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  • Writer's picturekellyharveylpc

Is excess weight a mental Illness?

It would be more accurate to say that excess weight can be a symptom of some physical and mental conditions. The more we learn about obesity, the less evidence points to excess weight as a symptom of “poor willpower” and “calories in=calories out” and more a complex combination of physical, mental and hormonal systems which are not fully understood. If you doubt this, consider the manatee, which glides through the water all day and exist on lettuce leaves, but weighs close to a ton!

As for linking excess weight and mental illness, there are a couple of things we do know. Binge Eating Disorder is a condition in which patients use food much like an addict uses drugs or alcohol, ingesting large (very large) quantities of food over a short period of time, even past the point of physical fullness, in order to cope with intolerable emotions. For people who do this, binging often leaves them numb, shameful, but feeling spacey and absent the original, intolerable emotion (anxiety, anger, grief, loneliness). To meet criteria, a patient has to do this regularly for a specified period of time, and the behavior has to cause significant distress and disruption.

There are some physical illnesses which create obesity as a secondary symptom: polycystic ovary syndrome and Cushing’s disease for example. Certain medications used for severe mental illness, (such as schizophrenia) can sometimes have the side effect of causing significant weight gain, which contributes to the link between excess weight and mental illness. In fact, studies have shown that people who are clinically obese are no more or less mentally healthy than any other sample population. They exhibit no more pathology overall than any other group. Steroid use and chemical exposure can also contribute to obesity.


January 5, 2017

"There has not been a single clinical study showing that a person can become obese despite normal caloric intake and normal activity levels. It *really* is a simple caloric intake issue, but not so simple explanation as to why obese people crave food all the time. Could be psychiatric like other eating disorders or hormonal triggering the hunger."

Kelly Harvey

January 5, 2017

You are simplifying something that is not simple. Levels of Leptin and Ghrelin are known to affect appetite. Metabolic syndrome, medications, and hormone balance all affect metabolism, and there is respectful disagreement within the field as to the exact mechanisms of this and how to best combat it. I might rebut your statement by saying that the weight loss industry has been unable to successfully prove that reducing calories while increasing energy output reduces weight, or we would not have a worldwide obesity epidemic. Governments have been preaching what you are stating for nearly forty years now, but the population, worldwide, is fatter than ever. Why is that? I don’t claim to know, although the theories range from hormonal interference in our food chain to overall better nutrition to decreased energy expenditure. My objection is to a simplistic answer to a complex question. Increasingly, there are babies who are born obese. Implying that they are not exercising enough is ridiculous. Something is wrong with our model.


January 5, 2017

I appreciated your answer, Kelly. There are certainly medical illnesses that are known to cause truncal obesity, such as Cushing’s disease. An overproduction of cortisol leads to a number of symptoms, which, yes, include obesity. Also, there are medications that will cause severe weight gain as a side effect. Depakote is one, mirtazepine is another. I know that anecdotal evidence isn't terribly strong, but I have taken this drug and have quite a few friends who have taken it. I have gained 40 lbs since I started taking it 4 months ago. A friend of mine put on 30 lbs in a month. These factors can certainly contribute to obesity.

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