The Pandemic 15: The Rise in Obesity and Depression

The COVID-19 pandemic began with overwhelming uncertainty for much of the general population. The bustle of early-morning commutes turned to empty streets and closed businesses. The government-imposed lockdowns have led to major lifestyle changes for individuals around the world. With the high risk for disease transmissibility in social settings, regulatory bodies had instructed citizens to stay indoors and practice social distancing. Following a rapid shift to virtual jobs, trips to the workplace had quickly turned into frequent trips to the fridge.

Personally, I found myself unable to keep up with my usual physical activity during the time spent at home. The occasional snack turned to a daily snack break or trip to the fridge. The accessibility and convenience of frequent snacking between meetings was irresistible.

Although lockdown measures are being reduced with rising vaccination rates, "normalcy" has not returned for many. An increase in sedentary lifestyle has led to a number of mental and physiologic morbidities. In particular, with more time spent inside the home, individuals have experienced a rapid decrease in physical activity, coupled with an increase in caloric intake. Taken together, the risk of developing obesity has increased, and this has seen a worsening of both metabolic and mood disorders.

In addition to an increase in obesity from social isolation, individuals are at an increased risk for poor mental health outcomes. The increased prevalence of social isolation under lockdown conditions increased the risk of developing obesity through the worsening of psychosocial risk factors. For example, sleep disturbance, employment insecurity, loss of income, and an increase in sedentary lifestyle can contribute to poor quality-of-life outcomes and increase the risk for obesity. People have experienced an increased prevalence of several of these risk factors throughout the COVID-19 pandemic.

For example, recent literature shows that the COVID-19 pandemic has led to an increase in anxiety, depression, and stress in the general population. These conditions are notable risk factors for obesity that require medical monitoring. Similarly, obesity is a common comorbidity and risk factor for the development of depression. That is, people with obesity are at a higher likelihood than the general population to develop depression. Therefore, because of the increase in non–COVID-related disorders, paired with the reluctance and difficulty to receive healthcare support due to the increased dedication of resources to COVID care, the rise in obesity and comorbid psychiatric conditions such as depression require additional monitoring.

Obesity and Depression

Obesity often co-occurs with a number of other metabolic (eg, diabetes mellitus) and brain-based disorders (eg, depression). They can interact to produce a worsened quality of life and higher risk for death. For example, 300,000 deaths in the United States per year are caused by morbidities related to obesity. Some common comorbidities include depression, diabetes mellitus, and hypertension.

With the onset of the pandemic, rates of depression and other mental health disorders are also on the rise. A common feature of depressive disorders is an increase in carbohydrate and sugar craving and consumption, which is a major risk factor for the onset of obesity. The two diseases share multiple features, and with the chronic nature of obesity, patients with comorbid obesity and depression generally have a worsened course of illness. As such, early intervention is critical to improving a patient's quality of life.

Nearly 80% of primary care physicians prescribe antidepressants as a first-line treatment option. As such, it can be assumed that the increase in mental health diagnoses during the pandemic will likely be accompanied by an increase in antidepressant prescriptions. However, this presents a valid point of concern for physicians and patients. Commonly prescribed antidepressants may contribute to weight gain through an increase in caloric intake and abhorrent metabolic functioning. Notably, a decrease in depressive symptoms and, subsequently, antidepressant intake, may be associated with weight loss.

Clinically significant antidepressive effects may also be reached through physical activity. Recent data suggest that regular exercise may be efficacious in reducing mild to moderate symptoms of depression. For more severe symptoms, physical activity may work well in conjunction with first-line pharmacologic treatments.

Weight loss also demonstrates depressive efficacy in obesity comorbidity. In fact, high-intensity exercise is found to be associated with improvements in executive functioning and working memory tasks, while all forms of exercise, regardless of intensity, help improve attention, visual memory, and spatial planning. Thus, due to the risks involved with social isolation and sedentary living, physical activity should be promoted as a priority course of action for the general well-being of individuals during the social isolation measures. Similarly, the effects of social isolation should be monitored for outcomes of obesity and mental illness.

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About Hartej Gill

Hartej Gill is a PhD candidate and researcher at the Canadian Rapid Treatment Center of Excellence and the Institute of Medical Science at the University of Toronto. He has expertise in mood disorders, investigating the etiology and pathophysiology of mental health disorders from both a clinical study and population health perspective, with over 50 peer-reviewed publications.

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