Weight loss and mental health

My experience, what the research says, and a message to anyone who wants to lose weight

Introduction

In April last year, I was taken to Accident and Emergency with chest pain. I was the heaviest I had ever been and was subsequently diagnosed with angina and plaque around my heart. This was the wake up call I needed to try and do something (again) about my weight.

Like many, I have struggled with fluctuating weight for my entire life. At 61, I'm on my latest weight loss mission. This time, like every time before of course, I am hoping it will last. In this article, I am going to explore how my weight, akin to my relationship with food (and drink) is tied up with my mental health, and I'll look at what the latest research evidence says about weight and mental illness, especially depression.

Where it all started for me

I have been bothered about my appearance in general, but particularly about my weight, for as long as I can remember. There's a photo of me aged just seven, sucking in my cheeks because I thought I was fat. I wasn't fat. I just wasn't as thin as my best friend. This was in 1970, before the internet, before influencers, before mewing even had a name, and before I was old enough to read teenage magazines.

Self-conscious tomboy

At school I always felt ugly and an oddball. I was a tomboy and chose to wear baggy and unfeminine clothes. Between the ages of 9 and 16, my diet was regularly controlled by doctors in an attempt to find out what I was allergic to, as I had chronic urticaria (hives) and angioedema (swellings). In time the doctors realised I wasn't allergic to anything, but I believe the habit of being obsessed about what I ate began from there. Then I discovered dressing up when I became friends with a bunch of young and exotic gay men and I hid behind tons of make-up and outrageous garments. I became a clothes horse for them, allowing them to dress me however they pleased, and taking their criticisms of my weight and looks very literally, desperately wanting to please them. It was around this time that I was first diagnosed with, and medicated for, depression, and that I began comfort eating. Food and then increasingly alcohol as well, provided instant gratification, a quick fix. In particular, I ate far too many carbs.

A brief history of humans and food

It turns out that there's a scientific explanation for why the food that we think tastes so good is often the food that is bad for us. For nearly all of human history, there was no such thing as fast food or year-round supplies of everything; food in plentiful and reliable supply is a very new phenomenon. Our hunter-gatherer ancestors had to eat when there was a good supply, storing excess calories as fat that they could use when there was less food about. As a species, we learned to distinguish between fresh food and rotten food, which helped shape our penchant for sweet foods. And we became attached to carbohydrates long before the agricultural revolution. Carbohydrates such as tubers, fruits, and seeds were often vital sources of energy, especially during times when hunting for meat or fish was not possible and protein sources were scarce. Around 10,000 years ago, humans started growing crops. These carbohydrate-rich crops included wheat, rice, and corn, and they enabled us to eat in a very different way, growing food rather than hunting for it. Our diet fundamentally changed. Our longing for carbs and sweet foods could be satisfied at any time. Fast forward to modern times, and food is available on every corner in many societies. Yet our bodies are still wired to seek out the quick energy boost and comfort that carbs provide. And there lies the problem!

Our bodies are hard-wired to seek out quick energy boosts

Becoming overweight

It was only after the birth of my two children that I actually did become a bit overweight. I'd done a self-control exercise as part of my psychology course at college, where I had given up smoking, so I tried to adopt the same techniques. I learnt that what I loved about eating - the instant fix of tasting something really good - had to be replaced with different instant fixes. I learned to get a buzz out of resisting the foods I wanted, of rewarding myself with praise for NOT eating that chocolate bar or having that glass of wine. I learned to get a quick fix from seeing my weight loss when I weighed myself. I lost three stone over the course of nine months and managed to maintain that for a couple of decades.

When my first marriage broke up, my relationship with food changed rapidly again. This time, instead of bingeing and comfort eating, I found that I couldn't eat much at all. The thought of food made me feel ill. I would not recommend this as a way of losing weight as I was really quite ill for a while. In fact, I had a mental breakdown and had to take three months off sick.

As I got older, and approached the menopause, my weight began to creep up again. Over the course of fourteen years, when battling with depression and anxiety as well as various physical health conditions, I put on a whopping six stone and ten pounds (42.6 kilos, or 94 pounds). The fatter I became, the more my self-esteem plummeted. I didn't want my photo taken, I didn't want to go out and be seen or judged, I chose over-sized clothing to try and hide the rolls of fat and I felt ashamed of myself. I became very depressed. I beat myself up for putting on weight and reached a point when I said to myself, "Fuck it, I am so big anyway, it doesn't really matter if I eat this or drink that." This is classic self-sabotage and I am an expert.

Obesity and Depression

Obesity and depression are both current major health concerns in many countries. On top of that, they are linked in a variety of ways, and researchers have identified various causal and inter-related factors. For example, depression, it has been argued, results in weight gain. Additionally, it has been said that obesity leads to depression. This is called bi-directional causality: one leads to the other and vice versa.

It has been a long held belief that depression is caused by a chemical imbalance in the brain. It was suggested that, for some people, having too few chemical messengers (neurotransmitters) could contribute to the onset or worsening of depression. However, this literal causality has recently been disputed, as evidence shows the chemistry of depression is extremely complicated and not yet fully understood. It's now thought that depression is caused by complex factors, and that it cannot be explained simply by a chemical imbalance in the brain.

Research indicates that there are many physical factors at play in relation to obesity and depression and that the interaction between these factors is complex. Both depression and obesity are linked with stress responses, and there is some evidence that an irregular stress response at a biological level plays a part in both conditions. Long term increase in the stress hormone cortisol has been reported as having a causal role in depression, as well as leading to weight gain. Another physical factor is the involvement of the endocrine system, our complex system of glands which produce hormones to regulate our bodies' functions. Inflammation is thought to play a role too - metabolic and inflammatory dysregulation are associated with depression and obesity. A condition called oxidative stress leads to an imbalance of free radicals and antioxidants in the body that causes cell damage. Increased levels of oxidative stress biomarkers are observed in both obese and depressed states. Low levels of tryptophan, an essential amino acid, could lead to lower levels of serotonin and thus affect mood. Also, the build-up of a type of white blood cell called peripheral monocytes in the brain, as a result of systemic inflammation, can result in increased anxiety and depression. Then there's leptin, yet another molecule that's associated with depression and obesity. Inflammatory and oxidative stress are not only associated with depressive symptoms and obesity, but also with sleep disturbances. And lack of sleep causes all sorts of problems itself. I know, as someone with lifelong insomnia, and someone who worked in sleep for a while, just how debilitating lack of sleep is, and how it affects our ability to function. It affects out ability to think straight, and our mood. It also puts all kinds of strains on the body, and increases the risk of heart disease, diabetes, and obesity. All these physical factors are interconnected in ways far more complicated than I can explain here, but I hope this has given you an idea.

On top of all these physical factors are the psychological factors. We may ruminate about our weight, leading us to become obsessed about it. We may feel stigmatised if we are not the "ideal" weight, or we might be on the receiving end of stigmatising remarks, which will affect our mood. And we could end up feeling ostracised, afraid of being seen in public and ashamed of ourselves. We are dissatisfied with our appearance and have low self-esteem. Some research has found correlations between body image dissatisfaction (BID) and depressive symptoms and it's suggested that obesity increases the risk of developing depression because of increased BID.

I have no idea which, if any, of the physical factors associated with depression are going on in my body. I would have loved to be part of some research project which studied what was going on, as this might possibly have led to better understanding and treatment. I know for sure that the psychological impact of weight gain is huge, as I mentioned before. I am prone to catastrophic thinking, literally to inflate a situation in my mind so that it becomes unbearable. Add that to concerns about my weight and I am the perfect candidate for gaining weight as part of my depression.

The interplay between physical and psychological issues can have an impact too. With access to cheap fast food all year round, we can feed our bodies and our depression. The type of food we eat, as well as the amount we eat, is so important - sugar highs and alcohol offer immediate short term feelings of a "fix" but long term detrimental effects. A diet high in processed foods, carbohydrates and sugar content and low in fruits and vegetables, is linked with worsening mood. This is typical of a western fast food diet, and the mood changes are thought to be related to biological processes such as increased systemic inflammation and oxidative processes that are linked to a western-style diet. When people face discrimination because of obesity, their cortisol levels rise. Cortisol is often referred to as the stress hormone as it is important in regulating our response to stress. Elevated levels are also associated with increased blood pressure and poor sleep. Therefore, continued discrimination can contribute to depression, poor health outcomes and lack of sleep.

Like I said before, it's complicated!

What is the solution?

The majority of studies looking at the relationship between weight loss and mental health report significant improvements in depression scores after diet and weight loss. The reasons why are thought to be as complex as the relationship between depression and obesity already mentioned.

Reducing the level of accumulated body fat, called adipose tissue, could reduce the effect of the inflammatory processes mentioned earlier, and this could therefore lead to improved mood. Reducing adipose tissue could also impact on the behaviour of leptin, resulting in improved mood.

Losing weight has been shown to improve body image satisfaction and improve low mood. Interestingly, research suggests that it's not the weight loss itself that improves perceptions of body image, but it's the active participation in weight loss activities. We get a kick out of doing something about it, of feeling in control.

The NHS advises that losing one to two pounds a week is healthy. Quite coincidentally, my current weight loss averages a pound a week.

Diet -

A Mediterranean diet, which is rich in fruit and vegetables as well as nuts, pulses and wholegrains, and low in fat and carbohydrate, with very little processed foods, is associated with higher mood scores. This type of diet can also of course help with weight loss. As a vegetarian, I eat a lot of these types of foods. In order to lose weight, I reduce the amount of carbs, avoid snacks and have smaller portions. I use a smaller plate or bowl so it deceives my eyes into thinking I have a plateful of food. Also, I load the plate with salad or vegetables so there is only room for a small portion of carbs. I still eat food that I enjoy. I am not one of those people who loses weight by having meal supplement drinks or never having treats at all. I've tried it and it fails every time. So I eat what I like, but I change it to make it more healthy. Take a fish and chips meal as an example - I still have a version of this. I eat a piece of breaded fresh fish with a few oven chips and fill the rest of the plate with peas. I eat three small meals a day and I stick to it. Every day. It's the only way I can maintain control.

Using a smaller bowl (top right) and plate (bottom right) help me control portion size

Exercise -

Being active for 150 minutes a week can help shift weight. Once I had committed to try and lose weight, I went to the gym every other day for a year and did an hour of exercise. Now, I go three times a week. I can't run anymore, and following various surgeries, I have a limited choice of the equipment I can use. But I have figured out a routine that works for me: I do one kilometer on the cross-trainer, followed by some upper body work, followed by three and a half kilometers fast-walking on the treadmill. The cross-trainer and treadmill combo burns 300 calories every time. I also walk my dog, and this combined with housework and gardening, all means I do something active every day.

Surgery -

This is only usually an option for people who are morbidly obese, unless you go private, like a friend of mine did. She lost loads of weight but it didn't fundamentally change her relationship with food and she still craves sweets and carbs. Another friend had bariatric surgery on the NHS. She says she thinks that she is addicted to food. She points out that people who are addicted to other things can try to stop taking them but you cant give up eating in the same way. Her relationship with food has not altered as a result of the surgery either.

Medication -

New weight loss drugs, such as Ozempic, have caused a big stir. But are they too good to be true? The answer isn't clear. Daube gives a thorough account of the ups and downs of these medications:

1. They seem much better than previous 'get thin fast' drugs. They might help improve health outcomes such as blood pressure, thereby reducing the risk of heart disease and stroke and there is evidence they can help improve depression. They seem to dampen inflammation in the brain.

2. They are not without risks and we're still learning exactly what these are. For example, they may actually slow digestion too much.

3. They are not suitable for everyone. Some people have nasty side effects.

4. The people that need them most might not be able to access them. There are supply problems and in America, some insurers won't pay for them unless people have specific conditions.

5. Weight loss might not be what you expect. People are reporting that they are disappointed with the way they look and feel after taking the drugs. This, I think, can be true whether or not you're on the drugs. I have noticed I am much more wrinkly after losing weight.

6. You might have to stay on them forever. Coming off them can lead to all the weight piling straight back on.

Personally, I would not try a weight reducing drug. That's just my choice.

I am hesitant to use anti-depressants too, as I dislike the idea of dependence, but the reality is that I have been on them on and off since I was a teenager. Mostly on. The drugs I have tried are all to treat depression, anxiety and insomnia, and I have been on so many that I can't remember all their names. Some I have had to come off as they aggravate my urticaria or make me feel worse, my anxiety soaring out of control. I am currently on trazodone, and have been told it's what they prescribe once everything else has been tried. Which it has. Unfortunately, medication does not always work for people with depression. One study found that antidepressants only work in about 60% of people with depression. Maybe I'm one of the 40% who aren't helped by them so much.

Weight loss programmes -

I have a friend who goes to a group once a week and loves it. He is the lightest he has been for forty years and enjoys the camaraderie. I would rather stick pins in my eyes. Well, not quite, but you know what I mean. These groups work really well for some people and I wish them all the best. But it's not for me.

Psychological approaches -

This, for me, is as important as what I eat and how much I exercise. The benefits of dieting only become visible over time; as I mentioned earlier, it's not an instant rush, a quick fix. It's about self control and persistence, and about adjusting my thinking away from the quick fix feeling I get from food and alcohol.

I have tried therapy many times, with varying degrees of success. Face to face, phone and online support have all helped me over the years. I managed to find one counsellor in North London who really helped me when my first marriage was breaking up. She was a fantastic listener, and after I had waffled on about myself for a bit, would see connections and make observations that were completely spot on. I think she really got me. Others, unfortunately have not. I even managed to find one person who falsely claimed to be a member of BACP, the governing body for counsellors and psychotherapists, and who told me I was attention-seeking and needy. There are some great practitioners but there are also some awful ones.

Conclusion

Since that time in hospital last April, I have lost 56 pounds, or four stone or 25.4 kilos, depending on the currency you prefer. I am proud of this, and can't quite believe I have done it. Physically, I feel so much better - I can walk up hills again, whereas a year ago, I was breathless after walking up the stairs. I feel more energised. I look better. I can get into smaller clothes. This all helps how I feel about myself. I am slightly less prone to self-loathing - it's one less thing to worry about. And my family are relieved.

As with many things in life, in fact I would say as with most things in life, there is no one size fits all. Those who claim to have THE answer may well have THE answer for themselves and some other people, but their answer won't suit everybody. I do believe there is an answer for everyone, if they can only find it. For some people, weight loss might be a health-driven thing, and for others an appearance thing. For me, it's a combination. And I also think the timing has to be right. For me, a switch went off in my head after that hospital visit - it was the jolt I needed. I have a way to go before I get to my target weight. Who knows if I'll manage to get there, or to keep it off for good this time. All I know is I am going to bloody well try.

I am not advocating you try anything unless it's what you want to do or have been told you need to do for your health. What I am advocating for is well-being - both physical and mental. If you are thinking of starting a weight-loss journey, maybe begin with some encouraging words to yourself. Then look around at what other people do and read up about it to find the option that you think will work for you. I wish you success. And most of all, I wish you happiness.

References

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Cleveland Clinic: Cortisol. Accessed online 17.05.2025. Cortisol: What It Is, Function, Symptoms & Levels

NHS website: Tips to help you lose weight. Accessed online 17.05.2025. Tips to help you lose weight - NHS

Technology Networks website: Researchers Uncover Why Eating Unhealthy Food Tastes So Great. Accessed online 18.05 2025. Researchers Uncover Why Eating Unhealthy Food Tastes So Great | Technology Networks

Sierra, D: Craving Carbs: How our ancient love for starch shaped human evolution (2024). Accessed online 18.05.2025. Craving Carbs: How our ancient love for starch shaped human evolution

Schimelpfening N: The Chemistry of Depression (2024). Verywellmind website. Accessed online 19.05.2025. The Chemistry of Depression - Neurotransmitters and More

NHS website: Tips to help you lose weight. Accessed online 19.05.2025. Tips to help you lose weight - NHS

Daube, E: Are the New Weight Loss Drugs Too Good to Be True? University of California website. Accessed online 20.05.2025. Are the New Weight Loss Drugs Too Good to Be True? | UCSF Magazine

Rigobon, A.V., Kanagasabai, T. & Taylor, V.H. Obesity moderates the complex relationships between inflammation, oxidative stress, sleep quality and depressive symptoms. BMC Obes 5, 32 (2018). https://doi.org/10.1186/s40608-018-0208-2