Unlocking the Surprising Link Between Sadness and Weight Loss: What You Need to Know

Introduction

The relationship between sadness, psychological distress, and weight loss is a complex and multifaceted issue, influenced by a web of biological, psychological, and social factors. Obesity, a global public health concern, is intricately linked to mental health, with conditions like depression and anxiety often co-occurring. While weight loss is frequently pursued to improve physical health, its impact on mental well-being can be varied, sometimes leading to unexpected or even detrimental outcomes. This article explores the intricate connections between sadness, psychological distress, eating behavior, and weight loss, highlighting the importance of a holistic approach to health that addresses both physical and mental well-being.

The Global Obesity Epidemic and Its Impact

Obesity has become a global epidemic, with staggering statistics highlighting its prevalence. In 2016, approximately 1.9 billion adults worldwide were classified as overweight, and over 650 million were considered obese. The World Health Organization (WHO) reported that approximately 60% of European adults were overweight or obese as of 2022. Severe obesity significantly increases the risk of various life-threatening diseases, including cardiovascular events, non-alcoholic fatty liver disease, and cancer.

It's important to note that weight loss outcomes vary significantly among individuals with obesity, even when employing the same strategies. This variability often leads to a cycle of weight loss and regain, a phenomenon known as weight cycling, which complicates long-term weight maintenance. Weight maintenance is defined as intentionally losing weight and sustaining that loss for at least six months. Weight cycling, characterized by repeated cycles of losing and regaining weight (≥ 5 kg), affects a significant portion of adults, estimated to be between 20% and 30%. Studies have indicated that weight cycling can increase weight, metabolic burden, and the risk of developing chronic diseases in individuals with obesity.

Psychological Distress: A Key Player

Psychological distress, encompassing conditions like depression and anxiety, plays a significant role in the complex relationship between weight and mental health. Previous research has established a strong link between psychological issues and weight cycling or regain. Large-scale statistical analyses have shown that individuals who experience weight cycling are more prone to depressive symptoms compared to those who do not. Furthermore, a correlation exists between frequent weight cycling and depression. Studies have also revealed that individuals with bipolar disorder and a history of weight cycling, particularly those who struggle to maintain weight loss, experience more frequent relapses of symptoms such as mania and depression.

Conversely, some remission of major depression and dysthymia has been associated with improved weight control and loss, highlighting the intricate interplay between psychiatric well-being, weight cycling, and weight maintenance. Psychological stress can influence changes in eating behavior and metabolic disorders among obesity-related diseases. Independent mental diseases are closely related to the occurrence of metabolic diseases.

Eating Behavior as a Mediator

Eating behavior is a crucial factor mediating the relationship between psychological distress and weight loss. Cross-sectional studies have revealed a link between psychological distress and emotional eating, binge eating, and external eating. Emotional eating behaviors, in general, mediate the effect of psychological distress on health-related quality of life. Psychological distress regulation is strongly linked to problematic eating behavior in adolescents. The indirect effect of psychological distress on emotional eating via emotional dysregulation was found to be significant in mediation analyses. Furthermore, a significant percentage of adults eligible for weight loss surgery exhibit food addiction and binge eating behavior, which is linked to a high prevalence of psychological distress, including depression and anxiety disorders.

Eating behavior has been linked to both psychological distress and weight loss levels, with changes in eating habits for weight loss associated with better outcomes. The presence and severity of eating behaviors may play a role in mediating the relationship between psychological distress and weight loss levels.

The Impact of Weight Loss on Mental Health: A Double-Edged Sword

While weight loss is often associated with positive physical health outcomes, its impact on mental health can be complex and sometimes contradictory. Studies have shown that intentional weight loss can be accompanied by improvements in mood, body image, physical functioning, and quality of life. When people lose weight, they often increase exercise, which is beneficial for mood. Patients often feel empowered and optimistic while losing weight, which can benefit their mood. Additionally, losing weight can improve physical health, which can boost self-esteem and overall well-being. This can lead to a positive cycle of improved self-esteem, increased motivation, and continued weight loss. Weight loss can also improve mental health by reducing the risk of depression and anxiety and enhancing the quality of sleep.

However, research also suggests a potential "dark side" to dieting and weight loss. Individuals who lost a certain percentage of their body weight over a period of time were more likely to feel depressed. A partner's weight loss could make the non-dieting partner feel jealous and more insecure about the partnership. Other studies caution that weight loss can dampen people’s moods. This highlights the importance of addressing the psychological aspects of weight loss alongside the physical changes.

GLP-1 Agonists: A New Frontier with Mental Health Considerations

The emergence of glucagon-like peptide-1 (GLP-1) receptor agonists, such as Ozempic and Wegovy, has revolutionized the treatment of obesity and diabetes. These medications have demonstrated significant efficacy in promoting weight loss and improving cardiometabolic risk factors. Mental health professionals are taking note of the drugs’ positive and negative effects on mood as well as their potential to quell some disordered eating symptoms while exacerbating others. Clinical psychologists, meanwhile, are helping patients navigate what happens on the inside when everything changes on the outside. These medications are “providing hope for our patients,” said Rachel Goldman, PhD, a clinical psychologist in New York City who specializes in cognitive behavioral therapy and health behavior change.

However, the use of GLP-1 agonists also raises important mental health considerations. While some individuals experience a quieting of "food noise" and a reduction in food-related intrusive thoughts, others may develop an unhealthy obsession with the number on the scale or experience a depletion of dopamine response to enjoyable activities. Some psychologists are concerned about the drugs’ physical side effects, too. Though rare, one observational study found a link between GLP-1s and blindness. Other research has shown that, like most methods of weight loss, as much as 60% of the pounds shed on GLP-1s can come from lean mass like muscles. Muscle depletion, in turn, is linked with bone issues like osteoporosis.

Research on the mental health effects of GLP-1 agonists has yielded mixed results. Some studies have found a slightly elevated risk of anxiety and suicidal behavior or even double the risk of major depression in people with obesity who were on GLP-1s when compared with controls. On the other hand, a study found that GLP-1 takers without known psychopathology weren’t any more likely to develop depression or suicidal thoughts or actions than controls.

Addressing the Challenges: A Holistic Approach

Given the complex interplay between sadness, psychological distress, and weight loss, a holistic approach is essential for promoting both physical and mental well-being. This approach should encompass the following key elements:

Screening for Mental Health Conditions: Health care providers should routinely screen patients for depression, anxiety, disordered eating, and other mental health conditions during weight loss journeys. Without treating underlying mood disorders and mental health conditions, it is tough to help people lose weight.
Integrated Treatment Plans: Treatment plans should address both the physical and psychological aspects of weight management. This may involve therapy, medication (when appropriate), lifestyle modifications, and strategies for managing emotional eating and stress.
Promoting Healthy Eating Behaviors: Encouraging healthy eating habits, such as mindful eating, balanced nutrition, and avoiding restrictive dieting, is crucial for both weight management and mental well-being.
Encouraging Physical Activity: Regular physical activity has been shown to improve mood, reduce stress, and promote weight loss. Exercise can be a powerful tool for mental health.
Addressing Weight Bias and Stigma: Clinicians should be aware of weight bias and stigma and strive to create a safe and supportive environment for their patients. They can avoid using stigmatizing language and promote positive body image and self-acceptance.
Body positivity: HAES supporters also focus on loving and accepting their bodies and exercising for joy, not weight loss. Individuals who live by these principles seek to celebrate, not shame, body diversity. They also challenge the “thin ideal” and other inaccurate messages about weight and body image.

The Role of Mental Health Professionals

Mental health professionals play a vital role in supporting individuals navigating the complexities of weight loss and mental well-being. Psychologists, therapists, and counselors can provide:

Therapy: Therapy can help individuals understand why they eat emotionally and learn coping skills.
Cognitive Behavioral Therapy (CBT): CBT can help patients on GLP-1s strengthen their body image and deal with body dysmorphia as their brains try to “catch up” with what their eyes see in the mirror.
Eye Movement Desensitization Therapy (EMDR): EMDR can treat people who used food to cope with a traumatic event like sexual abuse.
Guidance on practical matters: Psychologists can help patients with more practical matters, too, like making sure they’re getting enough protein, engaging in resistance exercise, and eating a variety of foods to help prevent muscle loss and malnourishment.

Read also: Weight Loss Meds & BCBS

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