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Effects of obesity and exercise: Is obesity a mental health issue? The Harvard Mental Health Letter investigates

Not so long ago, it was commonly believed that overweight and obese people were compulsive eaters, anxious, depressed, under stress, or trying to compensate for deficiencies in their lives. But today, when almost everyone seems to be getting heavier and obesity has become a national issue, both experts and the public are dismissing the idea that weight gain is a personal emotional problem. The October issue of the Harvard Mental Health Letter looks at the undefined relationship between mental health and obesity.

The American Psychiatric Association has never regarded overeating or excess weight as a psychiatric disorder, and most obese people do not qualify for a psychiatric diagnosis. Accordingly, most studies do not find a clear association between mental health and weight.

But with the abundance of overweight people, there is plenty of room for exceptions. Some research suggests that depressed persons are more likely to develop the metabolic syndrome that often accompanies excess weight, especially when this weight is concentrated around the waist. People may console themselves with “comfort food”, which is usually high in fat, sugar, and calories because they are anxious, lonely, angry, or suffering from low self-esteem. There is a characteristic type of depression with symptoms that include lethargy and overeating. Like most mind-body interactions, obesity can lead to ill health, which is linked to depression and anxiety.

Additionally, overweight people are also more likely to lose the psychological benefits of exercise. If they feel rejected, unattractive, or suffer social discrimination, the emotional strain may cause further weight gain. The problem is worse if they fail to lose weight and are blamed (or blame themselves) for lack of self-control.

The October issue discusses the therapeutic approaches available for obesity. A common approach is behavioral therapy, often in groups directed by a dietitian or psychologist. The pillars of this therapy are self-monitoring and stimulus control. Therapy may help dieters repel self-defeating thoughts and reject unrealistic goals.

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Harvard Health Publications publishes four monthly newsletters--Harvard Health Letter, Harvard Women's Health Watch, Harvard Men's Health Watch, and Harvard Heart Letter--as well as more than 50 special health reports and books drawing on the expertise of the 8,000 faculty physicians at Harvard Medical School and its world-famous affiliated hospitals.