09/17/2014 10:35 am ET Updated Nov 17, 2014

Obesity Due to SSRIs Is Not a Chronic Disease

A comprehensive evaluation of the best ways to treat obesity was published in an early September issue of JAMA [1] and offers valuable advice to physicians dealing with obese patients. There is only one little problem: Almost no attention was paid to the subset of obese individuals whose weight gain is not related to their overeating and sedentary lifestyle, but rather a side effect of their medication.

Kushner and Ryan, the two authors, did state that unexpected weight gain could be a side effect of antidepressant medication, but their advice was limited to changing the drug. Although sensible, their recommendation did not consider that most of the drugs now prescribed for depression, anxiety and bipolar disorders and other mental illnesses can cause weight gain. There are very few which do not do so. Moreover, patients are often on more than one drug, each with its own weight-producing side effect.

The article failed to acknowledge that this subset of obese individuals had a "before" when they were thin, fit, energetic, not embarrassed to be seen in public, or the target of offensive remarks often directed toward the obese. Their obesity is not chronic; it is not an ongoing struggle to control overeating and under exercising. Were it not for their medication, they would not be obese.

But they are now. They are in the "after" and suffering from a transformation of their eating habits, physical activity, bodies, and even their social life, starting sometimes only weeks after beginning treatment with an SSRI or mood stabilizer.

And to the dismay and chagrin of this subset of obese individuals, no one is paying much attention.

When was the last time the media talked about the problem, if they have ever talked about it? Endless headlines fill our newspapers, computers and smartphones about whether we should be eating 40 grams of carbohydrate or 200 grams of carbohydrate, or whether fasting and feasting is a better way of losing weight or that 30 minutes of exercise broken into 10-minute intervals provides optimal results. But where are the weight loss organizations, clinics, and medical journal articles pinpointing specific weight loss interventions for those formerly thin who think that, because of their medication, they may be permanently fat?

These individuals can be helped to establish control over their food intake even while still being treated with the drugs that are causing their overeating. They can be helped to restart their exercise routines even with bodies sluggish from their drugs and excess weight. And they can be helped to deal with the stigma they share with all other obese individuals and the unfortunate responses by the public. But they need someone to notice.