Obesity and Mental Disorders PDF

Preface

Obesity and mental disorders are major public health problems that co-occur to a significant, but unknown, degree. Indeed, whether or not these conditions are related has been a focus of scientific debate for over 50 years. However, the evaluation and treatment of the patient with obesity and a comorbid mental disorder have received extremely little empirical study, and presently there are very few treatment guidelines to help clinicians manage such individuals.

Many emerging lines of evidence suggest that reexamination of the relationship between obesity and mental disorders is in order, particularly for mental health professionals. In this regard, the significant overlap between obesity and psychopathology in clinical populations may be the most important. Weight gain, overweight, and obesity frequently complicate the treatment of patients with mental disorders, especially those with psychotic disorders, mood disorders, and eating disorders. Conversely, mood and eating symptoms and disorders are common in persons of all ages seeking treatment for obesity, as well as some of the general medical conditions associated with obesity, such as type 3 diabetes and cardiovascular disease.

However, the reasons for the overlap between obesity and mental disorders in clinical populations are not understood. First, iatrogenic factors likely play a role. Many of the drugs used to treat psychotic and mood disorders are associated with weight gain. Conversely, some of the drugs used to treat the general medical conditions that co-occur with obesity may induce psychological systems. Second, both obesity and many mental disorders are increasingly severe public health problems. Substantial epidemiological evidence indicates that obesity has increased in prevalence in the general population from the late 1970s to the present. Birth cohort data suggest that mood and eating disorders are becoming more prevalent in younger populations. Thus, obesity and mental disorders may be co-occurring to a greater degree simply by chance alone. On the other hand, since smoking cessation is often associated with weight gain, some have hypothesized that the current obesity epidemic is due in part to decreasing rates of smoking. Third, mounting family history, twin, and genetic data suggest that obesity and many mental disorders, including psychotic, mood, and eating disorders, are polygenic, heterogeneous conditions. In light of recent epidemiologic studies showing that obesity co-occurs with certain types of psychopathology in certain populations, including major depression in females and binge eating disorder in males and females, it might be possible that certain forms of obesity and certain types of mental disorders share common inherited pathogenic factors.

In short, it is unknown how much of the clinical overlap between obesity and mental disorders is due to iatrogenic factors, because of the chance co-occurrence of two common conditions, due to shared inherited pathogenic factors, or to various combinations of these possibilities. A better understanding of this overlap would likely lead to improved treatment of obesity and mental disorders when they co-occur, and possibly of the individual conditions.

This book provides an accessible and expert summary of obesity, its relationship to mental disorders, and its management (including when associated with psychopathology) for the mental health professional. The first chapter of the book defines obesity and provides an overview of its epidemiology, causes, and natural history. The next eight chapters provide a stateof- the-art update on the relationship between obesity and mental disorders. Specifically, chapters two through seven summarize the relationship between obesity and schizophrenia, depressive and bipolar disorders, eating disorders, substance use disorders, smoking, and impulsive-compulsive spectrum disorders. Chapters eight and nine review two important and common syndromes often associated with both obesity and psychopathology, namely the metabolic syndrome and polycystic ovary syndrome.

The third part of the book summarizes behavioral treatments of obesity. Chapter 10 provides a comprehensive update of dietary therapy for obesity without psychopathology. Chapter 11 reviews research on the use of dietary therapy, exercise, behavioral weight management, and specialized psychotherapies in the treatment of obese patients with psychotic, mood, and eating disorders.

The last part of the book focuses on the medical treatments of obesity with and without associated mental disorders. Chapters 12, 13, and 14 in this section provide overviews of pharmacologic agents used in the treatment of three separate but related conditions: obesity without psychopathology (or ‘‘uncomplicated obesity''), binge eating and binge eating disorder, and medication-induced weight gain. Chapters 15, 16 and 17 summarize the most up-to-date literatures regarding the medical treatment of three important ‘‘subtypes'' of obesity: uncomplicated obesity, obesity with mood disorders, and obesity with eating disorders. The last two chapters (Chapters 18 and 19) discuss the crucial role of bariatric surgery in the treatment of severe obesity, including in the obese patient with psychopathology.

It is our hope that this volume will serve as a reference source for physicians, researchers and other health care professionals seeking answers to the many questions related to understanding and treating obesity and mental disorders.