The Crushing Depression of Morbid Obesity

If you've ever seen the MTV show Catfish, you know the idea is to reveal all the ways people are duped online. Past episodes have exposed women posing as men, fraudsters claiming to be recording artists, and a girl pretending to be a former Miss Teen USA to impress her high school crush. But one of the weirdest episodes involved a girl from Michigan who wanted to know why her long-time online confidante Matt Lowe refused to ever meet her in real life. As it turned out, Lowe—a 29-year-old from Vancouver, Washington—was everything he claimed to be, with one significant omission.

Lowe had neglected to mention, during the ten years of this online relationship, that he had become extremely overweight—over 600 pounds at his heaviest. It was shame about his body image that had led him to stall their in-person meeting, and at first, to turn down the Catfish producers' request to film him for the show.

"I would have had all these cameras filming me from every angle, following me around in the street, drawing attention to me," Lowe told me. "And on top of that, the pressure of knowing that this was going to be watched by millions of people around the world… It was the scariest thing I could've done." (The producers later persuaded him to appear on the show.)

The fact that obesity—more than an outright false identity or, say, pretending to be Lil Bow Wow when you're actually a young woman in Atlanta—caused this anxiety says something about the stigma of fat. It's no secret that obesity has reached epidemic levels in the United States. More than two-thirds of American adults are now considered overweight or obese. Of these, a small percentage (4 percent in men and 8 percent in women) have a Body Mass Index over 40, which is considered morbidly obese.

But instead of the prevalence of obesity leading to greater acceptance, the opposite is true: As obesity rates rise, research shows that discrimination has gotten worse. A study by the Yale Rudd Center for Food Policy and Obesity found that over a ten-year period, between 1995 and 2005, reports of weight discrimination had gone up by two-thirds. The center also found that women are more likely to face discrimination based on their weight than their race.

"Obesity is one of the most stigmatized conditions in the US," said Ashley Gearhardt, a food addiction expert and professor in the psychology department at Michigan University. "Individuals with obesity are more likely to be discriminated against, bullied, and isolated. Children and teens who are overweight are particularly prone to weight-related bullying and teasing."

All this prejudice has an inevitable psychological toll. Depression is common among obesity sufferers and grows in prevalence the more severe the weight gain, says Lucy Faulconbridge, director of research at the University of Pennsylvania's Weight Loss and Eating Disorder clinic.

"What you find is that with each class of obesity, depression levels go up, and with the morbidly obese depression levels jump up dramatically to between four and six times compared to a normal weight," said Faulconbridge.

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Lowe had not only been depressed, but also suicidal. In 2013, he made a public posting on Facebook where he revealed the contents of a suicide letter he had written two years prior, when he was 25 and severely depressed. The letter underscores just how much the fear of judgement by others was contributing to his unhappiness: "Weighing over 600 pounds does not even seem like something I can fathom so I cannot imagine what goes through other minds when they see me or hear of my size."

He said the only thing that stopped him from going through with the suicide was the thought of someone handling his grossly-overweight corpse.

"I didn't want a coroner or for my family to see what I had become," he told me. "I wanted to die, but I didn't want the last thoughts that people had of me to be about what I had done to myself and what I looked like."

Lowe said he has struggled with his weight since his early teens but at the time he wrote the letter his binge-eating had spiraled out of control. Too ashamed to go out in public, he would hide out in his room and play video games. On the few occasions he did venture out, he noticed others pointing and snickering at him.

His depressive mood was made worse by the effect his morbid obesity was having on his health. He could barely stay on his feet for more than five minutes without suffering chronic pain in his feet and back and had developed severe sleep apnea, which left him constantly tired.

At Faulconbridge's clinic in Pennsylvania, the morbidly obese are assessed for bariatric surgery, a weight loss procedure that involves reducing the size of the stomach, usually by tying a band around it. Faulconbridge said that for most patients, health concerns are the motivator for seeking surgery rather than the stigma of being overweight.

"It's not surprising," she said, "since pretty much any health problem you can think of is associated with obesity."

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But while weight-reduction can improve physical health problems, it doesn't always solve mental health issues, like depression. A study published in October, which tracked a population of bariatric surgery patients in Ontario, Canada, over six years, showed that instances of self-harm—most commonly intentional overdoses—actually increased significantly in the three years after their operations.

"One of things we counsel people about when they come in is what the surgery can and can't do," said Faulconbridge. "It can help you lose weight but it can't fix your marriage, it can't make your mother love you, and it can't get you a job."

Lowe, who now weighs 370 pounds, says his depression persisted even after his weight loss. "I still deal with it every single day," he said. "I think it will always be there in me. The difference between then and now and is that now I'm fighting it."

The research also raised the question of how much obesity is the cause or the symptom of depression. A study by Rutgers-Camden University in New Jersey showed that depression among teenage girls is a strong predictor of future obesity, but there's also plenty of research that shows the causality running the other way.

Faulconbridge thinks this apparent contradiction might be because current research is mixing up two distinct population groups—those who are depressed because they are obese, and those whose depression is unrelated to their weight gain.

Donna Phair, a New Jersey-based psychologist who specializes in treating eating disorders, said the majority of her obese clients describe being anxious rather than depressed. And while most can't remember whether the anxiety pre-dated their obesity, she is sure that their overeating is a way of coping with it.

"When you masticate, your body releases dopamine in the brain and serotonin in the gut, hormones that make you feel good," said Phair. "So are they eating to improve their mood and quell some of the disturbance inside of them? Absolutely."

That cycle can be perpetuated by the stigma against obesity, which can make people feel worse about themselves and turn to food as a pacifier. "Contrary to some popular beliefs, shaming people about their weight actually backfires and leads to greater overeating," said Gearhardt.

Additionally, the popular assumption that fat people are simply lazy is itself, well, lazy.

"I would say that that attitude of 'they do it to themselves' comes from people who don't have any experience of obesity," said Faulconbridge, "Because the truth is that there's a huge amount of data that shows a genetic predisposition to being obese. I would urge people to be compassionate and not to assume they know the causes of another's problems."

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