Myth Two: Fat is Mental Illness

Dr. Pattie Thomas wrote a book called Taking Up Space: How Eating Well and Exercising Regularly Changed My Life that is just really awesome. If you haven’t read it, it’s well worth investing in.

The first chapter of the book has 10 fat myths. As I read them, I had so many ideas and thoughts and things I wanted to say about each one. I contacted Dr. Thomas and she said that it would be okay for me to use her list to talk about each of the myths here. So–welcome to a 10-week Thursday series.

The second myth in her book is Fat is Mental Illness.

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I’ve thought about this topic, this myth, all week and for some reason I struggled with it. It made me uncomfortable. And I finally realized the reason is because I was afraid I wouldn’t have the skill to write it in a way that didn’t sound like this:

We may be fat, but at least we aren’t mentally ill.

And that isn’t where I want to go. While it is a myth that being fat is a mental illness, that doesn’t mean that having a mental illness is somehow “worse” than being fat (or vice verse.) Just like bodies come in all different dimensions, brains come in all different varieties as well. I believe that it takes a wide variety of people, in body and mind, to make the world go ’round.

As a mental health professional and the mother of a child who has a pretty traumatic history with the mental health industry, I truly believe that it is often those who don’t fit in the ‘normal’ mold who have the biggest impact on the world.

The National Alliance on Mental Illness describes mental illness as a group of medical conditions that disrupt a person’s thinking, feeling, mood, ability to relate to others and daily functioning.

There are mental illnesses that correlate with weight gain or being fat. Some eating disorders, for instance. Body dysmorphic disorder. Depression often leads to overeating for comfort, which causes weight gain. While many drugs cause weight loss when they’re abused, alcohol abuse or dependence often causes weight gain. In addition, many drugs used to treat mental illness result in sometimes spectacular weight gain.

When my son was nine, he had been misdiagnosed with ADHD for three years. After it became clear he didn’t have ADHD, he was re-misdiagnosed with bipolar disorder and given a handful of pills to take everyday.

Nick went from 60 to 180 pounds in three months. His weight tripled. Not only that, but because he was finally eating, his body took advantage of the calories (I guess) and started growing. He grew almost six inches and three shoe sizes. In three months.

That is what the medication for bipolar disorder can do to your body.

A recent study showed that among 800 people with mental illness, two-thirds were overweight or obese.

This article is so startlingly misguided that it’s hard to organize the reasons why. It  glosses over the fact that the patients studied have schizophrenia or bipolar disorder, both of which are treated with medication that cause weight gain. And totally skips that the correlation between bipolar disorder and alcoholism, which also can cause weight gain, is so strong that many professionals believe that patients who present with alcoholism should be screened for bipolar disorder.

No. This article blames mental health professionals for influencing their patients with their own bad behavior.

Is being fat a mental illness all by itself though?

Food clearly affects your mood. I think nearly everyone has eaten out of emotion rather than hunger at least occasionally. Lack of exercise can result in both weight gain and depression. Being fat causes such severe stigmatization, isolation and often public humiliation, that many people who are fat benefit from mental health treatment.

The definition of insanity is doing the same thing over and over and expecting different results, right? Constant dieting, the starve/fail/repeat cycle, fits that bill. In fact it is some disordered repetition of this cycle that sometimes results in a diagnosis of an eating-related mental illness.

Yeah, it’s no wonder that some people think that being fat is a mental illness. If we only had the capacity to understand that we’re killing ourselves with our deathfat. If we only were able to take the advice to eat less and move more. If only we didn’t hate ourselves so much, which must be a mental illness. And you know, those fat kids who eat donuts for breakfast every morning have a harder time concentrating at school. That’s a mental illness, right?


Or is this is another case of correlation is not causation?

Looking again at NAMI’s definition of mental illness, it is impossible to fit fat in there without some underlying problem. Being fat does not automatically cause dysfunction in thinking, feeling, mood, ability to relate to others and daily functioning. Sometimes the reality of being fat causes other problems that lead to these dysfunctions, and sometimes these dysfunctions are caused by another illness that leads to being fat or to treatment that causes fat.

There are fat people who aren’t mentally ill. There aren’t people who have bipolar disorder who aren’t. Or people who have post traumatic stress disorder who aren’t. Everyone who is anorexic or dependent on drugs or suffers from depression, they all have mental illnesses.

Mental illness, in fact, is pretty cut and dry. The diagnoses sometimes isn’t. Many mental illnesses are not diagnosable with blood tests or MRIs or some other concrete proof. But once the diagnosis is made, the term “mental illness” sticks. Nick’s double-misdiagnoses is a sample of this. But when he was diagnosed with ADHD and then bipolar disorder, there was never any question about whether he had a mental illness. Now that he’s diagnosed with a developmental disorder instead, no one ever suggests that he is mentally ill anymore.

As Dr. Thomas says in her book, benefiting from mental health treatment is not the same as a mental illness. It isn’t, any more than benefiting from exercise is a sign of heart disease.

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Filed under mind, spirit

6 responses to “Myth Two: Fat is Mental Illness

  1. Emerald

    Yes. This is true.

    Another angle: I’ve suffered from depression – starting, probably, in my teens, but not diagnosed till I was in my thirties. Interestingly, one of the doctors who failed to diagnose me during that time claimed I couldn’t be depressed because depression involved not sleeping and not eating, and that obviously didn’t apply to me, he said. The actual problem I’d gone to him with was a fatigue so debilitating, even after nine hours’ sleep at night, that I was falling asleep at my desk at work during the daytime, but note that I’d mentioned nothing to him about my eating habits, normal or otherwise (and they were more or less normal at the time). I gather that doctors now assume that it’s a change in those and many other everyday habits, in either direction, that rings alarm bells, but I wonder how many other fat women remained undiagnosed and untreated because doctors assumed they ‘obviously’ weren’t off their food.

    • Emerald

      Whups, sorry….html fail!

    • That’s so ridiculous, Emerald. Something has to give. Seriously. I had a long talk with my step sister yesterday. Her dad, who was a very big man, died last year of a GI bleed that could have been easily treated, but the doctor’s assumed that he was just having–I don’t know, fat man stomach pains? Disgusting. Really.

  2. Quinlan

    Wait a minute, so two thirds of the mentally ill group were overweight or obese, as in exactly the same proportion as the oft quoted stat for the general population? So zero relationship between size and mental health?

    Typical obesity researchers, forget the obvious we’re too busy panicking and scaremongering.

  3. Not labeling fat as a mental illness is important not because mentally ill people are bad, but because it’s wasteful and even damaging to treat people for something they don’t actually have. It’s also important because many psych meds cause weight gain, and if fat is ipso facto a mental illness, that means remission is impossible on medication that causes weight gain, even if that’s what you need to get better (which not all people with mental illnesses do, but many of us do). Every day, I kiss it up to Gawd that I have a psychiatrist with a clue.

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