Obesity and anxiety are closely linked, and research has shown that individuals with obesity are more likely to experience anxiety disorders. For example, a systematic review and meta-analysis conducted by Amiri and Behnezhad in 2019 found that anxiety is more common in people who are obese or overweight compared to those of normal weight. This relationship can be bidirectional: obesity may contribute to anxiety, and anxiety may increase the risk of developing obesity.
Several factors play a role in this association, including biological, psychological, and social influences.
Biological Factors:
- Hormonal Changes: Obesity often leads to dysregulation of stress-related hormones like cortisol, which can increase anxiety. For example, a study by Schiefelbein and Susman in 2006 found a link between cortisol and anxiety in girls. The study revealed that girls who exhibited a significant increase in cortisol levels over a year were more prone to experiencing heightened levels of general and social anxiety.
- Inflammation: Obesity is associated with low-grade inflammation, which in turn causes anxiety. For example, a study by Pitsavos and colleagues in 2006 found that anxiety was associated with inflammation and coagulation markers in individuals who did not have cardiovascular disease.
Psychological Factors:
- Body Image and Self-Esteem: Individuals with obesity often experience negative body image and low self-esteem. For instance, a study by Sarwer and Polonsky in 2016 acknowledges that individuals struggling with weight may face challenges recognising and appreciating their talents and abilities. This can lead to a diminished sense of self-worth and confidence, impacting various aspects of their lives and may also lead to anxiety disorder.
- Emotional Eating: People with anxiety may engage in emotional eating as a coping mechanism. In a study conducted in 2023, Erdem, Efe and Ozbey identified social anxiety as an important predictor of emotional eating for adolescents. This can lead to weight gain and eventually obesity, which can, in turn, worsen anxiety levels. Moreover, a review by Dakanalis and colleagues in 2023 acknowledged that Psychological distress is also related to a greater risk for emotional eating.
Social Factors:
- Stigma and Discrimination: Obesity-related stigma is widespread and can increase anxiety, particularly in social situations. Individuals with obesity often face discrimination in various areas of life, including personal relationship, healthcare and employment, leading to heightened anxiety. For example, research conducted by Tauber and Mulder & Flint in 2018 suggested that to diminish weight-based stigmatisation and discrimination, workplace health promotion programs (WHPP) should be carefully designed and communicated to emphasise the responsibility of the organisation in creating an inclusive and supportive environment, rather than placing the onus solely on the individual employee. This approach aims to foster a workplace culture that recognises and addresses weight-related biases, promotes a more equitable and respectful treatment of all employees and reduces the anxiety faced by people who are obese at the workplace.
- Physical Activity: Obesity can significantly restrict physical mobility, leading to a reduced engagement in physical activities that are known to have a positive impact on alleviating anxiety. For instance, a study carried out by Ma and colleagues in 2023 demonstrated a clear connection between physical activity and anxiety and depression. The researchers’ findings suggested that an increase in physical activity could play a crucial role in preventing the co-occurrence of anxiety and depression. This highlights the potential benefits of promoting physical activity as a preventive measure for obese people to reduce anxiety and depression in daily life.
Managing the Connection:
Treatment for individuals experiencing both obesity and anxiety typically involves a combination of behavioural therapy, dietary management, physical activity and for some people medication.
Cognitive-behavioral therapy (CBT) is often effective in addressing anxiety. For example, a meta-analysis conducted by Carpenter and colleagues in 2018 showed that CBT is beneficial for anxiety disorder than placebo.
Moreover, dietary management plays a crucial role for obese people who have anxiety. For example, a study by Wang and colleagues in 2022 found that obesity-associated anxiety is prevalent among college students and could be alleviated by moderate calorie restriction.
Furthermore, physical activities are crucial for helping manage obesity and related anxiety. For example, a meta-analysis conducted by Chen and colleagues in 2024 found the positive effects of incorporating physical activity on children and adolescents with overweight or obesity into daily life to reduce symptoms of depression and anxiety. This suggests that incorporating physical activity into the daily routine of overweight or obese individuals could serve as an effective non-pharmacological approach to improving mental health.
Medications for anxiety and weight management may also be prescribed, but care must be taken to avoid drugs that could exacerbate either condition.
Conclusion : This complex interplay of obesity and anxiety calls for a holistic treatment approach, addressing both physical and mental health aspects.
Where to seek help ? : Dealing with anxiety and obesity can be difficult. It is important to contact your GP or local healthcare provider for assistance. Seeking support promptly can make a big difference in helping you feel better.
References :
Amiri, S., & Behnezhad, S. (2019). Obesity and anxiety symptoms: a systematic review and meta-analysis. Neuropsychiatrie, 33(2), 72–89. https://doi.org/10.1007/s40211-019-0302-9
Carpenter, J. K., Andrews, L. A., Witcraft, S. M., Powers, M. B., Smits, J. A. J., & Hofmann, S. G. (2018). Cognitive behavioral therapy for anxiety and related disorders: A meta‐analysis of randomized placebo‐controlled trials. Depression and Anxiety, 35(6), 502–514. https://doi.org/10.1002/da.22728
Chen, L., Liu, Q., Xu, F., Wang, F., Luo, S., An, X., Chen, J., Tang, N., Jiang, X., & Liang, X. (2024). Effect of physical activity on anxiety, depression and obesity index in children and adolescents with obesity: A meta-analysis. Journal of Affective Disorders, 354, 275–285. https://doi.org/10.1016/j.jad.2024.02.092
Dakanalis, A., Mentzelou, M., Papadopoulou, S. K., Papandreou, D., Spanoudaki, M., Vasios, G. K., Pavlidou, E., Mantzorou, M., & Giaginis, C. (2023). The Association of Emotional Eating with Overweight/Obesity, Depression, Anxiety/Stress, and Dietary Patterns: A Review of the Current Clinical Evidence. Nutrients, 15(5), 1173. https://doi.org/10.3390/nu15051173
Erdem, E., Efe, Y. S., & Özbey, H. (2023). A predictor of emotional eating in adolescents: Social anxiety. Archives of Psychiatric Nursing, 43, 71–75. https://doi.org/10.1016/J.APNU.2022.12.016
Ma, R., Romano, E., Vancampfort, D., Firth, J., Stubbs, B., & Koyanagi, A. (2023). Association between physical activity and comorbid anxiety/depression in 46 low- and middle-income countries. Journal of Affective Disorders, 320, 544–551. https://doi.org/10.1016/j.jad.2022.10.002
Pitsavos, C., Panagiotakos, D. B., Papageorgiou, C., Tsetsekou, E., Soldatos, C., & Stefanadis, C. (2006). Anxiety in relation to inflammation and coagulation markers, among healthy adults: The ATTICA Study. Atherosclerosis, 185(2), 320–326. https://doi.org/10.1016/j.atherosclerosis.2005.06.001
Sarwer, D. B., & Polonsky, H. M. (2016). The Psychosocial Burden of Obesity. Endocrinology and Metabolism Clinics of North America, 45(3), 677–688. https://doi.org/10.1016/j.ecl.2016.04.016
Schiefelbein, V. L., & Susman, E. J. (2006). Cortisol Levels and Longitudinal Cortisol Change as Predictors of Anxiety in Adolescents. The Journal of Early Adolescence, 26(4), 397–413. https://doi.org/10.1177/0272431606291943
Täuber, S., Mulder, L. B., & Flint, S. W. (2018). The Impact of Workplace Health Promotion Programs Emphasizing Individual Responsibility on Weight Stigma and Discrimination. Frontiers in Psychology, 9. https://doi.org/10.3389/fpsyg.2018.02206
Wang, J., Ran, X., Ye, J., Deng, R., Dang, W., Fan, Y., Hu, Z., Yang, L., Dong, W., Lv, Y., Lin, K., Li, M., Jiang, Y., & Zheng, R. (2022). Obesity-Associated Anxiety Is Prevalent among College Students and Alleviated by Calorie Restriction. Nutrients, 14(17), 3518. https://doi.org/10.3390/nu14173518
© 2024 Dr Mukta Bhattarai Pandey (MD, PGDip Public Health, MRCP(UK), MRes)