Obesity and psychiatric disorders – Endocrinologist’s perspective.

Volume 6 Issue 9 September, 2016

Consultation Liaison Psychiatry Focus: Endocrinology

Obesity is a medical condition in which excess of body fat has accumulated to the extent that will have a negative impact on health. Currently obesity is one of the leading causes of non-communicable diseases like type 2 diabetes, coronary heart disease, osteoarthritis and OSA. Obesity is due to genetic susceptibility, excess of food intake and lack of physical activity.

Obesity and psychiatric diseases are interrelated, probably at genetic origins as well. Impaired appetite regulation, emotional regulation, circadian rhythm and related endocrinal disturbances and disordered eating behaviors often co-exist even before the onset of psychiatric disorders as well as clinical obesity. Recent studies have showed that, in obese peoples there is increased incidence of mood disorders like major depression, dysthymia and maniac and hypomanic episodes. Food is often used as a coping mechanism by those with obesity particularly when they are sad, frustrated and lonely. In many obese patients, there appears to a perpetual cycle of mood disorder, over eating and weight gain. In addition to depression, anxiety, other problematic eating behaviors are mindless eating, frequent snacking on high calorie diet, overeating and night eating. Binge eating disorder (at least 2 days /week over 6 months) causes weight gain. Obese patients are usually compared with peers and are criticized. They internalize themselves putting them at risk of mood disorder, anxiety, substance abuse. They usually suffer low self-esteem and feel uncomfortable with their bodies (body image dissociation). So behavioral therapy should be involved in the program of lifestyle modification along with diet and exercise in obesity.

Some of the Antidepressant drugs are associated with significant weight gain- Paroxetine, Amitriptyline, and Mirtazapine. So in patients with obesity and depression use of drug which are weight neutral like Bupropion and fluoxetine can be substituted. Many of the newer Antipsychotics drugs were associated weight gain as a side effect, for example- Olanzapine, and Risperidone, whereas Ziprasidone and Aripiprazole have lesser risk of weight gain compared to other drugs. Some of the endocrine diseases associated with obesity (Cushing’s syndrome and hypothyroidism) have underlying psychiatric manifestations like depression, anxiety and psychosis. So while evaluating for psychiatric diseases with obesity always looks for endocrine causes of obesity.

Obesity often contributes to cause and effect of psychiatric disorders and hence for effective management of obesity, underlying psychiatric problem should be addressed.