The disease of obesity is associated with many other ailments. With some of these, such as type 2 diabetes (T2D), we observe a mechanistic linkage, driven by insulin resistance mediated by obesity. Other ailments would be comorbidities in the classic sense, correlated with obesity but not caused by it so far as we can tell. Depression falls into this second category.
While there is no universal biochemical signature of depression, we do know that patients with obesity suffer depression at higher rates than the general population. The intersection between the 2 is made clear particularly in adolescent patients, who often experience weight bias and weight-based victimization (eg, teasing, bullying, social isolation), peer and social isolation that affect mood and quality of life, regardless of physical mechanisms that may connect the diseases.
Research into the matter will no doubt continue, but for now it is enough that we know obesity and depression often appear together in young people. It is important for physicians to have at least a foundational knowledge of obesity, so that they can best advise the adolescents they see who may be struggling with excess weight and depression all at once.
Obesity is a complex, chronic disease. Many children and adolescents with severe obesity suffer from cardiometabolic disorders and other obesity-related comorbidities that require frequent specialty appointments. Obesity treatment and weight management require a lot of time and can be difficult for patients and their families. Rates of attrition (ie, dropout and loss to follow up) are high.
Add depression to this picture, and the complexity increases. Many symptoms of depression have a negative impact on treatment of obesity. For example, the fatigue and apathy characteristic of depression may make it more difficult for children and adolescents to form new eating patterns, follow an exercise regimen, or engage in goal setting in general. Disrupted sleep patterns, characteristic of some patients with depression, can cause changes in appetite and food seeking that may also contribute to weight gain. These are not superficial problems: sleep disturbance with concomitant obesity and depression is associated with a significantly higher risk of early cardiovascular disease. In addition, we have data that suggest adolescents with weight-related complications, like polycystic ovarian syndrome or T2D experience higher rates of depressive symptoms and lower self-esteem and body image.
As a final piece of the puzzle, some of the medications used to treat depression can lead to increased appetite, food-seeking behaviors, and weight gain, making it increasingly difficult to manage the one problem without exacerbating the other.
Prevention is the best treatment for obesity, which can partly be accomplished by measuring and plotting anthropometrics (ie, weight, height, or length) at each visit and providing anticipatory guidance on growth patterns to parents and caregivers. Learning more about patients and their lived experiences may uncover weight-based victimization, trauma, or other social drivers of health—food insecurity, housing instability, poor health literacy,limited English proficiency—all of which can affect both mood and weight. Becoming familiar with practice guidelines for screening and assessment of childhood obesity may also give health care providers an advantage in forming treatment plans.
For those adolescents with obesity, treatment includes nutrition, physical activity, behavior therapy and medical management. The Obesity Medicine Association (OMA) has a number of resources that clinicians may find helpful as they treat adolescents with obesity and depression, including the Pediatric Obesity Algorithm. The good news is that with the right tools, and a deep enough understanding of these interlocking diseases, both separately and together, clinical outcomes may improve, and patients may discover pathways toward better health.
For more OMA clinical resources or to become a member, visit https://obesitymedicine.org/mental_health_new_membership_may2022/.
Dominique R. Williams is board-certified in Pediatrics and Obesity Medicine and has a Master of Public Health in Nutrition. She currently practices in a multidisciplinary clinic where she specializes in Pediatric Weight Management and Obesity Medicine with emphasis on health behavior theories and patient empowerment for children and adolescents with obesity. Dr Williams has varied research interests that include social health determinants and weight management, healthy equity, and the role of mentoring and coaching on the professional development of trainees from pre-med to residency.