Effective obesity medicine requires more than managing a single disease—it demands careful consideration and treatment of the whole patient. The annual observation of World Mental Health Day in October (October 10, 2021) serves as an important reminder that mental health plays a pivotal role for patients living with obesity and must be incorporated into treatment plans for optimal success.
The intersection of mental health challenges and obesity has demonstrated ramifications for patients. Research shows obesity is associated with a 25% increase in mood and anxiety disorder diagnoses, including major depression, bipolar disorder, panic disorder, and agoraphobia.1 We must be hyper-aware of this correlation and take a thoughtful approach to care that balances mental health and weight loss in patients with obesity.
Patients with overweight or obesity frequently struggle with significant psychological roadblocks, from within and without. It is critical to consider the spectrum of unique circumstances that comes with each patient and address their mental and physical health in tandem.
The state of a patient’s mental health can contribute to their obesity—and vice versa—and can significantly factor into their decision-making process for treatment. For example, psychotropic medications for mental health treatment can come with significant weight gain side effects. Unsurprisingly, excessive weight gain is the most common cause of discontinuation of medications for conditions like depression.2 Similarly, mental health struggles, such as anxiety and depression, can drive patients to consume large amounts of high caloric, unhealthy foods and contribute to the development of obesity.
Weight bias is another common challenge for people struggling with obesity and the associated social stigma can create numerous challenges and risks. Weight bias refers to negative attitudes, judgments, and stereotypes toward people with overweight or obesity—and can occur in families, among peers, teachers, employers, and even among health care providers. People with overweight or obesity are commonly characterized as undisciplined, unmotivated, or unattractive.
Viewing obesity as a personal moral failure, applying their own internalized weight bias, patients may avoid medical appointments altogether. They may also have had past experiences with health care providers who did not receive proper training in current approaches to non-biased and evidence-based obesity treatment. This weight bias can pose serious obstacles to obesity treatment and often leads to increased eating and decreased self-regulation.
The toll of social stigma does not end there. Patients with obesity who experience weight bias also tend to experience higher levels of stress—and a host of related physiological effects. In the long term, exposure to cortisol and other stress hormones can exacerbate conditions, such as heart disease, stroke, depression, and anxiety disorders,3 all of which already disproportionately impact people with obesity.
The good news is health care providers have the potential to make a powerful impact on patients by focusing on mental health—and even the simplest actions can create results. For patients with obesity who are beginning treatment, it is critical that mental health issues are addressed and optimized first, or at least concurrently.
Clinicians can help patients make time for their mental health as a part of their overall care plan by encouraging them to incorporate these daily wellness practices:
When the health care community prioritizes person-first approaches to care that focus on who the patient is and what they can do instead of their condition, patients feel safe, supported, and respected. Creating space to recognize and accommodate mental health in our practices and approaches to care sets patients up for greater success overall. By prioritizing the balance between mental health and physical health, we help our patients strike a better balance in life.
Our knowledge of obesity and mental health continues to evolve. Discover updates and resources to incorporate into your practice here.