Obesity and depression: They're entwined, yet scientists don't know why
Newton Press MentorOct 14, 2017
About 15 years ago, Dr.
McElroy was convinced there had to be a connection.
Many of my [depressed] patients were obese. And they were very upset by obesity, McElroy recalled. I looked into the literature, and it said there was no relationship. It didnt make sense.
That sense of disconnect has started to change, promising new avenues for treatment, but also presenting a puzzle: Just how can you chart the mechanics of what ties the two together? And how can treatment be linked for two disorders that exist in totally different parts of the health care system?
You cant address obesity in a person thats struggling with major depression without addressing that major depression, said Donato, chief of mental health promotion at SAMHSA, the
The relationship between obesity and depression is what researchers call bidirectional. Being obese or overweight ups the odds of depression, and vice versa.
For example, about 43 percent of people with depression are obese, according to the federal
While on the surface the two conditions appear very different, they share important similarities. Both are chronic diseases that are tricky to treat, requiring long-term physical and mental health interventions.
In cases in which depression and obesity coincide, those interventions can be even more complex, with research often showing the best results when care involves not only doctors and nurses but also other health professionals such as dietitians, behavioral health specialists and physical therapists.
We need to find synergistic therapies or its going to be the same kind of messy system in which we spend a lot of money and dont get any return, said
A 2011 paper by researchers from the
Still, this kind of care-syncing is not yet the norm. While the Affordable Care Act promoted coordinated care as part of its efforts to lower costs, those initiatives havent yet been directed toward depression and obesity.
But federally funded efforts to coordinate care for diabetes and depression could provide a template, said
This is going to require a real mindset change. We have to be thinking at a policy level, Trivedi said.
One reason is cost. Depression and obesity are among the largest drivers of health care cost increases.
Obesity already costs the medical system almost
Depression makes the price tag worse. Its most severe variant, major depressive disorder, costs the country more than
The federal government foots much of this bill.
About 13 million Medicare-eligible senior citizens an estimated 35 percent of people older than 65 are obese, according to
These are both incredibly burdensome on the health care system. Theyre both on the rise, and theres a correlation, said
And resources to tend to patients with each condition, even individually, are limited.
The federal government has worked to expand mental health care access and insurance coverage, but in many parts of the country, few mental health specialists accept insurance, rendering that theoretical benefit useless.
Obesity interventions also fall short. The
And theres the added challenge of finding a physician able to address both problems at once.
Its not a one-shot thing. Both of these are chronic conditions. They dont lend themselves to episodic treatment, said
Already, research suggests primary care physicians, who are on the front lines in providing care, arent meeting clinical standards for treating depression. Most psychiatrists arent trained in weight management.
This is an important area, and I dont think people are trained how to do it, said Dietz.
Progress has been slow, in part, because of the stigma surrounding both conditions.
Having either is like having the scarlet letter, suggested
We have a long, long way to go before we treat obesity like we do heart failure, Coleman added.
In her
Her patients vouch for her methods.
Ask 26-year-old
Ive had to work harder with my doctor to find something that works so that I dont weigh 500 pounds, he said.
McElroy has prescribed him a new pill thats helped control his weight, he said. Had his psychiatrist known how to treat both conditions, he added, he would for sure had begun addressing weight sooner.
McElroy worries that without broader changes to the health care system, patients like Stewart are just that: individual cases.
If we addressed this systematically, you would think it would be not only better for patients health but also cost-effective, she said.
This story is part of a reporting partnership between POLITICOs The Agenda 2020 and
http://www.pressmentor.com/article/20171013/LIFESTYLE/171019841