Mental health issues a missing link in the fight against weight gain

Double iatrogenic, double epidemic,  double trouble – what’s up doc?

 SNAFU- that’s what.

“You have to care about the whole person, and not just one symptom.”

Dr. Valerie Taylor, chief psychiatrist at Toronto’s Women’s College Hospital.

…a healthcare system that cared about people, what an incredible idea.


Article in Vancouver Sun Mon 18 June 2012
By Sharon Kirkey, Postmedia NewsJune 18, 2012


Mental health issues a missing link in the fight against  weight  gain

Psychiatrist says it’s the ‘No. 1 reason we’re not getting  anywhere’

Depression, anxiety, attention-deficit and post-traumatic  stress can cause changes in appetite, energy and metabolism.
Photograph by: Lucas Jackson, Reuters Files , Postmedia News

Canada is losing the war against obesity because we’re ignoring one of its  major drivers, doctors say: the state of our mental well-being. Some say obesity  and mental health are so intricately entwined, they should be considered a  “double epidemic.”

Depression, anxiety, sleep disorders, attention deficit disorders, post  traumatic stress, addictions – all can cause changes in appetite, energy and  metabolism that can prime people to gain weight. What’s more, antidepressants,  mood stabilizers and newer generation antipsychotics – drugs Canadians are being  prescribed in record numbers – can themselves cause rapid and dramatic weight  gain.

No one is suggesting that everyone with a weight problem has a mental  illness. But missing in the relentless drumbeat to “eat less, move more” is any  public discussion about the role common mental health problems are playing in  the obesity dilemma, observers say.

“We absolutely have not looked at this issue at all,” says Dr. Valerie  Taylor, chief psychiatrist at Toronto’s Women’s College Hospital. “This is  probably one of the No. 1 reasons that we’re not getting anywhere in terms of  battling the obesity epidemic.”

Increased risk of depression

The relationship works both ways. Fat tissue isn’t inert. It’s biologically  active. It produces cortisol, a stress hormone, as well as inflammatory  chemicals, both of which have been linked to mental illness. Cortisol is  neuro-toxic. It can act on the brain in vulnerable people – putting them at  increased risk for depression.

Conversely, people with depression produce excess cortisol. And one of the  effects of cortisol on the body, Taylor and her colleagues recently reported in  the Canadian Journal of Psychiatry, is a propensity to accumulate fat around the  abdomen.

The interplay between obesity and mental health is complex, but “we have not  had a public discourse on how tightly these two epidemics are linked,” says Dr.  Arya Sharma, professor of medicine and chair in obesity research and management  at the University of Alberta.

Nowhere in the recent report from Canada’s mental health commission is there  a mention of obesity, he says. “And vice versa. With all the talk about healthy  weights, there’s a lot of focus on diet and exercise, but I don’t see any focus  on improving the mental health of our kids and our adults. And that is a huge  part of what is really driving the obesity epidemic.”

Studies have found that 66 per cent of those seeking bariatric, or weight  loss surgery have had a history of at least one mental health disorder.  Attention deficit disorder occurs in an estimated one in four. “These people  really struggle with being able to eat healthy – they make impulsive choices,  they can never make it to the gym, or they get to the gym, they’ve forgotten  half their stuff,” Taylor says. “If you get that illness under control they can  be successful in losing weight.”

Sixty-two per cent of the country’s adult population is either overweight or  obese, a trend that’s tracking at an even faster pace among children and  adolescents. Today, there are more overweight than “normal” weight Canadians,  and the heaviest weight classes  are growing the fastest. In many cases, the weight gain happens so insidiously,  people can’t put their finger on exactly how it happened.

Drawn to sugar and fat

Humans have been hardwired through evolution to eat as much, and as often, as  we can, and the food industry, critics say, has done a formidable job creating  extraordinarily seductive foods loaded in sugar and fat. Some of the world’s  leading addiction researchers believe today’s highly processed foods interact  with the brain in ways similar to cocaine or heroin.

It takes significant impulse control to resist the smorgasbord before us,  “because your brain wants all of those things and can’t get enough,” says  Sharma, who will be among the featured speakers at a three-day conference on  obesity and mental health in Toronto later this month sponsored by the Canadian  Obesity Network, the International Association for the Study of Obesity and the  Centre for Addiction and Mental Health.

“Even the slightest problem with impulse control and decision-making is going  to expose you, and make you much more likely to gain weight,” Sharma said. “I  can’t think of a single mental health problem which would not, in some form or  fashion, contribute to weight gain, or make weight management extremely  difficult for someone who has the genetics to put on weight.”

Sleep plays a role

Mood affects metabolism and changes the way the body responds to certain  foods, he said. Depression or bipolar disorder can cause changes in appetite,  energy and motivation. Depression and anxiety cause play havoc with sleep, and  the link between sleep problems and weight has never been stronger.

In a normal, sleep-wake cycle, lep-tin – the satiety or “I’m full hormone”  that tells the brain to reduce food intake – increases, while ghre-lin, which  triggers appetite, decreases. That’s so that people don’t feel hungry when  they’re sleeping. But when sleep is disrupted, the opposite occurs, Taylor’s  team wrote, so that people are not only awake, but they’re also hungry.

Taylor says the links are also strong between adult obesity and abuse in  childhood – emotional abuse, physical abuse and neglect.

“Sexual abuse is probably the biggest one,” she says. “Often times children  incorrectly blame themselves for causing the abuse, so they want to change the  way they look.”

Psychiatric drugs – among the most commonly prescribed pills nationwide – are  adding to the problem. Antipsychotics – medications that are now even being used  for insomnia – can trigger “hedonic hyperphagia” – eating in pursuit of reward,  rather than to ease hunger.

“Food soothes anxiety and stress. It becomes a coping mechanism. Certain  foods like carbohydrates can boost serotonin, which affects mood. For brief  periods of time, we feel relaxed and comforted. But it doesn’t last, and so  people get into a cycle, Taylor says, “where they’re constantly using food to  feel better.

“We have to teach people how to stop doing that.”

Taylor says she can’t think of a more stigmatized group than those who have  both obesity and mental illness.

“Lots of times people don’t come for-ward and say they have a psychiatric  illness going on when they’re looking for obesity treatment. Family doctors  don’t ask about it.

“We need to raise awareness. This is a complicated illness. It’s not a blame  thing. There are associations and things occurring that people aren’t aware of,”  Taylor says.

“You have to care about the whole person, and not just one symptom.”

© Copyright (c) The Vancouver  Sun

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