Obesity enhances risk of many mental ailments

Beware! Obesity is not only directly linked to several physical ailments, but it has an established relation with various mental health disorders as well, doctors say.

Many studies have shown that obese people have a higher risk of developing various mental health disorders along with other cardio-vascular diseases and stroke.

This happens mainly through hormonal and neuro-chemical imbalance. However, a little modification in lifestyle can go a long way in addressing these issues and reducing dependency on medicines.

Obesity: definition & prevalence

Obesity is defined as abnormal or excessive fat accumulation in the body that presents a risk to overall health. A body mass index (BMI) over 25 is considered overweight, over 30 is obese and over 40 is morbidly obese. In India, obesity is prevalent in about 40.3% of estimated adults in the age bracket of 18 to 80 years. Southern India (46.51%) shows the highest prevalence of obesity, while it is lowest in eastern India (32.96%).

Increased risk

According to Dr Charan Teja Koganti, neuropsychiatrist at KIMS and associate professor at VRK Medical College “Many studies have shown that obese people have an at least 55% chance of developing various mental health disorders such as major depression, bipolar disorder, anxiety disorder, panic disorder, eating disorder, and body image issues besides obesity-related physical ailments such as cardio-vascular diseases, coronary artery diseases, hypertension, diabetes, fatty liver disease, gastrointestinal cancers, stroke, osteoarthritis, Obstructive Sleep Apnoea  and so on. The younger people are worse affected.”

Obesity impacts brain hormones

Explaining the impact of obesity on brain hormones, Dr Charan Teja says, “The hypothalamus area of the brain produces two hormones, leptin and ghrelin. While leptin is associated with satiety, ghrelin is associated with hunger. In obese people, the secretion of leptin decreases while the secretion of ghrelin increases. The imbalance in the level of these two hormones releases the stress hormone cortisol, which is also associated with stress or binge eating disorder.”

Shared gene pool with bipolar disorder

“It is also interesting to note that obesity shares a gene pool with disorders such as bipolar mood disorder, anxiety disorder, hypertension, stroke and diabetes. People with bipolar disorder have higher chances of developing obesity and vice-versa,” says Dr Charan Teja, adding that since a few psychiatric medicines also cause weight gain, it is important for the psychiatrist to check the patient’s BMI and prescribe medicines accordingly.

Correlation between obesity and depression

“Depression is the most common mental ailment due to obesity, accounting for more than half the cases of mental ailments associated with obesity. In people with depression, there is hypo activity in the pre-frontal cortex - the part of the brain that is responsible for inhibiting the impulses. This happens due to decreased blood flow and reduced oxygen uptake. As a result, people with depression cannot control their impulses when it comes to eating,” explains Dr Charan Teja.
“Further, the limbic system in the brain influences motivation, for instance motivation to do workouts and stay fit. Due to limited activity of the limbic system, depressed people lack the motivation to stay fit and healthy and this  increases obesity and in turn depression. It’s a vicious cycle,” adds the neuropsychiatrist.

Body image suffers due to obesity

It has also been observed that society and environment favour non-obese people. Their confidence and energy levels are higher and they also tend to display better leadership skills. Thus, they have a more positive body image than their obese counterparts.
A bi-directional relationship

Prevalence of overweight issues and obesity in India is increasing faster than the world average. It can have a bearing on all the organ including mental health. Dr Shivam Gakkhar, psychiatry pass-out from Andhra Medical College and resident doctor at a government mental health institute says, “There is a bi-directional relationship between obesity and psychiatric disorders. Persons with mental illness are at a higher risk of developing obesity and vice-versa. The quality of life in patients with both psychiatric disorders and obesity can be compromised. Although there does not appear to be an increased association of severe psychopathology among obese patients, there are several psychological issues that should be looked for and explored if necessary. Many patients express emotional triggers for their eating, such as loneliness, boredom, or stress. Others express feelings of low self-esteem, social isolation and depression.”

Approaches to treatment

“Medicine is used to treat obesity. However, it alone is inadequate in many cases. Psychological interventions among many other therapies are therefore employed in obesity treatment. Understanding the issues that are supportive of or interfere with a weight loss plan and the home and work environment of the patient are needed during interaction with the patient. In assessing patients with obesity, a supportive, non-judgmental and sensitive approach usually leads to the best results and more complete information. It is also imperative that overweight individuals engage in at least weekly 150 minutes of moderate-intensity physical activity to promote health,” adds Dr Gakkhar.