Obesity and depression can go hand in hand, making it harder for people to shed the pounds, according to Bermuda Wellness and Outreach Centre physician Caren Griffith-Fadlin.

Although the link is not absolute, people are more likely to default from a weight management programme if they have depression or regain the weight because the root cause has not been addressed, she said.

As part of Public Health Week, Dr Griffith-Fadlin spoke to medical professionals about the link between obesity and depression at the Bermuda Hospitals Board Continuing Medical Education programme yesterday.

“I’m trying to increase awareness that this is something that we as a medical community should be addressing not overlooking,” she said. “We know that obesity is of big concern here in Bermuda because over 70 per cent of the population is either overweight or obese.”

Depression is one of the rising public health issues that “often goes understated”, she said, adding that “part of the challenge is the social stigma that is associated with depression, where so many people feel you should just snap out of it and start behaving normally again and don’t recognise that this is a medical condition that has changes that can occur in your brain”.

“But the truth is that it can escalate to serious levels and can require medical intervention, psychological intervention and, for sure, more and more studies are coming out now, showing that there is a link between depression and obesity.”

While there is still uncertainty over which comes first, Dr Griffith-Fadlin said she had observed the link among her own patients, with about 25 per cent suffering from depression.

She stressed that the link was not absolute, but noted that especially her female clients often have a “direct association between their body image and how they feel about themselves”, which can cause depression.

This in turn can make it more difficult to stick to weight-loss management programmes because there is no “central sense of self-worth”.

“Persons are more likely to default from a weight management programme if they have depression. If they are not able to see themselves as worth the process of getting to the point of losing weight and if that depression is not dealt with initially then you’re not going to move very far.”

Others may lose weight but regain it because the “root cause has not been dealt with”, she added.

“I also find that some persons might not be fully aware that they’re having issue with depression when they come in and it’s something that we happen upon during our consults.”

Other times it is someone else who recognises that they are suffering from a depressed mood or lack of interest “in things they were interested in before”.

“Some people sleep less, some people sleep more, some people are more irritable,” she said, adding that others eat more, which can lead to a pattern of “spiralling” behaviour.

“You feel unhappy about yourself, you feel unhappy about what you’ve done and yet you are still eating more.”

She added that there was also a tendency to opt for high-fat, high-sugar foods that stimulate the pleasure centres in the brain.

While this results in a temporary high, “when the sugar rush ends, it drops you back into that depressed mood”.

“It can be very challenging to get out of,” she added. “And sometimes you wonder, how can somebody allow themselves to get so obese, what are they doing?”

Noting that the stigma attached to obesity is another aspect to contend with, she said “a lot of times it isn’t necessarily that the individual wanted to become that way, but the different factors that pressed upon them basically resulted in that end”.

She stressed that there was “room” for both the community and the medial fraternity to be “sympathetic, if not empathetic with these individuals and to really help them identify these challenges and move towards change”.

Pointing to the PHQ9 screening test for depression as an example, she said there were useful tools that can help doctors determine if patients are experiencing depression and address them at the primary care level. But Dr Griffith-Fadlin added that there was also “more room” for doctors to talk to patients about their weight should it be of concern.

“Sometimes your weight can be seen as something that is so personal that it’s not necessarily addressed.”

But she said: “Somebody has to bring it up to you and help you confront a matter that is of serious consequence.”