Is Obesity a Mental Health Issue?

Understanding the mind/body connection.

Posted Dec 11, 2015

Obesity may be the largest health epidemic to ever sweep the nation. More than two-thirds (69%) of Americans are classified as either overweight or obese, where obesity is defined as a BMI in excess of 30 and overweight is defined as a BMI that exceeds 25. People with BMIs in excess of 40 are classified as extremely obese, putting them at the greatest risk of a host of health issues.

At the Rochester Center for Behavioral Medicine, we often work with patients who struggle with obesity and other mental health issues. Indeed, this is a common phenomenon at mental health clinics across the country. Obesity in itself is not a mental illness, but it is closely related to a number of mental health issues. Moreover, the stress of being obese in a thinness-obsessed society can undermine the well-being of even the most psychologically sound minds.

A Word of Caution: Obesity is Not a Mental Illness

In a world obsessed with thinness, people with larger bodies are often ostracized, and treated as less than others. This phenomenon, sometimes called fatphobia, sizeism, or size discrimination, is a form of oppression that undermines the quality of life of millions of larger people across the country. Some even resort to drugs, suicide or self-harm.

It is not fair to assume that, simply because someone is overweight, he or she has a mental health condition. Indeed, many overweight people are very psychologically sound, extremely physically healthy, and are overweight due to bad luck, a history of unhealthy living, or a medical condition. Don't assume you know another person's health status just by looking at him or her, and never tell an overweight person to lose weight; heavy people already know society judges them as too heavy, because messages about the value of thinness are virtually impossible to avoid.

Binge Eating and Compulsions

Binge eating disorder is an eating disorder that compels people to consume large quantities of food in short periods of time. A binge eater might consume 1,000 or more calories in just a few minutes. Unlike other eating disorders, people who binge eat do not purge after, but they often feel guilt, shame, or depression.

Anorexia, Bulimia, and Other Eating Disorders

Some people with a history of obesity cycle in and out of obesity and food-restrictive eating disorders. Though people with eating disorders are often thin, that's not always the case, especially with diseases like bulimia. Pressure to conform to an unrealistic standard of beauty can tip some people with obesity into anorexia or bulimia, or cause them to so severely restrict their calories that they miss out on vital nutrients. This is just one of many reasons it's important not to insult the appearance or value of people who struggle with their weight, or to blame all health problems on weight issues. Put under enough pressure, an eating disorder is the natural outcome of the desire to lose weight as quickly as possible.

Depression, Anxiety, and Trauma

It's not easy to talk about painful emotions, so it's no wonder that many people turn to food to drown their feelings. Depression, anxiety, and post-traumatic stress disorder are common among people with obesity. Often, doctors must treat these symptoms before real weight loss can begin.

In one recent study, doctors found that traumatic stress—such as from child abuse or rape—greatly increases a person's likelihood of becoming overweight or obese. The risk is especially pronounced among women. Traumatized people may turn to food to avoid their pain, may harm themselves with food as a manifestation of self-loathing, or may feel so hopeless that the notion of embarking on a weight-loss plan feels impossibly overwhelming.

The Effects of Living in a Thin-Obsessed Society

Simply being overweight exposes people to a number of mental health risks, due to the extraordinary pressure most overweight people face to be thin. Indeed, even doctors sometimes label an overweight person as unhealthy based solely on his or her physical appearance. Some of the issues overweight people face include:

-Intrusive but well-meaning questions and comments from loved ones.
-Medical providers who do not take their concerns seriously.
-Hurtful commentary from children and other people who do not know better.
-Employment discrimination.

Over time, these factors can take a toll, depleting quality of life and potentially leading to depression, anxiety, and a host of other ills. Obesity may be a health problem, but another person's weight is not necessarily an appropriate topic of conversation; behaving otherwise may trigger a host of psychological challenges that complicate weight loss.

References:

PTSD raises risk for obesity in women. (n.d.). Retrieved from http://www.hsph.harvard.edu/news/press-releases/ptsd-raises-risk-for-obe...

Watman, M. J. (n.d.). Weight bias and discrimination: A challenge for healthcare providers. Retrieved from http://www.obesityaction.org/educational-resources/resource-articles-2/w...