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OBESITY and MOOD DISORDERS The Obesity Epidemic 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 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 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 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: 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: 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 Type II Diabetes, Coronary Heart disease, Cancer, Hypertension (high blood pressure), Cardio-respiratory Dysfunction, Stroke, Congestive Heart failure, Problems Associated with Obesity 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 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 In psychological thought, there are two chief standpoints on obesity, the externality hypothesis and the psychodynamic hypothesis 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 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 Psychological factors also influence eating habits. Many people eat in response to negative emotions such as boredom, sadness, or anger. 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. 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)? 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). How do psychological factors influence eating (and overeating)? Restraint theory – internal physiological signals cue hunger . 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 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 . Restraint theory not always a good predictor of eating behavior – Lowe (1993) How do psychological factors influence eating (and overeating)? Lifestyle and culture 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 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 Mental - depression - anxiety - personality disorder - self esteem - etc Psychological factors 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 Socio-economic? Emotional? Comorbidities? Medications? Saboteurs? Substance abuse? Genetics? 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. 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. 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. 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. 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 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 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. 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. 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 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. 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 (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 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. 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. Daniel J. DeNoon, WebMD Health News Psychological and social of obesity effects 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. 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.