Editors note: This is the second column in a series on obesity and mental health:

Perhaps in no other realm of human existence is the mind-body connection more evident than in the complex relationship between obesity, physical health and mental health.

Obesity occurs due to a variety of factors that can include various psychological and physiological stressors that may prompt people to overeat in an attempt to cope.

People suffering from severe depression or anxiety, for example, may lack any motivation to exercise, and the serotonin deficiency in the brain that is related to depression and anxiety may cause poor sleep and/or cravings for foods that are high in carbohydrates and which accelerate weight gain.

Eva Panigrahi, a psychologist at the Ohio State University’s Wexner Medical Center, is one of the nation’s most prominent experts in the relationship between obesity and mental health.

“The relationship between obesity and depression can be explained as a vicious, mutually strengthening cycle that includes negative physiological and psychopathology factors,” Panigraphi said in an article that was published on the Medical News Today website.

People who turn to food to deal with an unpleasant or disturbing emotional state can become caught up in a cycle that can be just as detrimental and destructive to their health as alcohol or drug addiction.

Compulsive overeating as a response to such problems as anxiety, depression, anger, personal trauma, grief or loneliness can be just as difficult a hurdle to overcome as any other type of physical addiction.

A proper and regular diet and exercise regimen is a big part of the battle plan for those who struggle with their weight, but by itself, such a regimen often doesn’t address the entire problem. Psychotherapy and certain types of psychiatric medications, as well as certain weight-loss medications such as Wegovy and Ozempic, are often required to give a person a fighting chance against obesity, and in some cases, bariatric surgery may also be required.

“There is growing research on the perfection of antidepressant medication management that does not stimulate eating and weight gain,” Panigrahi said. “A few antidepressants (such as the medication Buproprion) are associated with weight loss.

“In conjunction with medication management, incorporating evidence-based psychotherapy such as cognitive behavorial therapy (CBT) has been demonstrated as an effective approach for depression and weight,” Panigrahi said.

Kimberly A. Gudzune, M.D., M.P.H., is the chief medical officer for the American Board of Obesity Medicine Foundation.

Gudzune spoke at the American Psychological Association’s mental health services conference last September, and her comments were published in a November 2024

article on the Psychiatry News website.

Gudzune emphasized the importance of taking medications that do not promote weight gain.

“When patients come to see me, they can be taking five or more different weight-gain promoting medications, and they don’t even realize it, because no one has ever told them that,” Gudzune said.

Diet and exercise are important in losing weight or maintaining a healthy weight, but Gudzune emphasized that diet and exercise alone are often not enough when people are battling obesity.

“Obesity is a chronic, relapsing progressive disease, so it is not enough just to tell people to eat less and move more,” Gudzune said. “Research has shown that (just) from lifestyle interventions alone, patients maintain (only) a 3.1 percent loss of initial weight after four to five years.”

The various physical and psychological underpinnings surrounding obesity may be the most significant factors in why it is not only difficult to lose weight initially, but even tougher to keep weight off for an extended period of time.

Denis Navarro, retired outpatient services supervisor and clinical specialist for the UPMC Altoona Behavioral Health Department, is a psychologist who has been doing evaluations for the UPMC Altoona Bariatric Center of Excellence for the past 10 years.

“A significant percentage of these people (with obesity) that I see are getting psychotropics (medications) because of the diagnoses of depression and anxiety, and it’s not unusual to see some of these folks with PTSD (post-traumatic stress disorder),” Navarro said.

Society’s generally negative bias toward obesity further complicates the problem for those who are affected by it.

According to the National Council on Aging, pre

-conceived and often incorrect biases about obesity include: People who are obese are lazy, irresponsible and lack willpower and self-discipline; People who are obese have only themselves to blame; People carrying extra weight have poor hygiene, or are less capable of succeeding in life.

These biases can cause an obese person to feel even more self-conscious — which, in turn, may trigger even more compulsive overeating.

“There is a lot of weight-based discrimination and stigma,” Navarro said. “These folks have been on a rough road in that way but I’ve been really impressed with how a lot of them persevere through this and have successful lives.”

Next week: Examining dietary and nutritional strategies.

Mirror Staff Writer John Hartsock can be reached at jhartsock@altoonamirror.com