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Which Comes First, Obesity or Depression?


People who are obese are often diagnosed with clinical depression, but which comes first - the increased weight gain or the depression symptoms? Researchers from Leiden University Medical Center in the Netherlands have found that it is actually a two way street and each condition influences the other.

Floriana Luppino MD and colleagues reviewed medical literature up to March 2008 on overweight and obese conditions and their link to depression. In total, the researchers screened almost 3,000 articles. They performed a more intense meta-analysis on 15 of those studies which covered 58,745 subjects.

They found that those subjects already overweight or obese were more likely to be clinically depressed and that those who were depressed had an increased tendency to become obese.

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The findings are not surprising. Dr. Luppino says those who are obese often have a low self-esteem and body dissatisfaction, especially in Western countries were being thin is often considered a beauty ideal. Her study showed that the link between obesity and depression was more pronounced that that of the average European.

Those who are depressed can become overweight or obese when they neglect their health due to a feeling of hopelessness. Some turn to food for comfort and can increase their caloric intake beyond their needs. Although exercise can actually relieve depressive symptoms, many depressed patients avoid working out.
Biologically, both obesity and depression are associated with an inflammatory state. Depression can also affect weight by interfering with the endocrine system. Some common antidepressants are also known to increase the risk of weight gain.

The researchers encourage doctors to use the study findings to collaborate with mental health professionals to treat both the depression and the obesity collaboratively.

The study is published in the March issue of the Archives of General Psychiatry.