Download OBESITY and MOOD DISORDERS

OBESITY and
MOOD DISORDERS
The Obesity Epidemic
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Obesity is America's fastest growing
health concern.
According to the National Institute of
Diabetes & Digestive & Kidney Diseases
(NIDDK), over 60% of Americans are
obese.
Compared to 1991 statistics, it has
increased by about 33%.
The Obesity Epidemic
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Eight out of ten people over 25
years of age in the U.S. are
overweight, 75% are not meeting
recommended basic activity level,
and 25% are completely inactive.
Obesity in Iran
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The whole prevalence of abnormal BMI
was 73.3%.
Of these 44.1% were overweight and
29.2% were obese.
Percentages for overweight were 82%
and 63.2% for women and men
respectively.
Sarvghadi F, Rambod M, Hosseinpanah F, Hedayati M, Tohidi M, Azizi F.
Obesity Research Center, Research Institute for Endocrine Sciences, Shaheed
Beheshti University of Medical Sciences, Tehran, Iran
Saudi Arabia
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The prevalence of obesity in Saudi
Arabia ranged from 14% in children
under 6 years to about 83% in adults.
Women were more prone to be
overweight or obese than men.
Factors associated with obesity were
age, sex, socio-economic status,
employment, education, and parity.
Khalid A Madani, MPH, DSc. Bahrain Medical Bulletin, Vol. 22, No. 3, Sep. 2000
The burden of obesity – costly, deadly
The financial burden of
obesity:
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WHO data show that obesity
accounts for 5-10% of the
total health care budget in
several developed countries
This is probably a low
estimate as not all of the cost
of management of obesity
and its related problems can
be calculated
The morbidity and mortality burden
of obesity:
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In 2000, the U.S. spent $117
billion on obesity (9% of the
national total health budget)
Overall, about 2.5 millions deaths are
attributed to overweight/obesity worldwide
In the UK, about 30,000 deaths are
attributable to obesity. Ten times this figure
occurs in the US where obesity is the
second greatest preventable cause of death
following smoking
Nearly 70% of cases of cardiovascular
disease are associated with obesity
Obesity predisposes to an overall reduction
of quality of life and premature death from
diet related, chronic non-communicable
diseases
Problems Associated with
Obesity
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Type II Diabetes,
Coronary Heart disease,
Cancer,
Hypertension (high blood pressure),
Cardio-respiratory Dysfunction,
Stroke,
Congestive Heart failure,
Problems Associated with Obesity
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Restrictive Lung Disease,
Pickwickian Syndrome (falling asleep while sitting up)
Degenerative Arthritis in the lower extremity joints
and spine,
Gallbladder Disease,
Infertility,
Varicose Veins,
Stasis Ulcer, and
Psychosocial incapacity (group acceptance, getting a
job, etc).
Stress and Obesity
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Stress plays a major role in besity. Emotions
and environment stress affects a person's
overeating pattern significantly .
Emotional status plays upon the mind of the
person while he is eating something.
When people are not in an emotionally stable
position due to some stress they tend to fall
back to over eating.
Stress and Obesity
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In psychological thought, there are
two chief standpoints on obesity,
the externality hypothesis and the
psychodynamic hypothesis
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Overeating is considered to be a means
of diminishing anxiety, relieving
frustration and deprivation, sedating
oneself, diminishing guilt and handling
anxiety.
Rakoff and Garetz describe overeating
as a means of coping with emotions
such as anxiety, anger, despair, and
depression all of which are associated
with stress
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The obese person may use food in
an attempt to regain a sense of self
control when that sense is
disturbed
Psychological factors for
obesity
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Psychological factors also influence eating
habits.
Many people eat in response to negative
emotions such as boredom, sadness, or
anger.
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Up to 10 percent of people who are
mildly obese and try to lose weight
on their own or through
commercial weight loss programs
have binge eating disorder.
This disorder is even more common
in people who are severely obese.
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Those with severe binge eating
problems are likely to have symptoms
of depression and low self-esteem.
These people may have more difficulty
losing weight and keeping it off than
people without binge eating problems.
How do psychological factors influence
eating (and overeating)?
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Mood regulation
People eat to make themselves feel
better when they experience stress,
anxiety, or depression.
 Females eat more when depressed
than males ( Rozin & Fallon,1988).
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How do psychological factors influence
eating (and overeating)?
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Restraint theory – internal physiological signals cue hunger .
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when people are trying to lose weight they
ignore internal signals, and use cognitive
rules to limit their intake
Cognitive rules related to “forbidden foods”
and “all-or-none” approach. If violated all
is lost therefore over consumption occurs.
Mood influences eating in restrained
eaters, when played sad music restrained
eaters ate more.
Psychological aspects of
obesity
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Obese people show more psychiatric disturbance.
There appear to be no global personality traits or
profiles that are associated with obesity.
However, obese people differ from non-obese
groups on psychological and behavioral variables
related to weight and eating and more frequently
display perceptual and emotional body image
anomalies.
Binge eating is common among obese groups .
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Restraint theory not always a good
predictor of eating behavior – Lowe (1993)
How do psychological factors influence
eating (and overeating)?
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Lifestyle and culture
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people eat more when with others – social
cues – .
What mothers eat while pregnant may
influence taste preferences in children –
Mennela et al. (2001) study with
expectant mothers drinking carrot juice
culture influences types of food and tastes
– dog or snake for dinner?
cultural factors like availability and
amount of food contribute to obesity –
U.S. has highest rate of obesity – change
in proportions over the years, the
“supersize” generation and video games.
Summary
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obesity results from a complex interplay of several
factors; genetic, environmental (lifestyle and
dietary), cultural, socio-economic, psychological and
medical conditions
rapid urbanization and economic development have
led to changing lifestyles and diets across the world
which promote excessive weight gain.
an increasing incidence of obesity is also being seen
in the poor, developing countries of the world.
Health Consequences of
Obesity
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Mental
- depression
- anxiety
- personality disorder
- self esteem
- etc
Psychological factors
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Psychological factors influence eating habits and
obesity.
Many people eat in response to negative emotions
such as boredom, sadness, or anger.
While most overweight people have no more
psychological disturbances than people at their
normal weight, about 30% of people who seek
treatment for serious weight problems have
difficulties with binge eating.
Barriers to Weight
Management
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Socio-economic?
Emotional?
Comorbidities?
Medications?
Saboteurs?
Substance abuse?
Genetics?
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Depression, anxiety, and other mood
disorders are associated with both eating
disorders and obesity.
Adolescents who are depressed may be at an
increased risk of becoming obese. One
recent study found that depressed
adolescents were two times more likely to
become obese at the one year follow up than
teens who did not suffer from depression.
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Many people with eating disorders suffer
from clinical depression, anxiety, personality
or substance abuse disorders, or in some
cases obsessive compulsive disorder.
Therefore, a mental health professional may
need to be involved in treating an individual
who is obese or suffers from an eating
disorder or other weight-related problem.
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Fonseca and colleagues aimed to identify
psychosocial and lifestyle behaviors which
distinguish overweight and obese teens from their
lean peers.
The study included 6131 students aged 11-16 who
completed questionnaires on their body weight,
body image, diet history, life satisfaction, health
perception, peer group involvement, happiness,
irritability and alcohol use.
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They report that overweight and obese
individuals were more likely to perceive
others as making less positive, and more
negative comments about them.
Further, overweight and obese teens found it
more difficult to become involved with their
peer group, were more likely to report being
unhappy, and more likely to report abusing
alcohol.
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One may need to recount certain past
incidents and habits to verify and confirm if
mental factors behind your abnormal weight
gain. The following points would authenticate
the psychological aspects of obesity:
If your binge eating habit is prompted and
initiated by stress, anger etc., the cause of
obesity is probably psychological
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It is a well-known fact that obesity and overweight
predisposition, which has its beginning in the
adolescence are likely to have psychological
influences.
When young people fail to come into terms with
their psychological insights, they generally indulge
in unhealthy eating practices, that can lead to a
permanent overweight or obesity.
And when one’s obesity has at least a faint clue of
mental undertones, the extra pounds become pretty
difficult to lose
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Certain events in life tend to raise the level of
stress in people. It inculcates in us a habit of
getting ourselves off the stressful situation in the
way we know best. It is common knowledge that
we falter in the face of emotions like rage, grief,
love, anger etc. Many of these emotions may relate
to food, like a history of being overfed. When a
food associated stress hits us, we tend to eat to
relieve the stress. This can lead to obesity due to
overeating.
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it has been well substantiated and
demonstrated that many people with
binge eating disorder have lived
through bouts of depression and low
self-esteem even before they became
obese and overweight.
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With overweight people who overeat to the point of
obesity, the following steps occurs, :
Feeling lonely, desperate or dejected
Eating to feel better and alleviate some of the
depressive symptoms
Self loathing about the overeating that just
occurred
Beginning back at #1 again… and again… and
again
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The Psychological Scars of Weight
Gain and Obesity
The psychological pain caused by
obesity often includes self loathing,
awkwardness and avoidance of social
situations and nurturing a love/hate
relationship with food, resulting in
emotional and mental scars.
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The most rigorous clinical studies suggest that (1).
children and adolescents with major depressive
disorder may be at increased risk for developing
overweight; (2). patients with bipolar disorder may
have elevated rates of overweight, obesity, and
abdominal obesity; and (3). obese persons seeking
weight-loss treatment may have elevated rates of
depressive and bipolar disorders.
The most rigorous community studies suggest that
(1). depression with atypical symptoms in females
is significantly more likely to be associated with
overweight than depression with typical
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(2). obesity is associated with major depressive disorder in
females; and (3). abdominal obesity may be associated with
depressive symptoms in females and males; but (4). most
overweight and obese persons in the community do not
have mood disorders. Studies of phenomenology,
comorbidity, family history, biology, and pharmacologic
treatment response of mood disorders and obesity show
that both conditions share many similarities along all of
these indices.
McElroy SL, Kotwal R, Malhotra S, Nelson EB, Keck PE, Nemeroff CB. J Clin
Psychiatry. 2005 Feb;66(2):265.
Obesity Linked to Mood
Disorders
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Obese people are 25% more likely to suffer mood and
anxiety disorders -- and 25% less likely to suffer substance
abuse disorders -- than people who aren't obese.
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The survey shows that, compared with people who are not
obese, obese people are:
21% more likely to suffer major depression
47% more likely to suffer bipolar disorder
27% more likely to suffer panic disorder or fear of open
places
22% less likely to suffer substance use disorders.
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Daniel J. DeNoon, WebMD Health News
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Psychological and social
of obesity effects
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Emotional suffering may be one of the most
painful parts of obesity.
Most societies emphasize physical
appearance and often equates attractiveness
with slimness, especially for women.
Such messages make overweight people feel
unattractive.
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Many people think that obese individuals are
gluttonous, lazy, or both, even though this is
not true.
As a result, obese people often face
prejudice or discrimination in the job market,
at school, and in social situations.
Feelings of rejection, shame, or depression
are common.