Mental health problems can lead to an imbalance of hormones, which can in turn trigger obesity. Photo: IC

Yang Panpan's misery started with her unhappy marriage, but that isn't where it ended. Over the past seven years since she first married, Yang, a 30-year-old woman who lives in Suzhou, Anhui Province, has seen her internal turmoil expressed outwardly as her weight ballooned from 75 kilograms to 190 kilograms. She couldn't seem to stop gaining weight; it was when she reached more than twice her original size that she began worrying for her life.

Abandoned by her then-husband when she was pregnant in 2009, Yang went on to marry a man she did not love in 2012, which only compounded her sadness. As her mood fell, her weight continued to rise.

"I felt angry, depressed, helpless and anxious, and even when I stopped eating for days, I continued to put on more than 10 kilograms each year," Yang told the Changchun Evening News in a May 10 report. "I tried many ways to lose weight but they all failed, and I am afraid that one day I will die of obesity."

According to a report by the American Journal of Epidemiology, the University College London Medical School recently released the results of a 19-year-long study on the relationship between mental health and the risk of obesity, which found that the two are closely related.

Among the 6,895 males and 3,413 females who were surveyed, all of whom were between the ages of 35 and 55, those who suffered from sustained bouts of stress and depression were 73 percent more likely to become obese.

Depression and other mental disturbances yield a variety of physiological responses - some people can't sleep, others become depressed and still others gain weight. Anxiety, depression and other mental afflictions can trigger what some experts call "psychological obesity," said Li Jing, a doctor at Nanjing Hospital of TCM (traditional Chinese medicine) in a May 20 report by the Nanjing Morning Post.

Experts say that people under prolonged stress should find healthy ways of dealing with their depression or anxiety, like watching movies or exercising outdoors. They should also monitor their weight on a weekly basis for major fluctuations. Photo: Li Hao/GT

Eating less but gaining more

Though it may look just like regular obesity, psychological obesity is a distinct condition, as evidenced by patients like Yang.

According to the Changchun Evening News report, Yu Shuzhong, a TCM therapist and expert in weight loss, decided to help Yang in December. Yu found that, in keeping with her assertions, Yang didn't eat much but continued to gain weight, which stands in stark contrast to those who become obese due to a combination of overeating and inactivity.

"Yang is suffering from typical psychological obesity, and the priority is mental intervention in her treatment," Yu said.

He said that Yang's depression and accumulated negative emotions have culminated to create such crushing pressure that it actually changed her physical situation.

"Actually today, we're seeing a sharp increase in psychological obesity, but it's often misdiagnosed," Yu said. "People rarely connect obesity with mental health problems , so they don't even think to consult a psychologist or psychiatrist."

Li said that mental health problems or stress can be expressed in a variety of ways, including mental illnesses like depression and anxiety, chronic pain and now, more frequently, obesity.

"Too much stress can lead to soaring levels of glucocorticoids, a hormone secreted by the adrenal gland," said Li.

"This hormone can change the location of fat in the human body, causing obesity. This is actually a kind of spontaneous attempt by the body to accumulate energy to cope with times of stress."

Li said glucocorticoids can "relocate" fat from less obvious places in the body to the abdominal region, which is also home to most of our vital organs. That makes this kind of obesity more dangerous.

Common complications related to obesity

Li said psychological distress can induce a stress response in the body, which is actually an evolutionary response geared toward self-preservation. However, when people are under prolonged pressure, and the stress response is always activated, it can lead to serious physical problems.

"Long-term stress can cause metabolic disorders, cardiovascular disease, diabetes and also obesity," Li said. "And the three diseases mentioned above can also lead to obesity."

Another hormone that comes into play, Li said, is ghrelin, which is secreted by the gastrointestinal tract after more than a week of depression or stress.

"It will make you hungry faster and your appetite will grow stronger," said Li.

In addition to the stress response and hormone fluctuations, the nervous system also plays a role in psychological obesity. According to Li, anxiety easily affects the neural centers controlled by the hypothalamus, which manages feelings of hunger and satiety.

"Satiety and hunger disorders are horrible," Li said. "Usually people feel insatiably hungry and only eating can calm them down when they are extremely nervous."

A dangerous vicious cycle

Li said psychological obesity is striking a growing number of people in China, and that people struggling with this condition should consider incorporating psychological therapy into their efforts to lose weight.

"One's emotional state is both the root cause of obesity and a main reason for its persistence," Li said.

She added that although some patients in her department succeeded in losing weight through medical methods like acupuncture and moxibustion, the weight soon returned due to the fact that their mental and emotional issues had not been resolved.

Yu shared Li's opinion, saying that stress and other mental health problems can cause a vicious cycle of obesity, which in turn leads to worsening emotional problems, which feed into the weight problems and on and on.

Eating disorders, including bulimia, can also emerge as a result of long-term obesity, Yu said.

Eating disorders are actually neurological diseases because they are caused by imbalances of the autonomic nervous system. "However, when the nervous system is out of whack, it can affect people's moods, which can easily develop into depression," said Yu.

Both Li and Yu said a healthy mental and emotional status is crucial to preventing psychological obesity.

"People must learn to find ways of actively seeking emotional release and dealing with negative emotions, especially young white-collar workers, under the mounting pressures of life and work," Li said.

"People should deal with stress in healthy ways like physical exercise and watching movies rather than eating."

Yu added that people who think they may suffer from psychological obesity should consult a professional therapist or a psychiatrist as soon as possible.

"People can record their weight every week, and if they see an obvious increase above three kilograms, they should seek professional help," he said.

As for Yang, she has entered a weight-loss program that incorporates both physical and mental health treatments. Since she started receiving therapy three months ago, she has lost more than 50 kilograms.

"I lost more than 10 kilograms one month, which is unbelievable," she said.

"Once I am happy and hopeful about my future life, my weight drops. My goal weight is 65 kilograms, and I think I can be beautiful again."



Newspaper headline: Bearing a heavy weight