- You cannot determine anything about a person’s mental health by looking at their body size.
- Obesity and overweight are not a sign of psychological problems.
It is worth discussing mental health and obesity because:
- controlling body weight has not proven to be easy for people and, in fact, it can be a difficult undertaking over many years. Given this, it is important to help people identify and find help for as many of their other burdens as possible, so these other issues do not interfere with their weight control.
- some medications, while being very beneficial to people over-all, can promote weight gain and it is important to be aware of this, monitor the situation, and adjust the person’s over-all care plan accordingly. It is also important to be able to offer a sound assessment of the balance of the potential harms of excess weight for that person versus the potential harms of any reduction, omission or change in medication. Achieving the best possible improvement of the mental health condition will virtually always be of much more benefit for the person than compromising that outcome in an attempt to improve weight status. (The health risks and impact of obesity are very real, but vary greatly among individuals of the same relative degree of extra weight.)
- there is some evidence that some background biological root cause or causes promotes both obesity and some mental health issues, particularly depression. Also, brain insulin resistance (the proposed “Type 3 Diabetes”) and altered brain insulin production are being investigated for their possible role in Alzheimer’s Disease.
- a person’s efforts to control their body weight may, over time, put them at risk of developing an eating disorder.
The conference Obesity and Mental Health was held in Toronto June 26 – 28 2012.
The Toronto Star has a good summary article. LINK (Shame on them for the picture, though.)
The speakers were well chosen and many important topics were presented.
For most of the presentations, the slides are published online. LINK
Some of the most clinically useful slide sets include:
Bulimia Nervosa and Binge Eating Disorder, by Allan Kaplan, MD LINK (excellent)
ADHD and Obesity, by Caroline Davis, PhD LINK (very important information)
Obesity and Mood Disorders, Dr. Roger S. McIntyre LINK (presentation was excellent, slides are a bit challenging when stand-alone) One of his points was that there may be a common underlying cause or set of causes that give rise to both a tendency for weight gain and a tendency for mood disorders. Among people who are obese, there is a higher than usual tendency to develop mood disorders and among people who have mood disorders, there is a higher than usual tendency to become obese.
Much of the important information in his lecture is also contained in the following paper:
The Canadian Network for Mood and Anxiety Treatments (CANMAT) task force recommendations for the management of patients with mood disorders and comorbid metabolic disorders. Full Text and PDF
Borderline Personality Disorder and Obesity, Randy A. Sansone MD LINK Upshot, BPD is present in an unknown (and not well-researched) percent of those with obesity, but it must always be considered, because of the difficulties that can arise in treatment. Not mentioned in the slides is his comment that Distress Tolerance Therapy can be very helpful.
Lessons Learned from the Field of Eating Disorders, by Annick Buchholz, PhD LINK Over the course of the conference, it became increasingly apparent, from the various presentations, that we must all be more focused on prevention of inadvertent harm from weight-related attitudes and weight-control recommendations and practices.
Healthy Body Image Across Weight Status, by Shelly Russell-Mayhew PhD LINK more on the harm from unintended consequences.
Unfortunately, for some of the presentations the slides are inadequate to get a real understanding of the presentation. Also, with such a group of experts collected in one room, the questions and comments from the audience contributed greatly.
I am very happy to report that there seems to be a strong move away from the classic “dieting” mind-set of calorie-restriction being either very useful or very safe. (As I have long held – see under “Satiety-Focused Weight Health” and “Restrict/Rebound”.)
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