How obesity and weight bias may affect your mental health

About 74 percent of adults in the United States are overweight, according to the Centers for Disease Control and Prevention Over half of the people in that group—42 percent of U.S. adults—are obese.

Carrying excess body fat is associated with a higher risk for a range of chronic health conditions, including high blood pressure, high cholesterol, type 2 diabetes, and heart disease (the leading killer of U.S. men and women).

In addition, overweight and obese people experience social stigma and discrimination and they often face difficulty accessing appropriate health care. Daily activities like studying, working, socializing, and traveling can be more challenging. Healthcare providers (HCPs), meanwhile, sometimes stigmatize overweight people and deliver lower-quality care. Those combined factors can have a severe effect on mental and physical health.

"There's not one medical discipline that obesity doesn’t touch,” says Michael L. Green, Jr., MD, medical director of bariatric surgery for Medical City Fort Worth in Fort Worth, Texas.

People who achieve weight loss may ease some of the mental and physical burdens associated with the condition. That said, severe obesity is not typically reversible by voluntarily eating less and exercising. Many people with severe obesity may need additional help from an HCP to lose weight.

In the meantime, experts agree that weight bias and discrimination—on the part of healthcare professionals, among others—is harmful and must stop.

The mental-health risks associated with obesity

Anxiety is a mental illness that affects about 19 percent of U.S. adults each year. Overweight and obesity are associated with a higher risk for the condition. Overweight people are about 10 percent likelier than normal-weight people to be anxious. Obese people are about 30 percent more likely.

Depression is another mental health issue many overweight people face, especially women. One 2020 study published in Journal of Affective Disorders found 48 percent higher odds of depression among women who perceived themselves as overweight compared to women who saw their weight as normal.

Connections between overweight and mental health issues

Why might overweight people tend to be more anxious or depressed?

Inflammation may be partly to blame. Many obese people experience chronic inflammation related to diet and physical inactivity. There is a lot of evidence tying inflammation to both depression and anxiety.

A clue to this link is that people with obesity who have metabolic problems, such as abnormal blood cholesterol or high blood glucose, are likelier to have these mental illnesses. By contrast, obese people who are metabolically healthy face, at most, only a slightly elevated risk for depression.

Genetics could also play a role. Researchers in the UK analyzed 73 genetic markers linked to a high body mass index (BMI) to investigate the relationship between obesity and depression. The study, published in 2019 in International Journal of Epidemiology, looked at hundreds of thousands of people. The authors found that genes associated with high BMI but with a low risk for metabolic diseases (like diabetes) were also associated with greater odds for depression. The results suggest that excess body fat is associated with an increased risk for depression, even in the absence of inflammation and other physiological effects of obesity.

At any given time, about 40 percent of obese people are considered metabolically healthy. This is defined as having normal blood pressure, a moderate waist-to-hip ratio (less than 0.95 for women and less than 1.03 for men), and no type 2 diabetes.

High-fat diets and excess sugar have also been linked to mental health problems. So have abnormal communities of bacteria in the gut.

The weight of weight-based bias

Other people’s bias and discrimination can also make life harder for overweight people. Dr. Green describes it as the “the social stigma placed on individuals, which may make them feel uncomfortable in their own skin.”

If you are overweight or obese, you may face humiliation simply while doing everyday activities. These include going shopping, working out at the gym, or flying, where you may have to request a seatbelt extender or be asked to purchase two seats. You may face insensitive comments or unjust treatment because of your weight. Over time, being treated this way may lead to a poor self-image and negative mood, especially for women. It can also hamper access to education and financial aid and harm career advancement.

No matter what your weight, chronic stress, such as from microaggressions like these, is associated with higher risk for many health conditions. These include heart disease, diabetes, and even obesity, as well as anxiety and depression.

How mental illness, weight, and stigma affect relationships

Anxiety and depression can make social activities less desirable. For some people, just leaving the house may be a challenge. This could reduce your ability to grow and maintain connections with the people you love. In some cases, your close relatives, friends, and family may be the ones making the most hurtful and stigmatizing comments.

Your intimate relationships may suffer as well. Feelings of shame related to your weight may:

• Make you less likely to date or go on dates in public
• Cause you to accept poor treatment or keep you in an unhappy relationship
• Affect your confidence during sex

While the science isn’t clear on whether obesity is associated with sexual problems in women, excess body weight has been linked to erectile dysfunction, making sex for some people more difficult.

What you can do

If you’re facing mental illness, unwanted excess weight, or both, start by speaking with an HCP, preferably one who is culturally competent and equipped to care for obese and overweight patients.

Look for providers who call themselves “fat-friendly,” “size-friendly,” or “weight-inclusive.” (Bear in mind that the word “fat” is not always used in a pejorative or insulting way. Many people who are overweight or obese—along with their friends, loved ones, and HCPs—choose to use “fat” as a neutral term, like “tall” or “dark-haired,” to reclaim it from its stigmatizing sense.)

At the HCP’s office, see if there are comfortable armless chairs in the waiting room, as well as gowns and blood pressure cuffs that are the correct size for you. A competent HCP should not humiliate you about your weight, ignore your concerns, or assume without asking that you’re not exercising or eating a balanced diet. An HCP may suggest changes that can protect your mental and physical health, if you are not doing them already, including:

• Eating a healthy, balanced diet
• Moving your body
• Getting enough sleep
• Limiting alcohol and caffeine
• Taking time to relax, meditate, or practice yoga

If those don’t help enough, there are other treatments you and your HCP can consider, which may include medications for weight loss or weight-loss surgery.

“Don't let someone get in the way of you becoming a healthier you,” says Green. “Get out and be confident and we can start finding solutions for you.”