When the upcoming 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) was being put together, a proposal was received that obesity and overeating be included as mental illnesses. Although this proposal was rejected, it does raise some interesting questions about the mental health of obese individuals.
Weight loss is a complicated process. People who have never had problems with obesity tend to think that losing weight is merely a matter of eating less and moving more. When obese people have trouble losing weight, others think they’re just not trying hard enough. This is the main reason for the hostility that is directed at obese people in our society: they are seen as lazy whiners who cost the health care system billions of dollars a year because of health problems that “they bring on themselves.”
The fact is, it’s not that easy to lose weight. There are myriad factors that play into weight gain. Some people inherit the tendency to gain weight. Others become heavy from poor eating habits, often instilled in childhood. Still others gain weight because of medications they’re on. Certainly lack of exercise plays a role as well. But the main reason obese people have trouble losing weight is that their obesity is all mixed up with mental health issues.
That’s not to say that obese people are mentally ill. But they are often depressed, have low self-esteem and lack confidence because of the way society judges them. If you were constantly being beaten down by “normal” weight individuals who see you as inferior, you’d have trouble mustering the courage and motivation to embark on a weight loss program, too.
That’s why it’s extremely important to have a mental health assessment if you find that you’re constantly trying and failing to lose weight. Clinical or bi-polar depression, anxiety disorders, PTSD, even ADD (Attention Deficit Disorder) can cause overeating. Sometimes medication and/or therapy can bring you up to a healthy level of functioning which in turn can be critical to your success.
This can be a two-edged sword, however. Most psychotropic medications cause weight gain, making it that much harder to accomplish your weight loss goal. Your doctor or therapist needs to be sensitive to the mental anguish this can cause. And you need to be aware that this is not your fault.
Even talk therapy can bring up issues that upset you and make you want to turn to food for comfort or to alleviate anxiety, further complicating your efforts to lose weight. It’s important to not get caught in a cycle of self-recrimination when you have these setbacks. It’s all part of the learning process.
In at least one study, obesity was associated with a 25-50% increased risk of lifetime psychiatric disorders (depression, mania, panic attacks, social phobia, agoraphobia), any lifetime mood or anxiety disorder, suicidal ideation, and suicide attempts. These issues must be dealt with or the obese person will find it nearly impossible to lose weight and maintain that weight loss, let alone be a fully functioning individual.
For more information about the DSM-5 and eating disorders, see this report by the American Psychiatric Association.
See also this article by Dr. Arya Sharma, “Obesity is Not a Mental Illness.”