When going to a restaurant, most people do not give a second thought about where they are going to sit. However, this simple event of having the hostess identify a table can strike fear in a person with obesity. “Will I fit?”
The same thing happens on an airplane or an amusement park ride. This fear only adds to the ongoing depression that people with obesity or morbid obesity face on a daily basis. Several studies show rates as high as 80 percent of those who are obese also suffer from some level of depression.
Obesity is defined as having a Body Mass Index (BMI) of 30 or over. Obesity has been on the rise not only in the United States but the world since the 1980s. The World Health Organization (WHO) estimates that by 2020 obesity will be the single biggest killer on the planet.
Obesity and depression: The cycle
Obesity is essentially due to changes in diet and exercise. We are seeing increasing rates of obesity in developing countries that are being exposed to Western lifestyles of fast food and food filled with refined sugar and fats. Furthermore, urban lifestyle and electronics have decreased mobility adding to the epidemic. As a person’s BMI increases so does the level of depression.
The obese person finds himself discriminated against in the workplace, at the doctor’s office and out in public. Many obese people do not go to the doctor’s office for fear of having the doctor say, “If you lose weight, then I can help you.”
In the meantime, there are many mental health issues that can lead to obesity. We are seeing an increase in depression where people start emotional or binge eating. Many medications used to treat psychiatric illnesses have side effects of weight gain. As a result, when treating the depressed patient with medication, the end result may be an increase in BMI, which then leads to more psychiatric symptoms. This cycle is not going away anytime soon.
The role of the mental health provider
As a mental health provider, you may be the only professional that the obese person trusts. As mentioned, many medical providers dismiss the overweight. It is important to discuss the person’s weight in a supportive manner. The best way to do this is to make sure that you are informed about obesity and are sensitive to the ongoing discrimination such patients face in all areas of their lives.
The first place to start the discussion is during the clinical assessment. When asking the patient about medical conditions and medications, make sure that you address how certain conditions and medications can either be impacted by a high BMI or how medications can cause weight gain.
Address the patient in a non-judgmental manner. Ask about recent weight gain or weight loss. Use this part of the interview to educate the patient and tell him how you can help. Let the patient know that you want to treat the whole person and that you are willing to work with his other care providers, such as his psychiatrist or primary care physician. This can help the patient really feel like he has an advocate on his side. It will also let the patient know that this sensitive topic can be addressed in treatment.
During treatment your role is to continue to monitor the patient. Letting the patient know that weight gain can be a part of some mental health issues will help to disarm the sensitive patient. If a patient becomes more depressed, then exploring an increase in symptoms such as obsessive thinking and hopelessness is a good place to assess if the patient is also noticing an increase in emotional eating.
Dialogue with the patient about working on healthy lifestyle habits that will help with obesity along with mental health issues such as sleep, hygiene, exercise and the benefits of decreasing sugar and caffeine in the diet.
Finally, remember that some patients may be resistant to discussing their weight. Most have faced some type of discrimination with other providers and are not always willing to discuss their weight history. However, if you make it part of your initial interview with the patient, then the patient will not be surprised when you bring it up later.
Melissa Bailey, Psy.D., is a licensed clinical psychologist, owner of the Bailey Psychology Group (www.drmelissabailey.com) and director of allied health for the National Obesity Foundation (NOF) (www.nofusa.org). NOF is a non-profit organization dedicated to helping individuals who are struggling with obesity and its related diseases. Bailey’s book, Pink Hell: Breast Cancer Sucks, is an Amazon best seller. Her email address is firstname.lastname@example.org.