‘A Vicious Cycle’: Decoding the Complex Link Between Obesity and Mental Health

FIT reached out to experts to understand how obesity perpetuates mental health issues and vice versa.

FIT reached out to experts to understand the complex relationship between mental health and obesity.

(Photo: Aroop Mishra/FIT)

People who have extreme obesity are five times more likely to "have experienced an episode of major depression" than people with an average body weight — this is what a 2018 study, titled The Psychosocial Burden of Obesity, suggests.

The researchers of this study also found that "approximately one-third of the candidates who opt for bariatric surgery report clinically significant symptoms of depression at the time of surgery, whereas about 50 percent report a lifetime history of depression."

For the longest time, the health implications of obesity were only associated with the physical consequences it often leads to – diabetes, heart disease, stroke, osteoarthritis, among others. The mental health effects of obesity have often been overlooked.

FIT reached out to experts to understand the complex relationship between mental health and obesity.

‘Higher Risk of Depression, Anxiety, Sleep Disorders’: How Obesity Manifests Mental Health Issues

As per the World Health Organization (WHO), obesity is defined as a chronic complex disease defined by excessive fat deposits that can significantly deteriorate your health. An adult is said to be obese if they have a body mass index (BMI) of over 30 (This varies based on sex, age, and race).

According to the WHO, in 2022, one in eight people in the world were living with obesity.

However, an important aspect of obesity – how it can impact a person's mental health – is still not paid much attention to.

Dr Kedar Tilwe, Consultant Psychiatrist, Fortis Hospital Mulund & Hiranandani Hospital, Vashi, speaking to FIT, explained that there are three different ways that mental health and obesity are linked to each other:

• Obesity deteriorating a person's mental health

• Mental health issues (such as anxiety or eating disorders) causing obesity

• Obesity and mental health manifesting independently but impacting a person's overall health

Dr Tilwe notes that there are several mental health issues that can crop up due to obesity, and vice versa.

The most common ways that poor mental health manifests in obese people are depression and anxiety.

"When we are growing up, we are brought up with certain ideal body types, depending on cultural and social factors. These influences play a crucial role in how we perceive ourselves as adults. It can cause body image issues which can further lead to depressive rumination, anxiety, and worsen your stress levels."

Dr Kedar Tilwe

The American Psychiatric Association says, "Rumination involves repetitive thinking or dwelling on negative feelings and distress and their causes and consequences."

However, according to the 2018 study, titled The Psychosocial Burden of Obesity, the risk of depression is higher in obese women than in obese men.

But it doesn't end there.

Patients often start indulging in behaviours such as binge eating or increased substance abuse to quell their anxiety – which again leads to weight gain, eating disorders, and a higher BMI, and causes a vicious cycle to form, says Dr Tilwe.

Dr Sweta Sharma, a psychologist at Gurgaon's Manipal Hospital, says that all of these factors, along with the social stigma of being obese, can further bring up "feelings of shame and self-loathing," adding to feelings of hopelessness or worthlessness, that can also lead to self-esteem issues.

Dr Tilwe goes on to say that people struggling with mental health issues often indulge in binge eating during the night.

This, experts say, could play a role in disrupting a properly regulated sleep cycle, and affect metabolism – increasing appetite and leading to weight gain.

But more that that, it also poses the risk of insomnia, sleep apnea, and chronic stress.

The statistics show this too. At least nine percent patients who opted for bariatric surgery have social anxiety disorder, approximately 10 percent have a history of illicit drug use or alcoholism, and 5-15 percent struggle with binge-eating disorder, states the 2018 study quoted above.

The Vicious Cycle of Obesity and Low Self-Esteem

People often find it difficult to cope with the social stigma and their negative body image, which can perpetuate self-loathing and toxic patterns of behaviour, says Dr Tilwe.

"What ends up happening is that people who are obese tend to isolate from their peers, avoid others, and distance themselves in the fear that others might be judging them for their weight or the way they look. They withdraw into themselves and might indulge in toxic behaviours."

Dr Sharma agrees, adding,

"This correlation is particularly noticed among introverts. This exacerbates the feeling of isolation and contributes to unhealthy eating habits."

A 2023 study, published in Frontiers in Public Health, had stated that people living with obesity showed "significantly decreased levels of quality of life, as well as increased depression scores compared to people of normal weight."

Not just that, several studies have shown that people who are obese or severely obese are subjected to discrimination in various settings, be it educational or professional.

So what can people struggling with obesity and mental health issues do then? The doctors that FIT spoke to have a few suggestions to help you:

• Try to practice mindful eating – enjoying and focusing on what you eat to avoid binge eating.

• Practice meditation or yoga.

• Follow a balanced nutritious diet.

But, they maintain, that in case of clinical obesity, medical intervention might be required and patients should seek help from professionals if they're struggling with mental health issues due to obesity, or vice versa.

(All of April, Quint FIT is decoding the alarming rise in obesity in India and the various health risks associated with it. Follow our full coverage here.)