1 / 58

Obesity and Mental Illness: Cause or Effect

Obesity and Mental Illness: Cause or Effect. Claudia Fox, MD MPH Diplomate , American Board of Obesity Medicine Director, Pediatric Weight Management Program. Disclosures.

arien
Download Presentation

Obesity and Mental Illness: Cause or Effect

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Obesity and Mental Illness:Cause or Effect Claudia Fox, MD MPH Diplomate, American Board of Obesity Medicine Director, Pediatric Weight Management Program

  2. Disclosures • I have no relevant financial relationships with the manufacturers of any commercial products and/or provider of commercial services discussed in this CME activity. • I do not intend to discuss an unapproved/investigative use of a commercial product/device in my presentation.

  3. What Kids Say Claire, age 19, 5'4", 210 lb, “I hate looking in the mirror :( it's the saddest part of each of my days. I hate myself.”

  4. What Kids Say sad and depressed, age 16, 5'9", 320 lb “i really am sick of being fat…ivebeen a big kid ever since i can remember and during all that time ive been teased and made fun of. i hate myself for being the size i am and I pretty much have no self esteem.”

  5. Objectives • Identify the prevalence of mental illness among youth with obesity • Understand the cause and effect relationship between mental illness and obesity • Identify the implications of mental illness in the treatment of obesity

  6. Most Studied Psychiatric Conditions Among Obese Individuals • Depression • ADHD • Binge Eating Disorder (BED)

  7. Objectives • Identify the prevalence of mental illness among youth with obesity • Understand the cause and effect relationship between mental illness and obesity • Identify the implications of mental illness in the treatment of obesity

  8. Rates of Psychological Complications in People with Obesity are Uncertain

  9. Rates of Psychological Complications in People with Obesity are Uncertain Other considerations: • Age, gender • Severity of obesity • Psychiatric definitions – rating scales, interviews, questionnaires

  10. Population-based Samples • No increase in psychopathology among obese youth, except for eating disorders • Maybe some increase in “behavioral problems” among obese school aged children Hebebrand, 2009, Child AdolescPsychiatrClin N Am 18:49-65 Puder& Munsch, 2010, Int J of Obesity 34: S37-S43

  11. Eating Disorders in Population-based Samples • Strong positive association between BMI and disordered eating • Binge-purge behavior among national US survey of 6,500 students between 5th and 12th grade: • 20% in obese girls • 17% in overweight girls Hebebrand, 2009, Child AdolescPsychiatrClin N Am 18:49-65

  12. Eating Disorders in Population-based Samples Hebebrand, 2009, Child AdolescPsychiatrClin N Am 18:49-65 Prevalence of Disordered Eating in Different Weight Categories in 1,895 adolescents

  13. Depression in Clinical Samples Zeller et al, 2009, Obesity 17(5):985-90 Hebebrand, 2009, Child AdolescPsychiatrClinN Am 18:49-65 • 39% of severely obese adolescents presenting for bariatric surgery have clinically significant depressive sx (BDI≥ 17) • 32% of adolescents who participated in weight management program had CDI>13

  14. ADHD in Clinical Samples 30 adolescents, aged 12-16yrs: • 13% in clinical obese group • 3.3% in non-clinical obese group • 3.3% in control group Cortese et al, 2008, Crit Rev Food Sci Nut, 48:524-537 Erermis et al, 2004, PediatrInt, 46:296-301

  15. BED in Clinical Samples • 126 youth age 10-16 residential treatment for obesity: • 36% reported binge episodes • 102 obesity treatment seeking adolescents: • 17% reported moderate to severe binge eating symptoms Decaluwe et al. 2003, Int J of Eat Dis, 33:78-84 Isnard at al. 2003, Int J Eat Disord, 34:235-43.

  16. Objectives • Recognize the prevalence of mental illness among youth with obesity • Understand the cause and effect relationship between mental illness and obesity • Identify the implications of mental illness in the treatment of obesity

  17. Determining Causality is Difficult • Cross sectional nature of most studies • Different definitions and assessments of psychopathology in childhood • Lack of inclusion of potential confounders or mediators (social parameters, sleep deprivation, etc)

  18. Context Adapted from Vander Wal& Mitchell, PediatrClin N Am. 2011; 58:1393-1401 Demographics: age, gender, race/ethnicity, SES Obesity stigma/bias Maternal mental health Trauma Weight related teasing/bullying Mental Illness Pediatric Obesity

  19. Weight-related Teasing Increases Psychological Complications Eisenberg et al, 2003, Arch PediatrAdolescMed, 157(8):733-8

  20. Depression and Obesity Getty Images/Sean Murphy

  21. Meta-analysis of Longitudinal Studies N=58,745 OR 1.55 obesity depression OR 1.58 *associations were not statistically significant for <20 yo Luppinoet al, 2010, Arch Gen Psychiatry, 67:220-229

  22. Depression and Obesity:Cause or Effect? Depressive symptoms in childhood predict obesity in later childhood, adolescence and adulthood Puder& Munsch, 2010, Int J of Obesity 34: S37-S43

  23. Nat’l Longitudinal Study of Adolescent Health9,374 teens grades 7-9 • Baseline depression was not significantly correlated with baseline BMI • Depressed mood at baseline predicted increased odds of obesity (OR 2.05; 95% confidence interval: 1.18, 3.56) at 1 year follow up, controlling for baseline BMI, age, gender, race, parental obesity, SES, smoking, and physical activity • Obesity at baseline did not predict depressed mood at follow-upGoodman and Whitaker, 2002, Pediatrics, 110(3):497-504

  24. Mediators Between Obesity and Depression inflammation HPA axis increased body dissatisfaction low self esteem pain insufficient physical activity unhealthy eating patterns sleep disturbances psychotropic medications Luppino et al, 2010, Arch Gen Psychiatry, 67:220-229 obesity depression

  25. Mediators Between Obesity and Depression inflammation HPA axis increased body dissatisfaction low self esteem pain insufficient physical activity unhealthy eating patterns sleep disturbances psychotropic medications Luppino et al, 2010, Arch Gen Psychiatry, 67:220-229 obesity depression

  26. HPA Axis

  27. Mediators Between Obesity and Depression inflammation HPA axis increased body dissatisfaction low self esteem pain insufficient physical activity unhealthy eating patterns sleep disturbances psychotropic medications Luppino et al, 2010, Arch Gen Psychiatry, 67:220-229 obesity depression

  28. Mediators Between Obesity and Depression inflammation HPA axis increased body dissatisfaction low self esteem pain insufficient physical activity unhealthy eating patterns sleep disturbances psychotropic medications Luppino et al, 2010, Arch Gen Psychiatry, 67:220-229 obesity depression

  29. Mediators Between Obesity and Depression inflammation HPA axis increased body dissatisfaction low self esteem pain insufficient physical activity unhealthy eating patterns sleep disturbances psychotropic medications Luppino et al, 2010, Arch Gen Psychiatry, 67:220-229 obesity depression

  30. Mediators Between Obesity and Depression inflammation HPA axis increased body dissatisfaction low self esteem pain insufficient physical activity unhealthy eating patterns sleep disturbances psychotropic medications Luppino et al, 2010, Arch Gen Psychiatry, 67:220-229 obesity depression

  31. Mediators Between Obesity and Depression inflammation HPA axis increased body dissatisfaction low self esteem pain insufficient physical activity unhealthy eating patterns sleep disturbances psychotropic medications Luppino et al, 2010, Arch Gen Psychiatry, 67:220-229 obesity depression

  32. Appetite Hormones

  33. “Leptin Hypothesis” • Low levels of leptin are associated with depressive behaviors • Leptin insufficiency and leptin resistance may contribute to alterations of affective status Lu, Cur Opin Pharmacology, 2007, 7:648-652

  34. Obesity-Sleep-Depression depression

  35. Mediators Between Obesity and Depression inflammation HPA axis increased body dissatisfaction low self esteem pain insufficient physical activity unhealthy eating patterns sleep disturbances psychotropic medications Luppino et al, 2010, Arch Gen Psychiatry, 67:220-229 obesity depression

  36. Weight Gain and Atypical Antipsychotic Medications Taylor & McAskill, 2000, ActaPsychiatrScand, 101:416-432

  37. ADHD and Obesity

  38. ADHD and Obesity • Obesity leads to ADHD • ADHD and obesity are expressions of a common biological dysfunction in a subset of patients with both • ADHD contributes to obesity Corteseet al, 2008, Crit Rev Food Sci Nut, 48: 524-537

  39. Obesity Leads to ADHD • Sleep disordered breathing can manifest as ADHD symptoms during the day • Binge eating may contribute to impulsive behaviors Chevrin et al, 2005, Sleep, 28: 885-890 Cortese et al, 2007, Int J Obes, 31: 340-346

  40. Obesity and ADHD Share Common Etiology Reward Deficiency Syndrome • Described independently for both ADHD and obesity • Low dopamine activity in attentionalareas and brain reward pathways results in an attempt to compensate by using reinforcing behaviors such as eating Corteseet al, 2008, Crit Rev Food Sci Nut, 48: 524-537

  41. ADHD Contributes to Obesity • Poor planning and an inability to delay reward may lead to overconsumption • Kids with ADHD are engaged in less physical activity and organized sports • Kids with ADHD have lower gross motor skills, poor physical fitness, and delayed motor development Davis et al, 2006, Eat Behav7:266-274

  42. Binge Eating Disorder and Obesity

  43. Binge Eating DisorderDSM V Diagnostic Criteria Recurrent episodes of BE characterized by BOTH: • Eating large amounts of food in a discrete period of time • A sense of lack of control (LOC) BE episodes are associated with ≥ 3 of: • Eating more rapidly than usual • Eating until uncomfortably full • Eating large amounts when not hungry • Eating alone because of embarrassed • Feeling disgusted or guilty Marked distress regarding BE BE occurs at least 2 days per week for 6 months Not associated with compensatory behaviors

  44. Binge Eating Disorder • Those with LOC had significantly higher BMIs and more adiposity • After controlling for BMI, those with LOC reported more anxiety, depressive symptoms, and body dissatisfaction. • No association between attempts to diet and episodes of LOC over eating Morgan et al 2002, Int J Eat Dis, 31:430-441

  45. Binge Eating Disorder • No evidence that BE is a result of dietary restraint • Disinhibition, rather than dietary restraint, seems to precipitate BE in many obese subjects • Negative emotional states, social situations, time of day, and type of meal trigger BE de Zwaan, 2001, Int J of Obes, 25:S51-s55

  46. ADHD and BED Emerging evidence that binge eating occurs at higher than expected rates in people with ADHD Corteseet al, 2007, Int J Obes, 31:340-346

  47. Objectives • Recognize the prevalence of mental illness among youth with obesity • Understand the cause and effect relationship between mental illness and obesity • Identify the implications of mental illness in the treatment of obesity

  48. Does Weight Management Cause Eating Disorders?

  49. Does Weight Management Cause Eating Disorders? National Task Force on the Prevention and Treatment of Obesity 2000 • Dieting and weight loss in obese adults: • NOT associated with development of eating disorders • typically associated with improvements in depression, anxiety • associated with decrease in BE in individuals who began weight management with this complication

  50. In Children? Review of 5 relevant studies: “Professionally administered weight loss interventions:” 1. pose minimal risks of precipitating eating disorders in overweight children and adolescents 2. associated with significant improvement in psychological status in several studies Butryn and Wadden, Int J Eat Disord , 2005, 37:285-293

More Related