The Intersection of Inflammation, Obesity, and Psychiatry
In this occasional feature on Psych Congress Network, members of the Psych Congress Steering Committee answer questions asked by audience members at Psych Congress meetings.
QUESTION: Is there a connection between inflammation and obesity and does this impact psychiatry?
ANSWER: The immediate answer is a yes. There is what appears to be both an associative as well as causative relationship between systemic inflammation and obesity. Additionally, this relationship negatively impacts the mental health of our patients with a variety of psychiatric conditions—major depression, bipolar disorder, schizophrenia, etc.
Let's first examine the association. We originally thought of adipose tissue as a quiet and silent tissue, but recent data show that adipose tissue actually is a significant source of peripheral inflammation. And worrisomely, this peripheral inflammation has significant central nervous system impact. Higher levels of inflammatory markers such as C-reactive protein (CRP) and interleukin-6 (IL-6) have been found in such individuals. Additionally, macrophages are excessively active both in patients with mood disorders and with obesity. And of course, having both at the same time complicates matters enormously.
These inflammatory markers are able to cross the blood-brain barrier and create significant central nervous system challenges that ultimately make the psychiatric illness worse, as well as limit the outcomes of treatments.
Now that this mind-body connection is fairly well-understood, we clinicians really become more aware of this overlap and create clinical paradigms that help this complex situation. There are several things I would suggest we do. We should explain this association to our overweight and obese patients, and recommend a gradual and steady weight loss program, utilizing a combination of exercise and dietary modification. We should be as careful as possible in selecting our medication interventions, and choose interventions with the least risk of further adding to a patient’s weight and metabolic problems. This might be the group of patients for whom we should additionally recommend optimized sleep hygiene, perhaps even mindfulness meditation, and of course physical exercise, as all of these interventions could positively impact a patient’s life.
— Psych Congress cochair Rakesh Jain, MD, MPH, Clinical Professor, Department of Psychiatry, Texas Tech Health Sciences Center School of Medicine, Midland
Rosenkranz MA, Davidson RJ, Maccoon DG, Sheridan JF, Kalin NH, Lutz A. A comparison of mindfulness-based stress reduction and an active control in modulation of neurogenic inflammation.Brain, Behavior, and Immunity. 2013;27(1):174-184.
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