Eating
Disorders
Severely Obese Face Major Depression
Risk
(January 18, 2004) -- In a variation on an age-old question, researchers
have long asked themselves which comes first -- obesity or depression?
A new study doesn't resolve the debate, but it does suggest the risk of
mental illness is a major problem for the severely obese, and less of a threat
for the merely overweight.
Women of average height who weighed more than 240 pounds and men of average
height who weighed more than 278 pounds -- defined as morbidly obese -- were
five times more likely to be depressed than people of average weight.
Women of average height who weighed more than 240 pounds and men of average
height who weighed more than 278 pounds -- defined as morbidly obese -- were
five times more likely to be depressed than people of average weight.
However, women who were overweight, but not obese, were also more likely to
be depressed.
"It's good news for the general population because it means the
depression burden might be lower among the obese than we worry it is,"
says study co-author Dr. Chiadi U. Onyike, a psychiatric researcher at Johns
Hopkins Hospital in Baltimore. "But it's not good news for people who are
morbidly obese."
The suspected link between depression and obesity is nothing new. "It
seems an obvious connection," Onyike says. But why? Do fat people get
depressed because of social stigma, or because of the chemical makeup of their
bodies? Or does depression cause a chemical reaction in the body that leads to
obesity?
In the new study, the researchers examined statistics from a 1988-94
federal study of the health and nutrition of Americans. They looked at 8,410
people who responded to a psychological questionnaire. The findings appear in a
recent issue of the American Journal of Epidemiology.
The people most likely to be depressed -- five times more so than those of
normal weight -- were those with a body mass index of more than 40, making them
morbidly obese. The index, a ratio of height to weight, is a measurement of
obesity.
For people who are 5-foot-4, their BMI will reach 40 when they hit 240
pounds. For those who are 5-foot-10, their BMI will reach that level at 278
pounds.
Among women, simply being obese, a step above being overweight, spelled
trouble, but not as much as among the morbidly obese, the study found. The risk
of depression doubled among those women who had BMI of 30 or more. That
translates to a weight of 180 or more for someone who is 5-foot-5. But the same
was not true for men.
The study reveals the importance of screening severely obese patients for
signs of depression, says Onyike. "Depression can undermine their
compliance with weight-reduction treatments," he says.
But what of the perception that fat people are the life of the party?
Some obese people do indeed seem happy, but that's because they're
successfully using food -- a "natural antidepressant" -- to treat
their depression, says Dr. Albert Ray, an obesity expert and physician advisor
with the Kaiser Permanente Health Plan's Positive Choice Wellness Center in San
Diego.
"What a physician normally does is throw a diet at them, [tell them
to] go out and exercise and lose weight and come back in a month," Ray
says. "It doesn't happen that way. The doctor hasn't gotten to the
underlying problem, which is depression or some inner psychological
problem."
Once obese people come to terms with their
depression, often related to childhood traumas such as
abuse, they can begin losing weight, he says. Counseling and medication are
often very useful in treating the depression, he adds.
But "there's a lot of denial," Ray says. "These patients
don't want to recognize that they're depressed, that they grew up in homes with
heavy levels of dysfunction."
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