Obesity and mental health: What’s the link?

It’s common knowledge that carrying too much body weight can have a negative effect on physical health. Indeed obesity, says the NHS, is a serious health concern that increases the risk of many other health conditions including type 2 diabetes, coronary heart disease, some types of cancer, asthma, arthritis and stroke (i). 
 
In general, however, there’s far less talk about how obesity can impact mental and emotional health. Yet the link between excess weight and mental health has been clearly established, with experts suggesting being overweight or obese can contribute to a range of mental health problems including low self-esteem and conditions such as depression (i). 
 
But the link works both ways. Not only can obesity lead to depression, anxiety and other mental health problems, but mental health problems can lead to weight gain too, with each aggravating the other.
 

Obesity and mental health

 
People who are overweight or obese can often have problems with body image. They may also have a lower quality of life because of the physical difficulties that come with being overweight or obese. Both of these things can have a serious effect on your mood.
 
Many people who are overweight or obese are also faced with social discrimination – for instance they may be unfairly thought of as undisciplined or lazy. This too can increase their risk of having low self-esteem and developing a mental health condition. Meanwhile if you’re constantly worried about being judged for how you look, there’s a chance you might develop anxiety.
 

Mental health and weight

 
Mental health problems including anxiety, depression and bipolar disorder can make some people use food as a coping strategy, which means they may overeat whenever they feel they can’t deal with their problems. And many people with mental health issues often make poor eating choices, which can also contribute to weight gain.
 
Having a mental health problem such as depression can make following to a weight management programme more difficult than it should be. It can also mean you may lack the incentive or energy to exercise regularly or take part in other activities that could help keep your weight under control.
 
Yet another reason why mental health problems are thought to be linked with obesity is that weight gain is a known side effect of many of the medicines used to treat mental health conditions (ii).
 

How many people are affected?

 
According to a 2021 poll of more than 2,000 UK adults, 25 per cent of people who were obese said their mental health was bad, compared with 15 per cent of those with a healthy body weight (iii). Meanwhile an overview of the psychological aspects of obesity claims up to 60 per cent of people living with obesity – particularly extreme obesity – also struggle with a mental illness (this is a significantly higher percentage than that seen in the general population) (iv).
 
Looking at depression alone, a Centers for Disease Control and Prevention report on adults in the US discovered 43 per cent of people with depression were obese (v). Another study, meanwhile, has found women with obesity have a higher risk of developing most mental disorders compared with obese men (vi). In this particular report, obese women experienced three times more depressive episodes than non-obese women (13.3 per cent compared with 4.8 per cent), with obese men twice as likely to be affected (6.61 per cent of obese men compared with 3.21 per cent of non-obese men).
 
Elsewhere medical experts have even suggested some people with mental illness die 25 years earlier than those without mental illness because of obesity-related conditions (vii).
 

How to tell if you’re overweight or obese

 
Currently around one in four adults is thought to be living with obesity in the UK (i). But it’s not always easy to tell the difference between being of normal weight and being overweight, or between being overweight and obese. The measurement most doctors use to check whether your weight is healthy is called body mass index. This determines whether or not your weight is healthy for your height. You can work out your BMI by using an online calculator such as the NHS BMI healthy weight calculator. 
 
Your results will tell you if you’re underweight, healthy weight, overweight, obese or severely obese:
 

• Less than 18.5 is underweight

• 18.5 - 24.9 is healthy weight

• 25 - 29.9 is overweight

• 30 - 39.9 is obese

• 40 and above is severely obese

 
People with an Asian, Middle Eastern, Black African or African-Caribbean family background should interpret their BMI results slightly differently in the overweight and obese categories:
 

• 23 - 27.4 is overweight

• 27.5 - 40 is obese

 
If your BMI suggests you’re anything other than a healthy weight, your GP can give you advice on how to make it healthier. This usually means involves a series of measures including following a balanced calorie-controlled diet and being more physically active.
 
For information about managing your weight read our article Weight loss: the facts; if you need to gain weight there’s advice in our report on what it means to be underweight. 
 

Which mental health disorders are linked to obesity?

 
Perhaps the most obvious mental health conditions connected with obesity are eating disorders, most notably binge-eating disorder (iv).
 
According to the eating disorders charity Beat, binge eating disorder (BED) is a serious mental illness. If you have BED you’ll typically eat very large quantities of food in a short period of time without feeling you’re in control of what you’re doing (viii). This differs from another eating disorder called bulimia, which is when people typically binge on food then vomit what they’ve eaten (other methods of purging include taking laxatives or diuretics, fasting or exercising excessively).
 
BED can affect anyone of any gender, ethnicity, background or age, though it’s more common in adults than in younger people and often starts when you’re in your 20s or older. It’s not about choosing to eat large portions or overindulging. Indeed it often involves having a much larger amount of food than you’d normally eat, and has nothing to do with the pleasure of eating (quite the opposite, as binging is usually very distressing).
 
Some of the actions that might warn you that you or someone you know is experiencing BED include:
 

• Eating much faster than usual

• Eating large amounts when you’re not hungry

• Eating until you’re uncomfortably full

• Bingeing alone

• Feeling disgust, shame or guilt during or after the binge

 
According to Beat, someone who experiences at least one of these actions a week for at least three months is likely to be diagnosed with BED (viii). The most common effect of BED is gaining weight and potentially becoming overweight or obese. Other complications associated with BED include high blood pressure, high cholesterol, type 2 diabetes and heart disease, as well as low mood, low self-esteem, low confidence, depression and anxiety.
 
Find out more about eating disorders, including how they are treated, in our guide to understanding types of eating disorders. 
 

Obesity, depression and anxiety

 
Depression is the most common mental health condition associated with obesity, with reports suggesting adults diagnosed with depression are more likely to be obese than those without depression (v). There’s lots more information on depression, including the signs to look out for and what you can do to cope with your feelings, in our article Depression signs and symptoms.
 
Anxiety has also been linked with obesity. According to researchers, it’s well established that anxiety disorders are common in people who undergo bariatric surgery for weight loss – though there’s less evidence for the incidence of anxiety in people having non-surgical weight-loss treatment (iv). The experts further suggest that society’s emphasis on thinness as a marker of physical beauty may explain why some people who are obese say they feel anxious in social situations. Other studies confirm that body image dissatisfaction often occurs alongside the symptoms of anxiety disorders (ix).
 
There’s more information about anxiety, including the causes, symptoms and treatments, in our anxiety guide. 
 

Other mental health conditions are also thought to be connected with obesity:

 
Attention deficit hyperactivity disorder (ADHD)   There is much evidence to suggest an association between ADHD and obesity, with researchers concluding that children with ADHD are four times more likely to also be obese than those who don’t have ADHD (x). Many factors may play a part in this connection – for instance, having ADHD may make it difficult for children and adults to eat healthily and stay physically active.
 
There’s more general information about ADHD in our guides to ADHD in children and in adults. 
 
Trauma   A review of studies that included 112,000 participants revealed those who experience abuse during childhood may be 34 per cent more likely to develop obesity when they’re older compared with children who don’t experience abuse (xi). Those who had experienced severe abuse were 50 per cent more likely to become obese, the review also claims. Childhood trauma has also been linked with the development of depression in adults (xii).
 
Bipolar disorder   Scientists have reported that people with bipolar disorder are more frequently overweight or obese compared with the general population (xiii). The study found 68 per cent of people treated with bipolar disorder are overweight or obese. A review of studies suggests factors contributing to obesity in people with bipolar disorder are generally illness-related (depression and manic mood/mania), treatment-related (weight gain is a side effect of bipolar medication) and lifestyle related (including physical inactivity, poor diet smoking and substance abuse). Find out more about the symptoms of bipolar disorder by reading What is bipolar disorder? 
 
Schizophrenia   Studies also suggest many people with schizophrenia are also living with obesity, with one report adding that diabetes is also highly prevalent in people with the condition (xiv). There’s more information about this severe mental health problem in our guide to schizophrenia symptoms and treatments. 
 

What can you do to help yourself?

 
Weight management can be difficult even if you don’t have any other health challenges to deal with. But if you’re overweight or obese, losing some of your body weight could help reduce your risk of developing mental health issues.
 
There’s lots of weight management help available from your GP who, for instance, may recommend an exercise programme and refer you to a dietitian to help with healthy eating if you need it. Your doctor may also suggest you join a local weight-loss group, some of which are provided free by local authorities or the NHS.
 
Some people who are living with obesity may also be suitable for prescription anti-obesity medicines such as orlistat as well as newer medicines given by injection called liraglutide and semaglutide (ask your GP for details). Meanwhile bariatric surgery is sometimes used to treat people on the NHS, though it’s only available for some people who are severely obese.
 
It’s also important to care for your mental health. There are of course many things you can do to support your own mental wellbeing – talk to your GP if you’re concerned about any aspect of your mental health as you may need medical treatment. Meanwhile a few of the things you can do yourself include the following:
 

• Focus on staying active, as exercise has been widely proven to improve mental health conditions such as depression

• Connect with other people, since isolation is known to have a negative effect on mental wellbeing – talking to people you trust about your feelings can also be very helpful

• Learn to relax – try meditation, for instance, as a way of destressing (though doing anything that helps you feel calmer can be just as effective)

• Spend time in nature as often as you can as there’s plenty of evidence being in a natural environment is good for your mental wellbeing

• Try keeping a gratitude journal to increase your awareness of the good things in your life

• Eat foods that boost your mental wellbeing – read our article Diet and mental health to get you started.

 

Can nutritional supplements help?

 
Eating a healthy balanced diet with plenty of fruit and vegetables and only small amounts of fatty and sugary foods is a great way to support your weight and your health, both physical and mental. But it’s not always easy to eat healthily all of the time, especially if you’re experiencing health problems. And even when you think you’re eating fairly healthily you may still be missing out on some important nutrients.
 
To make sure you’re getting all the essential nutrients your body needs to stay healthy, try supplementing your diet with a good-quality multivitamin and mineral. There’s even some evidence to suggest taking a multivitamin may help you cope more effectively with stressful situations (xv), which may be useful if you’re struggling with your emotions. Other studies, meanwhile, have found taking multivitamins may help boost your mood and feelings of wellbeing (xvi).
 

Other natural supplements you may want to consider include:

 
Vitamin D   Probably best known for its role in helping your body absorb calcium, vitamin D has also been associated with mental wellbeing. For instance, researchers have discovered low levels of vitamin D may be linked with depression in adults (xvii).
 
However many people living in northern hemisphere countries like the UK are thought to be at risk of vitamin D deficiency, especially during the autumn and winter, as our main source of vitamin D is sunlight exposure (food sources are limited, including oily fish, liver, egg yolks, red meat and fortified foods). This is why the UK government’s Department of Health and Social Care advises everyone considers taking a daily supplement containing 10 micrograms of vitamin D during the autumn and winter months (xviii).
 
Those who are also at high risk of not getting enough vitamin D during the spring and summer, however, are advised to take vitamin D all year round. People with dark skin may also not make enough vitamin D from sunlight and are also advised to consider taking a supplement throughout the year.
 
The recommended form of vitamin D is vitamin D3 or cholecalciferol, as it’s the natural form of vitamin D your skin makes when it’s exposed to sunlight. Vitamin D3 supplements are available in tablet form, and now you can get them in veggie-friendly drops too. However most vitamin D3 supplements are made from the fat of lamb’s wool, which means they’re unsuitable for vegans – but vegan vitamin D3 supplements sourced from lichen are now more widely available.


High-strength fish oils   Two omega-3 fatty acids – namely EPA and DHA – found in oily fish such as salmon, herring, trout, mackerel and sardines are widely thought to be beneficial for human health. Research even suggests they may be helpful for mental health conditions such as depression.

For instance a study involving older women suffering from depression discovered that, after taking high doses of EPA and DHA for eight weeks, their symptoms improved significantly compared to other women who received a placebo (xix). Other studies have looked at the benefits of EPA in treating depression too, with some suggesting it may be helpful (xx). Scientists elsewhere have found omega-3s helps reduce levels of the stress hormone cortisol, which may help your body cope with the effects of stress more effectively (xxi).

Fish oil supplements are widely available, and even vegetarians and vegans can benefit from taking the beneficial omega-3s found in oily fish as you can now buy supplements that contain EPA/DHA sourced from marine algae instead of fish.

Gut health supplements   The link between the gut and mental health may not be an obvious one, but there’s a popular theory that a direct connection between the gastrointestinal system and the brain exists. Called the gut-brain axis, this involves the gut microbiota, the 100 trillion or so living micro-organisms including bacteria that live in the gut. One of the gut microbiota’s roles is to make certain chemicals that interact with and carry messages to your brain, such as serotonin and dopamine. These chemical messengers (or neurotransmitters) help regulate a number of different functions, including sleep, mood and emotion. This suggests a healthy gut microbiota might well support a healthy mental and emotional state.
According to the Mental Health Foundation it’s important to look after your gut health because your digestive system can reflect how you’re feeling, speeding up or slowing down if you’re stressed (xxii). Foods that are widely thought to help keep your gastrointestinal system healthy include fruit, vegetables, beans, legumes, whole grains and fermented foods such as live natural yoghurt, sauerkraut, apple cider vinegar, kefir, kombucha and kimchi. Supplements designed to help support gut health include soluble fibre products containing fructo-oligosaccharides (FOS) as well as live bacteria (probiotics) such as acidophilus capsules.
 

Need more information?

 
There’s lots more information and advice about mental and emotional wellbeing in the mental health section of our pharmacy health library. Meanwhile to read more about some of the things that are associated with excess weight and obesity, take a look at our weight management section. 

 

 

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Disclaimer: The information presented by Nature's Best is for informational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as cited in each article. The results reported may not necessarily occur in all individuals. Self-treatment is not recommended for life-threatening conditions that require medical treatment under a doctor's care. For many of the conditions discussed, treatment with prescription or over the counter medication is also available. Consult your doctor, practitioner, and/or pharmacist for any health problem and before using any supplements or before making any changes in prescribed medications.

 

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