They are both heavy burdens - weight problems and depression. And they often go hand in hand.
Some people gain weight when they're depressed. Others lose weight, to an unhealthy degree.
Depression and Weight Gain
A March 2010 review of 15 studies, published in the Archives of General Psychiatry, linked obesity to a greater risk of developing depression - and vice versa.
But do people gain weight because they are depressed? Or do they become depressed because of the excess pounds they are carrying? No one knows.
“It’s a chicken and the egg phenomenon,” says psychologist Leslie Heinberg, PhD, who directs the Bariatric and Metabolic Institute at the Cleveland Clinic. “But we do know that depression has lots of symptoms that can worsen obesity - appetite disturbances, lack of energy, lack of motivation to do things.”
In 2009, researchers at the University of Alabama at Birmingham reported that depressed people tend to gain weight faster than people who aren't depressed.
The bulk of those extra pounds was concentrated around their waists. That’s not good. Belly fat is a risk factor for type 2 diabetes, heart disease, and high blood pressure.
Depression, of course, comes with its own set of risk factors, including suicide, social isolation, drug and alcohol addiction, and anxiety.
Whichever comes first - depression or overweight/obesity - it is a very unhealthy combination. Often, it is a self-reinforcing combo as well.
Eating Yourself Blue
“Some foods, especially foods with high sugar and/or fat content, make you feel better, if only briefly,” says psychiatrist James Gordon, MD, author of Unstuck: Your Guide to the Seven-Stage Journey out of Depression.
“That good feeling makes you want to eat more, which in turn makes you feel bad about yourself,” Gordon says. “That leads to deeper depression, and more eating, and greater amounts of weight gain. It’s a vicious cycle.”
Getting out of that cycle can be a real challenge.
“When you are depressed, it is much harder to get out of bed, much less pay attention to what you are eating,” says Edward Abramson, PhD, an emeritus professor of psychology at California State University at Chico and the author of Emotional Eating: What You Need To Know Before Starting Another Diet.
For doctors, it’s less important to know which came first: the patient's depression or the weight problems. The question is, which one should get the most initial attention?
“If someone comes to me who is severely depressed and overweight, the depression is going to be the primary focus,” says Abramson.
However, he continues, an eating disorder that causes a patient to binge might need to be addressed first: “If their eating is out of control, that becomes the primary focus.”
Weight Loss and Depression
Although weight gain is commonly associated with depression, weight loss can also be a problem.
“With severe depression, you might lose weight because you’ve lost your interest in food, which comes from losing in interest in pleasure,” Gordon says. Loss of pleasure is a hallmark of depression.
Depression may also accompany an eating disorder. In Heinberg’s practice at the Cleveland Clinic, patients with anorexia nervosa are often depressed.
“In patients with low body weight, the brain becomes starved and they develop symptoms that meet the criteria for depression,” she says. “Often, once you feed them, the depression goes away. It’s resolved, and it’s generally resolved quickly.”
If You Move, You Lose - Pounds and Depression
It's important to know that weight gain is a common side effect of some of many prescribed antidepressants.
Fortunately, patients who are both overweight and depressed can help themselves with the same prescription: exercise, which can help counterbalance drug-related weight gain.
“I won’t necessarily tell them to watch what they are eating at first,” says Abramson, “but I will work with them to get them to move.”
At the beginning of therapy, that usually means walking. Abramson recommends picking up a pedometer before hitting the sidewalk. By measuring the number of steps they take each time they walk, they can monitor their progress. And, says Abramson, “small victories equal positive thoughts.”
Heinberg often prescribes walking as well. She likes to focus on her patients’ depression for the first six to eight weeks of therapy, introducing low-key exercise only to keep weight steady rather than bring it down. Once the depression is under control, she says, it becomes easier to address weight problems.
Be Active, Make Choices, Feel Better
Exercise is a key part of treating overweight and depression, in part because it allows patients to play an active role in caring for themselves. In fact, Gordon maintains that exercise is the best prescription for treating mild to moderate depression, as well as being helpful for severe depression.
“People feel good about doing things for themselves - that, in itself, is therapeutic,” Gordon says.
Gordon also recommends taking a break from fast food and other unhealthy eating habits; instead, he says, make time to cook a meal for yourself.
“It goes beyond just preparing something healthier to eat than fast food,” says Gordon. “People get engaged in their own care, and that’s crucial to dealing with weight.”
Gordon, who is the founder and director of the Center for Mind Body Medicine in Washington, D.C., includes alternative and complementary treatments in his practice. Key among them is meditation.
“You have to become aware of what and how you eat, through mindfulness,” says Gordon. “Very often, if you are anxious, you are going to eat more. But if you are in a state of relaxation, you won’t be eating frantically or mindlessly.”
Don’t be discouraged if therapy does not provide positive results right away. Treatment takes time. And keep in mind that treating depression and weight problems will likely require more than just a pill and a one-size-fits-all diet plan.
“It is important to have a comprehensive program,” says Gordon, one that addresses all aspects of a patient’s problems and prepares them for the hard road back to health. “I don’t have a magic bullet, and you are going to do most of the work.”