jueves, 12 de diciembre de 2019

Mental Health Disorders, Weight Gain, and Exercise

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By Lois Zoppi, BAReviewed by Dr. Jennifer Logan, MD, MPH

Studies have shown that people living with serious mental illnesses such as schizophrenia, bipolar disorder, and major depressive disorder have poorer physical health and lower life expectancy when compared with the general population.

Image Credit: Tero Vesalainen / Shutterstock.com

However, research into the links between mental health and weight, and its consequent effect on self-esteem, confidence, and the ability to improve overall health is lacking.

Patients have reported that their mental health problems, side effects of psychiatric medication, lack of support, finances, and stigma all present barriers to improving their health. Often, these elements are linked with one another, further complicating the link between mental health and weight gain.

Additionally, chronic anxiety and stress, as well as depression, can cause some to overeat, use food as a coping mechanism, and lead a more sedentary lifestyle. These behaviors all lead to weight gain. Anxiety and depression can also affect the quality of a person’s sleep and induce disordered sleep patterns, which again, can result in weight gain through slowing down the metabolism and increasing appetite.

There are a number of factors that lead to reduced life expectancy in people living with serious mental health problems, but weight gain and obesity are thought to be majorly significant contributors.

Existing research on mental health and weight gain

The Centers for Disease Control and Prevention (CDC) reported that 43 percent of adults living with depression were obese, with women of any age living with depression being more likely to be obese than both men or women without depression.

Additionally, adults taking antidepressants to treat depression were more likely to be obese than those who were not on medication.

However, it is important to note that this particular study did not suggest a causative relationship between medication and weight gain, meaning that obesity did not stem directly from depression or that depression developed as a result of obesity. But, a bidirectional relationship has been suggested, proposing that obesity increases the risk of depression, and depression also increases the risk of obesity.

There have also been studies looking into the link between gut health and mental health, although no solid link between the two has been made as of yet.

Weight gain and antidepressants

Weight gain has also been linked to a number of antidepressant medications, which are used to treat depression, generalized anxiety disorder (GAD), obsessive-compulsive disorder (OCD), and post-traumatic stress disorder (PTSD), among other conditions.

Weight gain as a side effect from antidepressant medication can be a factor in nonadherence as well. Some patients will not take medications if they are concerned about possible weight gain related to medication use.

Abruptly stopping medication can induce significant negative side effects. Furthermore, taking antidepressant medication can sometimes help patients begin talking therapies such as counseling and cognitive behavioral therapy (CBT), which they may find more useful than psychiatric medication.

Older antidepressant medications (in this case, tetracyclic antidepressants first developed in the 1970s) have been recently implicated in cases of weight gain, but these medications have largely been replaced with more modern antidepressants that present fewer side effects.

The dose of antidepressant medication may also influence the effect on weight gain, although there has been no definitive, causative link made between antidepressant use and weight gain.

A concern is that as the use of antidepressants becomes more widespread, weight gain amongst people living with mental health conditions will also increase, potentially increasing cases of diabetes and cardiovascular disease by extension.

As such, it has been suggested that treatment or support for physical health problems such as weight gain should be integrated with the treatment and support being given for mental health conditions. When antidepressants are prescribed, the potential effects on weight should be considered.

Diet, exercise and mental health

Lifestyle changes not only significantly improve physical health but mental health too.

A 2014 study, including over 13,000 adults in the UK, found that alcohol intake and obesity were associated with low mental wellbeing, with the consumption of fruits and vegetables being linked with high mental wellbeing. A separate study found that a diet high in fruit, vegetables, legumes, nuts, beans, cereals, grains, and fish, reduced levels of depression.

However, poor nutrition is a complex issue and can be associated with lower income, lower levels of education, cultural influence on diet, or a lack of local availability of fresh or healthy food options, which can all also influence an individual’s mental wellbeing and may, in some cases, be the root causes of poor mental health.

The reasoning behind healthy eating improving mental health is not clear, but it has been suggested that eating well can increase certain species of gut bacteria that are able to produce the neurotransmitters (serotonin and dopamine) necessary for improving mental health.

Exercise, like a healthy and balanced diet, is also closely linked to improved mental health. Any exercise that raises the heart rate (such as running, swimming, skipping, or cycling) is considered exercise; the definition does not require gym or exercise class memberships. Daily activities such as walking to and from work, picking children up from school, gardening, or cleaning, can also count towards the weekly recommendations for exercise.

Regular physical activity has been found to raise self-esteem, mental alertness, and reduce anxiety and stress as it triggers the production of endorphins, which ameliorate moods and act as pain relievers. Regular exercise can also be effective in treating sleep disorders, which often makes depression and anxiety worse.

Changing people’s perspectives around exercise from something they ought to be doing or have to do may help alleviate feelings of guilt and inspire more people to become active in ways they enjoy and in turn, improve their mental health.

Considering how medication, lifestyle, and mental illness itself is influencing weight at the point of treatment is an important future consideration, with treatments considering mental and physical health in tandem in order to best alleviate the symptoms of mental illnesses.

Sources

Every-Palmer, S., Huthwaite, MA, et al. (2018). Long-Term Psychiatric Inpatients’ Perspectives on Weight Gain, Body Satisfaction, Diet and Physical Activity: A Mixed Methods Study. bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-018-1878-5
Fava, M. (2000). Weight Gain and Antidepressants. www.psychiatrist.com/jcp/article/pages/2000/v61s11/v61s1106.aspx
Stranges S, Samaraweera PC, Taggart F, et al. (2014). Major Health-Related Behaviours and Mental Well-Being in the General Population: the Health Survey for England. BMJ Open https://bmjopen.bmj.com/content/4/9/e005878
Mental Health. How to Look After Your Mental Health Using Exercise. https://www.mentalhealth.org.uk/publications/how-to-using-exercise
NHS. (2018). Antidepressant Use Linked With Weight Gain. www.nhs.uk/news/medication/antidepressant-use-linked-weight-gain/
Pratt, L. A., PhD, Brody, D. J., MPH. (2014). Depression and Obesity in the US Adult Household Population, 2005-2010. https://www.cdc.gov/nchs/products/databriefs/db167.htm
Valles-Colomer, M., Falony, G., Darzi, Y., et al. (2019). The Neuroactive Potential of the Human Gut Microbiota in Quality of Life and Depression. Nature Microbiology https://www.nature.com/articles/s41564-018-0337-x