let's take a close look at the evidence that links obesity and mental health, explore how they impact each other and what can be done to c

Understanding the Obesity-Mental Health link
According to World Health Organisation (WHO), obesity is having a Body Mass Index (BMI) equal to or higher than 30.0. It is a complex condition resulting from various factors, including genetics, lifestyle, and environmental factors. Mental health, on the other hand, refers to a person's emotional, psychological, and social well-being. Mental health conditions can range from mild to severe and can include anxiety, depression, and bipolar disorder among others.

Research suggests that individuals with obesity have a 55% increased risk of developing depression over time. Conversely, people who suffer from depression are 58% more likely to develop obesity. This compelling evidence suggests that addressing one condition may positively impact the other.

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Can obesity lead to mental health problems?

Recent studies have highlighted a strong direct correlation between obesity and depression due to the physiological and psychological factors associated with excess body weight. Hormonal imbalances, chronic inflammation, and a negative body image can contribute to depression in obese individuals, leading to a complex interplay between physical and mental health. Obesity can lead to mental health problems due to various interconnected factors such as: 

1. Quality of life: Individuals struggling with obesity often face societal stigma and negative perceptions about their appearance, leading to low self-esteem and poor body image. The emotional toll of such biases can result in social withdrawal and isolation, further exacerbating mental health problems. 
2. Weight bias and discrimination: Obese individuals frequently encounter weight-based discrimination, leading to feelings of shame, guilt, and worthlessness. This constant mistreatment can trigger anxiety, depression, and other psychological issues. 
3. Poor body image: The societal pressure to conform to unrealistic beauty standards can take a severe toll on those with obesity, leading to body dysmorphic disorder and heightened anxiety about their appearance. 
4. Hormonal imbalance: Obesity is often associated with hormonal imbalances, including disruptions in the production of serotonin and dopamine. These chemicals play crucial roles in regulating mood and emotional stability. As a result, obesity can contribute to mood disorders like depression and anxiety.

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How does mental health affect obesity?

1. Emotional eating: Mental health problems such as stress, anxiety, and depression can trigger emotional eating or binge eating as a way to deal with these difficulties. Food, especially high-calorie, unhealthy options may temporarily relieve emotional distress. However, this behaviour can lead to weight gain and further perpetuate the cycle of poor mental and physical health. 
2. Sedentary lifestyle: Mental health problems can significantly impact an individual's motivation, energy levels and mood disorders. Those experiencing depression or anxiety may find it challenging to engage in physical activities, leading to a sedentary lifestyle and weight gain.
3. Low or no compliance to weight loss interventions: Addressing obesity involves lifestyle changes, dietary modifications and exercise routines. However, individuals grappling with mental health issues may find it challenging to adhere to these interventions due to a lack of motivation or self-discipline, hindering their weight loss journey. 
4. Binge Eating Disorder (BED): Psychiatric eating disorder characterised by recurrent episodes of binge eating without engaging in compensatory behaviours like purging, can lead to significant weight gain and obesity.

All these behaviours profoundly affect an individual's relationship with food and body image, requiring comprehensive psychological, nutritional, and medical support for recovery. Early detection and professional intervention are vital for effectively managing and treating these mental health conditions and promoting overall well-being.

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So, how does one break the cycle?
To address the complex interplay between obesity and mental health, a holistic approach is needed that includes the following steps:

1. Spread awareness and recognition: Raising awareness about the connection between obesity and mental health is crucial. Recognising both conditions as serious medical issues can reduce the stigma and provide better support for affected individuals. 
2. Identify common risk factors: Identifying common risk factors for obesity and mental health problems is vital. Genetic predisposition, childhood trauma and unhealthy lifestyle habits are shared factors that can be addressed through targeted interventions. 
3. Integrated treatment approaches: Combining therapy, medication, nutritional plans and lifestyle modifications can effectively manage obesity and mental health issues. Collaborative efforts between healthcare professionals from different specialties can yield comprehensive and successful outcomes. 

The relationship between obesity and mental health is multifaceted, with a complex interplay of biological, psychological and social factors. It is crucial to approach these issues with empathy, understanding and evidence-based strategies. By recognising the bidirectional connection and implementing integrated treatment approaches, a more compassionate and effective approach can be drawn to support individuals dealing with these challenging conditions.

Dr Aman Priya Khanna is a General, Laser, Bariatric, and Minimal Access Surgeon. He is also co-founder and medical director of HexaHealth.

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