Obesity a common problem in mental illness

We’re all aware of the rising epidemic of obesity in North America. A quarter of all Canadian adults are clinically obese as well as one in 10 Canadian children and many more are overweight.

We know obesity is associated with all sorts of health problems and can even lead to premature death – yet in spite of all of this awareness and myriad public health initiatives aimed at preventing obesity – the epidemic continues with no signs of stopping.

Of course, its intractable nature is because obesity is complicated – and it is a state affected not only by genetics or simple lifestyle choices, but significantly and subtly connected to social, psychological and behavioural factors as well.

Perhaps not surprisingly, mental illness is often a very significant factor in obesity.

Individuals with mental illness are much more vulnerable to weight gain than the general population. When a person has both a genetic predisposition to put on weight and a psychiatric illness, it can be very difficult to prevent or treat weight gain.

For one thing, the symptoms of many common psychiatric conditions lend themselves to weight gain. Mood disorders and ADHD are some of the most difficult for weight gain with symptoms such as increased appetite, loss of motivation, reduced energy and increased impulsiveness.

Biological changes that occur within these disorders such as inflammation and hormonal dysregulation can also make weight gain more likely.

Substance abuse is much more common among those with psychiatric conditions and when this is a problem, it is very difficult to make healthy lifestyle choices surrounding nutrition and exercise.

Even those receiving treatment for their mental illness are more vulnerable to unwanted weight gain as many psychiatric medications themselves have weight gain as a side effect.

With all of these compounding factors, it is unrealistic to simply tell an individual experiencing ADHD or depression to “eat less and exercise more”. It is not surprising that this approach is often unsuccessful.

In spite of the difficulty, we do need to address this issue as obesity-related medical problems are common and not benign among those with mental illness.

There are a variety of tools being used in addition to common lifestyle recommendations.

Various forms of talk therapy have shown some promising results to date. These tend to challenge negative thinking surrounding weight loss and work on adaptive behaviours and thought patterns.

Prescription medication for weight loss is a very controversial topic and there is currently only one drug approved in Canada for obesity treatment (orlistat). It has shown some positive results but is associated with negative side effects and is not widely used.

Bariatric surgery is a method with dramatic results and has definitely been on the rise over the past decade. This can be a good option for those with significant weight problems. It serves as a kind of forced behavior modification and is only recommended after in-depth consultation with professionals. Many morbidly obese individuals with a controlled mental illness could be candidates for bariatric surgery. Although effective, bariatric surgery is not easily available and is very expensive so not accessible for many people.

As always, it is important to identify and treat any underlying mental illness. If you are having difficulty losing weight in spite of repeated efforts, speak with your doctor about what weight loss tools that may be helpful in your situation.


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