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Obesity obesity and mental health 11-may-2015

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Obesity obesity and mental health 11-may-2015

  1. 1. Obesity and mental health DR WALID SARHAN SENIOR CONSULTANT PSYCHIATRIST AMMAN-JORDAN
  2. 2. Intoday's society,leannessisoften equated with beauty, success,fitness,and self-control Obesity, onthe other hand, is consideredas undesirableas leanness is desirable, forreasonsthat are often morerelated to cosmeticconcernsthan to actual orpotential medical complications. Complexphysicalandpsychologicalrelatontionship Overview
  3. 3. Five types of mental illness appear in the top 20 causes of global burden of disease (GBD): 1. Major depression (second) 2. Anxiety disorders (seventh) 3. Schizophrenia (11th) 4. Dysthymia or persistent depressive disorder (16th) 5. Bipolar disorder (17th) Global Burden of Mental Illness
  4. 4. Common global psychiatric disorders Disorder Estimated lifetime prevalence Typical symptoms Anxiety ~16% • Situational (e.g. phobias) or generalised • Often comorbid with depression Mood disorders ~12% • Major depressive disorder • Persistent low mood, lack of enjoyment • Low energy, fatigue • Poor concentration • Appetite and sleep disturbance • Suicidal thoughts • Bipolar disorder • Episodes of depression and mania/hypomania Externalising disorders* ~2–15% • Overactive, aggressive or dissocial behaviour • Poor attention/concentration and focus Substance misuse** ~1–15% • Intoxication, dependence, withdrawal, psychosis *attention-deficit/hyperactivity disorder (ADHD), oppositional-defiant disorder (ODD), conduct disorder, intermittent explosive disorder; **alcohol and illicit drug use and dependence Kessler et al. Epidemiol Psichiatr Soc 2009;18:23–33
  5. 5. Risk of mental illness in obesity Lifetime risk of disorder Simon et al.1 Mather et al.2 All obese Men Women All obese Men Women Any mood disorder 1.27 (1.15–1.41) 1.21 (0.99–1.46) 1.29 (1.11–1.50) 1.29 (1.12–1.49) 1.17 (0.91–1.50) 1.38 (1.16–1.64) Any anxiety disorder 1.28 (1.05–1.57) 1.17 (0.82–1.67) 1.34 (1.09–1.64) 1.22 (1.10–1.36) 1.25 (1.06–1.46) 1.20 (1.05–1.38) Any substance misuse disorder 0.78 (0.65–0.93) 0.75 (0.60–0.93) 0.88 (0.65–1.18) – – – Data are lifetime odds ratio (95% CI) compared with normal weight individuals in all obese individuals, obese men and obese women. Studies cited are large U.S populations studies 1. Simon et al. Arch Gen Psychiatry 2006;63:824–30; 2. Mather et al. J Psychosom Res 2009;66:277–85
  6. 6. 6 Dr. Latefa Dardas The Global Burden of Mental Health Problems
  7. 7. Frequency of Moderate to Severe Depression Symptoms among Adolescents in Jordan Male Female 7
  8. 8. Help Seeking Intentions among Jordanian Adolescents 8
  9. 9. Meta-analysis of 17 epidemiological studies1 Risk of depression in obese and normal weight individuals (1) 1. de Wit et al. Psychiatry Res 2010;178:230–5 In obese women, odds are 32% higher than in non-obese • Male gender did not influence risk 1 OR (95% CI) Pooled OR: 1.18 (95% CI: 1.01-1.37) 10 0.1 1 OR (95% CI) Pooled OR: 1.32 (95% CI: 1.23-1.40) 0.1 10 Odds of depression in obese individuals are 18% higher than in non-obese, i.e. obese individuals are 1.18 times more likely to have depressive symptoms than non-obese
  10. 10. Large epidemiological surveys1,2 ◦ Lifetime odds of depression are significantly greater in extreme obesity (BMI ≥40 kg/m2) vs. normal weight Risk of depression in obese and normal weight individuals (2) 1. Onyike et al. Am J Epidemiol 2003;58:1136–47; 2. Petry et al. Psychosom Med 2008;70:288–97 CI, confidence interval; NHANES, National Health and Nutrition Examination Survey; NESARC, National Epidemiologic Survey on Alcohol and Related Conditions; OR odds ratio 1 OR (95% CI) OR: 2.60 (95% CI: 1.38–4.91) 10 0.1 1 OR (95% CI) OR: 2.00 (95% CI: 1.74–2.31) 10 0.1 NESARC3 NHANES2
  11. 11. Meta-analysis of 15 longitudinal studies (n=58,745)1 Obesity increased odds of developing depression ◦ OR for developing depression if obese: 1.55 (95% CI: 1.22–1.98; p<0.001) ◦ Effect stronger in US (OR: 2.12) than Europe (OR: 1.33) ◦ Since average BMI in US is higher, observed differences could indicate dose–response relationship. Different sociocultural mechanisms may also be at play Depression increased odds for developing obesity ◦ OR: 1.58 (95% CI: 1.33–1.87; p<0.001) Obesity and depression have a bi-directional relationship (1) 1. Luppino et al. Arch Gen Psychiatry 2010;67:220–9 CI, confidence interval; OR odds ratio
  12. 12. Obesity and depression have a bi-directional relationship (2) Left hand image Association between baseline obesity and development of depression Favours A: negative association between BMI and depression Favours B: positive association between BMI and depression Horizontal lines represent individual studies; filled diamond represent overall finding Right hand image Association between baseline depression and development of obesity Favours A: negative association between depression and BMI Favours B: positive association between depression and BMI BMI ≥30 BMI 25–29.99 1 0.01 0.1 10 100 Favours B Favours A OR (95% CI) 1 0.01 0.1 10 100 Favours B Favours A OR (95% CI) 1. Luppino et al. Arch Gen Psychiatry 2010;67:220–9
  13. 13. Winter depression Atypical Overeating Over sleeping 7/31/2021 13
  14. 14. Drug misuse Pregablin Gabapentin Ceptagon Opiate Alcohol 7/31/2021 14
  15. 15. Physiology of weight regulation Behavioural Neural Metabolic Genetic Learning, memory, reward, mood, emotion Insulin, leptin, gut hormones, circulating nutrients Zheng et al. Int J Obes (Lond) 2009;33(Suppl. 2):S8–13 Food availability, sedentary lifestyle, Food cues Energy intake Energy expenditure FTO, IRX3
  16. 16. Physiological1 Obesity may cause HPA axis and neuroendocrine disturbance, leading to depression Obesity increases insulin resistance and diabetes, potentially causing depression via cerebral changes Psychological1 Being overweight causes psychological distress (poor self-esteem, social stigma etc.) Genetic2 Shared genetic risk of both conditions Pharmacological3–5 ◦ Numerous psychotropic drugs are associated with weight gain including amitriptyline, mirtazapine, paroxetine, olanzapine and clozapine4,5 Obesity and mental health: potential mechanisms 1. Luppino et al. Arch Gen Psychiatry 2010;67:220–9; 2. Afari et al. Depress Anxiety 2010;27:799–806; 3. Smits et al. J Psychiatr Res 2010;44:1010–16; 4. Serretti, Mandelli. J Clin Psychiatry 2010;71:1259–72; 5. Rummel-Kluge et al. Schizophr Res 2010;123:225–33 HPA, hypothalamic–pituitary–adrenal
  17. 17. Cross-sectional Canadian population study1 ◦ n=36,984 ◦ Mean BMI: 25.7±4.8 kg/m2 Increased odds of obesity mediated by medication ◦ Odds of obesity greater if taking: ◦ Antidepressants (AOR: 1.50; p<0.0001) ◦ Antipsychotics (AOR: 3.03; p<0.0001) ◦ Risk remained when controlling for other psychotropic medications Antidepressants and antipsychotics accounted for: ◦ 86% of the relationship between mood disorders and obesity ◦ 32% of the relationship between anxiety disorders and obesity Antidepressants and antipsychotics increase odds of obesity Odds adjusted for gender, age, education, physical activity level, Charlson Comorbidity Index scores. AOR, adjusted odds ratio 1. Smits et al. J Psychiatr Res 2010;44:1010–16
  18. 18. Clinical trials show that certain antidepressants and antipsychotics cause weight gain1–3 ◦ These include amitriptyline, mirtazapine, paroxetine, olanzapine and clozapine2,3 Certain agents may also cause weight loss2 ◦ Bupropion and possibly fluoxetine Weight gain is associated with development of diabetes, hypertension and dyslipidaemia2,4 Psychotropic-related weight gain may be mediated by: ◦ Gender: women have a greater risk of antipsychotic-induced weight gain5 ◦ Cognitive distortions related to weight*5 ◦ Cytokines, including TNF-α6 ◦ Genetic susceptibility7 Psychotropic agents and weight gain 1. Smits et al. J Psychiatr Res 2010;44:1010–16; 2. Serretti, Mandelli. J Clin Psychiatry 2010;71:1259–72; 3. Rummel-Kluge et al. Schizophr Res 2010;123:225–33; 4. Berkowitz, Fabricatore. Psychiatr Clin N Am 2011;34:747–64; 5. Khazaal et al. Clin Pract Epidemiol Ment Health 2006;2:29; 6. Chen da et al. Schizophr Res 2008;106:367–8; 7. Changnon. Curr Drug Targets 2006;7:1681–95 *strict weight regulation, fear of weight gain, self-control as basis of self-esteem, weight and eating behaviour as basis of approval. TNF, tumour necrosis factor
  19. 19. The GLP-1 receptor agonist exenatide is being investigated for treatment of antipsychotic-associated weight gain in obese adults with mental illness (NCT00845507, NCT01794429) Recent guidelines from Canada (Canadian Network for Mood and Anxiety Treatments; CANMAT) state that “for excess weight, the best-studied pharmacologic approaches are metformin and topiramate, with emerging evidence for liraglutide and modafinil”1 Medications to offset psychotropic-induced weight gain 1. McIntyre et al. Ann Clin Psychiatry 2012;24:69–81 GLP-1, glucagon-like peptide-1 Liraglutide is not approved for weight management
  20. 20. 11.1 8.5 13.2 22.5 35.6 34 43.4 28.6 0 5 10 15 20 25 30 35 40 45 50 Sibutramine alone Lifestyle modification alone Combined therapy Sibutramine plus brief therapy Increased by ≥5 points Decreased by ≥5 points Effect of weight loss on mood 1-year randomised trial of lifestyle and/or sibutramine therapy1 ◦ Mean overall depression scores* decreased across all groups (p<0.001) ◦ In 13.9% of participants who lost significantly less weight, symptoms of depression increased In a meta-analysis of 31 RCTs, all lifestyle and medication interventions reduced symptoms of depression2 1. Faulconbridge et al. Obesity (Silver Spring) 2009;17:1009–16; 2. Fabricatore et al. Int J Obes (Lond) 2011;35:1363–76 *Beck Depression Inventory-II. BMI, body mass index; RCT, randomised controlled trial 194 obese participants Age: 43.7 ± 10.2 years BMI: 37.6 ± 4.1 kg/m2 Proportion of participants (%)
  21. 21. Liraglutide for psychiatric disorders: clinical evidence and challenges These preliminary results suggest that liraglutide could be a potential add-on therapeutic strategy against mood disorders to control not only the weight and metabolic dysfunction of patients, but also coexistent cognitive impairment. It could also open new venues of investigation of the neurobiology of mood disorders. Camkurt, Mehmet Akif, Lavagnino, Luca, Zhang, Xiang Y. and Teixeira, Antonio L. "Liraglutide for psychiatric disorders: clinical evidence and challenges" Hormone Molecular Biology and Clinical Investigation, vol. 36, no. 2, 2018, pp. 20180031. https://doi.org/10.1515/hmbci-2018-0031
  22. 22. Effect of liraglutide 3.0mg treatment on weight reduction in obese antipsychotic-treated patients Liraglutide 3.0 mg significantly decreased body weight in obese patients treated with antipsychotics without altering the status of psychiatric diseases. A randomized controlled study is required to corroborate the results of this study. Seung Eun Lee et alPsychiatry Research Volume 299, May 2021, 113830 7/31/2021 22
  23. 23. Psychiatric disorders are prevalent and have a significant impact on wellbeing and productivity Mood/anxiety disorders are more common in individuals with obesity There is a bidirectional relationship between depression and obesity; various mechanisms may be responsible Obesity may cause neuroendocrine disturbances which could potentially lead to depression Certain psychotropic medications, particularly antidepressants and antipsychotics, are associated with weight gain Further research is needed to elucidate the relationship between mental health and weight gain, and to identify potential targets for intervention Conclusions
  24. 24. wsarhan342gmail.com Thank you

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