As spring begins, most people take time to think about goals they would like to achieve before summer, and losing weight is among the top three resolutions made every year.
While many of us would like to lose those extra 10 to 20 pounds that seem to hang on year after year, according to the Centers for Disease Control and Prevention, the prevalence of obesity (defined as a body mass index of 30 or greater) has increased over the past 20 years in the United States. In 2008, 32 states had prevalence equal to or greater than 25 percent.
According to the Merriam-Webster Medical Dictionary, eating disorders are described as "any of several psychological disorders characterized by serious disturbances of eating behavior." Most people think of eating disorders as anorexia nervosa (restricting intake) or bulimia (binging and purging). But ask anyone who is overweight why they eat and you will get any number of answers, such as "I eat when I'm depressed," "I eat when I want to celebrate or because I'm bored" (commonly called emotional eating), or "I have an addiction to food.
There are few people in America who can say "I eat when I'm hungry and stop when I am no longer hungry." Eating long after we are comfortable appears to feed the emotional rather than the physical self.
Although not well researched, there appears to be a link between obesity and mental illness, especially depression. In an October 2009 editorial in the British Medical Journal, Dr. Evan Atlantis of the University of Adelaide wrote, "Obese people ... often experience weight-related stigma and discrimination and present with symptoms of low self-esteem, low self-worth, and guilt. Obesity is associated with socioeconomic disadvantages and low levels of physical activity, both of which are strong predictions of depression. Comfort foods rich in fats and sugars improve mood and are common among depressed and anxious patients."
Many morbidly obese opt for weight loss surgery. While research shows that if these patients suffer from depression, mood is often elevated the first year after surgery, but depression increases the second to fourth years, and some research has shown that the suicide rate in these individuals is higher than expected. The surgery may improve the physical health of this population, but if the mental illness that caused the obesity is not addressed, the patient is still at risk for relapse of the mental illness and the obesity.
Dr. Blair Davison, a psychiatrist with Providence Psychiatry and Neuroscience, specializes in eating disorders. While most of the patients she sees for these disorders suffer from either anorexia or bulimia, she believes there are treatment options available for those suffering from obesity caused by binging but not necessarily purging, to include psychotherapy and medication.
The surgeon general has stated that the nation needs to make a concerted effort to research the causes, prevention and treatment of obesity. Specifically, the study of behavioral and environmental causes, treatment interventions, along with research on the prevalence of obesity among racial and ethnic, gender, socioeconomic and age groups is needed.
Including obesity in the treatment of eating disorders is complex, multifaceted and interesting for those involved in the mental health field. For those who suffer from eating disorders and mental illness, it is an ongoing battle. Each new year brings new research, new treatment and new hope.
Bev Jensen is clinic nursing supervisor at Providence Psychiatry.