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Mental health and being overweight

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I am currently doing my psychiatry rotations, and I am SHOCKED to see how depression and anxiety ruins peoples’ lives. Keep in mind that I’m talking about CLINICAL depression and anxiety. This is NOT the same as feeling sad after a tragic event or feeling anxious due to stress at work. A severe clinical depression is PERSISTENT DAILY depressed mood or loss of interests together with guilt, inability to concentrate, loss of appetite, disrupted sleep, inability to get out of bed and suicidal thoughts. Symptoms are so severe that the affected person is unable to function in their everyday life for at least two weeks. Some patients are so deep in their depression that the only treatment that helps them is a series of electric shocks to their brain (electroconvulsive therapy, which surprisingly can help up to 90% of severe psychotic depressions!).

Despite so many people affected, we STILL don’t know what causes depression. One condition that is linked to depression is obesity. Remember though, we don’t know what is causing what here. Observational studies find that depressed people tend to develop obesity, but also that obese people risk developing depression (as well as bipolar disorder and panic syndrome). Overweight women are at higher risk than men. Still, we can’t know if the increased risk in these groups is due to body fat, social stress, smoking, or simply genetics.

Interestingly, a meta-analysis of 36 studies found that psychological therapies can help with weight loss (on average 2.5 kg compared to placebo therapy). Adding changes in exercise and diet to these therapies could boost weight loss up to 4.9 kg. While this might not seem like much, it can make big differences in terms of risk of heart disease. Unfortunately, we know of no studies looking at how therapy affects risk of death, heart disease or quality of life in obese individuals.

Take home: mental health plays a role in weight loss, and many times as a coach there might be a depression or eating disorder coupled with obesity. As doctors, we hope for a future were personal trainers and physicians can work closely together to optimize for physical and mental well-being for affected people.

THE EVIDENCE:
Shaw et al. Psychological interventions for overweight or obesity. Cochrane Database Syst Rev. 2009 Jan:CD003818.pub2.

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