Presentation is loading. Please wait.

Presentation is loading. Please wait.

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

Similar presentations


Presentation on theme: "Obesity and Mental Illness: Cause or Effect Claudia Fox, MD MPH Diplomate, American Board of Obesity Medicine Director, Pediatric Weight Management Program."— 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…ive been 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 1.Identify the prevalence of mental illness among youth with obesity 2.Understand the cause and effect relationship between mental illness and obesity 3.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 1.Identify the prevalence of mental illness among youth with obesity 2.Understand the cause and effect relationship between mental illness and obesity 3.Identify the implications of mental illness in the treatment of obesity

8 Rates of Psychological Complications in People with Obesity are Uncertain

9 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 Adolesc Psychiatr Clin 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 5 th and 12 th grade: –20% in obese girls –17% in overweight girls Hebebrand, 2009, Child Adolesc Psychiatr Clin N Am 18:49-65

12 Eating Disorders in Population-based Samples Hebebrand, 2009, Child Adolesc Psychiatr Clin 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): Hebebrand, 2009, Child Adolesc Psychiatr Clin N Am 18: % 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: Erermis et al, 2004, Pediatr Int, 46:

15 BED in Clinical Samples 126 youth age 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:

16 Objectives 1.Recognize the prevalence of mental illness among youth with obesity 2.Understand the cause and effect relationship between mental illness and obesity 3.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, Pediatr Clin N Am. 2011; 58: Pediatric Obesity Mental Illness Demographics: age, gender, race/ethnicity, SES Obesity stigma/bias Maternal mental health Trauma Weight related teasing/bullying

19 Weight-related Teasing Increases Psychological Complications Eisenberg et al, 2003, Arch Pediatr Adolesc Med, 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 Luppino et al, 2010, Arch Gen Psychiatry, 67:

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 Health 9,374 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-up Goodman and Whitaker, 2002, Pediatrics, 110(3):

24 Mediators Between Obesity and Depression obesity 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:

25 Mediators Between Obesity and Depression obesity 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:

26 HPA Axis

27 Mediators Between Obesity and Depression obesity 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:

28 Mediators Between Obesity and Depression obesity 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:

29 Mediators Between Obesity and Depression obesity 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:

30 Mediators Between Obesity and Depression obesity 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:

31 Mediators Between Obesity and Depression obesity 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:

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:

34 Obesity-Sleep-Depression depression obesity sleep deprivation ↓ leptin ↑ grehlin increased hunger

35 Mediators Between Obesity and Depression obesity 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:

36 Weight Gain and Atypical Antipsychotic Medications Taylor & McAskill, 2000, Acta Psychiatr Scand, 101:

37 ADHD and Obesity

38 1.Obesity leads to ADHD 2.ADHD and obesity are expressions of a common biological dysfunction in a subset of patients with both 3.ADHD contributes to obesity Cortese et al, 2008, Crit Rev Food Sci Nut, 48:

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: Cortese et al, 2007, Int J Obes, 31:

40 Obesity and ADHD Share Common Etiology Reward Deficiency Syndrome –Described independently for both ADHD and obesity –Low dopamine activity in attentional areas and brain reward pathways results in an attempt to compensate by using reinforcing behaviors such as eating Cortese et al, 2008, Crit Rev Food Sci Nut, 48:

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 Behav 7:

42 Binge Eating Disorder and Obesity

43 Binge Eating Disorder DSM 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:

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 Cortese et al, 2007, Int J Obes, 31:

47 Objectives 1.Recognize the prevalence of mental illness among youth with obesity 2.Understand the cause and effect relationship between mental illness and obesity 3.Identify the implications of mental illness in the treatment of obesity

48 Does Weight Management Cause Eating Disorders?

49 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:

51 Psychological Difficulties are Associated With Decreased Weight Loss Success Baseline depression and LOC eating are associated with higher rates of weight loss treatment drop out Presence of fewer psychological complications predicts better long term weight loss maintenance Van der Wal & Mitchell, Pediatr Clin N Am. 2011; 58:

52 Screening Screen children with obesity for mental illnesses (Screen children with mental illness for obesity)

53 Address Psychosocial Factors in the Environment May be that addressing psychosocial elements, eg peer environment, could improve outcomes of obesity treatment

54 Identify Context of Overeating Emotional eating Binge eating Impulsive eating

55 Psychotherapy Aid in drawing connections between triggers and behaviors Improve social skills Improve attentional and organizational strategies Develop response inhibition Van der Wal & Mitchell, Pediatr Clin N Am. 2011; 58: Cortese et al, 2007, Nut Rev, Sept,

56 Pharmacotherapy Some evidence that treatment with stimulants improve ADHD and abnormal eating behaviors in patients with both conditions SSRIs can decrease binge eating episodes Cortese et al, 2007, Nut Rev, Sept,

57 Conclusions: Obesity and Mental Illness Co-occur with maladaptive eating behaviors Involve problematic coping strategies Share: –abnormal inflammatory response –dysregulated HPA axis –perturbations in neurotransmitter systems –genetic vulnerabilities

58 Address the Mind and the Body


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

Similar presentations


Ads by Google