Which Comes First: Depression or Weight Gain?

Yoni Freedhoff

For many people, weight is depressing. Whether consequent to society's hateful weight biases, which expose individuals with obesity to mood-killing bullying, scorn and discrimination, or to personally held beliefs and attitudes, there's little doubt that weight is often a huge psychological burden.

[See When Science Met The Biggest Loser.]

There's little doubt, too, that those who struggle with both weight and depression often feel a tight relationship between them, that their depression would lift were they to lose weight. And for some it does.

A recent meta-analysis of the impact of intentional non-pharmacologic weight-loss programs on depression revealed that indeed weight loss is associated with an improvement in mood. But that's not the whole story. And so, before you rush out and join a weight-loss program, you need to know that the mood benefits shown occurred in folks enrolled in behavioral weight-loss programs, regardless of whether or not they lost weight. In other words, it wasn't the losing that was helping mood, it was something else.

The researchers believe that most likely mood was shown to improve due to either exercise or the social support offered by the programs themselves.

[See Are You Exercising for the Right Reasons?]

There's another proviso to the aforementioned results. The folks whose moods improved weren't clinically depressed to begin with. For those who are mired in the throes of a full-blown clinical depression, intentional weight loss is likely not a wise first step and, in fact, it's a first step that's usually aggressively discouraged.

[See How to Handle Extreme Stress.]

That's not to say that a person's weight might not be fueling their lowered mood, just that successful weight management necessitates the ability to plan, organize and concentrate. And for people dealing with a true clinical depression, those are challenging, if not impossible, traits to maintain.

To help illustrate what I'm getting at, let's use a marathon analogy. Successful weight loss is no doubt a marathon - perhaps even the world's most difficult marathon. Unlike a typical marathon, the effort involved in maintaining a weight loss is ongoing and lifelong, whereas a typical marathon actually has a finish line. So if your plan were to run a marathon, would you start your race if you had a sprained ankle? Probably not, as the likelihood of you completing a typical marathon (let alone a never-ending one) that you began with a sprained ankle is virtually zero.

[See The Most Important Skill for Weight Management.]

The analogy here is clear. Starting an intentional weight-loss effort in the midst of a poorly managed clinical depression is like starting a marathon with a badly sprained ankle. My advice is straightforward. If you're suffering with depression, before you consider a weight-loss effort, and even if your weight is playing into your low mood, you're better off treating your mood before your weight. You feeling like a failure because you couldn't finish the never-ending marathon you started with a sprained ankle sure isn't likely to help with anything.

Hungry for more? Write to eatandrun@usnews.com with your questions, concerns, and feedback.

Yoni Freedhoff, MD, is an assistant professor of family medicine at the University of Ottawa, where he's the founder and medical director of the Bariatric Medical Institute--dedicated to non-surgical weight management since 2004. Dr. Freedhoff sounds off daily on his award-winning blog, Weighty Matters, and you can follow him on Twitter @YoniFreedhoff. Dr. Freedhoff's latest book, The Diet Fix: Why Everything You've Been Taught About Dieting is Wrong and the 10-Day Plan to Fix It, will be published by Random House's Crown/Harmony in 2014.