In addition to their physical challenges, older adults who carry excess weight often struggle with depression and other mental health disorders.
Research has revealed a complex interrelationship between obesity and mental health, with each posing treatment barriers to the other.
For adults living with obesity and mental health problems, an effective treatment approach takes both conditions into account.
The physical consequences of excess weight are well known, ranging from type 2 diabetes, increased risk of falls, heart issues, and osteoarthritis. Yet not quite as much spotlight is given to its impact on our mental and emotional health. May is Older Americans Month and Mental Health Awareness Month—and a great opportunity to explore the “invisible” burden shouldered by many older adults living with obesity.
What Mental Health Challenges Do Older Adults with Obesity Face?
In addition to their physical challenges, people living with obesity often struggle with mood and anxiety disorders.
One study found that adults with excess weight had a 55% higher risk of developing depression over their lifetime compared to people that did not struggle with obesity.1
Other research linked being overweight with significant increases in major depression, bipolar disorder, and panic disorder or agoraphobia.2
How Obesity Causes Mental Health Problems
There are a variety of practical and societal factors that can lead to mental health issues for patients living with obesity. These include:
Quality of life: Men and women who carry significant extra weight often face problems related to physical and occupational functioning, both due to their size and chronic ailments. Being physically unable to do the things they love—such as attend fun events, travel, or visit with friends and family—can lead to social isolation, loneliness, and more difficulty coping with life’s hardships. Chronic pain on its own has been linked to depression.3
Weight bias and discrimination: One of the biggest challenges for those struggling with weight issues is society’s negative perspectives on obesity. Weight bias refers to the stereotypes and attitudes that define people with obesity as unattractive, lazy, and undisciplined. These unfavorable misperceptions can be widespread within families, among peers, in the workplace, and in medical settings by healthcare providers. They can lead to discriminatory behavior that affects a person’s self-esteem, employment opportunities, and even the quality of healthcare they receive.
Poor body image: Weight bias and poor body image tend to go hand-in-hand. Patients may internalize society’s stigma against obesity, which causes them to feel embarrassed about their weight and dissatisfied with their appearance. People who struggle with excess weight may also experience anxiety over being judged for how they look.
Physiological issues: There are also obesity-related health factors that can negatively influence mental health. Research suggests that excess body fat and poor eating habits increase inflammatory markers. This heightened inflammation can lead to a higher risk of developing depression and also plays a role in immune system health.4
Can Mental Health Problems Cause Obesity, Too?
The link between obesity and mental health issues is not a one-way street. While it’s clear that excess weight can take a toll on someone’s emotional wellbeing, it’s also true that mental health conditions may influence a person’s weight. Here are some examples of how:
- Chronic stress, anxiety, and depression—as well as mental health conditions like bipolar disorder—may cause someone to use food as a way to cope. They might also make poor dietary choices, which in turn can cause weight gain.
- The serotonin deficiency linked with depressed mood, interrupted sleep patterns and anxiety has been found to lead to carbohydrate cravings and weight gain. In other words, people who lack serotonin may self-medicate with food.
- Adults who are depressed may lack the energy or desire to exercise or take part in other activities. Leading a sedentary lifestyle can set the stage for weight problems.
Studies over the years have revealed a complex interrelationship between obesity and mental health. Obesity and mental health issues also share some common risk factors including lower socioeconomic status and sedentary behaviors, both of which can lead to depression and weight gain.
Barriers to Treatment
Mental health disorders and obesity are recognizable and treatable conditions. However, there are barriers to treatment that can’t be ignored.
As with obesity, adults with mental health issues also face stigmatizing attitudes about their disability. The stigmas attached to obesity and mental illness can keep people in a vicious and harmful cycle. This is why spreading awareness of these conditions—and recognizing them as valid and serious diseases—is so important.
Treatments themselves can pose obstacles. For example, there are many pharmacotherapies that can be effective in treating depression and other mental health disorders. The drawback is that some of them—including certain antidepressants and mood stabilizers—can cause weight gain as a side effect. People already struggling with excess weight may avoid seeking treatment out of fear they’ll gain even more weight.
On the flip side, for someone who is overweight, mental health challenges can pose an additional hurdle to living a healthier lifestyle. Traditional weight-management therapies—such as following a nutritional plan or physical activity regimen—may be difficult for someone already struggling with low mood or anxiety.
Evidence-based obesity care, including Intensive Behavioral Therapy (IBT) and anti-obesity medications (AOMs), are an important component of the obesity continuum of care to help reduce risk of heart disease, diabetes, osteoarthritis, and other complications.
However, many Americans do not have access to the full obesity continuum of care. Medicare Part D still prohibits coverage of FDA-approved AOMs. In addition, Medicare limits coverage for IBT only when these services are provided by a primary care provider in the primary care setting. It is important that your health care provider is aware of the full spectrum of evidence-based interventions to manage your obesity.
Hope for Patients with Obesity and Mental Health Challenges
If you’re an older adult living with excess weight and mental health issues, you should know help is available. There are safe and effective anti-obesity medications that can provide added support when conventional weight loss approaches are not enough. These medications may also help counteract the weight gain caused by certain mental health pharmaceuticals.
Good health and happiness are things we all deserve, at every age. A balanced, holistic treatment plan can help improve your mood and outlook while empowering you to achieve and maintain a healthy weight.
1. Floriana S. Luppino, MD; Leonore M. de Wit, MS; Paul F. Bouvy, MD, PhD; et al. Overweigh Overweight, Obesity, and Depression: A Systematic Review and Meta-analysis of Longitudinal Studies. Arch Gen Psychiatry. 2010;67(3):220-229.
2. Gregory E. Simon, MD MPH; Michael Von Korff, ScD et al. Association Between Obesity and Psychiatric Disorders in the U.S. Adult Population. Arch Gen Psychiatry. 2006 Jul; 63(7): 824–830.
3. Jiyao Sheng, Shui Liu et al. The Link between Depression and Chronic Pain: Neural Mechanisms in the Brain. Neural Plast. 2017; 2017: 9724371.
4. Richard C. Shelton, MD; Andrew H. Miller, MD. Inflammation in depression: is adiposity a cause? Dialogues Clin Neurosci. 2011 Mar; 13(1): 41–53.