The forgotten psychosocial dimension of the obesity epidemic.

On reading the paper by Claire Wang and colleagues on the health and economic burden of obesity in the USA and UK (Aug 27, p 815),1 we were surprised that psychiatric disorders were not considered among the burdens of obesity. Obesity is often comorbid with eating disorders, especially binge- eating disorder, which is thought to be present in 20—40% of obese patients.2 Other psychiatric disorders are also very common in obese people, especially mood disorders.3, 4 Many lines of evidence suggest that obesity and depression might be functionally related.5 Since most obese individuals tend to have higher scores in depression,4, 5 the projected increase in the rates of overweight and obesity in future years could generate a parallel increase in obesity-related depression. The association between psychopathology and obesity is likely to be bidirectional: obesity can lead to major depressive symptoms;4 in turn, major depression and binge-eating disorder can be an obstacle in adhering to treatments for obesity and attaining long-term weight-loss goals,2 thereby contributing to weight gain. Eating disorders and depression are common and treatable conditions. They are already part of the burden of obesity, and they might become even more prevalent in the future. Clinicians and policy makers should be ready to target them with appropriate interventions.