The Five Stages Of Living With Obesity | Dr. Sharma's Obesity Notes

stages-of-grief-300x282Some readers may be well aware of the five stages of grief, the natural process of grieving, which, according to Kubler-Ross, move from denial to anger to fear to grief and finally to acceptance.

As others have pointed out, the same five stages apply to virtually every serious life event, including being diagnosed with a chronic or severe illness.

Now that we have come to appreciate that obesity is a chronic disease (for which we have no cure!), it should come as no surprise that these five stages also apply to obesity.

First comes denial: not denial that I am gaining or have put on weight – that is obvious enough. Rather, denial that this may be a real problem or may have serious consequences down the road. A normal response in this stage is to not want to know about it. I don’t see a doctor because I don’t want to hear that I have a problem. I don’t listen to advice because it doesn’t apply to me. I don’t weigh myself because I don’t want to know. Pseudoacceptance – it may be as it may, but if that’s the case, then that’s the case – don’t tell me I have a problem and don’t tell me I need to do something about it – leave me alone!

Second comes anger: often it is the anger that fuels the denial. Anger at my body. Anger at myself. Anger at the people around me (including those offering help or understanding). Anger at life in general. Why me? Why this? Why can I not stop myself? Why can I not stick with my diet or exercise plan? Nothing works!

Third comes depression: this phase is characterized by sadness, a sense of loss, despair, anxiety, fear of what is to come. What if this weight gain continues? What if my health problems get worse? I don’t want to be the “fatty” that people make fun of. I don’t want to be ridiculed in public. I don’t want my pains to get worse. I don’t want to end up in a wheelchair or have diabetes or sleep with a CPAP machine. There will be restrictions – giving up things I love. It will mean effort – doing things that I don’t care for. No longer can I live like I used to or like others continue to – lucky them!

Fourth comes bargaining: OK, I get that I have a problem but really, there must be some simple way out of this. If I can only find the right diet or right exercise or maybe cut my carbs or go vegan or get myself tested for food allergies. How about I just give up the white stuff, or the fat, or the pop? What if I buy a treadmill and religiously used it every day? How about I just share my story ? May be someone will help me – or I will find the strength. I have been successful in every other aspect of my life – so really – how hard can this be?

Fifth we reach acceptance: This is where I finally accept that I have this problem and reach the point where I am ready to move on. Once I accept that this problem is not simply going to go away, nor will it be fixed by another quick diet or weight-loss supplement, I reach the stage where I accept that I need to become more realistic about the solutions. I am now ready to find and accept the help I need (and fight for it if I have to) or I am ready to accept that this is what I will have to live with for the rest of my life – so let’s make the best of it and move on.

Research shows that these stages are not perfectly sequential – often they occur in parallel and even regress or sometimes flip-flop from one stage into another. That is perfectly natural. Some folks may never move beyond denial or anger, some may be stuck forever in depression or bargaining. Even those, who have accepted their situation may occasionally regress (e.g. the surgical patient who is in denial having to take his vitamins).

At this point it is important to point out that acceptance does not simply mean accepting the status quo.

Rather, acceptance means accepting the fact that I need to now deal with this problem the best I can. If I need to become a marathon runner to conquer this weight, so be it. If I need to open my soul to a psychologist to work through my childhood trauma, then that’s what I have to do. If in the end the only solution is bariatric surgery – bring it on. If this is what it will take – I am now ready to accept it, embrace it, use it to my advantage. I am now ready to stand up to bullies and the “wise guys” who have all the answers.

As health professionals, it is important that we recognise what stage our patients is at. The denial and anger stage are not the best time to discuss diet plans. Nor is the depression or bargaining stage the best time to bring up the topic of surgery or lifelong medication.

With true acceptance comes hope and a positive change that sets the foundation of whatever is to come next. This is no longer the time to point fingers, assign blame, nurse regrets,  hide in shame, dissolve in despair.

Things are as they are and I accept them. But, as they say, when life throws you lemons, reach for the tequila!

If you have experienced or can relate to these stages – I’d love to hear your story.

Edmonton, AB

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25 Responses to “The Five Stages Of Living With Obesity”

  1. EC says:

    I am slightly confused on the denial part where you say “that this may be a real problem or may have serious consequences down the road.” Do you consider it denial if someone is overweight or obese (by the BMI chart), is weight-stable, has good health measures, exercises and eats a mostly healthful diet? Or are you specifically referring to someone a little higher on the Edmonton Obesity Scale by this? That would be more in line with my understanding of your general message, but it’s not clear to me here.

    I guess I feel a little touchy on this one, because this smacks of the “Vague Future Health Threat” a lot of people get hit with by their doctors and pretty much all of society the instant they get above BMI 25.0. Any argument that says “really, I’m healthy,” is countered with the idea that we’re in denial.

  2. Nanette says:

    You hit the nail on the head every single time. This blog is full of win. Thank you!

  3. Arya M. Sharma, MD says:

    EC – if your weight is not really a problem then this is not a question of denial – after all there is nothing to deny. But, let us be honest, the vast majority of people with excess weight do have a problem – people who don’t, make up a rather small healthy minority of fat people. If this is where you belong, good for you.

  4. Dagny Kight says:

    I’ve gotten a lot of response to a section in my book where I write about how going on a diet takes a person through stages of struggling with a sense of control.

    You pick a day to start a new diet and make a plan. The planning gets you all motivated and excited.

    At first, you stick to the plan very specifically and it makes you feel proud of yourself. You have a sense you’re “doing something” to solve a problem and you’re being good at it.

    The diet plan imposes changes on your regular routine and lifestyle that are difficult to maintain so little by little, it starts to break down. The breakdown usually begins with a temptation to eat something off the diet plan so you bargain with yourself that you’ve “been good” up to this point so you deserve a treat and it’s OK.

    The diet plan becomes more difficult to maintain over time so the bargaining gets bigger. You fall off the diet one day so you consider that day a total loss, you might as well eat whatever you want. You do it because you bargain with yourself to be back “on” the diet tomorrow.

    Eventually you consider the diet a complete failure. You bargain with yourself to be “off” the diet and decide it’s over. You eat whatever you want in an “off” a diet manner until the day that you decide you will start your new diet. You feel OK about what you’re eating as long as you stick to the terms of the bargain you make with yourself.

    You start the cycle over again.

    People have written to me that they do this all the time and they realize they’ve used up months and years of their lives living like this. I know I did.

  5. DebraSY says:

    I would like to share a little correction to your premise, based on my limited time as a lay chaplain. These are the Kubler-Ross stages of death. They are what people go through from diagnosis to final chapter of life as they confront their own mortality (and, as you rightly point out, the order is not set — though bargaining is usually listed before depression). The stages of death are frequently confused with stages of grief, and often misapplied, especially in early grief. The first stage of grief — when one learns that someone dear has died — is chaos. The grieving person may bounce back and forth from feeling numb to feeling profound sadness to feeling uncharacteristic emotions. Often friends see the numb stage or an uncharacteristic emotion and inform the poor griever that he or she is in denial and must move on. This is unhelpful. It makes the grieving person feel guilty for something that is natural.

  6. Kelly. Proulx says:

    This is awesome Dr Sharma. Thank you for putting this together. As a Dietitian I see people battling with their weights all the time and some days I struggle to help them. I use the stages of change, but this is excellent. Thank you.

  7. Linda Fair says:

    I wrote this a couple of years ago and your article reminded me of it:
    The Many Layered Cake of Obesity

    1. The bottom layer is the pain that started it all. Whatever drove us to seek comfort, solace, numbness in food, over and over again. Most of this probably started very early in our lives and was not our fault.

    2. The next layer contains the real physical effects of being obese: diabetes, cholesterol, heart disease, fatigue, joint deterioration, etc.

    3. The next layer contains the self-loathing that we cannot control this thing that eats at us.

    4. Another layer is all the unkind judgmental things that others have said to us, well intentioned or not.

    5. …all the times and ways that others have tried to “help” or “fix” us by controlling us.

    6. …all the misinformation and unhelpful advice that we have received directly or indirectly.

    7. …the isolation we seek in order to avoid being hurt again.

    8. …all our other needs, wishes and desires that cannot be fulfilled because of our obesity and/or others’ attitudes.

  8. Melinda Munro says:

    I’m with EC. I am super healthy and fit but with a BMI over 30. So am I in denial? No, actually bargaining, most of the time and sometimes acceptance. But EC is right, there is a constant pushback to doctors that the BMI does not mean I have any illness which I am denying.

    But I am curious about your comment about numbers, Dr. Sharma. What is the percentage of EOSS 0 or 1 in the population of people who have BMI’s over 30? Are we a tiny minority or are we sizable enough to warrant attention to what genetic factors drive our ability to be fit, strong and fat?

  9. Pierre Trudel says:

    Pierrette I live with these steps everyday.We have “been there,done that”.When we talk to others that are still in denial we no longer try to convince them.
    Until they reach the other factors, we are talking for nothing.
    I know of “no” people that are obese and exercise regularly and eat properly.
    Those that say they do are full of it and are in real strong denial.
    People that are obese simply eat all the time because they are always hungry.I know.I did also.
    When I changed my lifestyle and realised that I can eat healthy foods and be totally satisfied, then and only then did I really join “my fight” to become healthy.
    My wife is 62 and I am 61 and we are both in the best health of our lives…..Wow
    Pierre Pierrette Trudel

  10. Arya M. Sharma, MD says:

    Melinda: The exact numbers based on NHANES III for population with BMI 30 to 35 is Stage 0 = 8%, Stage 1 = 19%. For BMI greater than 40, the numbers are Stage 0 = 5% Stage 1 = 14%

  11. Arya M. Sharma, MD says:

    Linda: The Layered-Cake of Obesity – interesting idea!

  12. Arya M. Sharma, MD says:

    DebraSY: You make an important point – all of these stages are “natural” and even “healthy” as part of the process. Thus, for e.g., although it sounds negative, “denial” is a very healthy initial response, so is “depression”. The problem is when people get stuck in one of the other stage or fail to eventually progress to acceptance. The notion of thinking of this as a staged process (not always linear) is for the professional to recognise where your patient is at and counsel appropriately. As I said, trying to talk someone, who is in the denial stage into addressing the problem will only create defensiveness.

  13. Arya M. Sharma, MD says:

    Dagny – you perfectly describe someone stuck in the bargaining stage. This person has not yet fully accepted that changes have to lifelong and that the expectations have to be realistic. I know hundreds of people (probably most people trying to lose weight), who are stuck in the bargaining stage and never make it to full acceptance.

  14. Valerie X Armstrong says:

    This is so much like a blog post I made on 11/13/12…great minds, you know

  15. Elina Josephson says:

    As usual, I find myself offering a contrary voice. I believe from experience, that these stages are better understood as interwoven threads. Rather than experiencing them one at a time, a person who is gaining weight cycles through them often on a moment by moment basis. All the threads exist in the same time and space but the person is more focused on one or the other. This is not nearly as true for grief, but it is true for weight management. What this means for a qualified and caring CBT is that you are not required to wait for the client to transition into acceptance, you can help the client shift focus and change perspective. You can help the client find motivation, strength and purpose. We are complicated and powerful. Within each one of us, at every single moment,lives the potential to simply make another choice.

  16. Arya M. Sharma, MD says:

    Elina – you are bang on that these stages are interwoven (which is why I chose the image of the ribbon for the illustration). I also agree all all these stages can co-exist from minute to minute, from day to day. A skilled CBT counsellor will recognise this and provide the necessary support.

  17. DebraSY says:

    Pierre: you no of NO ONE who is obese and exercising regularly and eating properly? All obese people are “full of it” and “in real strong denial”? Wow, that’s harsh. Is Diana Nyad in denial? What about 75% of the Kansas City Chiefs (my team) or, for that matter, 75% of other people’s football teams. What about Oprah (also proof positive that no amount of accountability and resources can assure permanent weight-loss maintenance). What about Janet Cook, the first person to swim the Berring Straight? There are also many non-famous obese people who quietly exercise and eat well with no fanfare. I knew quite a few when I belonged to the YMCA.

    Please reconsider your judgments. Weight bias hurts people.

  18. Dagny Kight says:

    I don’t deal with weight because of “pain that started it all.” I don’t allow people to treat me like I am some weak, broken emotional wreck or to label me in that way. Some of us can have bodies that manage energy very efficiently and brains that want to think about food and connect it to everything in our lives. Fighting that to manage your weight in an intensely obesogenic environment is VERY DIFFICULT. Even if you think certain situations triggered certain habits, the struggle with weight itself becomes the difficulty.

    We have to get rid of this paradigm that says every fat person is a screwed up mess of emotional issues and “pain that started it all.”

    Food is its own driver.
    Weight is its own stressor.
    Fighting to control your body and mind is immensely difficult and can feel endless

  19. Benedetta says:

    Dagny, well said. Thank you!

  20. Sharon says:

    Very wise words. So how can one move on to that stage of acceptance, or help a client or loved one to do so? I find myself cycling between denial, depression and bargaining–and would love to be able to move to acceptance, so I can fix my weight and my life.

  21. Arya M. Sharma, MD says:

    Sharon – that’s a great question. I am not a counsellor but there are many who read this – they may wish to chip in with some advice.

  22. Elina Josephson says:

    This is at Sharon- You might just not be done cycling yet. Acceptance often comes when all the other possible versions of reality have been exhausted. When you get tired of running in circles and the reward of one more bite does not seem worth it. When the payoff from the denial and the depression and the bargaining no longer works for you. When that times comes, find a great CBT counselor, come in with a willing heart and and an open mind. Walk in to work, do not expect to be fixed, but rather to be empowered to fix yourself. When that day comes, your counselor will help you open the door and you will have found acceptance.

  23. EC says:

    Pierre’s comment is exactly why I brought up the “denial” issue, because this is the kind of thing I hear over and over. Thank you, Debra and Dagny, for pointing out the flaws in assuming that every fat person is an emotional wreck, or a lazy glutton, or “in denial” — an attitude I find frustrating and insulting.

    While the numbers of obese in EOS 0 or 1 are small, it is still enough that it’s not a total anomaly. I would guess that for people in overweight BMI (where I am — high side of it), those numbers are a bit higher. It needs to be addressed instead of doctors having the knee-jerk reaction of prescribing intentional weight loss to everyone above BMI 25, even if those folks are healthy and weight-stable with good enough habits.

  24. Melinda Munro says:

    You go Dagny!

    If we aren’t being judged as being lazy and deceitful (Pierre), we are judged as being broken emotional wrecks with childhoods laden with abuse.

    The reality is our bodies are hyper efficient and in some of our cases, due to external drivers to be thin, we engaged in behaviours, like yo-yo dieting, that made our bodies even more efficient.

    However, thin friends of mine face some of the same labels – if you are skinny, you must be anorexic with an unaccepted history of abuse.

    How about we agree that we can be healthy people whose genetics and body morphs are different from someone else’s.

    If we are struggling with mental illness that impacts our physical health, then focus on that and not make stereotypical judgements.

  25. Diane says:

    Dr. Sharma, I have bounced back and forth through all of these stages, spending lots of time in denial. It took a lot of work with an addictions counsellor to get me to the stage in which I was willing to go to any lengths to get healthy again. I am on the waitlist for surgery in BC and have been for 4 1/2 years. I don’t have a date yet but I have reason to believe I will have one soon. I appreciate that you recognize that it is sometime a battle to get what we need to get healthy. Thank you for all the work you do on our behalf.

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Depression with diabetes may speed mental decline

By Veronica Hackethal, MD

NEW YORK (Reuters Health) – In a study of middle-aged and older people with type 2 diabetes, declines in thinking and memory that are often linked to later dementia happened faster in those who were depressed compared to those who were not.

Over less than four years, U.S. and Canadian researchers saw significant differences between depressed and non-depressed diabetes patients in the erosion of a wide range of cognitive abilities.

“Depression appears to be an important risk factor for dementia and cognitive decline among patients with diabetes,” Dr. Mark Sullivan, professor of psychiatry at the University of Washington and lead author of the study, told Reuters Health in an email.

Both diabetes and depression have been found to raise the risk of Alzheimer’s disease and other forms of dementia later in life. But whether depression is a cause or an effect of cognitive decline remains unclear.

Diabetes can damage organs, especially the kidneys, eyes, nervous system and brain. The disease also raises a person’s risk for having a cardiovascular “event” such as a heart attack or stroke.

More than one-quarter of Americans older than age 65 have diabetes, according to the Centers for Disease Control and Prevention. An estimated 6.5 million Americans in this age group suffer from depression, according to the National Alliance for Mental Illness.

To assess the role of depression in cognitive decline among older diabetes patients, Sullivan’s team looked at data on nearly 3,000 people over age 55 with type 2 diabetes and risk factors for cardiovascular events. On average, participants had had diabetes for about 9 years.

Tests of cognitive abilities were given to all participants at the study’s beginning, and again at 20 months and 40 months. One test measured psychomotor speed, or how long it takes the brain to register a stimulus, process it and respond. Another looked at the ability to remember words over time. A third test measured executive functioning, or how the brain uses memories to plan actions, pay attention and inhibit inappropriate behavior.

Researchers determined whether an individual was depressed using a 9-question form patients filled out themselves.

More than 2,600 people completed the tests at all three time points. Sixty-two percent of these never had scores indicating depression. Eighteen percent were depressed at the start of the study, 16 to 17 percent were depressed at 20 and 40 months and five percent had scores indicating depression at all three time points.

Researchers found that people with symptoms of depression at any point were more likely to be women, younger, non-Hispanic whites, overweight or obese, and to have higher blood sugar, total cholesterol and low-density lipoprotein, or “bad” cholesterol, than others.

Yet, the researchers report in JAMA Psychiatry, depression was linked to greater cognitive decline regardless of other risk factors. These included age, gender, race, obesity, smoking, alcohol use, previous cardiovascular events, as well the types of diabetes and heart disease medications the participants were taking.

“This study demonstrates that depression accelerates cognitive decline in patients with diabetes, over a short time frame, in all patient subgroups, and in all cognitive domains assessed,” Sullivan said.

“Whether depression treatment will reverse this effect remains to be tested in a separate randomized trial,” he said.

“The broad range of cognitive tests used indicates widespread cognitive problems in performance, memory and speed of task completion,” said Dr. Mark Nathanson, director of the geriatric psychiatry fellowship at Columbia College of Physicians and Surgeons in New York, who was not involved in the study.

He and Sullivan both cautioned, however, that the role of depression in cognitive decline may be complex.

Depression itself is associated with increases in stress hormones, inflammation and other processes that could directly contribute to cognitive decline, Sullivan said. But the array of other diseases that often go along with diabetes may also harm cognition and promote depression.

People with diabetes are at higher risk for vascular dementia, for example, which develops when blood supply to parts of the brain is cut off, often during a series of unnoticed “mini-strokes” that cause brain cells to die. Depression might be an early symptom of vascular disease in the brain, which later develops into dementia.

“My clinical experience is that dementing illness like Alzheimer’s disease and vascular dementia commonly present to the primary care clinician and mental health professional with depressive symptoms,” Nathanson, who is also a clinical assistant professor of psychiatry, wrote in an email.

Vascular dementia is different from Alzheimer’s disease, which causes the majority of dementia cases in the U.S. and forms characteristic plaques in the brain.

One implication of this study, Nathanson said, is that primary care physicians would do well to pay attention to and treat depression in people with chronic illnesses like diabetes.

SOURCE: JAMA Psychiatry, online August 14, 2013.

Mom's Depression Tied to Childhood Obesity | Psych Central News

Mom's Depression Tied to Childhood ObesityIn low-income urban families, a mother’s depression is linked to childhood obesity and disengaged parenting.

“We know many mothers experience feelings of sadness and depression. Despite this awareness, many mothers really suffer in silence and don’t feel comfortable [talking to someone about their feelings],” said Dr. Rachel S. Gross, lead author of the study.

While most research shows a link between a mother’s feelings of depression and a child’s development and social health, “This was one of the first [studies] to look at younger children [and how depression] can impact the physical health of children,” she said.

Gross has spent most of her career working with low-income families in the Bronx in New York. There she has witnessed patients struggling with feelings of depression as well as children who are gaining weight more quickly than expected.

For the study, moms self-reported depressive symptoms — such as loss of interest, fatigue, low energy and poor concentration — along with their children’s body mass index (BMI) at age 5.

The researchers controlled for such factors as decreased access to parks and fresh produce and still found the link.

According to the study, mothers who are depressed, have less than a high school education and are unemployed often display “… permissive parenting, where they place fewer demands on their children.”

“They are less responsive to their child’s needs, choosing parenting strategies for coping that require less cognitive effort and often neglect to set limits on the child’s behavior,” the study reports.

“They were more likely to have children who consumed more sweetened drinks, infrequently had family meals, more commonly ate at restaurants and had fewer regular breakfasts than children with mothers without depressive symptoms. Depressed moms also were less likely to model healthy eating than non-depressed mothers.”

Feeding practices, such as preparing daily breakfast, modeling healthy eating and setting limits on the child’s diet, all require active maternal involvement, Gross said, possibly explaining why these practices were less common among depressed mothers.

The American Academy of Pediatrics has updated its guidelines that emphasize the importance of maternal mental health, said Gross.

“My advice is to encourage mothers to seek out help from their doctors but also to consider talking to their pediatrician,” said Gross. “Mothers with young children take them to the doctor more frequently than they take themselves, so it’s an opportunity to help mothers in a pediatric setting.”

Source:  Academic Pediatrics

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Children and Teens, Depression, General, Health-related, Mental Health and Wellness, Obesity and Weight Loss, Parenting, Psychology, Research


Obesity, Genetics, Depression and Weight Loss | Psych Central

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.


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    Last reviewed: By John M. Grohol, Psy.D. on 27 Mar 2013
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Larry King says talking about depression is a good cure

Larry King

Larry King is a household name in America and has cast his influence across the Pacific and Atlantic oceans reaching shores across the world. The lively TV personality has anchored the entertainment industry for years and has notched an impressive amount of interviews down the years – more than 40,000 to date.

He has soldiered on dogmatically since 1987 when he suffered a heart attack and had to undergo quintuple bypass surgery.

Larry looks back at his life prior to the heart attack and pins the blame squarely on his three-packs-a-day smoking habit. The heart problems subsequently triggered depression and led him down the path to the darkest period of his life. Despite the crippling depression he remained open about his illness ad spoke honestly about it on his shows ‘Larry King Live’ and ‘Larry King Weekend’.

The famous Larry King mugshot

His family background is littered with stories of depression, his brother being the worst affected.

Larry’s first encounter with his own behavioural change disturbed him deeply: “What was most puzzling to me, I would be crying and not know why I was crying.”

After diagnosis of post heart-attack depression, King was put on antidepressants for a period of six months and while undergoing the treatment he said, The tough part is distinguishing between depression and bad news.”

Larry King confronts his demons


But Larry found a way out of the situation and soon got work on raising awareness of mental health conditions. Although he interviewed numerous celebrities in his career it was his special show on depression got really drew all the plaudits.

Celebrities including Drew Barrymore, Carrie Fisher, Mariel Hemingway and Brooke Shields poured their hearts out on the show and he sympathetically listened to their stories of depression and their remedies, solutions and recoveries, all the while understanding their situations.

King, with his undying spirit to fight depression insisted on creating awareness and is of the belief that the more knowledge you have, the better… This is not having a bad day. [These people] need comfort and understanding… The one thing you can’t do with a person with depression… is you can’t say ‘Feel good. Get out of bed. This is silly.’ That won’t work.”

Jemma Kidd opens up about Anxiety Disorder

Jemma Kidd

Jemma Kidd is a successful career woman, mother of twins and somehow manages to be both model and girl-next-door with consummate ease. Behind the often smiley demeanor portrayed in the media, Kidd hides a torrid struggle with anxiety and panic disorder; an overwhelming illness that can literally paralyse sufferers.

Panic disorder and anxiety attacks are the most common anxiety disorders and affect at least 20% of adult Americans. In an interview with Fiona Shield for Celebrity Angels, Jemma described how the crippling disorder adversely affected her life on a daily basis.

The attacks are so random and debilitating that you become fearful of the fear that they bring. You start to anticipate them and find yourself doing anything to avoid them. I stopped driving on my own; I manipulated my life so that when I had to go somewhere, I had someone with me. I couldn’t go into the supermarket or anywhere crowded. If I was going to stay at someone’s house for the weekend, I would be anxious for about ten days before and would insist on knowing how close they lived to a hospital. The symptoms were so real that I believed I could have a heart attack at any time.”

Jemma Kidd's make up brand is a huge success

A panic attack is an exaggeration of the body’s normal response to fear or stress. According to the Anxiety and Panic Disorder Center of Los Angeles, when we experience a threatening situation, the fight or flight response takes over and the body prepares itself for danger by releasing adrenalin. The physical symptoms that accompany this include rapid heart rate, palpitations and an increase in blood pressure and hyperventilation.

For most of us these symptoms taper off and the body is restored to it’s normal state but when the body produces too much adrenalin, the sufferer can be left experiencing absolute terror that can linger on for hours. In the worst case scenarios a person might pass out but according to records nobody has ever died as a result of a panic attack.

Jemma Kidd in her make-up studio

Jodie suffered from the disorder throughout her twenties and she credits Charles Linden ( who developed the Linden Method) with helping her find mechanisms to deal with panic. Experiencing up to 20 panic attacks a day, Linden came up with a routine to treat his own symptoms and break the habitual nature of anxiety.

Although there is no “quick fix”, Linden suggests practising the following techniques to help divert a panic attack:

  • The dive reflexWhen you feel a panic attack building up, take a towel, soak it with cold water then place it on the back of your neck. You can also splash your face with cold water.
  • DiversionDo anything to divert your mind. Put on headphones and listen to music, practical chores, count trees or lampposts, immerse yourself in whatever is present and practical at the time.
  • Eat a cold appleWhen you feel an attack is imminent take an apple from the fridge and eat it very slowly. This will help to slow your breathing and the coldness of the apple helps to create positive, non-anxious sensations.

To learn more about his anxiety elimination techniques visit

Emma Thompson: English Rose Discusses Thorny Depression

Emma Thompson

Emma Thompson has known the highs of stardom as an iconic British actress and screenwriter but she has also tasted bitter, emotional lows because of her long running battle with depression.

The English rose says her depression led her to such lows that at one stage in her life she didn’t wash or dress.

I’ve certainly been there, in various depressions, when you never wash, and wear the same things all the time,” she told her interviewerfromEasy Living magazine.

It’s the sort of depression that doesn’t necessarily make you want to kill yourself – you just don’t want to be, you want to switch it off and stop. That’s not the same as saying ‘I’m going to kill myself’. But it’s a feeling I know well.”

emma thomnpson - english rose

Thompson looks back to the 1980s when she first had clinical depression at a time when she was performing in a stage version of Me and My Girl.

I really didn’t change my clothes or answer the phone, but went into the theatre every night and was cheerful and sang the Lambeth Walk. That’s what actors do,” she told the Telegraph.

But the blight of depression returned when she divorced Kenneth Branagh in 1995. The double Oscar winner branded divorce as a “ghastly, painful business”, adding: “But also fame, in some ways a ghastly, painful business as well. You become slightly more public property in a way that’s not necessarily always comfortable.”

emma thonspon and emma watson

But for Emma the perfect tonic was work and it served as her income and saviour in those dark times. She points to her writing work on Sense and Sensibility for which she wrote the screenplay and starred her husband Greg Wise and fellow British actress, Kate Winslet.

The only thing I could do was write,” she said. “I used to crawl from the bedroom to the computer and just sit and write, and then I was alright, because I was not present. Sense and Sensibility really saved me from going under, I think, in a very nasty way.”

Writing still provides and escape for her and when asked what from, she pointed at the inner demons: “Oh, you know, the voices in my head. The constant “must do better”, “must try harder” plus “you’re too fat and not really a very good mother.”

Indeed the stress of trying for a second child after the birth of her first, Gala, was another factor that fuelled her illness: “It was hellish after Gala was born, trying to have another baby through IVF. That was terrible – I blamed myself, and no-one could persuade me that it wasn’t my fault – and that led to another depression.”

Emma Thompson

She unofficially adopted a 16-year-old Rwandan orphan, which she says made it possible for her to “balance” herself, rather than constantly trying to escape into a “fantasy world”.

As with so many cases, the illness is never far away, but through help, therapy and meditation, a lot of people manage to keep it at bay.

Sufjan Stevens suffers with depression

Sufjan Stevens with angel wings

Poor Idiosyncratic contemporary folkster Sufjan Stevens has revealed that watching Wes Anderson’s Fantastic Mr Fox led to him suffering a nervous breakdown.

During an interview with UK newspaper The Observer, the quirky singer/songwriter acknowledged that he’d been afflicted by mental health issues which affected him so heavily that doctors proscribed avoiding crowded rooms and noise.

Sufjan has always had a propensity towards depression although that’s fairly run of the mill for a sensitive musician type of his ilk, but things came to a head during the recording of his last album when he considered retiring from music completely.

In the interview he recounts how he tried to deal with his problems whilst recording the album, explaining that he’d woken up one morning and experienced adrenaline like rushes in his chest.

After three months of no stimulus such as films Sufjan sat down to watch Fantastic Mr Foxbut found the experience intolerable; a harsh review some might say.

Once recovery was underway and the album, The Age of Adz, completed, he was able to watch the film again but with a greater level of enjoyment. He described it as “beautiful”.

I went through a period of questioning motive and function and now I no longer have the privilege of questioning. I just have the privilege of celebrating my music and sharing it,” Sufjan said about his songwriting.

I don’t really want to get caught up in that self-doubt any more. I’ve always been really insecure about what I do, but those existential conundrums are really circuitous and – what’s the word? – unproductive. You know, I don’t think my music is important, I don’t think it’s changing the world, I don’t think it’s art. I just think it’s music. It is what it is.”

Creativity and mental illness often seem to go hand in hand and scientists have been studying the common links between the two for centuries. In fact, since the time of Aristotle, links have been noted between creativity and melancholia.

Other musicians who’ve experienced depression and mental illness include Brian Wilson of Beach Boys fame, Syd Barrett, Joy Division’s Ian Curtis, and Nick Drake. The final two taking their lives due to depression.

Kirsten Dunst thinks people who don't get depressed are weird

I was going to write another interesting article about Beyonce’s latest amazing revelation – that pregnancy is a gift – but then thought that even the most persevering of CWD readers would become bored of the spoilt, small-minded woman’s inane babble. SO, for a change, we get Kirsten Dunst instead!

According to an interview published in Flare magazine, the 29-year-old think people who don’t suffer from periods of depression at some point in their lives are pretty strange.

Dunst, who has admitted to struggling with the disorder in the past, says, like many others, that it still a lot of stigma surrounding the issue.

Lars von Trier's own depression inspired the film Melancholia

“People are embarrassed to talk about it…I would never put anyone down [who] was in that kind of space.”

In fact, she reckons experiencing the depression at some point or another in one’s life is completely normal:

“I think most human beings go through some sort of depression in their life,” she says. “And if they don’t, I think that‘s weird.”

Thanks for the insight, Kirst. Actually, I don’t really have anything negative to say about Kirsten Dunst. It is possible that privately she, like Beyonce, is an irritating and boring little brat, but she’s been in some cool films. And I’d say to have been picked for a leading role by Lars von Trier is a good indication of one’s coolness.

Lars von Trier’s latest film, Melancholia is due out in the next month. The director himself describes it as “a beautiful film about the end of the world”. And if you watch the trailer, I think you’ll agree that it certainly looks pretty visually stunning.

Anyway, Kirsten Dunst plays the role of Justine alongside Charlotte Gainsbourg, her on-screen sister, Claire. Justine has just got married, but all the while the earth is being approached by a rogue planet, signaling the end of the world.

[adsense]The idea for the film originated during a therapy session Lars von Trier attended because he suffers from depression. The therapist told Trier that depressive people tend to act more calmly than others under heavy pressure, because they already expect bad things to happen. Trier then developed the story not primarily as a disaster film, and without any ambition to portray astrophysics realistically, but as a way to examine the human psyche during a disaster.

The movie premiered in May this year at the 64th Cannes Film Festival. Dunst received the festival’s Best Actress Award for her performance.

Click here to find out more about Melancholia.

Emma Thompson saved from depression by her work

Emma Thompson has known the highs of stardom as an iconic British actress and screenwriter. But she has also known the lowest lows due to her battle with depression.

The 51-year-old says her depression was once so bad she was unable to wash or even dress herself.

“I’ve certainly been there, in various depressions, when you never wash, and wear the same things all the time,” she said in an interview with Easy Living magazine.

Emma Thompson has clinical depression

“It’s the sort of depression that doesn’t necessarily make you want to kill yourself – you just don’t want to be, you want to switch it off and stop. That’s not the same as saying ‘I’m going to kill myself’. But it’s a feeling I know well.”

Thompson thinks her first bout of clinical depression occurred in the 1980s, when she was doing on-stage performances of Me and My Girl.

“I really didn’t change my clothes or answer the phone, but went into the theatre every night and was cheerful and sang the Lambeth Walk. That’s what actors do,” she told the Telegraph.

She suffered another severe bout when she divorced her husband Kenneth Branagh in 1995. The double Oscar winner branded divorce as a “ghastly, painful business”, adding: “But also fame, in some ways a ghastly, painful business as well. You become slightly more public property in a way that’s not necessarily always comfortable.”

Thompson says work was the saviour. She refers to her work on Sense and Sensibility, starring Kate Winslet and her now husband Greg Wise, for which she wrote the screenplay.

She says her work saves her from depressive bouts

“The only thing I could do was write,” she says. “I used to crawl from the bedroom to the computer and just sit and write, and then I was alright, because I was not present. Sense and Sensibility really saved me from going under, I think, in a very nasty way.”

Writing provides and escape for Thompson, and when asked what from, she answered: “Oh, you know, the voices in my head. The constant “must do better”, “must try harder” plus “you’re too fat and not really a very good mother.”

Trying to have a second child after the birth of her first one, Gala, was another factor fuelling her illness: “It was hellish after Gala was born, trying to have another baby through IVF. That was terrible – I blamed myself, and no-one could persuade me that it wasn’t my fault – and that led to another depression.”

Nine years ago, the actress unofficially adopted a 16-year-old Rwandan orphan, which she says made it possible for her to “balance” herself, rather than constantly escaping into a “fantasy world”.

Read about other celebrities who suffered with depression such as Hugh Laurie; Owen Wilson; Mel Gibson; Alanis Morrissette and Halle Berry.

Images: Wikipedia