Overeating is a Symptom

Last week, I blogged about the results of a study showing an association between vital exhaustion and weight gain.

This blog posting prompted Sharon Kirkey (award-winning health journalist and diligent reader of my blog) to explore this issue further by actually talking to the researchers themselves. Her article appeared yesterday via the Canwest News Service and contains far more details than I bothered to report in my blog.

For e.g. Sharon lists the actual questions Bryant and colleagues used to explore the presence of vital exhaustion. I found them most interesting so I list them below:

- Do you often feel tired?

- Do you wake up repeatedly during the night?

- Do you have the feeling that you have not been accomplishing much lately?

- Do you believe that you have come to a 'dead end'?

- Do you lately feel more listless than before?

- Do little things irritate you more than they used to?

- Does it take more time to grasp a difficult problem than it did a year ago?

- Do you have increasing difficulty in concentrating on a single subject for long?

While to me none of these questions seem particularly specific and are likely to get a "yes" response from a lot of people (hey, even I have to say "yes" to some), I guess when you have to say "yes" to most or all of them, you are probably not hopping around like the Energizer Bunny or scrambling to follow diet plans.

Sharon quotes me as saying:

"Nobody is claiming all of obesity is exhaustion, but if people are clearly eating more than they need the question is not (just) how to get them to stop, but why, exactly, are they doing that. Maybe you're losing your job. Or you're overworked. Or it's some private issue that needs to be addressed. You don't fix obesity by giving people a copy of Canada's food guide. You have to try to understand what it is that's contributing to the weight gain."

Exactly! Obesity is a symptom of overeating, which in turn is a symptom of something else that's going on: it can be that you simply lack the knowledge about healthy nutrition or caloric content of foods, but it can also be a symptom of emotional (e.g. depression, vital exhaustion) or biological (e.g. MC-4 receptor defect) issue, medications (e.g. clozapine) or any number of other reasons I can think of.

Always remember: overeating (and/or sedentariness) is not a diagnosis - overeating (and/or sedentariness) is a symptom!

AMS
Edmonton, Alberta

Exhaustion Promotes Weight Gain

OK, we know stress, lack of time, low socioeconomic status, poor locus of control and poor sleep promote obesity - but here is a new one (at least for me): Vital Exhaustion.

The term Vital Exhaustion (VE) has three defining characteristics: (1) feelings of excessive fatigue and lack of energy, (2) increasing irritability, and (3) feelings of demoralization.

People often attribute these feelings to overwork, or to problems at work or in other important life areas that the person has not been able to solve, or to a real or symbolic loss. Therefore, it has been suggested that VE is a mental state at which people arrive when their resources for adapting to stress are broken down.

Now Maria Bryant and colleagues from the University of Leeds, UK in a paper just out in OBESITY, examined the relationship between VE and BMI cross-sectionally and after 3 and 6 years of follow-up among the 13,727 participants in the Atherosclerosis Risk in Communities (ARIC) study.

BMI was significantly higher among both white and African-American men and women in the highest VE quartile compared to those with no VE. Similarly, high VE at baseline was associated with higher BMI 3 and 6 years later. Baseline VE predicted future excess weight gain in white men and women, but not in African Americans.

Clearly, if this relationship is causal, identifying the factors contributing to VE and addressing them may help prevent and reduce the burden of obesity - certainly easier said than done.

Anyone who thinks we will solve the obesity crisis by handing out diet plans and chasing people around the block are kidding themselves.

AMS
Edmonton, Alberta

Mood & Food

This weekend (June 8) I was part of a lunch symposium on the Complex Depressed Patient at the 30th Annual Meeting of the Canadian College of Neuropsychopharmacology (CCNP), held in Toronto.

Other members of the panel were Claudio Soares (McMaster), Pierre Blier (Ottawa) and Valerie Taylor (McMaster).

While Soares and Blier focused their discussion on a case of peri-menopausal depression, Taylor and I discussed a patient who was non-compliant with her antidepressant medication due to weight gain.

As blogged previously, weight gain is a common complication of neuropsychiatric medications and there are few proven strategies to treat or prevent it. While there is some data to support co-prescription of metformin or sibutramine with some of the psychotropic medications, this is clearly not current medical practice.

As always, prevention of weight gain may be easier than treating obesity. Thus it may perhaps be advisable to start patients on weight-gain prevention strategies (which may include both behavioural interventions and antiobesity medications) right off the bat rather than trying to treat the excess weight gain or risk non-compliance resulting from the weight gain.

As pointed out by Taylor, based on her own (unpublished) observations and other studies, weight gain with psychotropic medications is by no means benign, resulting in all of the usual complications of weight gain.

We know that simply telling people to eat less and move more is as effective for treating obesity as simply telling people to cheer up is for depression.

Both are complex multifactorial conditions that need to be addressed by behavioural, psychological and often medical interventions - not uncommonly for life!

AMS
Edmonton, Alberta

Hat tip to Bryan Ashuk for suggesting the title for this post