depression

How Obesity Can Lead to Depression

Phat in My 40's Health Guide May 18, 2010
  • “If only I weighed less, I’d be happier.”

    Is this a thought that has ever crossed your mind?  It might have crossed my mind once or twice during the past two decades, just maybe.  However, I intellectually know that the two are not connected....or are they?

    Last week I found an article in the journal Obesity in which researchers explored the relationship between obesity and depression.  They examined a population-based sample of US women who participated in the 2005 or 2006 National Health and Nutritional Examination Survey (NHANES).  Basically this means that the researchers looked at data which had already been collected by the survey and analyzed potential relationships between various measures of depression and weight classes.


    To determine the presence of depression, the nine-item Patient Health Questionnaire (PHQ-9) was used.  You may have answered this simple survey at some point during your tenure as a patient.  I know I have.  Rather than reproduce the PHQ-9 here, you can read more about it, view a sample, and learn how it is graded by health professionals, on the Macarthur Initiative on Depression & Primary Care website

    Go ahead and check it out, then come back here to continue reading.

    To determine degree of obesity (or lack there of), height, weight, waist circumference, and Body Mass Index were determined.  The BMI in this selection of patients ranged from 13.4 to 76.1.  Wow, for someone of my height, this would represent a range of weight from 80-458 pounds, a full spectrum indeed.  BMI categories were defined using the following cutoff points, i.e., BMI <18.5 for underweight, BMI 18.5–24.9 for normal weight, 25.0–29.9 for overweight, and BMI ≥30.0 for obesity. The obese category was subdivided into three levels of severity: obese class 1 (BMI 30.0–34.9), obese class 2 (35.0–39.9), and obese class 3 (≥40.0).

    With my current BMI of 40.9 (that is until I lose another 6 pounds), I would be in the Obese Class 3 group.  However since patients who were taking antidepressants or other antipsychotic medications were excluded, my data would have been excluded from the study since I currently take antidepressants.  Just to be clear, I did not participate in the 2005-2006 NHANES nor this study.  I’m just talking hypothetically.

    I’ve been on antidepressants sporadically for 20 years and continuously for the past 10 years.  And since I’ve weighed more than 180 pounds during the majority of that time, I would be considered chronically obese.  With this background, perhaps I might have something to say about obesity and depression.  Let me think.....

    Actually this is a huge topic and one which cannot be thoroughly explored in just one little Sharepost, however here are my initial thoughts based on personal experience.

    During the college years:

    • When I was depressed or bored, I ate more.  One of my favorite go-to foods during college was Doritos chips and pimento cheese.  I loved this combination.  Well, that and serial crunching of M&M’s.
    • When I started to feel better after starting antidepressants, food started to taste better and life became somewhat more enjoyable.  Then I REALLY liked the taste of those chips/cheese and started to indulge in sweet deserts such as cheesecake and pie.
    • Based on both of these situations above, I gained weight.  Note that I was depressed first and overweight second.

    Since the onset of two incurable chronic illnesses:

    • I was so thankful to already have a relationship with a therapist and a steady stream of antidepressants in my system.  Both were quite necessary in accepting some new realities of my life.
    • My physical abilities have been diminished and as a result I have gained weight (especially since I didn’t adjust calories-in and calories-out.).  This has not exactly made be happier.
    • Depression is a common symptom of MS and is often associated with inflammatory autoimmune diseases such as RA.  I believe that the onset of my depression was actually one of my first MS symptoms nearly 20 years ago.

    Since starting this pubic journal of my weight-loss journey:

    • I admit that I’ve been less depressed.  Perhaps it is the shedding of hidden secrets (ie. food in the nightstand) or the shedding of pounds.  I’m not sure.
    • I did change antidepressants last year and even upped the dosage last fall.  I used to take Zoloft (even getting up to 250mg daily at one point) and now I take Wellbutrin XL 300mg daily.  I know that this change in medication has helped my mental outlook and Wellbutrin is an antidepressant which is doesn’t have weight gain listed as a potential side-effect.  

    Last fall I changed RA medications to Rituxan and as a result my RA is doing much better which has also helped my mental outlook.  Feeling better, I have probably been somewhat more active and as I lose weight, my RA is continuing to do even better.

     

    Admittedly I have become less depressed at the same time I am weighing less.  I wonder more if it could be related to less inflammation since visceral fat (deep abdominal fat) produces cytokines.  Researchers have discovered that inflammation is associated with depression.  However, not all studies support this finding

    In the Obesity study, researchers found that the risk of depression begins to increase noticeably among US women with BMI of ≥30 and continues to increase considerably as BMI increases.  Abdominal obesity may add to the depression risk factor beyond that of BMI.  Among obese women, “severe obesity, compromised physical health status, young or middle-aged adulthood, low income, and relatively high education” represent potentially important risk factors for depression.

    According to the results of this one study, I have several risk factors for depression: severe obesity BMI of ≥40, comorbid diseases compromising physical health status, middle-aged adult aged 41, low income (primarily due to health status and economy), and high education as a doctoral degree candidate.  Just seeing all of these spelled out in one sentence is ‘depressing.’

    But awareness is empowering and I will use this knowledge to accept the risk factors and face the depression demon head-on.  That’s what I’ve learned to do over the years.  Already the monster is shriveling up but I can never become complacent. 

    Depression will not derail me from my weight-loss journey - this I know!!

    This post was written in honor of Mental Health Awareness Month.


  • References:

    Jun Ma and Lan Xiao. Obesity and Depression in US Women: Results From the 2005-2006 National Health and Nutritional Examination SurveyObesity (2010) 18 2, 347–353. doi:10.1038/oby.2009.213

    Magdalena Olszanecka-Glinianowicz, Barbara Zahorska-Markiewicz et al.
    Is Chronic Inflammation a Possible Cause of Obesity-Related Depression?
    Mediators of Inflammation (2009), Article ID 439107, 4 pages.  doi:10.1155/2009/439107

     

    May 16, 2010
    Weight:  246.0 lbs
    Blood Pressure:  124/81
    Pulse:  60

     

    Lisa Emrich is author of the blog Brass and Ivory: Life with MS and RA and founder of the Carnival of MS Bloggers.