Obesity is not just killing people.

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One thing I notice in Bulgaria that has become increasingly rare in the U.S. – normal weight people.

Over the last 50 years, the prevalence of obesity has seen a significant and concerning rise globally. From 1975 to 2016, the World Health Organization (WHO) reported that the global prevalence of obesity nearly tripled.

In the United States, the obesity rate in the early 1970s was about 14.5% for adults. By 2020, this number surged to approximately 42%. The COVID pandemic and lockdowns made things even worse.

In contrast, in Bulgaria, about 26 – 28% of people struggle with obesity, which is actually higher than the regional average of about 25%, and much higher than it used to be 50 years ago, but still well behind the US.

That's why medical professionals in the U.S. and globally call obesity a health crisis. We owe it to multiple factors, including economic development, urbanization, and changes in food production and marketing by food manufacturers. But we also owe it to cultural shifts and personal choices.

We know the health risks of obesity – diabetes, heart disease, stroke, etc. But anything happening to the body is also happening to the mind. I am especially interested in how obesity affects mental health. This post is about that.

The post summarizes a few hours of research and a few days of thinking. I appreciate all of you who support Life Intelligence with your paid subscriptions, helping me to help others with the information I provide. I am leaving this post open to all because of its health-related nature. But if you want to support my work, consider upgrading. Thank you in advance 😊

The link between obesity and mental health is quite intricate, involving a complex interplay of psychological, biological, and social factors.

1. Depression

The relationship between obesity and depression goes both ways: obesity can increase the risk of developing depression, and depression can lead to behaviors that may result in obesity. Obese individuals often face discrimination and social stigma, which contributes to feelings of worthlessness and sadness, common symptoms of depression.

Statistics

Studies suggest that people who are obese have a 55% higher risk of developing depression over time compared to those with a healthy weight. Moreover, about 43% of individuals with depression are found to be obese, indicating a strong overlap between these two conditions.

Why It Happens

Physiologically, the inflammation associated with obesity may affect neurotransmitter pathways and brain regions that regulate mood. Psychologically, the social stigma and reduced quality of life experienced by many obese individuals can lead to depressive symptoms.

2. Anxiety

Obesity can exacerbate anxiety symptoms, especially in social situations where individuals might feel judged about their weight. The fear of negative evaluation can lead to avoidance behaviors, increasing social isolation and anxiety.

Statistics

Research indicates that obese individuals report higher levels of anxiety than their non-obese counterparts. While not as robust as the link with depression, the prevalence of anxiety disorders in obese populations is notably higher than in the general population.

Why It Happens

Biologically, the stress caused by obesity-induced health complications can trigger anxiety. Socially, the stigma of obesity can lead to a heightened state of alertness about one's environment and interactions, fostering anxiety.

3. Eating Disorders

Obesity is strongly linked with binge eating disorder (BED), where individuals frequently consume unusually large amounts of food and feel unable to stop eating. This disorder is the most common eating disorder in the United States among adults.

Statistics

About 2-3% of all adults in the U.S. will struggle with BED at some point in their lives, with higher rates observed among those who are obese. Binge eating can lead to further weight gain, which exacerbates the obesity issue.

Why It Happens

BED and obesity often share common psychological vulnerabilities, such as poor impulse control, emotional dysregulation, and high levels of distress. Environmentally, the availability of high-calorie, "engineered" foods packed with unhealthy ingredients and addictive can also trigger binge episodes.

In addition, obesity negatively impacts interpersonal relationships, and not only from the perspective of the obese person. Obese people frequently suffer from low self-esteem, which, in turn, causes dysfunction in personal relationships, potentially straining relationships with family, friends, and intimate partners. Their health issues become their family's problem as everyone must adapt to their specific needs.

Obesity limits the ability of the individual to engage with others and participate in social and physical activities. This isolates them. However, by extension, their family members change their lifestyle in response. That's how if one partner is obese, eventually the other partner becomes so, and if they have children, they too follow in the same unhealthy direction. Then, the whole family reinforces each other's habits and food choices, making it much more difficult to escape that reality.

Also, obese people have less sex, as obesity negatively affects libido and causes physical discomfort, shame, and fear of judgment. I know somewhere some sumo wrestler has lots of sex, but for most people, obesity is a barrier to physical intimacy that no one likes to experience and even fewer like to talk about.

A lot has been written and documented about the environmental factors at play enabling obesity trends, so I am skipping this part. Everyone knows not to eat Doritos, but they still do. Everyone knows that our lives confine us to small spaces in a sitting position, and we should all exercise, but we don't.

I am, however, super interested in the cultural shifts and society's relationship with obesity. So, here, I'll deviate from strictly obesity and clump very overweight people in this category even though they may not be clinically obese.

You are entering "fat shaming" territory. If you want to stop reading now, close your eyes. Warning: It won't make the problems go away.

American culture and social justice issues play complex roles in the increase in obesity, influencing both individual behaviors and broader societal trends, as much as we don't like to admit it. Here's me saying the quiet parts out loud.

We are a culture of consumerism, which extends to food consumption. My Costco shopping habit was immediately checked when I got to Bulgaria, where people buy the food they need for whatever they'll cook and eat in the next day or two only. It amounts to a couple of shopping bags at the most, not an SUV-with-the-back-seets-down trunk-full. I asked my mom, why don't we just buy a bunch of stuff and not go to the store every day? She said it gets forgotten in the cuberts, is no longer fresh, and she didn’t know what she’d want to eat two days from now. OK, then… I stand corrected.

Sadly, there are now junk-food isles in Bulgarian supermarkets, too, choke full of high-calorie snacks proudly produced by the same ten or so food conglomerates on a mission to addict the whole world. If it worked in America, it should work everywhere else. And they advertise just as heavily here as they do back home.

Meanwhile, bad food has never been cheaper. Lower-income families often lack access to fresh, healthy foods due to cost or availability, a phenomenon often referred to as "food deserts." These are areas where the availability of affordable, good-quality fresh food is limited or nonexistent. Many people feel forced to compromise quality to get the quantity they need to feed their families.

Urban planning discourages walking or biking, relying heavily on cars. Californians know that best. Things are spread around, and public transportation sucks. The cultural push towards long work hours and high productivity often reduces the time available for physical activity. People literally wake up, sit in a car to go to work, ride the elevator, sit at their desks with short breaks, then sit back in their cars to go home to sit on the couch because they feel spent! We also have Lazyboy chairs and Tempurpedic beds. No one needs to use their lower extremities anymore! Just press a button or yell at Alexa to turn on the lights.

Yes, all of the above, but also personal choice. I live (used to live) in the same environment but chose the produce aisle, hiking, yoga, and dancing. And I choose to call a spade a spade. Most people agitating about “fat shaming” do no one a favor by aiding bad behavior.

“Body positivity” asks for acceptance of an unhealthy state and demands others to agree. Acceptance is only good when it is the first step to realizing the necessity of change. It should not lead to another trip to the refrigerator. Given the enormous physical and mental costs obesity imposes on people, I do not comprehend why anyone would put an “accept” label on it.

“Accept the things you cannot change,” goes the Serenity prayer. “Change the ones you can.” Obesity definitely falls in that category and we should know the difference.

The body positivity movement goes as far as confining people to obesity by penalizing those who choose to shed the extra pounds.

Behold the Case of Cassey Ho:

Cassey Ho, known for her fitness videos and as a proponent of body positivity, experienced significant backlash when she shared her personal 90-day weight loss journey on social media. Her goal was to feel stronger and gain muscle, but the transformation also included losing fat and changing her diet.

After posting her results, which included visible weight loss and muscle gain, Cassey faced criticism from a portion of her follower base and the wider public. Critics accused her of betraying the body positivity movement. Her detractors felt that by engaging in a public weight loss journey, she was reinforcing stereotypes about the need to lose weight to attain fitness or beauty standards.

Cassey responded to the backlash by emphasizing that her journey was about feeling strong and healthy, not conforming to societal beauty standards. She addressed the criticism through her videos and social media posts, explaining that her intentions were focused on her personal health and fitness goals and not on promoting a universally ideal body shape or size.

Imagine if social justice activists invented a “poverty positivity” cause whose goal was to support people who chose to remain poor at all costs. Anyone who decided to save money and pull themselves up and out of poverty would experience backlash for betraying the “poverty positivity” movement. How much traction would a movement like this get? Probably none, and for a good reason. Why, then, do we reinforce another type of bad behavior by protecting it and calling its critics “fat shamers?”

Meanwhile, obesity also contributes to poverty, not just vice versa. Managing health conditions exacerbated by obesity leads to expensive medical bills and not just for the individual. It leads to loss of work and earnings, too. It leads to shrinking options for work and limits earning potential. All of these can lead to increased debt, less savings, and a lot more financial strain.

Obesity can also indirectly increase living costs. For example, the need for specialized equipment, clothing, or additional seating space on public transportation and airlines can all add extra costs. While these might seem minor individually, collectively, they add up to a significant financial burden over time.

No wonder obese people are prone to a lot more depression and anxiety than the general population.

I am sorry if this post has been a buzzkill. What are your thoughts and experiences with obesity, directly or indirectly? I know this is a complicated topic. I think it needs to be discussed honestly and openly, and we need to be objective about it. What has been does not have to continue. But to help people and for them to help themselves, there needs to be a sober and honest look at the situation first.

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Yours truly,

V