Mental Health’s Effect on Your Weight

Learn about the link between mental health and obesity, and what you might do about it. By: Marijke Vroomen Durning, RN Mental health and physical health are interconnected. One often affects the other. This is especially true when it comes to weight and obesity. If you’re struggling with weight — whether it’s gaining the pounds or trying to lose them — you need support from your health care team and your mental health has to be taken into account. Let’s start with the more common mental health issues that many of us face: anxiety, chronic stress, and depression. Depression and Anxiety Can Play a Role “When people are depressed or anxious, they often engage in emotional or comfort eating. These foods are typically high in calories and unhealthy,” says Renee Solomon, PsyD, a clinical psychologist and CEO of Forward Recovery in Los Angeles, California. Stress changes how you react to things, and it can lead to impulse control and affect your judgment. This means you might be more likely to reach for that so-called forbidden food or you might decide you don’t need to go for that walk or gym session. The result is sudden comfort or relief from what’s bothering you, rather than looking at the long-term. photo of overweight couple doing yoga When people are depressed or anxious, they often also experience sleep disturbances and fatigue, Solomon says. “[This] can also throw off the regulation of the body and make people think that they are hungry when they are actually tired.” Anxiety and major depressive disorder can increase cortisol, a steroid hormone, which in turn increases your appetite. In other words, the higher cortisol levels alter your brain and it’s now telling you that you’re hungry when you’re not. So you’re not imagining the increased cravings and feeling of hunger when you’re depressed or anxious. “When people are depressed or anxious, they often engage in emotional or comfort eating. These foods are typically high in calories and unhealthy.” Renee Solomon, PsyD Food is sometimes a way to help us cope through tough times as well. “Eating behaviors like emotional eating or eating to soothe emotions or numb from distressing thoughts or emotions can be a temporary maladaptive coping strategy or can become a full eating disorder,” says Janet Lydecker, PhD, associate professor of psychiatry at Yale School of Medicine. This type of eating can lead to weight gain, and weight gain can lead to further depression or anxiety. Other Mental Health Disorders Other mental health disorders can have a significant effect on your health, but sometimes the mental health diagnosis is only made after someone has gained weight. For example, one study found that people who had a body mass index (BMI) of 30 or higher, the medical definition of obesity, had a higher rate of being diagnosed with major depression, bipolar disorder, panic disorder, or agoraphobia at some point in their life. Remember, though, this doesn’t mean that everyone who has a high BMI will or does have any of these disorders. The study just found that more people who live with obesity have these disorders than those who don’t live with it. People who have schizophrenia also have a higher rate of obesity, but it’s more likely the medication used to treat the disease that causes the weight gain rather than the disease. This is the same for bipolar disorder and major depression disorder. “It’s also important to note that there are some psychiatric medications that can change appetite and weight, for example, medications that treat persistent depression or schizophrenia,” Lydecker says. “It’s tough to balance the treatment of these debilitating disorders with preventing metabolic health problems that can come from being on these medications long-term.” Balancing Mental Health Treatment and Weight-Related Concerns Living with a mental health disorder is tough enough, but when it’s combined with obesity, and its related physical health issues and how society looks at you, it can be much tougher. Treating the mental health disorder is vital, but the physical side is as well, so doctors must find a way to balance that care. “For the most part, how treatment is approached by providers depends on the patient’s goals and the history of the problem they’re experiencing,” Lydecker explains. Mental health professionals tend to focus on the underlying problem — the mental health issue — because it’s more likely that the added problems, like weight gain, may also improve at the same time. But if the weight gain is being caused by the treatment, then other options might be available. “[Dieticians] can help people map out a healthy eating plan and work on developing intuitive eating.” Renee Solomon, PsyD “There are many ways to treat mental illness and obesity,” Solomon says. “If medication is causing the weight gain, there are certain medications that are less likely to cause weight gain. These can be explored with a primary care doctor or a psychiatrist.” She also suggests exploring the use of the new weight loss drugs because they could be helpful for some people. “There are many medications right now that have been proven to help with treating obesity such as the GLP-1 medications.” Studies have shown that one of these medications, liraglutide, may be the most effective for people who are gaining weight due to antipsychotic medications and it doesn’t seem to have negative effects on the antipsychotic treatment. For extreme weight gain, there might be a conversation about gastric surgery — either bands, sleeves, or bypass — called bariatric surgery. But this isn’t a solution for everyone. Researchers found that while the quality of life might improve after bariatric surgery, it doesn’t seem to be all that helpful in improving mental health overall. That doesn’t mean you can’t discuss this with your doctor, though, if you’ve tried everything else. It might be an option to think about. So What Can You Do? Speaking to your doctor about your concerns is the first step. Understand that weight gain may be part of the illness or its treatment, but there might be steps you can take to help slow down or stop the weight gain, or even reverse it. If you are taking medications that can cause weight gain, ask if there are other drugs you can try. If not, ask your doctor if there are other options. For some, it’s going to therapy as well as taking medications. For example, Solomon says that cognitive behavioral therapy can be very helpful for people who have anxiety or depression. She also recommends getting a referral for a dietitian or nutritionist: “They can help people map out a healthy eating plan and work on developing intuitive eating.” If you don’t have insurance or it doesn’t cover dietitian services, there might be community services that are free, either individual or in a group. Don’t be shy about asking around for any resources that might be available to you. webmd.com