They’re en­twined, yet sci­en­tists don’t know why

They’re en­twined, yet sci­en­tists don’t know why

Imperial Valley Press - - FRONT PAGE - By Kaiser Health News

About 15 years ago, Dr. Sue McEl­roy, a psy­chi­a­trist in Ma­son, Ohio, started notic­ing a pat­tern. Peo­ple came to see her be­cause they were de­pressed, but they fre­quently had a more vis­i­ble ail­ment as well: They were heavy.

McEl­roy was con­vinced there had to be a con­nec­tion.

“Many of my [de­pressed] pa­tients were obese. And they were very up­set by obe­sity,’’ McEl­roy re­called. ”I looked into the lit­er­a­ture, and it said there was no re­la­tion­ship. It didn’t make sense.”

That sense of dis­con­nect has started to change, promis­ing new av­enues for treat­ment, but also pre­sent­ing a puz­zle: Just how can you chart the me­chan­ics of what ties the two to­gether? And how can treat­ment be linked for two dis­or­ders that ex­ist in to­tally dif­fer­ent parts of the health care sys­tem?

In­grid Donato, a top of­fi­cial in the fed­eral agency that pro­motes men­tal health treat­ment, says that both con­di­tions are on the rise, height­en­ing the need to un­lock the con­nec­tion and de­velop treat­ments that ad­dress both con­di­tions si­mul­ta­ne­ously.

“You can’t ad­dress obe­sity in a per­son that’s strug­gling with ma­jor de­pres­sion with­out ad­dress­ing that ma­jor de­pres­sion,” said Donato, chief of men­tal health pro­mo­tion at SAMHSA, the Sub­stance Abuse and Men­tal Health Ser­vices Ad­min­is­tra­tion. “When a per­son’s com­ing in with de­pres­sion … or they’re com­ing in with the strug­gles on the phys­i­cal side of obe­sity, if they’re not hav­ing those treated both ways, they’re only go­ing to be hav­ing half a treat­ment plan.”

The re­la­tion­ship between obe­sity and de­pres­sion is what re­searchers call “bidi­rec­tional.” Be­ing obese or over­weight ups the odds of de­pres­sion, and vice versa.

While on the sur­face the two con­di­tions ap­pear very dif­fer­ent, they share im­por­tant sim­i­lar­i­ties. Both are chronic dis­eases that are tricky to treat, re­quir­ing long-term phys­i­cal and men­tal health in­ter­ven­tions.

In cases in which de­pres­sion and obe­sity co­in­cide, those in­ter­ven­tions can be even more com­plex, with re­search of­ten show­ing the best re­sults when care in­volves not only doc­tors and nurses but also other health pro­fes­sion­als such as di­eti­tians, be­hav­ioral health spe­cial­ists and phys­i­cal ther­a­pists.

“We need to find syn­er­gis­tic ther­a­pies — or it’s go­ing to be the same kind of messy sys­tem in which we spend a lot of money and don’t get any re­turn,” said Wil­liam Di­etz, the di­rec­tor of Ge­orge Wash­ing­ton Univer­sity’s Sum­ner M. Red­stone Global Cen­ter for Preven­tion and Well­ness.

A 2011 pa­per by re­searchers from the Univer­sity of Texas-South­west­ern found that pa­tients’ de­pres­sive symp­toms were re­duced when physi­cians gave them pre­scrip­tions for weekly ex­er­cise ses­sions, which were su­per­vised at the Cooper In­sti­tute in Dal­las or at home. And in 2014, a study at Duke Univer­sity found that sim­ply help­ing obese women main­tain their weight — via small life­style changes and monthly di­eti­tian check-ins — cut their rates of de­pres­sion in half.

Still, this kind of care-sync­ing is not yet the norm. While the Af­ford­able Care Act pro­moted co­or­di­nated care as part of its ef­forts to lower costs, those ini­tia­tives haven’t yet been di­rected to­ward de­pres­sion and obe­sity.

Al­ready, re­search sug­gests pri­mary care physi­cians, who are on the front lines in pro­vid­ing care, aren’t meet­ing clin­i­cal stan­dards for treat­ing de­pres­sion. Most psy­chi­a­trists aren’t trained in weight man­age­ment.

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