Obesity and depression are two unfortunately common problems in the United States and several other parts of the world today. Alone, each of these disorders can have a devastating impact on a person’s health, mental well-being, and ability to live a satisfactory life. But when they occur in tandem, the potential devastation can be exponentially more severe.
As is often the case with co-occurring disorders, people who are struggling with both obesity and depression risk falling into a downward spiral of ever-worsening symptoms, as the two disorders influence and exacerbate each other. For example, depression may cause a person to overeat, which leads to greater weight gain, which intensifies feelings of shame and failure, which pushes the afflicted individual into deeper depression. In cases like this, it is essential to get treatment that addresses both the obesity and the depression.
The good news is that both obesity and depression are highly treatable disorders and, with the right help, that downward spiral can transform into a cycle of success.
Statistics Show More Show Less
The obesity rate among American adults ages 18 and above has been on an upward trend since the 1970s, and currently stands at around 31% (various studies put the exact nationwide number as low as 27.7% and as high as 35.7%). Another 35% of U.S. adults meet the criteria for a diagnosis of overweight, which means that more than two-thirds of all adults in the United States weigh more than what is considered safe or healthy.
On the mental health side, about 19.7 million American adults (or about 8.5% of the population) meet the diagnostic criteria for either major depression or persistent depressive disorder.
Looking at this from a co-occurring disorder perspective, about 43% of adults with depression are also obese, a percentage that rises when adjusted to focus on individuals with more severe forms of depression. Coming at this problem from another angle, experts estimate that adults who meet the diagnostic criteria for obesity are 25% more likely to also be depressed than are those whose body mass index (BMI) is within the “normal” range.
The Connection Between Depression and Obesity Show More Show Less
No definitive cause/effect relationship has been established between depression and obesity. However, as indicated earlier on this page, anecdotal evidence and considerable research show a strong association between both disorders, with each exhibiting the potential to impact or exacerbate the other.
Lethargy, appetite changes, and withdrawal are three common symptoms of depression. Some depressed individuals experience a loss of appetite, while others find themselves eating much more than usual. Lack of activity and increased appetite are an ideal combination for weight gain, and an extended period of lethargy and overeating is a blueprint for becoming overweight, then obese.
Treatment for depression can reduce fatigue, normalize eating habits, and increase a person’s desire to resume a more active lifestyle. However, this does not mean that depression treatment is a surefire cure for weight-related problems. Relapse is far from uncommon during depression recovery, and patients whose overeating is directly tied to their depression can quickly slide back into unhealthy habits when they encounter obstacles to their continued mental health progress. Also, some medications that are commonly prescribed to treat depression can have the side effect of promoting weight gain. For example, experts estimate that about one in four depression patients who take selective serotonin reuptake inhibitors (SSRIs, a class that includes Prozac, Paxil, and Zoloft) gain 10 pounds or more.
Continued weight problems can also counteract a person’s efforts to overcome depression. Obesity is often accompanied by feelings of failure, shame, and self-loathing; emotions that are unfortunately often reinforced by societal biases and stigmas attached to being overweight. From bullying and mockery to job discrimination and even substandard medical care, obese individuals are at increased risk for experiencing a range of external stresses and pressures that can prompt depression, prevent recovery, and otherwise threaten their mental health.
Signs and Symptoms of Depression Show More Show Less
Regardless of a person’s weight, depression can manifest via a variety of thoughts, emotions, and behaviors. The experience of depression can vary widely depending upon a number of factors, but the following are among the more common signs and symptoms that may suggest a person is struggling with depression:
- Withdrawal and isolation
- Loss of interest in issues or activities that were previously very important and/or the source of pleasure
- Change in appetite
- Lethargy, exhaustion, and fatigue
- Feelings of shame and guilt
- Feelings of failure and hopelessness
- Inability to concentrate or focus
- Neglect of grooming and personal hygiene
- Dramatic mood swings
- Expressions of self-hatred
- Thoughts of (or attempts to commit) suicide
Effects of Depression When an Individual is Battling a Weight Concern Show More Show Less
As suggested above, depression can have a strong impact on a person’s efforts to achieve and maintain a healthy weight. In order to put the patient in the best possible position for long-term success, an effective weight maintenance plan should also identify and address depression or any other mental health issues. Three of the most important elements in an obesity treatment program are motivation, nutrition, and activity. Unfortunately, depression can impede progress in all three of these areas.
Depression can prompt unhealthy changes in appetite, leading to overeating as well as a desire for junk food, fast food, and other less-than-nutritious options. Breaking poor eating habits can be difficult for even the most focused and motivated patients; for patients whose appetites have been affected by their mental health challenges, this effort can be much more challenging. Also, some depressed individuals abuse food the way that others abuse alcohol or other drugs in a misguided effort to self-medicate or ease their symptoms. If the depression is not addressed as part of the obesity treatment, the patient’s ability to make effective diet/nutrition changes can be doomed from the start.
Another common symptom of depression is fatigue. Both major depression and persistent depressive disorder can make it difficult for people to summon the energy and focus that are necessary to establish and maintain an effective exercise regimen. Not matter how badly a person’s body needs regular activity, the deep fatigue (and related desire to withdraw and isolate) of depression can prevent progress before it even begins.
Finally, depression can have a devastating effect on a person’s motivation, concentration, and self-esteem, all of which are essential when faced with the challenge of achieving significant weight loss, and then maintaining that success. Overcoming obesity is a long-term process that will tax a person’s mind, body, and spirit. Both significant progress and temporary setbacks present challenges that can derail the effort and, if a person is already struggling with a lack of motivation or low self-esteem, it will be difficult if not impossible to maintain the focus and discipline that are necessary to achieve ultimate success.
Co-Occurring Mental Health Disorders Show More Show Less
The following disorders are common among individuals who are struggling with obesity. While obesity is associated with these issues, it is important to understand that no cause/effect relationship has been established.
- Chronic pain
- Substance use disorders
- Anxiety disorders
- Panic disorder
- Binge-eating disorder
Treatment for Depression When an Individual is Battling a Weight Concern Show More Show Less
When a person is receiving treatment for depression while also working to overcome obesity, attention must be paid to the physical and emotional strain of the weight loss effort. For example, it is important to determine if changes in weight, appetite, energy, self-esteem, and related issues are the result of the depression treatment or have been influenced by the weight loss effort. For example, therapy-related improvements in mood or outlook can be masked by stresses related to weight setbacks. Similarly, improved energy and motivation because of effective medication management may be counteracted by exhaustion related to changes in diet or exercise patterns.
As is always the case in mental healthcare, the most effective depression treatment for an overweight or obese person will be holistic in nature and will identify and address all issues that may be influencing the patient’s continued mental and physical health problems.