Obesity is common, serious and costly. At the time of publication the CDC reported that a third (33.8%) of the U.S. population is obese and no state met the Healthy Peoples’ goal for 2010 to decrease the rate of obesity to 15%.
Importance of Decreasing Obesity
This condition is crucial to control, due to the health risks for obese individuals. According to the WHO, obese individuals are at significantly increased risk for developing numerous health problems including, “coronary heart disease (CHD), hypertension, stroke, high cholesterol, gout, osteoarthritis, sleep problems, asthma, skin conditions and some types of cancer.”
In addition, it can cause serious mental health problems. While not categorized in the Diagnostic and Statistical Manual as a disorder so as not to stigmatize those with medical illnesses resulting in obesity or who are unable to lose the weight due to a natural set point, according to the WHO it continues to be a major cause of depression, eating disorders, distorted body image and lowered self-esteem.
Mental Health and Obesity
The Swedish Obesity study carried out in 1993 was one of the first to discover high rates of severe mental health problems in obese individuals including significantly higher rates of suicide, either directly or indirectly caused. Also, these mental health problems were shown to continue long after individuals obtain a "normal" body weight.
Somewhat different findings resulted from research conducted by the National Institutes of Health. Acording to the NIH, severe mental disorders, such as binge eating disorder and major affective disorders predict obesity as opposed to being a result of obesity.
A third area of research with produced yet more contradictory findings was conducted by Herpertz and collegues who examined the predictive value of post-operative mental distress on post-operative bariatric surgery weight loss. The authors concluded “contrary to distress independent of or only reinforced by obesity, obesity-associated psychological distress such as low self-esteem, depression and anxiety, and social phobia resulting in social isolation probably predicts more postsurgical weight loss. Patients suffering from serious and chronic psychiatric diseases such as personality disorders might have more difficulties in adapting to the major demands of controlled eating behavior imposed on them by the operation.” Thus, the effects of psychological distress are similar to what is seen in non-obese individuals. Mainly, that extreme negative mental state frequently results in weight loss. As weight loss after bariatric surgery is the goal, the psychological effects may be ignored. This can result in social isolation, agoraphobia, and potentially suicide, as these individuals feel subjective distress which is ignored while being praised for objective weight loss which they can’t appreciate due to their mental state.
Implications
In conclusion, the relationship between mental health and obesity is quite complex. On the one hand, literature shows that obesity results in not only physical health risks but serious mental health risks as well. Yet other studies have demonstrated that mental health problems predict obesity in certain cases. Finally severe mental health problems following bariatric surgery have been associated with increased weight loss or the desired outcome. Regardless of the mechanisms through which mental health effects or is affected by obesity and weight loss, it is important for health care professionals to recognize it has been shown in a wide variety of research that relationship does exist though it may differ from individual to individual. This is an ideal example of a disorder that would greatly benefit from the collaborative model including not only physicians, nutritionists and exercise professionals but also a mental health specialist in order to insure the greatest improvement and quality of life for obese individuals.
Sources
Centers for Disease Control and Prevention, Overweight and Obesity; U.S. Obesity Trends. Retrieved August 13, 2011.
Herpertz, S., Kielmann, R., Wolf, A. M., Hebebrand, J. & Senf, W, (2004). Do Psychosocial Variables Predict Weight Loss or Mental Health after Obesity Surgery? A Systematic Review. Obesity Research, 12, 1554–1569; doi: 10.1038/oby.195.
National Institutes of Health. (1998) Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults: the evidence report. Obes Res 6(Suppl 2): 51–209S.
Sullivan, M. et al. Swedish obese subjects (SOS) – an intervention study of obesity. Baseline evaluation of health and psychosocial functioning in the first 1743 subjects examined. International Journal of Obesity and Related Metabolic Disorders, Vol. 17, September 1993, p. 503-12.
World Health Organization, Obesity, Retrieved August 12, 2011. http://www.who.int/topics/obesity/en/
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