Last year, we published an article for Childhood Obesity Awareness Month that answered this question:

What do treatment for substance use, mental health disorders, and obesity have in common?

You can read that article in full – Substance Use, Obesity, and Mental Health Treatment: Changing the Paradigm – or read the quick summary that follows.

In short, the article points out the fact is that for decades, what treatment for substance use, mental health disorders, and obesity had in common was that we treated them exactly wrong. We treated them as if they were signs of personal weakness, moral failings, or a lack of willpower on the part of the person living with a substance use or mental health disorder or the person living with obesity. For all three conditions – substance use, mental health disorders, and obesity – we tried to shame people into getting better. The basic message we gave people for years was it’s your fault you have a substance use disorder or obesity – and if you don’t get better, that’s your fault, too.T

That approach didn’t work.

What we’ve learned does work is treating substance use, mental health disorders, and obesity the way we treat other chronic, relapsing illnesses. It takes a coordinated, integrated effort. Treatment needs to address lifestyle, behavior, family dynamics, and any underlying mental health issues present. We’ve been using this new approach for substance use and mental health disorders for close to a decade now. However, we’ve barely recognized we need to use this approach for obesity, too. Now that we do know, we’re working to make changes and help people living with obesity with treatment that’s grounded in science and delivered with empathy and compassion.

Childhood Obesity Awareness Month 2019

This year, we pose a new question:

Is there a relationship between obesity and mental health disorders?

In order to answer this question, we need to make sure we’re all on the same page with the latest developments with regards to obesity. Many people may not know that in 2013, the American Medical Association (AMA) designated obesity as a chronic disease closely related to other chronic diseases like heart disease, hypertension, and type 2 diabetes, as well as certain cancers and joint diseases.

This proved to be a watershed moment in the treatment of obesity. Among other things, advocates of this new policy hoped it would lead to the following changes:

• Increased physician training in obesity in medical schools and hospital residencies
• Decreased stigma around obesity in the general public and medical professionals
• Increased insurance benefits for obesity treatment
• Increased funding for research on obesity prevention and treatment

We’ve made progress in all these areas, but we still have a long way to go, especially where reducing stigma is concerned.

Now that we’ve identified one way in which obesity and mental health disorders are related – they’re both chronic illnesses – let’s take a look at obesity and mental health prevalence statistics to see if there’s a connection.

Obesity Statistics: Adolescents

Here’s what the latest data from the Centers for Disease Control (CDC) shows about adolescent obesity and overweight in the U.S.:

• Almost 20% of children and adolescents meet criteria for obesity
• 5.6% meet criteria for severe obesity
• 16.6% meet criteria for overweight

That 20% figure is concerning: one in five adolescents in the U.S. meet the criteria for obesity. It’s concerning, but there is a glimmer of hope. Whereas obesity rates for adolescents rose steadily for three and a half decades – from 1980 to 2016 – they’ve leveled off since 2016.

Now, let’s have a look at the latest statistics on mental health.

Mental Health Disorders: Adolescents

Here’s what the latest data from the National Alliance on Mental Illness (NAMI) shows:

• 49.5% of adolescents met criteria for a mental health disorder
• 22.2% of adolescents age 13-18 have a mental health disorder that causes severe impairment
  • 11.2% met criteria for mood disorders
  • 9.6% met criteria for behavior disorders
  • 8.3% met criteria for anxiety disorders
• Only 50% of youth with a mental health disorder receive adequate professional treatment

We’ve presented the data for obesity and mental health disorders. Now we’ll identify where – if at all – obesity and mental health disorders overlap.

The Connection Between Obesity and Mental Health

First, we’ll offer a tidbit of information that you may be curious about. Research shows no increased risk of alcohol or substance use disorders for people with obesity. In fact, some studies show that people with obesity are less likely to develop an alcohol or substance use disorder.

Back to the topic: obesity and mental health.

For decades, there was conflicting evidence around the relationship between obesity and mental health disorders in adolescents. Some studies found correlations between obesity and depression, some found correlations between obesity and anxiety, while still others found correlations between obesity and personality disorders.

Two major studies published recently – one in 2016 and the other in 2019 – offer some clarity around the relationship between childhood/adolescent obesity and mental health disorders. We’ll list their findings by type of disorder and indicate the relationship between the disorder and obesity.

Here’s what the studies found.

Obesity and Mental Health Disorders: The Connections

• Depression. A diagnosis of obesity or overweight during childhood or adolescence indicates a significantly increased risk of developing a depressive disorder.
• Anxiety. A diagnosis of obesity or overweight during childhood or adolescence indicates marginally increased risk of developing an anxiety disorder.
• ADHD. A diagnosis of obesity or overweight during childhood or adolescence does not indicate an increased risk of developing ADHD. However, researchers did identify a correlation between ADHD accompanied by disobedience, defiance, aggression, cruelty, and destruction of property and disproportionate weight gain during early adolescence or adulthood.
• Eating Disorders. A diagnosis of obesity or overweight during childhood or adolescence indicates a significantly increased risk of developing an eating disorder.

The studies also identified other notable trends:

• Self-esteem: Children and adolescents with a diagnosis of obesity or overweight showed significantly lower scores on self-esteem assessments, compared to peers in typical/healthy weight ranges.
  • These children also had lower scores on measures of body satisfaction, perceived self-worth, and self-competence.
  • Girls reported more negative perceptions about their physical appearance, self-worth, and feelings of social acceptance, compared to boys.
• Quality of Life: Children and adolescents with a diagnosis of obesity or overweight showed consistently lower scores on health-related quality of life measures as compared to peers in typical/healthy weight ranges.
• Social Factors: Children and adolescents with a diagnosis of obesity or overweight more likely to be bullied and teased.
  • These children reported bullying and teasing by peers, teachers/educators, parents, and health care providers.
  • Children age 6-13 were 4-8 times more likely to be bullied by typical weight range peers.

How We Can Help

The first and most obvious thing we can all do with regards to childhood and adolescent obesity is to look inside ourselves for any remaining stigma around obesity. We now know that obesity is a disease. It’s got nothing to do with quality of character or strength of willpower. It’s got far more to do with genetics, environment, and a cluster of other factors unrelated to questions of personal integrity or individual decision-making.

The next thing we can all do is read the CDC Fact Pages on childhood obesity. We should pay special attention to their Childhood Obesity Awareness Month page in order to understand the health risks, proactive steps, and preventive measures to take to help decrease the prevalence of childhood obesity in the U.S.

Finally, we can make the connection between obesity and mental health. We all need to understand that it’s not simple. In the words of Dr. Melody Covington, writing for the Obesity Medicine Association:

“The link between obesity and mental health is complex and multi-faceted. It is important that patients with mental health disorders are monitored for weight, and that people with obesity are screened for mental health disorders.”