Psychiatric Aspects of Obesity: A Narrative Review of Pathophysiology and Psychopathology

Abstract

In the last decades, obesity has become a major concern for clinical and public health. Despite the variety of available treatments, the outcomes remain—by and large—still unsatisfactory, owing to high rates of nonresponse and relapse. Interestingly, obesity is being associated with a growing surge of neuropsychiatric problems, certainly related to the pathogenesis of this condition, and likely to be of great consequence as for its treatment and prognosis. In a neurobiologic direction, a sturdy body of evidence has recently shown that the immune–metabolic–endocrine dyscrasias, notoriously attached to excess body weight/adiposity, affect and impair the morpho-functional integrity of the brain, thus possibly contributing to neuroprogressive/degenerative processes and behavioral deviances. Likewise, in a neuropsychiatric perspective, obesity displays complex associations with mood disorders and affective temperamental dimensions (namely cyclothymia), eating disorders characterized by overeating/binge-eating behaviors, ADHD-related executive dysfunctions, emotional dysregulation and motivational–addictive disturbances. With this review, we attempt to provide the clinician a synoptic, yet exhaustive, tool for a more conscious approach to that subset of this condition, which could be reasonably termed “psychiatric” obesity.

Food addiction comorbid to mental disorders: A nationwide survey and register‐based study

“…This finding is of importance as individuals living with a mental disorder are at substantially elevated risk of developing obesity (Simon et al, 2006). There are most likely a number of different mechanisms contributing to this tendency, including sedentary lifestyle (Vancampfort et al, 2017), poor diet habits (Teasdale et al, 2019), and treatment with psychotropic medication with weight gain as side‐effect (Firth et al, 2019; Weiss et al, 2020). The results of the present study suggest that food addiction also represents a potential link between mental disorder and obesity.…”

Prevalence of mood, panic and eating disorders in obese patients referred to bariatric surgery: patterns of comorbidity and relationship with body mass index

“…Although no conclusive data have been produced, there is strong evidence of a close bidirectional relationship between obesity and various psychiatric disorders [5][6][7]. This association appears to strengthen with increasing BMI and to be moderated by several variables, such as age, gender, or socioeconomic status [8,9]. In addition, bariatric patients seem to exhibit significantly higher rates of psychopathology than obese individuals who do not seek treatment or obese individuals who adhere to conservative programs that emphasize dietary restriction or promote weight control [4,10].…”

Neurocognitive and Psychopathological Predictors of Weight Loss After Bariatric Surgery: A 4-Year Follow-Up Study

“…In exploring the possible influence of all the above cognitive domains, we were able to achieve the significant prediction of executive functions and basic cognitive level as measured by WCST and SPM tests on short and long-term weight loss. Executive functions mainly carried out by the prefrontal cortex can be defined as “high level” activities that modulate “lower-level” subcortical responses ( 52 ). Executive functions such as decision making, response inhibition, and cognitive flexibility, consist of mental capacities necessary to engage in the planning for and achieving of goal-directed activities.…”