When Being Overweight Becomes a Mental Health Issue
People who are both under and overweight often attribute it their genes. I remember as a teenager saying that my weight was due to a high metabolism. To some extent, research has backed this assertion, suggesting that genetics contribute to obesity by influencing things like metabolism, body-fat distribution, food cravings, and the tendency to use eating as a way to cope with stress. The latter two are the aspects that mental health professionals tend to focus on. A phrase that has become repeated in the fields of mental and medical health is, "Genetics loads the gun, but environment pulls the trigger." In fact, it has become so prevalent, no one any knows exactly who to attribute it to.
The strength of the genetic influence on weight varies from person to person but studies have indicated that genes account for only a portion of the predisposition to being overweight. People who have a genetic predisposition typically have been overweight much of their life, have blood relatives who are significantly overweight, and cannot lose weight even when increasing physical activity and reducing calories.
So when does being overweight become a mental health issue? Of course, a weight disorder does not always equate to an eating disorder or even disturbed eating for that matter. However, the condition known as binge eating disorder (BED) has long been associated with a higher incidence of obesity and a number of mental health problems.
To start, over a third of obese men and women in treatment programs for weight loss have been found to have an issue with binge eating. Binge eating is defined as consuming an amount of food in a discrete amount of time that is significantly larger than most people would eat during the same period. By comparison, compulsive overeaters, who also tend to be overweight, often engage in grazing behavior characterized by eating a large amount of food throughout the day, resulting in a high number of consumed calories even though the amount of food being eaten at each interval may be relatively small.
BED has only recently become recognized as an actual eating disorder in new Diagnostic and Statistical Manual of Mental Disorders (DSM-5) published in 2013. Previously, the DSM-IV listed it as an eating disorder not otherwise specified and subsets of anorexia nervosa and bulimia nervosa. BED is linked a number of psychiatric disorders. Approximately half of all people with BED have a history of depression.
A 2012 Italian study of 80 patients diagnosed with BED discovered that over 27 percent had current suicidal ideation and 10 participants had previously attempted suicide. The researchers noted, however, that suicidal behavior is no less common in BED than in other eating disorders. Instead, they found that individuals with BED can have increased suicide ideation, especially in the presence of alexithymia.
Alexithymia is a condition in which a person has difficulty identifying and communicating their feelings. In addition, an individual with alexithymia has problems focusing cognitively on their internal environment and differentiating between feelings and bodily sensations including satiation (a feeling of fullness after eating). All types of eating disorders have been associated with increased levels of alexithymia, especially challenges in identifying and describing feelings. Researchers have suggested this is due to the fact that eating disorder sufferers report that they use their eating disorder symptoms -- such as restricting food intake, bingeing, and purging -- as a way in which to avoid difficult feelings.
Not surprisingly, other psychiatric disorders are associated with being more alexithymic, most notably substance abuse, anxiety, and mood disorders. A common thread through all of these conditions is a difficulty with navigating thoughts and feelings on a consistent basis. In terms of evaluating if being overweight is a mental health issue, the level of alexithymia the person is experiencing may be one helpful measure.
American Psychiatric Association (APA). (2013). Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5(TM)). Arlington, VA: APA. ISBN-10: 089042554X
Carano, A., De Berardis, D., Campanella, D., Serroni, N., Ferri, F., Di Iorio, G., Acciavatti, T., Mancini, L., Mariani, G., Martinotti, G., Moschetta, F. S., & Di Giannantonio, M. (2012). Alexithymia and suicide ideation in a sample of patients with binge eating disorder. Journal of Psychiatric Practice, 18(1), 5-11. doi: 10.1097/01.pra.0000410982.08229.99
Fredricks, Randi. (2008). Healing and Wholeness: Complementary and Alternative Therapies for Mental Health. Bloomington, IN: Authorhouse. ASIN: B00BARVB96