06 January 2006

Obesity, eating disorders and depression

Severe depression can be responsible for pronounced weight gain or loss, and diet-related conditions such as obesity and anorexia can be responsible for causing depression.


In Part I of ‘Diet & Depression’, I mentioned that there is the link between depression and obesity. Severe, endogenous depression can be responsible for pronounced weight gain or loss, and diet-related conditions such as obesity and anorexia can be responsible for causing depression.

Obesity and Depression
It is often difficult to determine if obese individuals became obese because they were depressed, or if depressed people tend to gain weight. Depression can cause excessive food intake and many people turn to food for comfort when they feel blue. When this is coupled with a reduction in physical activity because the depressed person no longer has the energy or inclination to work or exercise, it is understandable that weight gain ensues. In addition some antidepressants may cause weight gain, so that the solution for the depression can exacerbate the problem of obesity.

On the other hand, many people who are overweight or obese suffer from depression because of poor self-image, discrimination by others, (including health workers (who should know better!), their families and friends, who regard the obese as ‘weak, lazy and self-indulgent’), repeated failure of attempts to lose weight, and a pervasive feeling of helplessness.

Practical Solutions
If you are suffering from endogenous depression, seeking comfort in food, feeling so down that you can’t work or exercise, and are gaining weight at an alarming rate, then it is essential that you seek expert assistance by consulting your family doctor, a psychiatrist or a clinical psychologist, and a dietician. Serious problems require serious solutions and major depression needs a team approach. The medical doctors and the clinical psychologist will assist you with medication if necessary and teach you better coping skills to combat the depression. The dietician will work out a balanced, energy-reduced diet for you that not only helps you to lose weight, but also provides adequate supplies of nutrients such as B vitamins which may be decreased by the medication you need to take.

Once your depression is under control and you start losing weight and feeling more positive about yourself and life in general, then you need to engage in regular exercise. Exercise will not only assist weight loss, help you to stick to your diet and stay motivated, but it also produces chemicals called endorphins which lift your mood and make you feel more positive.

If you suspect that your antidepressants are slowing down your weight loss, then discuss this with your doctor and dietician. Some antidepressants actually promote weight loss. You cannot stop taking antidepressants without medical supervision, so it is always best to chat to your prescribing doctor and ask him or her to change your medication if it is retarding weight loss.

If you feel depressed because you are overweight, then start doing something positive and sensible about your condition as soon as possible before you sink into deepest gloom and need medication to rescue you. Most people who set their minds to losing weight can achieve this objective by reducing their energy intake with a low-fat, high-fibre diet and regular exercise.

Instead of spending money on more chocolate, cold drinks and comfort food, use that money to pay for your gym membership or to join Weigh-Less or Weight Watchers. These organisations use sensible, well balanced diets and group consultations to give you moral support while you are dieting. This support and the knowledge that you are not alone, may be particularly useful for individuals who are prone to depression because of their weight.

The reason why it is so important to use a balanced diet for weight reduction either prescribed by a clinical dietician or an accredited organisation such as Weigh-Less or Weight Watchers, is that unbalanced or starvation diets can lead to deficiencies of nutrients (B vitamins, minerals, proteins, carbohydrates), which keep the brain and nervous system functioning at an optimal level and prevent depression.

Eating Disorders
The link between depression and eating disorders is also reciprocal. Patients who develop anorexia often either have a family history, or a personal history of depression. Conversely the nutritional deprivation of anorexia and bulimia usually causes deficiencies, which in turn can contribute to depression. Depression is more common in women, as are eating disorders. Individuals who are particularly vulnerable to eating disorders are young women with a lack of self-esteem and a distorted body image. By starving themselves, purging and vomiting, these patients believe that they are ‘controlling’ their lives and bodies, which they perceive as ‘uncontrollable’.

Get help fast!
As mentioned above in relation to obesity, if you suffer from an eating disorder and your world is a deep, dark hole, then go for professional help. Once again you need the support of a team of qualified health professionals to get you out of this dangerous cycle of self-loathing and self-destruction. A psychiatrist and/or clinical psychologist and dietician will be able to get you back to eating normally again. There are Eating Disorder Clinics at Tara Hospital in Gauteng (Tel: (011) 783-2010), the Riverside Manor in KwaZulu-Natal (Tel: (033) 701-1911) and the Kenilworth Clinic in Cape Town (Tel: (021) 797-1400). The team approach is vital for anorexics and bulimics to learn to use less harmful ways of coping with their psychological problems and to eat without fear of losing control.

Vitamin and mineral supplements to redress the months and years of unbalanced dieting and purging, and special high-energy, high-protein liquid meal replacements are indicated for patients recovering from eating disorders. If your weight is dangerously low, then you need to boost your intake of healthy foods and special meal replacement products such as Ensure, Nutren or Fresubin, to name but a few, can help you to gain weight. But remember, you must take the first step towards reversing the ravages of an Eating Disorder by asking for professional help, so pick up the phone right now and call your doctor or dietician before it is too late. (Dr I.V. van Heerden, registered dietician)

Any questions? Ask DietDoc


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