Navigating the intersection of obesity and mental health

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Table of Contents

Explore the linkages among obesity, psychological wellbeing, nutritious eating and medications. 

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A multi-faceted problem: Obesity’s ramifications beyond the body

Obesity is a complex issue affecting not just fitness but with profound implications for psychological wellbeing. Research has demonstrated those with extra weight often battle with mood disorders, diminished self-image, and a negative body image, highlighting the intersection of weight and mental health. Successful weight management has been associated with improvements in both the sense of self and in actual psychosocial status and functioning.

In addition to the psychological implications, weight-based discrimination contributes to mental health challenges for overweight individuals. Discrimination exacerbates existing mental health conditions and leads to increased levels of anxiety, depression, and other mood disorders. Moreover, the prevalence of adverse childhood experiences among individuals with obesity underscores the subtle interplay between early life trauma, mental health issues, and weight management. Addressing these interwoven factors through a holistic approach that includes mental health support, dietary interventions and medical treatment, when indicated, is essential for promoting overall well-being and quality of life.

The Impact of Excess Weight on Psychological Well-being

Excess weight not only affects one’s physical condition, but one’s emotional state as well. Many individuals struggling with their size battle depressed mood, poor self-image, and diminished confidence. Society’s prejudices toward obesity can instill sentiments of shame, defensive detachment from others, and inferior self-worth – all risk factors for developing or exacerbating mental health issues. 

Overweight individuals in addition suffer from actual discrimination as well, which need not always be overt, but results in various kinds of rejections, for example lower likelihood of being promoted. Well-intended campaigns to reduce discrimination by deliberately promoting obesity as normal show little signs of success; they appear mostly to make openly discriminatory comments socially unacceptable while driving discriminatory actions underground. However, they do have an effect on overweight individuals themselves, making them more likely to under-estimate their weight and increasing the well-known and quite serious medical dangers of obesity. These include:

  • All-causes of death and shortened lifespan (mortality).
  • High blood pressure (hypertension).
  • High LDL cholesterol, low HDL cholesterol, high levels of triglycerides (dyslipidemia).
  • Type 2 diabetes.
  • Coronary heart disease.
  • Stroke.
  • Gallbladder disease.
  • Osteoarthritis (a breakdown of cartilage and bone within a joint).
  • Sleep apnea and breathing problems.
  • Many types of cancer.
  • Chronic pain and difficulty with physical functioning

Reducing weight bolsters self-assurance, reduces stress levels, and enhances overall satisfaction, thereby positively impacting mental health. In contrast, the cycle of weight loss followed by re-gain can trigger demoralization and the return of even worse psychological symptoms, underscoring the delicate and dynamic nature of the association between excess weight and psychological wellbeing.

A balanced diet rich in crucial nutrients plays a significant role in managing both weight and psychological wellness. Fatty fish like salmon contain omega-3 fatty acids shown to boost mood and lessen signs of despair and unease. Similarly, vitamin D from sources such as fortified dairy or supplements, plus sunlight, is essential for physical and psychological health. Certain foods supply more than sustenance for the body—they also nourish mental stability.

Furthermore, a healthy post-procedure diet is crucial for those who undergo stomach shrinking surgery. Research demonstrates these procedures have the potential to enhance psychosocial well-being, personal satisfaction and general mental health. Behavior modification programs addressing both physical and psychological health, coupled to pharmacologic choices, all help manage weight successfully.

Low Carbohydrate and Ketogenic Diets

Diets low in carbohydrates work well for many people in losing weight relatively rapidly and in maintaining weight loss, as the Harvard School of Public Health advises. In addition, they report that:

A 20-year prospective study of 82,802 women looked at the relationship between lower carbohydrate diets and heart disease; a subsequent study looked at lower carbohydrate diets and risk of diabetes. Women who ate low-carbohydrate diets that were high in vegetable sources of fat or protein had a 30 percent lower risk of heart disease (4) and about a 20 percent lower risk of type 2 diabetes, (34) compared to women who ate high-carbohydrate, low-fat diets. But women who ate low-carbohydrate diets that were high in animal fats or proteins did not see any such benefits. (Halton TL, Willett WC, Liu S, et al. Low-carbohydrate-diet score and the risk of coronary heart disease in women. N Engl J Med. 2006;355:1991-2002)

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The Keto Diet showing types and proportions of food

A stricter variation of a low carbohydrate diet is the Ketogenic diet, requiring in addition to very low carbohydrate intake but also elevated fats. It is not widely known that this kind of diet was used in the 1800’s to manage diabetes; it did not just start with the Atkins diet craze. The Harvard School of Public health discusses its pros as cons. Its benefits include the following:

  • A satiating effect with decreased food cravings due to the high-fat content of the diet.
  • A decrease in appetite-stimulating hormones, such as insulin and ghrelin, when eating restricted amounts of carbohydrate.
  • A direct hunger-reducing role of ketone bodies—the body’s main fuel source on the diet.
  • Increased calorie expenditure due to the metabolic effects of converting fat and protein to glucose.
  • Promotion of fat loss versus lean body mass, partly due to decreased insulin levels.

They caution however:

Some negative side effects of a long-term ketogenic diet have been suggested, including increased risk of kidney stones and osteoporosis, and increased blood levels of uric acid (a risk factor for gout). Possible nutrient deficiencies may arise if a variety of recommended foods on the ketogenic diet are not included. It is important to not solely focus on eating high-fat foods, but to include a daily variety of the allowed meats, fish, vegetables, fruits, nuts, and seeds to ensure adequate intakes of fiber, B vitamins, and minerals (iron, magnesium, zinc)—nutrients typically found in foods like whole grains that are restricted from the diet. Because whole food groups are excluded, assistance from a registered dietitian may be beneficial in creating a ketogenic diet that minimizes nutrient deficiencies.

A ketogenic diet is best undertaken with the supervision of a physician and dietician.

Obesity and Psychiatric Treatment

The relationship connecting weight with mental health is evident in increased risks for those experiencing obesity. For example, individuals managing excessive weight confront elevated rates of major depression, mood variations, schizophrenia, ADHD, and trauma, highlighting how profoundly body mass and psychological wellness intersect. 

It is important to acknowledge that certain medicines recommended for psychological issues can lead to weight gain as an unwanted effect, potentially exacerbating the struggles faced by people with both obesity and mental health. Weight gain is the single most common reason that people will stop a psychiatric medication, even when doing so places their stability, emotional well-being, job and relationships at risk. This fact underscores, of course, just how important maintaining a healthy weight can be for many people’s sense of self. It is equally important for physicians to understand how important a factor this is and take it seriously into account when prescribing. That a medication works might be the most important criterion in advising its use and continuation, but it is not the only factor.

That said, it is likewise important for patients to understand that just because weight gain is listed as a possible side effect does not mean it is a certain side effect. One should not avoid a potentially very helpful medication in advance simply because it might cause weight gain (or other unacceptable but reversible side effects). If recommended for good reason it should be tried at low doses first and the results assessed. To continue it, it must work (of course) but also show no evidence of causing weight gain. Otherwise, it needs to be stopped. The types of psychiatric medications that might cause weight gain are:

High Risk of Weight Gain

  1. Olanzapine (Zyprexa): 6-7 patients out of 10 experience significant weight gain, 3-4 do not.
  2. Clozapine (Clozaril): 5-6 patients out of 10 experience significant weight gain, 4-5 do not.
  3. Quetiapine (Seroquel): 4-5 patients out of 10 experience moderate to significant weight gain, 5-6 do not
  4. Mirtazapine (Remeron): 3-4 patients out of 10 experience moderate weight gain, 6-7 do not.

Moderate Risk of Weight Gain

  1. Risperidone (Risperdal): 2-3 patients out of 10 experience weight gain, 7-8 do not.
  2. Lithium: 2-3 patients of 10 experience moderate weight gain, 7-8 do not. 
  3. Aripiprazole (Abilify): 2-3 patients of 10 experience moderate weight gain, 7-8 do not
  4. Valproate (Depakote): 2-3 patients out of 10 experience moderate weight gain, 7-8 do not.
  5. Amitriptyline (Elavil): 2 patients out of 10 experience weight gain, 8 do not.

Lower Risk of Weight Gain

  1. Haloperidol (Haldol): 1-2 of patients of 10 experience some weight gain, 8-9 do not.
  2. Carbamazepine (Tegretol): 1-2 patients of 10 experience slight weight gain, 8-9 do not.
  3. Sertraline (Zoloft): 1 patient of 10 experiences weight gain, 9 do not.
  4. Escitalopram (Lexapro): 1 patient of 10 experiences weight gain, 9 do not.

Lowest Risk of Weight Gain

  1. Bupropion (Wellbutrin): Less than 1 patient of 10 experiences slight weight gain, more than 9 of 10 do not and often associated with weight loss.
  2. Ziprasidone (Geodon): Less than 1 patient of 10 experiences weight gain, 9 do not.
  3. Viibryd: 

These percentages are based on clinical studies and can vary widely in real-world scenarios. Factors such as diet, lifestyle, duration of medication use, and individual metabolic differences significantly affect the likelihood of weight gain.

Diet Medications

Diet medications have varying degrees of success and various risks. They must be used, of course, under the supervision of a physician. 

There are seven FDA-approved medications for weight loss. You can find an excellent review of all of them, their pros and cons, at https://www.verywellhealth.com/7-fda-approved-drugs-for-weight-management-7568596

Surgery

When all else fails, there are seven different surgical procedures to assist with weight loss, suitable for different situations, two of which are reversible. Three are common in the US.

Conclusion

In conclusion, the intricate relationship between obesity, mental health conditions, and diet underscores the importance of adopting comprehensive approaches to health and wellness. By prioritizing both physical and psychological well-being through lifestyle modifications, individuals can achieve better overall health outcomes. Seeking professional help and support from mental health professionals is vital for effectively managing mental health disorders related to obesity and their treatment, while promoting holistic well-being. 

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