What you need to know about the link between obesity and depression
"Am I depressed because I'm overweight, or am I overweight because I'm depressed?"
It might seem obvious that there's a correlation between obesity and depression. People with depression often experience symptoms such as a lack of motivation or interest in doing things they enjoy, such as getting outside for a walk, or they may turn to unhealthy behaviors, such as overeating or eating junk food—all of which can lead to weight gain. In turn, people with obesity may naturally experience depression due to low self-esteem and isolation from people and activities. Obesity-related conditions such as diabetes or joint pain can further contribute to poor mental health
It's still not entirely clear whether obesity causes depression or depression causes obesity, but a recent study suggests that regardless of related health issues, people with a higher body mass index (BMI)—especially women—have a greater risk of depression due to certain inherited genetic variations that occur with both conditions.
Forty-three percent of adults with depression were obese, and adults with depression were more likely to be obese than adults without depression. – Centers for Disease Control, Data from the National Health and Nutrition Examination Surveys, 2005–2010
Certain stress hormones, particularly leptin, which helps regulate mood and emotion, and cortisol, the body's fight or flight hormone, also come into play, as does the gut microbiome. Leptin, for example, is made in the fat cells and can actually contribute to loss of fat tissue in people with normal weight. In people with obesity, however, it doesn't perform the same way, even though levels of it are higher. People who are obese seem to be resistant to it and therefore the hormone is less effective at modulating a person's mood.
"Obesity is a highly complex condition and can truly be a cause as well as a result of depression," says Victoria McKenna, MSN, nurse practitioner at Bryn Mawr Hospital's Bariatric Program. "While many of our patients naturally experience elevated mood after losing weight with weight loss surgery, we understand the importance of mental health and coordinated care throughout this process."
Patients considering surgical weight loss options undergo a bariatric surgery psychological evaluation so the bariatric team can better understand how to support people with depression, anxiety, and other mental health conditions before and after surgery.
When is it time to consider weight loss surgery (bariatric surgery)?
You may meet the qualifications for bariatric surgery if you have a body mass index (BMI) of 35 with one or more obesity-related health problems, or a BMI of 40 without these conditions. Bryn Mawr Hospital, part of Main Line Health, offers several types of insurance-approved bariatric procedures that reduce the size of the stomach and others that restrict absorption of food.
Keep in mind that weight loss surgery is not a cure-all for depression. If you are overweight or obese and you are also living with depression, it's important to be evaluated by a mental health professional. For some people struggling with depression from obesity, bariatric surgery is merely a part of the solution, a tool that works in combination with long-term lifestyle changes, including proper nutrition and exercise, and psychological support.
Depression after bariatric surgery
Extreme weight loss has many positive physical benefits and in many cases helps people feel better about themselves and improves their quality of life. But BMI and depression remain inextricably linked and some people still experience depression, or experience it newly after weight loss surgery, for a variety of reasons, such as:
- Unmet expectations – Some patients think that most of life's problems will be solved if they can just lose the weight but they soon discover life is still dealing them the same issues. Pre-surgery fantasy might not live up to post-surgery reality.
- Social adjustments – Whether interacting with old friends or with a spouse or partner, a person who has lost a lot of weight has to navigate some relationships differently, especially when it comes to food and the culture of eating.
- Ongoing food issues – Even with bariatric surgery, eating behaviors and thoughts and feelings about food don't automatically change. New patterns and ways of thinking take time and practice, and often require emotional and psychological support.
McKenna emphasizes the benefits of the holistic approach to weight management (physical as well as emotional and psychological) taken by the bariatric team at Bryn Mawr Hospital and the lifetime of support provided to bariatric patients.
"Bariatric surgery can be life-changing for people with mood disorders and obesity with the majority of our patients appearing to be happier and more energetic after surgery," adds McKenna. "That being said, some patients face different challenges after surgery and we often encourage our patients to follow up with our psychologist who is specially trained with bariatric patients."
The best way to find out more about bariatric surgery is to attend one of our upcoming bariatric seminars, held in-person and online.
Main Line Health serves patients at hospitals and health centers throughout the western suburbs of Philadelphia. To schedule an appointment with a specialist at Main Line Health, call 1.866.CALL.MLH (225.5654).