Society is obsessed with how we look, and in particular what size we are. Even people who are generally quite polite feel entitled to comment on our weight and body shape, without having any idea what the backstory might be. In the case of mental illness, there is often a great deal of backstory, including both illness symptoms and treatment-induced weight gain.
Depression and weight loss
Over the last 10 years, there’s been about an 80-pound span between my lowest weight and my highest, and I’ve ranged from a size 6 to a size 16. When I’m depressed, I tend to lose my appetite, and at times have lost significant amounts of weight because of this. When I’m really unwell, I could easily go days without eating, but I know that I should eat, so I try to force food down. If this is too hard, I try to choke down something like Boost instead. The only time I have ever counted calories was when I was pushing myself to cram in 1000 Calories a day, about half of what I should actually be taking in.
When people complimented me on my weight loss, I would have thrown those bottles of Boost at them if I had the energy. Why did these people see skinny sick me as somehow better than curvy well me? It was almost certainly done out of ignorance rather than malice, but that shouldn’t make it okay to essentially say “you look better when you’re sick”.
Psych meds and weight gain
Psych meds-induced weight gain is a common story. For the last several years I’ve been on a trifecta of weight gain-inducing meds (quetiapine, mirtazapine, and lithium) that tipped the scales to over 200 pounds. I had mixed feelings as the weight piled on. I wasn’t thrilled about the changes in my body, especially since it felt so out of my control.
Still, that med combo kept me well for a few years, and that was really my priority. After a solid period of stability on this med combo, I decided to try going off the Seroquel, hoping that would bring my weight down a bit. What actually ended up happening was that I had a relapse of my depression. At that point, I decided it was time to just fully accept my new body, because if I wanted to be well, I needed these meds, even if it meant ongoing weight gain.
The anti-inflammatory approach
Earlier this year I began seeing a naturopath. I had gotten depressed again despite my med cocktail, and I was willing to try anything that might help. Based on my history and bloodwork, one of her recommendations was an anti-inflammatory diet. It’s not a weight loss diet; instead, it’s all about putting healthy foods into your body and keeping unhealthy things out.
I have ended up losing some weight as a result, and I’m feeling more comfortable in my body, but I’ve faced the issue again of people commenting on my weight loss. Yes, the weight loss is a healthy thing this time around, but people don’t know anything about that when they make comments. My body should not be theirs to pass judgment on.
I don’t recall ever actually saying anything in response to people who commented on the changes in my body. There’s just too much backstory to be able to fit into a one-line zinger. Our bodies may reflect to some extent what’s going on inside of us, but often not in a way that is consistent with societal expectations around body size and shape. From anorexia nervosa to depression to binge eating disorder, mental illness can warp our bodies. The combination of psych meds and weight gain can also play a role. I just hope that someday more people will understand that our bodies are not theirs to judge.
Ashley L. Peterson
BScPharm BSN MPN
Ashley is a former mental health nurse and pharmacist and the author of four books.