Is Obesity a Sign of Mental Illness?

By Stewart Lonky, M.D.

Let's put our cards on the table.

People with weight problems are not mentally ill. Obesity isn't a sign of a weak mind. Some of the world's most successful people struggle with weight problems. As a colleague once said, "You don't have to be crazy to be crazy about a cookie." 

Yet, a recent study found that a disproportionate number of patients with mental illness are obese compared to the general population. A study comprising randomly selected outpatients receiving psychiatric care in Maryland found that their body mass index (BMI) was almost twice that of the comparison group.

Obesity is a multifactorial illness, which explains why it's so difficult to treat. Obesity also brings with it higher risks of type 2 diabetes, cardiovascular disease, and dementia, all of which affect psychological well-being.  Patients with a history of attention-deficit/hyperactivity disorder (ADHD) are at increased risk of obesity. A Swedish study found that obese patients suffered from depression comparable to chronic pain sufferers. Another study found that obese people had a 55 percent greater risk of developing depression than normal-weight people. Most alarmingly, the mentally ill die 25 years earlier than those without mental illness due to obesity-related conditions such as heart disease and cancer.

Clearly, a history of mental illness may increase obesity risk, while being obese increases a person's risk of developing a psychiatric illness. 

Still, I want to emphasize that being obese or overweight doesn't mean you have psychiatric problems. Obese folks don't lack self-discipline or self-respect. They're not by default self-loathing, though I haven't met that many overweight people who feel happy with their bodies. Carrying around an extra 75-100 pounds can't make anyone feel good. 

So, what’s the answer?

Sure, some overweight and obese people use food to deal with depression, anxiety, and low self-esteem. 

However, the problem with this line of thinking is that obesity isn’t purely a psychological problem. For a majority of people, obesity is a multi-factorial problem that can’t be appropriately addressed only with psychological treatments. 

And since obesity is a complex disease, it might be easier for some people to simply label it a mental illness. Classifying people as mentally weak or unstable is easier than thinking about obesity’s complexity and all that’s needed to effectively deal with the problem.

Think of it another way. If we buy into the idea that weight is purely a mental illness, then we have to believe that 70 percent of the adult population in the US is nuts. Obesity is more likely the cause and not the consequence of psychological problems. 

To deal effectively with the obesity epidemic, we should spend less time pointing fingers and more time looking for solutions and providing help.

#obesity #obese #epidemic #crisis #pandemic #mentalhealth #eatingbehavior #weightlossjourney #mentalhealthday #risk #science #study #research #psychology #stewartlonkymd