Weight gain and depression: what is the link?

A Mediclinic expert unpacks the emotional impact of obesity and what help is available to break the cycle.

The obesity and depression connection

Obesity often goes hand in hand with depression. But the good news is that there are lasting and effective ways to address both issues, assures Johan Erasmus, a senior clinical psychologist at Denmar Mental Health Services in Pretoria.

“We have a holistic view of managing obesity,” he explains. “A multidisciplinary team approach leads to the best patient outcome. This can include input from psychologists, psychiatrists, psychiatric nurses, and occupational therapists. Obese patients may also be referred to an endocrinologist or surgeon.”

Am I overweight or obese?

Overweight and obesity are defined as abnormal or excessive body fat, which can harm your health. A body mass index (BMI) greater than or equal to 25 is overweight, and a BMI of 30 or higher is classified as obese.

The “obesity epidemic”

“My focus is on mental health and the correlation with obesity, and research shows a direct correlation between obesity and depression,” says Erasmus. “When you’re obese you have a higher risk of becoming depressed on both an emotional and physiological level. Your body metabolises differently and releases certain hormones differently. You tend to be less active because you’re simply unable to do more physically. Your quality of life is also  likely to be impaired.”

So it’s a concern that obesity is an increasing problem, with the global incidence tripling over the past 40 years. In fact, the World Health Organization (WHO) refers to it as a “global obesity epidemic”. In South Africa, figures from 2023 show that a third of men were overweight or obese, over two thirds of women, and more than 1 in 10 children.

“The rise in obesity is caused by eating more foods high in sugars and fats,” explains Erasmus. “This is coupled with less physical activity because of more people working in desk jobs, more use of vehicles, and urbanisation.”

The emotions behind obesity

Many of Erasmus’s patients have tried “every diet under the sun”, he says. After losing weight, they fail to sustain a new programme, and regain the weight. “This damages their willpower and self-confidence, and these are also signs of depression. People may experience personal and social losses because they feel judged by others. The negative perception is difficult to shed.”

This can lead to feelings of not being good enough or not being accepted, causing people to isolate themselves, adds Erasmus. The more they isolate, the less motivation and energy they have. If someone has an emotional connection to food, they might eat for self-comfort, which can create a cycle that gets worse over time.

The encouraging news is that help is available. If you haven’t had a recent check-up, see your GP, who will measure your BMI, blood pressure, blood sugar, and cholesterol levels and provide health advice. You may then be referred to one or more healthcare professionals, such as an endocrinologist to check for any physiological problems, a clinical psychologist for support with behaviour changes, and a dietitian for nutritional guidance.

What help and treatment can I get?

• Endocrinologist: “Being overweight isn’t solely linked to emotions or lifestyle; there could be physiological causes, such as a metabolic disorder,” says Erasmus. “So I always recommend that my patients with obesity first see an endocrinologist.” This specialty deals with the endocrine system, which includes the glands and organs that produce hormones and release them directly into the bloodstream to reach various tissues and organs throughout your body. Your specialist can identify any physiological, metabolic, or thyroid problems that may need treatment.
• Clinical psychologist: Weight gain is often related to the need for love, says Erasmus, and a clinical psychologist can help uncover the emotional root of the problem. “On the emotional side, I start by determining if the patient has a mood disorder or eating disorder. I also look at the patient’s relationship to food – is it one of nurture or nature?”
• Dietitian: They will guide you towards a structured approach to eating and draw up a personalised diet plan for you.

To find a healthcare professional near you, go to www.mediclinic.co.za.