21st Century Aging

Living longer and better.

How Weight Gain Relates to Factors We Can't Control

Who is to blame if you gain a little weight over the holidays?

The holiday season is filled with food. It’s everywhere you go: at holiday parties, social events at the office —even in grocery stores, shoppers are tempted to bring home food they wouldn’t normally even think about eating (peanut brittle? What is it and does it even taste good?). And while it’s customary to remind ourselves to eat less, or to eat more mindfully (prescriptions I wholeheartedly believe in), I also think it’s important to remember the real truth about eating and weight gain: that it’s partly self-control, and partly biological.

The biological aspect of health problems with a behavioral component can easily be overlooked. And in my work as a medical psychologist, a 2008 article by Paula Caplan reminds me how tempting it can be to instruct people on changing eating habits and then to make the common assumption that patients must be doing something wrong if they do not drop pounds.

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Caplan, a clinical and research psychologist, soberly and cogently describes how for some psychotropic drugs, weight gain is an unforeseen side effect. She points out that obesity receives popular attention in the medical and popular literature; what is rarely, if ever mentioned, is that as prescription rates of some psychological medications have risen, so has the prevalence of obesity. And while it is unclear what the mechanisms are that lead people on popular psychotropic medications to gain weight (meaning whether it is an increase of appetite, metabolic change or both), as experts don’t yet know the answers, obesity is a complicated, multi-factorial condition, which requires us all to be more sensitive when we talk to our patients, friends and family about their weight.

Of course we know that the obesity epidemic is not solely due to psychotropic drugs. The prevalence of less physical activity, larger portions, massive marketing of fattening carbohydrates, and the fact that healthy and nutritious food are much more expensive than higher calorie options, are but a few of the factors contributing to obesity. 

Regarding biology, people are born with different metabolic rates, and as we age our metabolisms slow down. Further, some have speculated (though this needs further scientific study) that the rise in certain hormonal conditions, such as Poly Cystic Ovary Disease, which is associated with obesity and extreme difficulty with weight management, is influenced by environmental toxins.

Biology, whether it is due to environmental exposures, genetic bad luck, as well as medications, can all influence metabolism and weight. Class is likely to play an additional role when it comes to medications, however. A recent New York Times article points out that children from poorer families are often recipients of one class of drugs known to cause weight gain, while middle-class children are offered psychotherapy.

The culture of prescribing medication is oriented around symptom reduction, rather than comprehensive, overall recovery. Though alleviating the symptoms of psychological disorders is a worthy goal, as conscientious healthcare professionals, we need to better inform our patients about the risks of pharmaceutical treatment and emphasize the importance and efficacy of psychotherapy for many mental health conditions--before turning to the all too common practice of prescribing medication.

However, not everyone wants psychotherapy. People who choose pharmacotherapy instead of, or in addition to psychotherapy make a valid choice. As recent PT posts suggest, therapy is not for everyone and may not work for everyone either. What we should question, however, is whether or not people who choose drugs are given true informed consent regarding the realities of weight gain.

Since many common psychological drugs cause weight gain and since millions of Americans are on these drugs, who is really to blame? Patients, doctors, or the drug companies who push the drugs and the fantasy of a cure?

A final note:

You might be interested in Caplan's response to a recent NY Times magazine article on the "Fat Tax." 

Also, you can subscribe to my articles on PT through RSS feed by clicking here.

Tamara McClintock Greenberg, Psy.D., M.S., is an Associate Clinical Professor of Psychiatry at the University of California, San Francisco.


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