Substance Use, Mental Health Problems on the Rise for Those With Obesity

Man looking depressed

Key Takeaways

  • People with obesity may be at higher risk for COVID-related mental health and substance use issues.
  • Researchers suggest this may be because of high levels of stress and maladaptive coping strategies.
  • Excess weight can put people at risk for other major health problems, including higher complication rates with COVID.

Although mental health concerns and higher substance use has been noted throughout the general population due to COVID-19, people with obesity, in particular, may be at higher risk, according to a study in Clinical Obesity.  

Researchers looked at online survey responses from 589 participants from June 1 to September 30, 2020, covering the use of substances like drugs, alcohol, and tobacco. In addition to mental health, participants also were asked about other behaviors like shopping for food, exercising, eating healthy meals, and getting quality sleep. About 17% had tested positive for COVID in that timeframe.

They found that among those with obesity, there was substantial drug use reported, particularly opioids. Participants also had more difficulty falling asleep, found healthy eating more challenging, and stockpiled more food. Over 40% reported at least one mental health condition, including anxiety or depression.

The Obesity and Mental Health Connection

Even before COVID, obesity was associated with an increased risk of mental health issues, and a study in Archives of General Psychiatry found that obesity increased the odds of mood anxiety disorders by 25%. But that research also found a 25% decrease in the risk of substance use disorders.

Sarah Messiah, PhD

There is a relationship between stress and obesity, through cognitive and physiological mechanisms.

— Sarah Messiah, PhD

However, keep in mind that those findings came well before the pandemic, according to the study’s lead author, Sarah Messiah, PhD, professor of epidemiology, genetics, and environmental sciences at the University of Texas.

“There is a relationship between stress and obesity, through cognitive and physiological mechanisms,” she says. “During the pandemic, our anecdotal clinical experiences with patients suggested that substance misuse may be occurring more frequently in this group than was previously thought.”

After looking at data from the surveys, their suspicions were confirmed, she adds. COVID-19 has significantly impacted people with obesity by negatively influencing mental health and prompting more substance use as a way to cope with stress and trauma.

“The concerns that this raises is that because stress levels are high, particularly in people with obesity, that could lead to more maladaptive coping behaviors like increased stress eating and food stockpiling,” says Messiah. “That can make achieving weight-loss goals more difficult and increase the likelihood of even more substance use.”

More Weight, More Risks

In addition to mental health issues like anxiety and depression, as well as substance use, those with obesity who gain weight as a result of stress could be at risk for other issues as well. Most notably, obesity increases the chances of developing metabolic syndrome, which includes five factors:

  • A large waistline
  • Elevated blood sugar levels
  • High blood pressure
  • High triglyceride levels
  • Low levels of HDL cholesterol

A research letter in the Journal of the American Medical Association concluded that the rate of metabolic syndrome is rising in all age groups, with as many as half of adults over 60 diagnosed with the condition.

The rate is surging upward in younger people the fastest, however. Researchers noted there's been a 5% increase over the past five years among those aged 20 to 39, which represents a serious public health problem.

Also, obesity may change a person's immune response to COVID-19, making it more difficult to fight off the virus and increasing the risk of complications, according to a recent commentary published in Endocrinology.

Next Steps to Consider

For those who have obesity or are struggling with excess weight, making even small changes can lead to a potentially important impact, suggests Sharon McDowell-Larsen, PhD, exercise physiologist and coach at the Center for Creative Leadership.

Sharon McDowell-Larsen, PhD

The main thing to keep in mind is to be gentle with yourself, and know that stress right now is very normal.

— Sharon McDowell-Larsen, PhD

For example, taking time to move more, such as doing short walks, could help with anxiety and depression, particularly if done outside in fresh air. Talking with a primary care physician and mental health counselor can also be important, especially if you’re struggling with substance use issues.

All the usual healthy habits should be considered as well, such as:

  • Eating plenty of fruits and vegetables
  • Maintaining social connections, even if it’s through online tools
  • Getting regular health check-ups
  • Practicing some form of mindfulness or gratitude
  • Getting physical activity throughout the day

“The main thing to keep in mind is to be gentle with yourself, and know that stress right now is very normal,” says McDowell-Larsen. “You don’t have to overhaul everything all at once, because that can feel like one more stressor. Instead, take more breaks, talk to your doctor, and make a plan for your health.”

What This Means For You

If you're struggling with obesity, you may be at higher risk right now for substance use disorders and mental health challenges like anxiety and depression. Consider talking to your primary care doctor or a mental health professional who can help.

The information in this article is current as of the date listed, which means newer information may be available when you read this. For the most recent updates on COVID-19, visit our coronavirus news page.

4 Sources
Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Almandoz JP, Xie L, Schellinger JN, et al. Substance use, mental health and weight‐related behaviours during the COVID‐19 pandemic in people with obesityClin Obes. 2021;11(2). doi:10.1111/cob.12440

  2. Simon GE, Von Korff M, Saunders K, et al. Association between obesity and psychiatric disorders in the US adult populationArch Gen Psychiatry. 2006;63(7):824‐830. doi:10.1001/archpsyc.63.7.824

  3. Hirode G, Wong RJ. Trends in the prevalence of metabolic syndrome in the United States, 2011-2016. JAMA. 2020;323(24):2526–2528. doi:10.1001/jama.2020.4501

  4. Huizinga GP, Singer BH, Singer K. The collision of meta-inflammation and SARS-CoV-2 pandemic infection. Endocrinology. 2020;161(11):bqaa154. doi:10.1210/endocr/bqaa154

By Elizabeth Millard
Elizabeth Millard is a freelance journalist specializing in health, wellness, fitness, and nutrition.