Obesity, Genetics, Depression and Weight Loss
There are a lot of different opinions and strong emotions when it comes to the topic of obesity and weight loss. This article is simply another opinion about obesity in America. By writing this article, I am not trying to convince anyone of anything; I’m just trying to give you something to think about — perhaps a new idea.
The statistics regarding obesity in America are alarming. Currently, 35 percent of American adults are obese (CDC, 2012), and that number is projected to rise to over 50 percent in most states by 2030 (Henry, 2011). We’ve been fighting the so-called “war against obesity” since the 1980s, and yet despite all of our efforts, the problem has only gotten worse. Clearly, what we’ve been doing to try to solve this problem isn’t working and is possibly making it even worse. In my opinion, the reason for this is that the psychological piece hasn’t been addressed yet and until it is, we will have an increasing problem on our hands.
Years ago I was seeing a client who we’ll call Sarah. Sarah was very obese and desperate to lose weight. Her doctor had recently told her that if she didn’t lose a significant amount of weight she would lose her mobility as well as have a host of other medical consequences. Sarah tried numerous diets and exercise programs but nothing worked. She even enrolled in a weight loss clinic but had no success. She actually ended up gaining even more weight during this time. Not knowing what else to do, Sarah’s doctor told her that she needed to talk to a therapist.
When I met Sarah she was quite desperate to lose the weight and very depressed. Much to her surprise, I told her that I didn’t want us to work on her losing weight, but rather I wanted to work on her depression and teach her to accept and love herself unconditionally. This seemed the opposite of what she needed in order to lose weight, but Sarah decided to trust me anyway. You see, like a lot of people, Sarah thought that if she could just hate herself enough, that would motivate her to do whatever it took to lose the weight. As a therapist, I know that that is simply not going to work. We therapists follow something called the “Rogerian hypothesis,” which states that people tend to move in a positive direction only when given unconditional love and acceptance. Well, I’m happy to say that after we had alleviated Sarah’s depression and she had learned to love and accept herself, the weight came right off.
The current methods for helping people lose weight seem to be the opposite of love and acceptance. Much of the efforts seem to involve trying to shame and scare people into losing weight. This simply doesn’t work. The worst thing you can do is give someone more anxiety and depression regarding their weight, and I’m going to explain why that is later on. Also, the ways we go about teaching people to lose weight are much more complicated than they need to be. One should not have to read a book, go to a clinic, or take a class to learn how to lose weight. There is a very successful diet that has been around for thousands of years and all of the big celebrities do it. Can you guess what it is? It’s called “Moving more and eating less.” How you go about accomplishing this is up to you. I believe that losing weight is not complicated and that people intuitively know how best to do it when it comes to themselves. They simply need to stop feeling so anxious and depressed about it.
Obesity and Genetics
Before I talk more about how obesity is linked to depression and anxiety, I first want to briefly address the popular belief that obesity is purely a problem of bad genes. This is the popular belief and I can see why it is so popular. In a society where people are constantly trying to shame you about your weight, it can feel good to be able to say “Hey, you have no right to shame me about my weight! It’s not something I can control! It’s because of these bad genes I have!” But in order for this to be true, it means that our genes would have had to somehow change since the 1960s. Scientists agree that genetics is not responsible for the obesity epidemic, although they do agree it is a factor. Depending on which study you look at, genes only account for between 1 percent and 5 percent of a person’s body mass index (Li et al., 2010). I think that most people would agree that 5 percent of bad genes doesn’t excuse the 95 percent of it that scientists claim is due to bad habits.
When confronted with these facts, people often cite that most of the people in their family are also obese, so it must be genetics. However, the more likely possibility is that families tend to eat the same foods and have similar habits. Genetics also doesn’t explain why obese people also tend to have obese pets (Bounds, 2011). Obviously the dog doesn’t share the same genes as the owner, but they do share the same environment. Of course, we can’t mention genetics without looking at twin studies. Since identical twins have identical genes, researchers often compare twins to examine the effects of genetics and the environment on a person.
Obesity and Depression
Researchers aren’t quite sure if obesity causes depression or if depression causes obesity, but the two are definitely linked. In fact, the two conditions are so intertwined that some are calling obesity and depression a double epidemic. Studies have found that 66 percent of those seeking bariatric, (weight loss) surgery have had a history of at least one mental health disorder. And of course, it doesn’t help that the medications people take for depression and other mental health issues can cause dramatic weight gain.
Consider this: According to the CDC, half of Americans will suffer from some sort of mental illness, and most of them will not receive any treatment for it. 63 percent of Americans are also overweight or obese. There are almost as many Americans taking diet pills as there are taking antidepressants (8 percent and 10 percent). People with mental health issues are twice as likely as those without them to be obese, and that’s even before they start taking psychiatric medication (McElroy, 2009).
So why are people with mental health issues so much more likely than those without them to be obese? We know that depression and bipolar depression slows down your metabolism (Lutter & Elmquist, 2009). Depression also depletes our willpower, making us less likely to avoid eating unhealthy foods. Depression also causes us to crave high-fat foods and sugar. This is where emotional eating comes in. When we’re feeling down, fatty and sugary foods make us feel better, at least temporarily. Of course, you don’t need to have depression or a mental illness in order to engage in emotional eating. It’s something we learn at a very young age. Eating something unhealthy is much easier than fixing the problem or dealing with what’s causing us to feel unhappy. Teaching people how to deal with unpleasant moods other than by eating would certainly cut down on emotional eating and would certainly lead to significant weight loss.
So if depression causes weight gain and antidepressants cause weight gain, then what is the solution? Well, research has shown that talk therapy is just as effective at relieving depression as antidepressant medication (Doheny, 2010), and talk therapy doesn’t have the negative side effects that medication does. Another option is exercise. In a 2005 study on the effects of exercise vs. Zoloft (anti-depressant medication) on the treatment of depression, participants were randomly placed into two groups. On group received 150 mg of Zoloft while the other group engaged in 20 minutes of cardiovascular exercise three to four times a week. After eight weeks, they found that the exercise was just as effective at reducing depression as the Zoloft! Another thing to consider is that Zoloft has negative side effects such as weight gain, sleep problems, and sexual dysfunction. As you can imagine, the side effects of exercising are the opposite of that.
Stress and Weight Gain
In addition to unresolved depression causing real biological changes — which in turn cause weight gain — we now know that stress and anxiety do the same thing. Stress doesn’t cause changes to our metabolism like depression does, but it does cause changes to the way our body decides to burn fat. When under stress, our brain releases a hormone called cortisol. This hormone sends a signal to our body to store fat rather than burn it (Björntorp & Rosmond, 2000). There’s also evidence that not getting enough sleep can cause our brains to release cortisol (Cauter et al., 2005). The stress we experience about work, school, family, and relationships is literally making us fat.
In modern society it seems strange that our body would see weight gain as an antidote to stress. In order to understand this, we have to understand the type of world we were living in when our body evolved this response. Before modern agriculture and technology, if we were under stress it was probably due to famine or other environmental issues that could lead to our dying of starvation. Throughout much of human history, dying of starvation was the No. 1 stressor and No. 1 threat to our survival. It was thus essential to our species’ survival that our bodies react to stress by conserving energy. The types of stressors we have now either didn’t exist or weren’t important enough to us back then.
Fortunately, there are ways that we can reduce cortisol. The most obvious way is to reduce stress levels. Talk therapy has been shown to be an effective way of reducing cortisol levels (Littrell, 2008). Other ways of reducing cortisol include exercise, meditation, and yoga. The important thing to take away from this is that so long as you are experiencing stress and anxiety, your body is going to do everything it can to prevent you from losing weight. This can be especially problematic if you are exercising and dieting in such a way that causes you stress and anxiety and keeps you up at night.
Feeling bad about the way you look and putting lots of pressure on yourself to lose weight simply isn’t going to work. A lot of people decide that they want to lose a large amount of weight immediately and go through drastic measures to do it. What they don’t understand is that those drastic measures are causing them loads of stress and anxiety, really the opposite of what you want to do to yourself in order to lose weight. You also can’t expect to be able to successfully lose weight if you’re living in a chaotic and stress-filled environment. If you truly want to be able to lose weight and keep it off, you need to work on your emotional health first.
Food as an Addiction
Whenever we are talking about addiction, we are talking about two things: tolerance and withdrawal. Tolerance simply means that over time it takes more “drug” in order to produce the same “high” you got the first time you used the “drug.” Withdrawal refers to the unpleasant symptoms a person experiences when they try to wean themselves off of the “drug.” Physical symptoms of withdrawal can include headaches, pain, nausea, and diarrhea. Emotional symptoms of withdrawal can include irritability, sadness, and anxiety. A good rule of thumb is that you can expect the withdrawal symptoms to be the opposite of what the “drug” does to you. So for instance, if a drug makes you feel less anxious, you can expect one of the withdrawal symptoms to be increased anxiety. If a drug causes you to fall asleep, you can expect insomnia to be a withdrawal symptom.
We experience tolerance and withdrawal because of very real changes in our brain. Your brain wants there to be a balance. When it senses too much of a certain chemical, it responds by decreasing its own production of that chemical. Drugs affect our brains because they mimic naturally occurring pleasure-inducing chemicals like dopamine, endorphins, serotonin, and norepinephrine. When the brain is artificially flooded with these chemicals, it doesn’t like the imbalance, so it responds by producing fewer and fewer of these chemicals on its own. That is why addicts eventually gets to the point when they need to take drugs just to feel normal, because the brain has stopped producing these important chemicals on its own.
Due to advances in technology, scientists now know that these same processes of tolerance, withdrawal, and real chemical changes in the brain happen in food addiction just like they do in drug addiction (Gearhardt & Corbin, 2011). Tolerance is manifested in food addiction in a couple of different ways. One way it is manifested is when people need to eat more and more food in order to feel full or satisfied. Another way is when people are unable to derive pleasure from eating healthy foods. We are biologically wired to find fruits, vegetables, and whole grains pleasurable, and feeling like these foods are “tasteless” is a sure sign of tolerance. Withdrawal symptoms in food addiction typically results in feeling hungry even though you are already nourished, headaches, mood swings, irritability, depressed mood, and anxiety. No wonder people have such a hard time sticking to diets!
Critics of food addiction point out that if food has addictive qualities, why is food addiction such a new phenomenon? And why is it just humans who seem to be susceptible to it? After all, all animals eat and we’re the only ones who seem to have a problem with obesity and food. Well, the reason is because the food we are eating today is drastically different from the food people have eaten throughout most of human history.
Genetically modified foods have only been around since the 1980s. Highly processed foods and so-called “convenience foods” are also a relatively new phenomenon. They didn’t come on the market until around the 1960s, and that is also when researchers started noticing an increase in rates of obesity. These processed “convenience foods” are loaded in salt, sugar, and fat. And it’s not just convenience foods that are to blame. For instance, the meat found in wild game (the type of meat that our ancestors used to eat) only contains about 10 percent fat. Compare that to a slab of meat you buy in the grocery store that is as high as 50 percent fat.
Our bodies are no different than they were a hundred years ago, but the food we are eating is. And when we’re eating these highly processed foods, it’s been shown, the reward centers of our brains light up just as if we had ingested cocaine (Lenoir, Serre, Cantin, & Ahmed, 2007). When we eat such unnatural foods, our bodies have an unnatural reaction.
The prevailing attitude toward obesity is that people just need to straighten up and take responsibility for their own behavior. Society used to have that attitude towards alcoholism and drug addiction and it was that same attitude that held back the recovery movement for a very long time. We need to have the same attitude shift in regards to food addiction and obesity. There’s no such thing as “eating in moderation” and “just practice self-restraint” when it comes to addictive foods. That attitude hasn’t worked for alcoholics and it won’t work for food addicts either.
So at this point you might be wondering, “So what do you do if you’re addicted to food?” Unfortunately, you have to do many of the same things a drug addict would have to do in order to recover. You first have to accept that you can’t eat even a little of the addictive foods. You are going to have to practice abstinence when it comes to these foods and unfortunately deal with the withdrawal symptoms until your brain chemistry becomes normal again. A therapist can teach you tricks and techniques for lessening these withdrawals and avoiding relapse.
Weight Loss and the Placebo Effect
A placebo typically refers to a “sugar pill,” or fake medical intervention. When researchers are testing the effectiveness of a new drug, they’ll assign half of their volunteers to receive the actual medication and the other half will receive the placebo. The researchers won’t tell the participants whether they received the real medication or the placebo until the study is over, so during this time the participants taking the placebo think that they are taking the real medication.
The interesting thing about this is that in these studies, even though the participants aren’t actually receiving any real treatment, they still get better simply because they believe that the placebo is a real medication. The fact that these people are able to benefit simply by believing they will is known as the placebo effect. Again: The placebo effect is when people experience real biochemical changes in their body simply because they believe that they will.
We know that the weight loss people experience when they take over-the-counter diet pills is entirely due to the placebo effect, and yet people do lose weight simply because they believe they will. A lot of people take the attitude that “hey, I’ll do whatever works.” So if diet pills “work,” even if it is just by placebo, people will see no harm in taking them anyway. The problem with this is that diet pills can be quite harmful. Diet pills have been known to cause liver failure, strokes, seizures, and even death. Researchers have found that there are safer ways of producing placebo-driven weight loss.
In one famous study, a Harvard psychologist proved that people can actually think themselves thin. The psychologist enlisted the help of 80 hotel maids. Half of the maids were randomly assigned to a control group, meaning that they received no treatment. She met individually with the other 40 maids and went over what they did on a daily basis for exercise and how many calories they ate a day. The psychologist then told these women that they were burning more calories than they were eating, so she expected that they should lose weight without having to make any changes. The psychologist was actually lying when she said this, but she wanted to know if the women would lose weight simply because they believed they would.
As it turned out, they did. She asked the participants to keep a log of their daily exercise and calorie intake to make sure that they simply hadn’t changed their behavior and that that was causing the weight loss. The only thing that had changed was the maids’ mindset. Amazingly, the participants not only lost weight but they lost inches off their waist and even had a drop in blood pressure (Shea, 2007).
Another study on the effects of positive thinking on weight loss found similarly positively results. In the study, participants were asked to do daily visualizations where they imagined themselves having more positive interactions with food and being able to successfully resist temptation. Those using positive thinking lost an average of 26 pounds more than the control group after a year (Oettingen & Wadden, 1991). It is becoming more and more clear that you can lose weight simply by changing the way you think.
If you are still not convinced that you can lose weight simply by changing your thinking, let me tell you about another study. Ghrelin is the biochemical responsible for making us feel hungry. When levels of ghrelin are low, we feel satiated. When they are high, we want to eat more. In this study, when researchers told participants that the milkshake they were about to eat had a lot of calories in it, the participants’ ghrelin levels dropped. When participants were told that the number of calories in the milkshake was very low, ghrelin levels increased. The chemical that causes us to feel hungry is not regulated by the number of calories we eat, but rather our perception of how many calories we eat (Wang, 2012). You can see why mindless eating can cause someone to become obese. Not being aware of how many calories we are consuming can cause us to feel hungry even though we’ve already eaten plenty.
The Psychology of Weight Loss
When psychologists examine why some people are successful at losing weight and others aren’t, they notice that successful dieters have key psychological differences from those who are unsuccessful:
- Successful dieters are realistic. They recognize that it took time to put all that weight on and that it will take time to take it off. They set realistic goals for themselves, such as to strive to only lose 1 pound a week. They make many small changes that they can live with rather than drastic changes that they can’t possibly live with long term.
- Successful dieters have a “no excuses” attitude. You simply have to stop making excuses for yourself and just do it. Don’t wait for New Year’s or any other special date to start living healthier, do it now.
- Successful dieters make a lifetime commitment. They don’t look at dieting as something they’ll just do until they lose the weight; they realize that it is a lifestyle change. This is another reason why it’s better to make little changes that you can live with rather than go on a fad diet. It has to be changes that you can realistically see yourself doing for the rest of your life.
- Successful dieters do it for themselves. You have to want to lose weight for yourself, not to make somebody else happy. One of the biggest causes in failure to lose weight is doing it for somebody else. If you’re trying to lose weight so that your spouse will find you more attractive or so that someone else will get off your back, you’re just causing more of that stress and anxiety that prevents you from losing weight. Lose the weight because you want to be healthier, not so that you can fit somebody else’s definition of what is acceptable.
- Successful dieters keep active. “Staying active” doesn’t just refer to physical activity, but can also refer to staying busy in general. Keeping your mind and body busy can keep you from thinking about food and thus keep you from feeling hungry. Mind-numbing activities like sitting around watching TV increases feelings of hunger.
- Successful dieters resolve underlying stress and emotional issues. Successful dieters have resolved any stress and emotional issues that have caused the weight gain. They also surround themselves with supportive and positive people.
- Successful dieters don’t weigh themselves. Research has found that weighing yourself is very demotivating and actually not that good of an indication that you’re losing weight. A glass of water weighs a pound. If you drink a glass of water and then get on the scale, it’s going to look like you’ve gained a pound even though you really haven’t. A better indication of weight loss is how your clothes feel on you.
- Successful dieters change the way they think about calories.People often get very confused when it comes to how many calories they should be consuming a day. How many of you think that it’s okay to be consuming 2,000 calories a day? Yeah, a lot of people do because on the package of every food product it says “based on a 2,000 calorie diet.”. But did you know that eating 2,000 calories a day will cause most people to gain weight? Those guidelines you see on the food wrappers are actually calibrated for an adult man with a very active lifestyle, not the average American.The amount of calories you should be taking in a day in order to be at and maintain your goal weight is actually different for every person. If you want to find out what your daily calorie allowance is, I recommend going to the website caloriecount.com. You plug in your current weight, height, gender, activity level, and goal weight, and it tells you how many calories you can eat per day in order to achieve your goal weight after a year. Something I tell my clients is that they need to think about calories like they do money. You only have so much you can spend per day, so you need to get used to adding up the number of calories in the food you eat. Just as most of us will look at the price of something before we consider purchasing it, we need to check the calories on something before we decide to eat it.
Let’s do a quick review of the psychological factors that lead to weight gain and weight loss.
Psychological factors that contribute to weight gain:
- Not getting enough sleep
- Trauma and loss
- Relationship problems
- Childhood abuse
- Family conflict
- Parenting issues
- Multitasking while eating
Psychological factors associated with weight loss:
- Self-love and self-acceptance
- Having regular sex
- Coping skills
- More consistent sleep
- Healthy relationships
- Positive thinking
- Emotionally detaching from food
- Having an active and fun lifestyle
Shaming people, stressing out about your weight, over-dieting, over-exercising, and trying to lose weight while not addressing the underlying emotional issues that caused you to gain the weight in the first place are not going to help you lose weight. If one of your goals is to lose weight, you first need to be willing to address your issues, such as depression, anxiety, stress, and relationship conflicts. This isn’t to say that everyone who is overweight is also struggling with mental health issues, but if you’ve been unsuccessful in losing weight in the past, this may be the reason why.
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