Leslie Heinberg, PhD, on Obesity, Depression, and Their Chronicity
Obesity and depression, two very common conditions in the United States, often go hand-in-hand. Recent data indicate that, between 2005 and 2010, approximately 43% of US adults with depression also had obesity, and that the proportion of adults with obesity increased in conjunction with the severity of depressive symptoms.1
Because these conditions often interact, treatment requires a comprehensive intervention and adequate follow-up care. In an interview with Consultant360, Leslie Heinberg, PhD, from Cleveland Clinic and the American Society for Metabolic and Bariatric Surgery, discussed the impact of depression on the treatment of obesity, and how the chronicity of obesity can contribute to depression.
Consultant360: What approaches may play a role in treating depression in patients with obesity?
Dr Heinberg: Depression is the most common comorbid psychiatric condition in patients with obesity, particularly in those with severe obesity, and this association is bidirectional.2 Some of the symptoms of depression, such as appetite disturbance and difficulty with getting going and staying motivated, may put patients at risk for weight gain. Furthermore, weight gain can be an adverse effect of many medications used to treat depression, which could play a role in the association between depression and obesity over time.
People who live with obesity often suffer from a number of comorbid physical conditions, such as chronic pain, which can raise the risk of depression. In addition, people with obesity often face societal stigma related to their condition. Unfortunately, individuals often internalize this stigma, which can exacerbate the guilt and negative self-evaluation that often occur with depression.
C360: What role can “fat shaming” play, especially when it comes from family, friends, and other loved ones?
Dr Heinberg: “Fat shaming” is often a part of the societal stigma against individuals with obesity. Sadly, that stigma is universal and often comes from friends, family members, and even health care professionals. No one is really immune to it.
Furthermore, many people with obesity have often met roadblocks when attempting to manage their weight, which can feed into stigmatization. Many patients have tried some diets they heard about or tried to change their eating habits. Although they may have had a short period of success, they inevitably regain weight or hit a plateau. People often perceive the lack of effectiveness in their weight loss attempts as personal faults rather than understanding that obesity is a complicated, chronic disease that requires multidisciplinary treatment.
C360: Can you describe a challenging patient case you’ve seen in your practice?
Dr Heinberg: There was a young woman who had done exceedingly well in one of our medical weight loss programs here at Cleveland Clinic. She had had a long history of binge eating disorder (BED), which was well-controlled while under my care and while in the program. She had also had a long history of depression, which was well-managed by her psychiatrist. She ultimately lost 60 lbs through the program, which our whole team considered a great success.
I saw her after 2 years , and she had regained about 35 lbs. She had developed some new medical problems and had 2 surgeries, which impeded her ability to exercise. In addition, during that 2-year period, her BED had fully relapsed, which also likely played a role in the weight gain. She had stopped coming into treatment because she was ashamed of her weight gain. What often happens is, instead of reaching out for help, patients feel ashamed and embarrassed, so they stay away from treatment.
C360: What can other providers learn from that experience?
Dr Heinberg: This case is an example of the chronicity of obesity. Obesity is not solved with a one-and-done intervention, and there is no real “finish line,” so to speak. Even when patients have done really well in a weight management program, they need ongoing care for weight maintenance and relapse prevention, because it is very easy for obesity to relapse. Ongoing care is just as important as the weight loss intervention and needs to be a fundamental component of a treatment plan for obesity.
Leslie Heinberg, PhD, is Chair of the American Society for Metabolic and Bariatric Surgery’s Integrated Health Program and Professional Education Committee; Director for Enterprise Weight Management at Cleveland Clinic; and Vice Chair for Psychology in the Center for Behavioral Health's Department of Psychiatry and Psychology and Professor of Medicine in the Cleveland Clinic Lerner College of Medicine of Case Western Reserve University.
Published in partnership with the American Society for Metabolic & Bariatric Surgery.
1. Pratt LA, Brody DJ. Depression and obesity in the US adult household population, 2005-2010. NCHS data brief, no 167. Hyattsville, MD: National Center for Health Statistics. 2014. https://www.cdc.gov/nchs/products/databriefs/db167.htm.
2. Rajan TM, Menon V. Psychiatric disorders and obesity: A review of association studies. J Postgrad Med. 2017;63(3):182-190. doi:10.4103/jpgm.JPGM_712_16.