Dr Alfred Dawes | Obesity and depression are deeply intertwined... Obesity causes depression and depression causes obesity

One of the lessons I've learnt from working with persons who have been struggling with weight issues is that Jamaicans as a whole lack sensitivity when it comes to obesity.

We are guilty of making insensitive comments about people's weight and go as far as to tease them. In fact, a common greeting to persons who have gained weight is "what a way you get fat". Another classic is "Weh you a get big a guh?"

Persons who make these utterances are not aware of the emotional distress that they may be causing with their words. A little-appreciated fact is that persons who are overweight and obese suffer from depression at a higher rate than persons who are at a normal weight. So a harmless joke can be a dagger to the heart of someone who may be battling obesity and depression.

As we battle the increasing rates of obesity worldwide, we focus on the associated diseases such as diabetes, hypertension, and heart disease. But what is overlooked is the fact that obesity and depression are deeply intertwined. Obesity causes depression and depression causes obesity.

COMFORT FOOD

Persons who are depressed may take comfort in food. To them, food becomes a drug, as it provides a temporary escape from their pain. Like some drugs, foods cause the release of chemicals in your brain that make you feel good.

The dependence on comfort food is more than emotional, it is a physical dependence as they crave the release of these chemicals and the subsequent good feelings they bring.

Persons who suffer from depression are less likely to have the motivation to eat healthier or engage in physical activity. Loss of interest in daily activities sees them becoming more sedentary. As a result, they may burn less calories and consume more, leading to weight gain. Additionally, the side effects of some antidepressants include weight gain.

POOR SELF-IMAGE

Whether they openly admit it, many persons who are overweight have a poor self-image. This is amplified by a world where the ideal body is constantly on display on TV, the movies and on social media. A distorted image of what we should aspire to look like is constantly shown in advertisements and by influencers and celebrities.

Persons who are different from the ideal body types may have low self-esteem and be self-conscious about what they wear and even where they go. Social isolation and an ever-present awareness of your weight can contribute to depression.

Obese persons may be stereotyped, bullied and discriminated against. This is particularly worse for adolescents as they are emotionally vulnerable.

Names like Fatta, Biggs, Bigga, Mampy, and Fatty are commonly heard in Jamaica. We never tease people about their cancer or diabetes, but it is socially acceptable to tease persons suffering from obesity.

LEAD TO CHRONIC DISEASE

Obesity can lead to chronic joint pain and chronic diseases that interfere with the quality of life. Constant health issues, worrying, and the financial costs of treatment can lead to depression. Simply being obese is enough to put one at risk for depression.

Add to this the burden of obesity-related diseases and the emotional distress they cause, and it is no surprise that studies show an increased rate of depression in persons suffering from chronic diseases. One study looking at persons who underwent bariatric surgery found that as the patients lost weight, their depression improved.

We are only just now looking at obesity as a major disease rather than simply treating the associated diseases - hypertension and diabetes. Obesity has been declared a disease in its own right. It is a component of the metabolic syndrome that includes diabetes, hypertension and high cholesterol. But physicians and policymakers have failed to address the fifth associated disease - depression.

Treating depression in the setting of the metabolic syndrome can be very challenging and requires a multidisciplinary approach. A psychologist or psychiatrist will need to assess the patient and help them to work through their issues and develop healthy coping mechanisms.

Since losing weight will help with the depressive symptoms and the chronic diseases, every effort must be made to achieve sustained weight loss. This means involving a nutritionist and even a training coach.

MUST CHANGE APPROACH

Simply giving patients tablets and telling them to try and lose weight has got us nowhere, and unless we change our thinking to our approach to obesity and its related diseases, we will continue to lose the battle.

Screening for depression is not commonly done. Most persons only recognise the signs retrospectively after a suicide. The low energy or withdrawal can easily be dismissed as being moody. Helping someone who is depressed begins with identifying the problem they themselves may not see.

Doctors asking a patient how they feel about their weight or their medical conditions may open up the door for patients to speak freely about their issues. For family and friends who may recognise a change, you are duty bound to ask about the emotional state of these loved ones.

But the biggest thing we can do to help obese persons suffering silently from depression is to stop commenting on their weight and joking about it.

Most persons recognise that they have put on weight. There is no need to bring attention to it, especially in public.

Fat-shaming is despicable and the time has come to stamp out this practice with the same efforts we expend on combatting other forms of bullying and discrimination.

- Dr Alfred Dawes is a general laparoscopic and weight loss surgeon at the island laparoscopy and medical care. Email: info@islandlaparoscopy.com; yourhealth@gleanerjm.com.