There’s a relationship between mental health, eating disorders (ED) and obesity that went unnoticed for years, but these links have always been crucial to treating the conditions. Fernando Fernández-Aranda, 59, a professor at the University of Barcelona and the director of the eating disorders unit at Bellvitge Hospital, emphasizes this connection. The clinical psychologist and researcher speaks of the importance of analyzing ED and obesity from an intersectional perspective in which mental health is valued as a factor that, in many cases, can be the cause or the consequence of developing these diseases. Fernández-Aranda is now the co-coordinator of the European project, EprObes, and over the next five years, he will study obesity and overweight to prevent them in the early stages of life.
Question. Is there a connection between obesity, ED and mental health?
Answer. Yes, that connection has always been there… There’s a lot of stigma around obesity, eating disorders and mental health. It’s important that we look at [everything] as a whole, since there are interrelationships [at play]. At some point, they are occurring together; some of them share many factors, and it is crucial that we understand that they have particular aspects that are unique to a disease, while there are other elements that may be shared. That [approach] will allow us to understand which factors, which biological and environmental vulnerabilities influence their occurrence and, as a result, we will stop seeing eating disorders and obesity as static.
Q. Are mental health problems a cause or a consequence in the development of obesity or an eating disorder?
A. We are currently seeing situations where a mental health problem can be a trigger, but it can also be a consequence. That is, the obesity problem can start and then a mental health problem emerges. Or it may happen that a patient with mental health problems [is] faced with certain types of events that he or she cannot resolve and develops eating problems.
Q. How are ED and mental health related?
A. We have to start distinguishing between ED and inappropriate eating behaviors, which happen because of stressful situations that influence eating. But eating disorders (anorexia nervosa, bulimia nervosa, binge-eating disorder, and a number of other atypical disorders) are mental health disorders, and we need to view them as such. Anorexia is an excessive preoccupation with food and weight, which affects health; the same is true of bulimia. These are emotional situations that are affecting me, and I use food as an escape valve. For example, teenagers who are victims of bullying may use food as an escape valve.
Q. On the other hand, obesity is not a mental disorder.
A. No, not at all. We cannot say that weight disorders — obesity or overweight — are mental disorders. It is true that obesity and mental health problems can present as comorbidities: either as a primary problem that is present and triggers a weight problem, which then becomes obesity, or as a consequence. The truth is that obesity can have consequences that affect mental health, especially because of how difficult it is for people to manage it [and] because of how it affects them at the individual, family and work levels. In addition to the obstacles that may exist in their environments, [there’s] a lack of empathy and the difficulty of handling certain situations related to their own self-esteem.
Q. Is someone who is obese more likely to develop a mental health disorder?
A. We have to see [obesity] as a disease in which mental health problems can be caused before or during it. Obesity and mental health should not be seen as two independent problems, but [rather] as diseases that can coexist at one time or another. Hence, the importance of psychological support.
Q. Why is that?
A. Because we have to consider the type of obesity we are talking about, whether it is linked to an ED or to emotional aspects of the person. Even in endocrinology and nutrition units, it is essential to involve psychologists and mental health specialists to provide support [and] help and to increase adherence to treatment. [That’s] especially [important] because of a series of aspects with which patients will be confronted that have to do with their self-esteem, how they value themselves and which aspects of their own bodies they accept or do not accept. The European EprObes project provides this amalgam of multi-causal variables to analyze their impact on ED and obesity.
Q. How does the project seek to address mental health and obesity?
A. The EprObes project aims to clarify the interaction between obesity and mental health, from an integral perspective. Thus, [it seeks] to identify mental health problems that may be risk factors or maintainers of overweight or obesity, such as ADHD (attention deficit hyperactivity disorder), sedentary lifestyle due to addictions to new technologies, sleep disorders, eating disorders. That is one of the main objectives of this EU-funded project. But it also aims [to look] at the reverse: to analyze the mental health problems that are a consequence of obesity, like depression, eating disorders or anxiety. In short, understanding obesity from a global and evolutionary perspective will make it possible to highlight the factors that can influence a person’s mental health during these stages and their quality of life.
Q. Have cases of obesity and ED increased after the pandemic?
A. During quarantine, there have been earlier and later cases. Both obesity and EDs are affecting all age groups, across the board. We do not have to think about ED or obesity only when it appears, but how long the patient is going to suffer from it. It is not a one-time thing, like the flu or a specific disease that one recovers from and that’s it; they are diseases that appear throughout one’s life.
Q. Does this increase also have to do with the increase in mental health problems?
A. That has been one of the factors: uncertainty, the difficulties experienced at the family or individual level in quarantine. But [there are] also the problems at the labor and social levels and the loss of purchasing power. This has jeopardized the general population’s mental health at all levels. That’s especially true of the most vulnerable, who have been less cared for [and have] more uncertainty and less support. Cases have appeared of people who didn’t have an eating disorder [before], mainly young girls and boys between 22 and 24 years of age. Just at Hospital de Bellvitge, we have gone from 300 new ED cases to 450 this year alone. We’re seeing a significant increase in the number of cases and in their severity. We know that this is the situation.
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