The desire to be obese is widespread

Tackling obesity and depression together

Katharina Lückel
published in: UGBForum 5/2020 | subscribe now!

Being very overweight can put a strain on the psyche or even have emotional causes. Researchers are increasingly observing interactions between obesity and depression. In nutritional therapy with overweight people, psychological aspects must therefore also be taken into account.

According to current estimates by the Robert Koch Institute (RKI), over half of all adults in Germany are overweight. About 67 percent of men and 53 percent of women weigh too much. At the same time, an estimated 8.2 percent of adults suffer from depression. The tendencies are increasing.

Mental health in danger

A quarter of men and women in Germany are very overweight (obese). It becomes particularly dangerous to health when other symptoms such as high blood pressure, type 2 diabetes or increased blood lipid levels are added. In addition, with increasing body mass index (BMI), health impairments such as movement problems or cardiovascular problems occur much more frequently. But being overweight can also be a major psychological burden. Very overweight people often have to struggle with prejudice and stigmatization in their everyday life: If you weigh too many pounds, you are to blame, eat poorly or are considered undisciplined and lazy. This can, for example, make it more difficult to find a job and thus endanger the basis of existence. Many are not aware of the impact stigmatization has on those affected.

Studies show that severely obese patients are more likely to develop depression. Conversely, researchers found that depressed people are more likely to be overweight. Women seem to be affected by this phenomenon more often than men. So far, however, it is unclear what the exact causes of the interactions between depression and obesity are. Because behind the causes there is a complex network of relationships.

Movement is a powerful factor in therapy

Experts assume that genetic, socio-cultural and psychological factors play a role in the mutual influence. On the one hand, movement problems caused by being very overweight can lead to restrictions in everyday life. The reduced physical activity is, in turn, often associated with depressive symptoms. In contrast, regular endurance sports such as swimming, cycling or jogging improve the symptoms of depression after just 10-14 days. Satisfaction with one's own appearance also plays an important role in the development of depression. Many overweight people suffer from decreased self-esteem and are dissatisfied with their appearance. Social stigmatization and slim ideals of beauty in film and advertising are partly responsible for this.

Cause western lifestyle

Both diet and lifestyle can promote the development of obesity and depression in rich industrial countries. An oversupply of sugar, highly processed and high-fat foods and the constant availability of food promote an unhealthy, over-calorie diet. The advertising of the food industry for high-fat snacks and ready meals or sugared soft drinks does its part. At the same time, in a fast-paced and increasingly complex world, stress is one of the main causes of the development of depressive illnesses. Stress, in turn, leads to obesity.

Hormonal dysregulation possible

Researchers suspect that similar hormones and pathways are involved in the development of obesity and depression. One possible connection could be explained, for example, by the overactivation of the hypothalamic-pituitary-adrenal cortex axis (HPA axis). The HPA axis is significantly involved in the regulation of the stress response. The HPA axis is over-activated in depressed people and people who are very overweight. This causes excessive cortisol to be released in the adrenal cortex. The released stress hormone has an appetite-increasing effect. Even in otherwise healthy people, dysregulation is associated with weight gain.

The overstimulation of the HPA axis can also affect the leptin regulation and lead to a dysregulation of the hormone. Together with the appetite-increasing ghrelin, leptin is involved in controlling the feeling of hunger and satiety. Disrupted regulation can increase appetite and weight gain and is observed in both depressed and severely overweight people.

Suspected antidepressants

Some mood-lightening psychotropic drugs are suspected of having an effect on weight. Substances such as tricyclic and tetracyclic antidepressants have been linked in long-term studies with a weight-promoting effect. Some scientists suggest that the widespread use of antidepressants contributes to an increased risk of obesity in the long term. However, the current study situation is very inconsistent. Therefore, no clear statements can be made about the effects of antidepressants on weight. In the event of unwanted weight gain during drug therapy, it is advisable to consult a doctor.

Stress causes emotional eating

Eating means much more than just taking in food. It is also a social event: a family meal together, a canteen meal with colleagues or a romantic dinner for two. In the same way, it can also serve to balance the emotions (affect regulation). Persistent stress can lead to unhealthy behavior patterns that favor weight gain. If those affected do not have the appropriate mechanisms at hand, stress, anger or sadness are compensated for by reaching into the refrigerator. Depression is one of the most common causes of emotionally controlled eating.

Binge Eating & Depression

Affect-controlled and emotional eating becomes particularly problematic when it solidifies in the form of what is known as binge eating disorder (BES). This is understood to mean repeated episodes of uncontrolled binge eating. In certain situations, those affected lose control over their eating behavior. They then eat faster than normal and often gobble up large amounts until they feel uncomfortable full. Often they are not hungry at all. For many, the loss of control means a great deal of psychological stress. Affected people often feel sad, guilty or disgusted by their behavior in retrospect.

Overweight women with BES are usually dissatisfied with their weight and body shape, have lower self-esteem and often show additional psychological abnormalities such as depression. Psychotherapy has now proven to be the best treatment for BES.

Sweets as a source of consolation, crisps against boredom and loneliness - learned behaviors like this play a major role in the development of obesity and are made worse by depression. Bad eating habits often persist over a long period of time. In order to break these patterns that have been trained for years, it takes time and perseverance. Depressed people often have difficulties with the latter. Studies show that more depressed patients drop out of nutritional therapy than participants who do not have depression. The reasons for this are often the typical symptoms that accompany depression such as listlessness, chronic fatigue and loss of motivation.

Increased risk for children and adolescents

If children and adolescents are already very overweight, this can have a major impact on their further development. Researchers found that adolescents who weighed too much were more likely to experience depression as adults than others. This relationship is observed in the other direction as well. Prospective studies suggest that childhood and adolescent depression promote the development of obesity in adulthood.

A study from Glasgow shows that depressed patients attended significantly fewer sessions than non-depressed patients during a weight loss program. Regular participation is an important factor for the effectiveness of a therapy. People who take part in therapy sessions more often achieve better results than those who appear less frequently. If your own motivation is lacking, it is important for a successful therapy that especially patients with depression are encouraged to participate regularly.

Appropriate therapy can help

Successful weight management programs rely on an interdisciplinary approach. The areas of nutrition, exercise and behavior therapy serve as the basic pillars of treatment. American scientists investigated the effects of integrated therapy for depression on 409 overweight and depressed patients. Participants who received additional therapy for depression had significantly better results in weight loss. The depressive symptoms also improved more clearly.

Further studies show that subjects who find themselves in a phase of subsiding depression during a weight loss program achieve better results than subjects who do not experience a decrease in their depression. The results show that in some cases additional psychological care proves to be helpful. However, success is individual and does not affect all patients.

Nutritionists who work with overweight people must also keep an eye on the psychological situation of the client. If there are indications of depression or other psychological disorders, it is advisable to address them. Together with the person concerned, it can then be clarified whether psychotherapeutic support makes sense.

Image © Seventyfor74 /

Keywords:Obesity, depression, therapy, binge eating, HPA axis, stress, inflammation

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