drain energy and motivation, making itdifficult to make the lifestyle changes—such as exercising regularly and eatingless and healthier—that help manageweight. Consider, too, that increasedappetite, which can lead to rapid weightgain, is a common side effect of manymedications (that is antidepressantsand antipsychotics) used to treat mentalhealth disorders. So, patients essentiallyhave two options: medicate and riskweight gain and possible obesity; ordon’t medicate and risk the challengesand complications related to their mentalillness. It truly is the proverbial double-edged sword.
“Some patients would rather bedepressed than gain weight because,for them, the bias against obesity andthe stigma of obesity are worse thanbeing depressed,” says Salas. “So theygo off their antidepressants.” She addsthat this makes treating children andyouth particularly challenging, becauseobesity is the number one reason forbullying in schools.
There’s yet another complication in
the obesity-mental health relationship.
When an individual has a mentaldisorder, the body produces excessamounts of the stress hormone cortisol.
Prolonged high levels of cortisol lead toan increase in abdominal fat—a headstart towards obesity and also a knownrisk factor for heart disease and diabetes.
Across the country, provinces are implementing a variety of obesity preventionstrategies and initiatives. And Albertais at the forefront of this movement.
Founded by Sharma and jointly hosted
by the University of Alberta and Alberta
Health Services, CON is the largest
professional obesity association of
its kind in Canada. Based at the Royal
Alexandra Hospital in Edmonton,
CON’s team of health-care professionals,
researchers and other stakeholders
focuses on three areas: “addressing the
stigma associated with excess weight,
changing the way policy-makers and
health professionals approach obesity,
and improving access to prevention
and treatment resources.”
In September 2011, AHS introduced
a comprehensive plan to tackle obesity.
The AHS Obesity Initiative includes asuite of services, from community-basedprograms to intensive medical intervention, all designed to reduce theeffects of obesity. A key part of the planis the Alberta Obesity Program, whichincludes establishing and expandingbariatric services in several citiesthroughout the province. (Bariatrics isthe branch of medicine that addressesobesity.)
Shandra Taylor, a psychologist onthe Provincial Bariatric Resource Team,belongs to a seven-member team thatgives health-care providers in bariatricprograms information about newresearch and clinical and best practicesof care for obesity patients.
Taylor stresses the importance ofhealth-care professionals being awareof weight bias and the stigma of obesity.
“Even very experienced and skilledclinicians can fall into the trap ofpromoting ideas—like ‘move moreand eat less’—that can reinforce bias.
Patients can walk away with the message
that they’re to blame. Addressing obesity
has to be done in a sensitive way that’s
respectful of its complexity, its challenges,
and its chronic nature.”
Many current efforts to prevent andmanage obesity target health professionals,policy-makers and other stakeholders.They’re receiving a clear message thatmental health is a significant driver ofthe obesity epidemic. As yet, no suchmessage is being delivered to the generalpublic, but when it is, it could go a longway towards eliminating weight biasand the stigma of obesity.
Salas believes a public campaign to
raise awareness of obesity’s complexity
could be the next step. Meanwhile, CON
is “reaching health professionals, and
hoping they’re bringing the message
to the community.”
Sharma believes there’s a noticeable
shift already. “ I think people are slowly
beginning to move away from the
‘it’s your own fault’ attitude towards
can be worse than