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