Doughnuts, Depression and Despair. November, 2014

Depression and Obesity:  What is the connection between the two? And what role do doughnuts play?

Recently some articles came across my desk that I thought were quite interesting since we're looking at the inflammatory connection of obesity and depression. Our society’s adage, ‘You can't be too rich or too thin,’ has placed great pressure on those people who are struggling to be slim.  I recently saw a young woman who had been in our program for well over two years. She had lost over 237 lbs and had only 43lbs to go to be at perfect weight for her.  She took a little bit of a vacation from the program in order to visit her 52-year-old mother.  During the four months she was gone, she regained 55 pounds. 

I asked her, “How on earth did you gain back 55 pounds?”  She told me that she went to the local doughnut café each morning with her mother and between them they would eat four to six doughnuts and drink two coffees!  Of course, they drank the coffee that was very sweetly flavored.  She replied tearfully, “I knew what I was doing was wrong, but I just couldn't help myself!”

She then described feeling defeated, hopeless, bored, and frustrated with her life since gaining 55 pounds.  She decided to go see her primary care physician about her feelings and her physical complaints.  Her doctor placed her on Lexapro for her depression. I asked her if she knew that Lexapro could potentially cause her to gain weight.  She said that was never discussed.  I explained to her that most of her complaints really had more to do with her low self-image and low self-esteem contributing to her weight gain than did depression.  She agreed whole-heartedly. We agreed that in her case there was no need for Lexapro. She just needed to start eating correctly once again.

Sadly in our American society we see increasing number of celebrities and prominent politicians overweight or obese due to their unhealthy lifestyles.  Increasing social acceptance of the overweight or obese individual in our culture has legitimized weight gain and obesity to the point where physicians feel it’s not worth their time discussing it any longer.  But as a physician, I strongly feel that we must continue to discuss the hazards of obesity on health and well-being, such as premature death, coronary artery disease, diabetes, arthritis, and many forms of cancer. 

Research has shown that obese or overweight individuals tend to interact with other overweight individuals because they are comfortable with them. One report showed that adults with obese friends are more likely to become obese than the individual without obese friends.  The study also found that overweight teenagers were twice as likely have overweight friends. The positive side to this problem is that the power of the social connection can be harnessed to be a treatment option for overweight or obese patients.  There is encouraging reports that therapeutic groups can help the overweight individual with his depression and his weight gain. In essence, there are options to help the obese or overweight person other than anti-depressants. The help you get here at The Weigh Station falls into one of these options.

 Another interesting fact I’ve recently read is that activity alone—even just a 20 minute walk--- has proven in some cases to be as effective as Prozac 20 mg a day.  Unlike prescription drugs, physical activity is free with no potential side effects!  There is much evidence that a regular exercise program can successfully treat certain types of depression. The Weigh Station will help you manage your weight and improve your cardiovascular fitness to help you learn

the healthy lifestyle you need to overcome obesity. However, I am aware that motivation is the key ingredient of any successful program.  The Weigh Station encourages patients to make exercise enjoyable, perhaps using video games or other interactive programs.  Getting involved with a certified trainer causes you to become accountable---another key ingredient to successful weight loss.

I also hear a lot about sleep disturbances. Did you know that disruptive sleep is another hallmark of depression and that this appears to be another risk factor for weight gain?  The basis of this relationship is still being investigated by multiple university study programs.  One possibility has emerged that patients with insomnia wake up to eat which is known as “nighttime eating syndrome.”  Researchers have recently shown that when sleep is curtailed in a sleep lab, patients consume approximate 20% more calories from snacks than non-sleep deprived patients which came to about 220 more calories than the latter group consumed. Although this is a 220 cal increase would seem small, it could easily amount to approximately a two to three pound weight gain per month.

You need to be aware that every pound you weigh over your ideal healthy body weight plays a significant role in reducing your overall body health. Stay with me here as I try to give you an understanding to what I have just said.

Leptin is the master hormone in our bodies associated with satiety. It plays a major role in our appetite control. Studies are being done on its role in our depressed mood and sleep disturbances.  Researchers have suggested that leptin insufficiency or leptin resistance may contribute to the vulnerability of depression. This hormone leptin may have antidepressant effects on our bodies.

There is a substantial body of evidence that shows that “Depressed patients have elevated levels of inflammatory markers particularly interleukin-6 (IL-6) and interleukin-1 (IL-1.)” OK,’ interleukins’ are a group of ‘cytokines’ which are secreted proteins and signaling molecules in our bodies.   IL-6 and IL-1 are both cytokines that play significant roles in regulating immune and inflammatory responses to infection in our bodies. IL-6 also plays a role in the regulation of our metabolic process.

 It is possible that there are pathways linking the cytokine actions and depression together.  Serotonin metabolism has been studied significantly and showed that “tumor necrosis factor alpha” (a big phrase for something that has the primary role to regulate our immune cells) activates brain receptors to deplete serotonin levels and exacerbate the level of depressive symptoms.   Physical problems can also ensue.  Evidence suggests that adipose tissue deprived pro-inflammatory agents are involved in the development of metabolic syndrome,  a condition characterized by insulin resistance, glucose intolerance, visceral adiposity, hyper coagulant ability, chronic inflammation, and oxidative stress and hypertension.  These conditions are a strong risk for type II diabetes, coronary artery disease, hypertension and stroke.

Another interesting note comes from a study I read which gave 160 mg of aspirin, taken for a month by  24 depressed patients who failed to respond to four weeks of antidepressant therapy. The study found that 52% in the study responded to aspirin when it was added to their daily regimen, and improvement was seen during even the first week.  Quite fascinating that the inflammatory response showed up again---a response we see in multiple areas of medicine!

I know that this is a lot of medical information crammed together in a short newsletter.  However, hopefully you can now understand why every pound over your ideal body weight is significant. Excess weight can contribute both to mental and physical problems throughout your mind and body.

So remember this as fall comes to an end and winter begins. Getting yourself outside to walk will make all the difference. If it's too cold, you can always go for a walk in the mall!  Let us help you keep your weight off.  Once you reach your goal and go into maintenance, it is an extremely important to learn how to maintain. Hint: walking plays a key role here!

Here’s wishing you a wonderful Thanksgiving holiday.  Remember to pick up your Thanksgiving menu suggestions at any of our locations.  If you have questions, please don't hesitate to email Tricia. ‘Ask the Dietitian’ is located on our web-page.

Psalm 28:7, NLT The LORD is my strength and shield. I trust him with all my heart. He helps me, and my heart is filled with joy. I burst out in songs of thanksgiving.

Happy Thanksgiving!

Chuck Shaffer MD