Obesity and mental disorders: building an effective care

Abstract

Health and disease processes are developed due to biological, psychological and social determinants. Obesity is usually associated with mental disorders, such as depression and anxiety. This association is evidenced in both directions. Mental disorders, such as depression, anxiety and eating disorders, contribute to the development of obesity, as well as obesity increases the incidence of mental disorders. When stability and homeostasis are disrupted, due to chronic stress and factors such as genetics, environment, affective relationships and psychosocial support, allostatic overload is evidenced. Through this overload, multiple systems are misbalanced and clinical diseases, such as hypertension, diabetes and metabolic syndrome, and mental disorders, such as depression and anxiety, occur. The diagnoses of mental disorders are made based on a combination of somatic and psychiatric symptoms. Unexplained physical complaints and generic symptoms like depressed mood, sadness, impatience, irritability and restlessness are the most frequent ones, together with sleep and appetite disturbances, caused both by physical and mental disorders. These factors often make the correct diagnosis in obese patients more difficult. The primary care professionals must be alert to physical complaints and psychological distress present in organic disorders. The understanding of physiopathological effects of stress and emotional suffering in somatic disorders reinforces that effective care in chronic diseases, such as obesity, has to be organized including these aspects. Treatment needs to be comprehensive so that care can be effective and physical and mental disorders can be properly solved. New therapeutic approaches must be focused on the person, the family and the community instead of focused on the disease. This is essential in the treatment of obesity as it is directly associated with lifestyle, emotional state and stress level, which depends on a change of the individual and his ways of living to be solved. Through this approach, primary care may promote health and prevent diseases.