Obesity and Depression

Are there links between obesity and depression?

People used to think that the link between obesity and depression was that fat people were depressed because they didn't like how they looked.  Later it was theorized that some people overeat because they're depressed--although depression often makes people lose their appetite.  I believe there may be a biological link between obesity and depression: Depression has been linked to inflammation (see my June 29, 2013 post on Vitamin D and mood) and obesity can increase inflammation. Therefore, it is possible that obesity can biologically contribute to depression by increasing inflammation.

There are other negative psychological effects from obesity. It can make people give up (or never try) activities that might make them feel better, such as exercise. It can make people self-conscious, which can lead to social withdrawal. 

It's possible, although not easy, to lose weight. Unfortunately, I come across misinformation about weight loss in the media: Recently I read a news article that implied losing weight is next to impossible. It was based on the experiences of contestants in "The Biggest Loser" who gained most or all of their weight back. The reason was that their metabolism slowed to a crawl after they lost weight. I don't think "The Biggest Loser" is a model for weight loss, because the weight loss program it advocates, extreme exercise, probably isn't feasible for many people and may not even be healthy. The show also uses public humiliation as a tool, and that doesn't help people.

It is possible to lose weight and keep it off.  I've worked with several persons who lost large amounts of weight that they managed to keep off--and none went to a weight loss camp. The most important elements in weight loss may be motivation and the taking of personal responsibility (which could be undermined by reliance on a trainer). 

Several persons who came to see me had already begun or completed their weight loss program before coming to therapy--perhaps change in one area motivates change in another. Here are some of the various methods with which they lost weight:

1. Weight Watchers--50 lb weight loss (I also knew someone in school who lost 100 lbs through Weight Watchers). Weight Watchers teaches portion control and healthy eating while providing social support.

2. Nutritional Counseling--60 lb weight loss. The nutritionist provided education as well as support.

3. Daily gym workouts (no trainer involved!) combined with eating only a Greek salad for dinner--100 lb weight loss. Exercise not only burns calories but also relieves stress. Exercising while listening to music may be especially effective and may provide a "safe space" where one escapes the stresses of daily life.(The person's main exercise was the elliptical machine, which avoids excess stress on the feet)


Therapy can help. I helped someone lose weight  by having her write in a journal everything she ate, along with when she ate it and other relevant information. We would discuss what she wrote, in our sessions. This method allows for the analysis of emotions and thought patterns that trigger overeating. Hypnotherapy may also be helpful for some people. 

I believe overeating is an addictive behavior no different in its psychological basis than addiction to alcohol or cocaine. Obese persons who aren't interested in losing weight can be observed to use the same sorts of denial and minimizing statements that one hears from active alcoholics and drug addicts. Behaviors such as secret use/bingeing, arranging social activities around the substance  and avoidance of others or activities that interfere with use, can be seen in both chronic drug users/alcoholics and the obese. Both drug addicts and morbidly obese persons have higher than average rates of childhood trauma according to some studies and many grew up in households in which addictive behaviors were common. After giving up drugs or alcohol, some people turn to food, and there's been some evidence that people who have had weight loss surgery are at increased risk for  problem drinking.

Given the similarities between overeating and alcohol/drug addiction, can a 12-step group help? I've heard mixed reports of Overeaters Anonymous, the 12-step program for food addicts. The 12-step  model was originally based on abstinence, and abstinence from food isn't possible. However, some may benefit from the support in OA.

Obesity isn't a problem because of how it makes you look. It is a serious health condition that not only raises one's risk for fatal conditions including diabetes, heart attack and stroke, but also can increase depression through increasing inflammation and reducing recreational and social activities.