Authored by Alex Lambrianidis
Art by Sabrina Chen
When you have a headache, what is the first thing you typically do? For many, it would be to reach for the bottle of Tylenol. What about an upset stomach? You would probably go for the Tums. For many disorders of the body, medications are a viable solution to remedy the trouble. For others, however, prescription drugs may impart minor improvements, if any at all, while others seem to exacerbate the problem altogether [1]. Obesity and depression are two common physiological disorders of the body and mind that fall into this unfortunate category. Metabolic studies and other biochemical indicators have linked these two together, but successful treatment regiments have eluded clinicians for decades [2]. Rather than attacking the issues separately, newly integrated therapies have shown promise to meet both challenges at once [3].
Obesity and depression remain to be two of the most prominent health challenges facing the United States today. As of 2010, the Center for Disease Control (CDC) has determined that over one in three adults aged 20 and older are considered obese, and 7.2% are diagnosed with clinical depression [4]. These trends are predicted to continue increasing at an extraordinary rate. Studies have suggested that by 2030, the U.S. will observe a 33% increase in obesity prevalence from the 2010 data [5]. While these revelations are certainly alarming, research in the field has demonstrated significant promise. Specifically, scientists have identified key biochemical links in the occurrence of obesity and depression within the same individual [6].
According to the CDC, 43% of adults with depression are also considered obese [4]. Researchers have linked the correlation between these two disorders to one prominent neurotransmitter: serotonin. The underlying issue for individuals with obesity is energy imbalance and metabolic dysregulation. Serotonin is believed to be integral in these biochemical systems to regulate energy intake and subsequent expenditure. Dysregulation of serotoninergic neuronal functioning within the central nervous system is also associated with changes in mood, leading to depressive states [6]. This common pathophysiology suggests that obesity and depression may represent neural manifestations of the same underlying dysfunction.
Serotonin-related studies have enabled the pharmaceutical industry to better understand the effects of neurotransmitters on the central nervous system. One widely prescribed antidepressant has been selective serotonin reuptake inhibitors (SSRIs) [7]. Between 1996 and 2005, antidepressant prescriptions doubled in the U.S. to potentially meet the challenges of obesity and depression simultaneously [1]. SSRIs work on serotonergic nerve terminals to prolong the effects of serotonin within the synaptic cleft by blocking reuptake of the neurotransmitter. The resulting increase in serotonin levels in the brain help facilitate weight loss by accelerating the onset of satiety and diminishing the impacts of mood disturbance. What clinicians observed, however, was that these effects were mostly transient, and could not sustain the desired long-lasting effects on behavior and mindset [7]. Consequently, despite the increased usage of antidepressants like these, obesity and depression continue to be a major public health concern [1].
In recent years, cognitive behavioral therapy (CBT) has been a widely accepted treatment for symptoms of major depressive disorder. Researchers have since wondered whether these practices can be applicable in the behavioral therapies aimed at diminishing rates of obesity in the population [3]. In one study, the short-term efficacy of combined behavioral weight management and CBT for depression were tested [3]. The 12 female participants received weekly group therapy for 16 weeks, led by a clinical psychologist. The first 90 minutes was dedicated to weight management strategies. Participants were educated on self-monitoring, stimulus control, setting calorie goals, and safe fitness techniques. In the second half, CBT was applied to treat depressive symptoms. Participants were taught to identify their negative conscious thoughts and core beliefs on body image and self-worth [3].
Over the course of the 16 weeks, there was a mean weight loss of 10.4 kg (equal to a reduction of 11.4% of initial weight), and depression scores were significantly decreased as well. While these findings do garner optimism for alternative, non-pharmaceutical treatment, researchers acknowledge the need for a larger, randomized control trial to establish the full efficacy of the combinatorial treatment plan [3].
One critical limitation of the study was the demographic of participants used. These individuals represented those from higher socioeconomic status, with sufficient access to primary care facilities [3]. For many across the U.S., such availability is not always present, as health is often determined by environmental factors well beyond control of the patient. While such practices may not seem feasible at first, the rising prevalence of telehealth presents an opportunity for equitable access in both rural and urban centers. Behavioral therapy and CBT by way of telehealth thus presents an opportunity to deviate from the conventional treatment regiments focused purely on pharmaceutical treatment [8].
Obesity and depression represent two of the most pivotal challenges facing the U.S. today. These disorders are associated with reduced quality of life, cognitive dysfunction, and an increased risk for cardiovascular complications causing decreased life expectancies [2]. Facing these disruptions to health and well-being requires the utmost sensitivity and dedication to appropriate care techniques, not only for adults, but for many adolescents as well. As researchers continue their diligent work to uncover viable solutions, many retain a hopeful optimism that group therapy over invasive drug treatments is well within the scope of the near horizon.
Works Cited
Toups, M.S., Myers, A.K., Wisniewski, S.R., Kurian, B., Morris, D.W., Rush, A.J., Fava, M. & Trivedi, M.H. (2013). Relationship between obesity and depression: characteristics and treatment outcomes with antidepressant medication. Psychosomatic Medicine, 75(9), 863-872.
Jantaratnotai, N., Mosikanon, K., Lee, Y., & McIntyre, R.S. (2017). The interface of depression and obesity. Obesity Research & Clinical Practice, 11(1), 1-10.
Faulconbridge, L.F., Wadden, T.A., Berkowitz, R.I., Pulcini, M.E., & Treadwell, T. (2011). Treatment of comorbid obesity and major depressive disorder: a prospective pilot study for their combined treatment. Journal of Obesity, 2011.
Pratt, L.A. & Brody, D.J. (2014). Depression and obesity in the U.S. adult household population, 2005-2010. Center for Disease Control and Prevention. https://www.cdc.gov/nchs/products/databriefs/db167.htm#:~:text=In%202005%E2%80%932010%2C%2034.6%25,limitations%20(2%E2%80%934).
Finkelstein, E.A., Khavjou, O.A., Thompson, H., Trogdon, J.G., Pan, L., Sherry, B., & Dietz, W. (2012). Obesity and severe obesity forecasts through 2030. American Journal of Preventive Medicine, 42(6), 563-570.
Rosmond, R. (2004). Obesity and depression: same disease, different names? Medical Hypotheses, 62(6), 976-979.
Wurtman, R.J., & Wurtman, J.J. (1995). Brain serotonin, carbohydrate‐craving, obesity and depression. Obesity Research, 3(S4), 477S-480S.
Garcia, R.A. (2017). Population health management telehealth intervention medical research treating comorbid clinical obesity and depression in geriatric patients part one: review of tele-medicine scientific research. RMES, 1(5), 1-4.