I just got this press release yesterday (article abstract here):
Piscataway, N.J. – June 2, 2008 – A major review in Clinical Psychology: Science and Practice reveals that research indicates people who are obese may be more likely to become depressed, and people who are depressed may be more likely to become obese.To understand the potential links between obesity and depression, researchers led by Sarah M. Markowitz, M.S., examined the correlational data that suggest a connection between the conditions and found evidence for causal pathways from obesity to depression and depression to obesity.
People who are obese may be more likely to become depressed because they experience themselves as in poor health and are dissatisfied with their appearance. This occurrence was particularly prevalent among women and those of high socio-economic status.
People who are depressed may be more likely to become obese because of physiological changes in their hormone and immune systems that occur in depression. Also, they have more difficulty taking good care of themselves because of symptoms and consequences of depression, such as difficulty adhering to fitness regiments, overeating, and having negative thoughts.
Treatments such as exercise and stress reduction can help to manage both obesity and depression at the same time. Potentially, dieting, which can worsen mood, and antidepressants, which can cause weight gain, should be minimized.
“The treatment of depression and obesity should be integrated,” the authors conclude. “This way, healthcare providers are working together to treat both conditions, rather than each in isolation.”
This is not the first time that a correlation between fat and depression has been posited, but it’s remarkable because the researchers actually seem to have noticed that the causality could run both ways. Instead of treating this as yet another danger of fat, they’ve (rather miraculously) said “wait a minute, maybe fat stigma is depressing. Maybe the stress of being fat in a hostile culture can either mimic or trigger clinical depression.” And how much do I love “experience themselves as in poor health”? They don’t actually say here that fat people ARE in poor health; instead, they acknowledge that fat people are constantly being told they’re in poor health, which as we know is a bigger health risk than being fat.
Once again I am convinced that FA is so much healthier for the general population than diet culture, no matter what our detractors might say. So fat leads to depression and depression leads to fat, huh? Well, what’s more likely to throw a wrench in that cycle — the people telling you that you will be ugly, unlovable, fatigued, ill, and not worth caring for unless you become smaller? Or the people telling you that you are worth caring for, worth nourishing, that you can participate in mood-elevating exercise for the joy of it instead of for punishment, that it’s possible for you to have a sense of health and well-being in your body, that your body is not a death sentence (any more than anyone else’s)? Our way might not wind up with fewer fat people, but we’re sure as hell going to have fewer depressed people. And isn’t that more important, really?
Well, that’s the problem — most people, including the researchers, don’t seem to think so. To be fair, the study is also remarkable because it calls for minimizing diets, “which can worsen mood” (ya think?). But what’s with the call to reduce antidepressant use? This is grievously irresponsible. Rio put it best, in her “Fat is a Symptom, Not a Disease” series:
I think it is absolutely ridiculous that anyone would be so upset over the associated weight gain, when the drugs often make a person feel as if his or her life is worth living again. I’m tired of hearing the fatophobes shrieking about it, trying their damnedest to drag down those who have finally been able to stand up again, just because their bodies are different.
So tell me, fat-haters, are you really so shallow and juvenile that you would rather see someone institutionalized than fat? Hanging themselves instead of fat? I’ve really begun to wonder if the fat-hate is not just about fat, but about an excuse to be misanthropic to anyone who is socially vulnerable. After all, the mentally ill you used as a punching bag in ages past have now become functional fat people, so whom are you going to punch in their place?
Of course, if someone doesn’t need antidepressants, and can get by with a new attitude (*cough*FA*cough*), decent nutrition for a change, regular exercise, a supportive therapist, etc., I am all for that. I’m sure that not everyone who’s depressed over being fat is suffering from a neurotransmitter imbalance; many are just reacting rationally to a hostile environment. And even some of us who do have neurotransmitter problems can get by fine most days without drugs, and overall I’m in favor of that, at least for me (I just don’t have the free time to embark on the medical odyssey of Finding the Right Antidepressant, since the wrong one is often so catastrophic, and meanwhile I can get along without them). I am not saying that anyone who exhibits symptoms of depression should be medicated. But to halfway acknowledge with one hand that fat stigma might be the problem, and on the other hand to discourage medication because it might make people fat? That is egregious victim-blaming, tantamount to saying “well, people can be cruel, and the best way to avoid that is to fit in perfectly.” If people are left unmedicated, it should be because they don’t need medication or prefer to have it as a last resort — NOT because it might contribute to a body that invites stigma. I appreciate the desire to reduce the levels of body-related stress that fat and depressed people are experiencing, but refusing to treat the stress because it might exacerbate the stressor is just nonsense. It’s like handing out plastic surgery to combat teenage angst.
In any event, this is a good reminder: While you’re exploring intuitive eating and exercise for its own sake and all that physically healthy stuff you thought was off-limits because you were fat, don’t forget to keep an eye on your mental health too. It’s reasonable to feel burdened sometimes, by expectations and stereotypes and mistreatment, but if you can’t climb out from under the stress (about your body, or about anything in your life), don’t neglect self-care in that regard. In the U.S., many cities have women’s centers that offer sliding-scale counseling, if you don’t have access to a therapist. Remember that stress and depression, whether or not it can make you fat as these researchers claim, is certainly more unhealthy for you than fat itself.