MEDICAL ARTICLES

Depression and Obesity

Obesity is the excess of fat that originates an increase of corporal weight in relation of stature, sex, and age and that prearranges to the person to suffer many diseases.

The Depression is a very common disease that affects the behavior, the feelings and the thoughts. Any person can suffer of depresiom, without concerning her sex, race, age, religion, economic level or profession. It is important to know that the first beginnings of a greater depression can not be very clear, because all the people who suffer that disease do not experience the totality and intensity of the symptoms. In some occasions it is possible to indicate some particular event like responsible of the beginning of a depression. However, this condition also can even attack some people without some apparent reason.

It has been verified which the people who suffer obesity have an increased risk to suffer depression, like many people with depressive history can trigger symptoms of feeding (hungry compulsive) uncontrol that can take them to certain level of obesity.

The depressive state induces the person to think that does not have chances, reason why an angustiante sensation of frustration and low self-esteem ends up seizing them. That is why the single idea is not enough to lower weight, but that also is important to review those psychological aspects associate to each individual case. To discover the true cause that induces to the action of eat, which is translated soon to obesity.

CUADRO CLINICO Y ETIOLOGIA

The people affected by this feeding disorder cannot let eat although has passed a small interval of time between completes food and the one that they have between hands (or in the mouth, to be more exact). The Institute of Mental Health of the United States investigations revealed that almost half of the impulsive eaters suffers severe depression and many others of certain disorders obsessive-compulsive or phobias. The reasons of these coincidences could be neurotransmitters like the serotonin that regulates the hormones production and mood swings and the vasopresine that is freed as answer to emotional and physical stress.

CHARACTERISTIC OF THE COMPULSIVE EATERS

• Frequent episodes of "comilonas" two or more times at week by minimum six months.
• Voracity episodes that can be more than one hour, to handle feelings of anxiety, depression, sadness, etc.
• They ingest great amounts of water generally
• They eat faster than most of the people and sometimes privily.
• They eat great amounts of foods without selecting flavors.
• Fault sensation and lost of control while eats.
• Fault sensation and depression after eating.
• Incapacity to avoid some food.
• They cannot stop eating.
• The episodes of voracity can be planned or spontaneous.
• Obsession for not increasing weight.
• To be on diet time to time, with recurrent failures.
• Low self-esteem and auto devaluation. Recurrent anxiety, sadness and depression.
• Indigestion.

COMPLICATIONS OF THE OBESITY

•  Constitute an important risk factor for the development of diseases (hypertension, dislispidemia, cardiopathies, sleep apnea, several forms of cancer, and others), with the consequent individual cost in health sector.

•  One of the main “social stigmas”, diminishing the opportunities of employment and education, with the consequent psicologic cost (low auto concept, auto image and auto efficiency, increase of the anxiety, diminution of the general quality of the interpersonal relations, etc.)

•  Constitute a syndrome with a high prevalence of psychiatric comorbidity (anxiety disorders, depression, addictive conducts, development of bulimic and/or anorexic symptoms, etc).

TREATMENT

At a first moment the situation is to establish a differential diagnose, since it exists many pathologies that attend with obesity. It is important to make the differentiation between some psychiatric diseases that can trigger obesity:

• Greater depression
• Generalized anxiety
• Certain forms of OCD (obsessive - compulsive disorder)
• Bulimic (exaggerated or excessive excess to eat, in which it can lack the hunger sensation)

Once it has been arrived at diagnose of depression like cause of his obesity triggered by his compulsive desires to eat, the corresponding treatment began.

The successful treatment must be multidisciplinary, and highly individualized.

This it must begin with a medical valuation and follow with the development of a plan that includes: individual psycotherapy, familiar psycotherapy, therapy of pair, group therapy, medication to improve the depression, the similar anxiety and other disorders, hospitalization, and nutritional consultant's office.

Important of the psychological factors in the development and the treatment of the obesity, are clear, reason why the therapist or another professional in charge of the obese patient must fulfill support, information, and education.

This last part mainly because in obese patient problems appears commonly in the affective and cognitive area, like low self-esteem, specially related to the own corporal scheme (conscious and unconscious psychic representation of the own body), being observed a certain image of himself and his body, losses expectations of auto efficiency and achievements.

By the previous thing, an integral treatment of the obese patient must facilitate not only tools to him that allow a change of nourishing habits and style of life (exercises, sports, etc), but also to provide basic tools to obtain basic an internal fortification, that helps them to also obtain optimal results (in this case, the reduction of weight) and some “supports” that, like any dependent patient of substances (drug addiction or drug dependency), grants them the security and confidence to face possible situations of “relapse” (excessive food ingestion, for example)

The treatment of the affective disorders (depression, anxiety) in the obese patient is of fundamental importance, because otherwise the patient will not be able to commit themselves suitably with the treatment, and in general will have greater difficulty to loss weight.

Like in other depressive patients, the treatment must contemplate the use of psico drugs, those that a nondespicable percentage can trigger an increase of weight in patients, reason why the election of the drug must contemplate adapted the psychiatric and nutritionales elements.

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BREAST CANCER

The breast cancer is diagnosed in thousand of women all years. It is not known which is the cause of this cancer, commonest in women. It is not necessary to be shamed to have breast cancer; it is not either going to contract the breast cancer; it is not either going to contract the cancer of breast or another type of cancer just by to think on the subject.

The breast cancer can affect the women of any age, race and social class, although it is commonest in the greater women of 50 years and the incidence of the disease varies around the world. Many of the changes that appears on breasts in general are not dangerous. Rarely these changes are because cancer, even if they are related, the early detection can make the treatment simpler and generally, more successful.

WHAT IS THE BREAST CANCER?

The breast is formed by many glands, that contain cells, that as well, can produce milk.

Some times, for reasons that still are not well known, some of these cells begin to divide themselves of an abnormal and uncontrolled form, producing a tumor. In some women, it can spend long time before they notice the tumor. Some tumors are benign (are not cancerous) and they are not scattered. These are relatively innocuous. Other tumors are malignant (cancerous) and they are scattered to near weaves, frequently near the chest.

WHAT CAUSES THE BREAST CANCER?

Although a great amount of investigations is being made in this area. Still it is not well known which are the causes of the breast cancer. Nevertheless, one has identified several possible factors of risks.

DURATION OF THE REPRODUCTIVE LIFE

Between greater it is the time between the beginning of the menstrual period and the end of the menstrual cycle (menopause), greater is the risk.

AGE AT THE TIME OF THE FIRST CHILDBIRTH:

The women whose first son born when she has an age less than 20 years have a half of the risk that the woman without children. A woman whose first son is born after the age of 35 years has a greater risk than a woman without children.

FAMILIAR HISTORY

The risk in woman with a breast cancer familiar history (near mother, sister, more familiar daughter) can be greater. It can be necessary that the women with several relatives with breast cancer require frequent revisions.

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