Nasty bedfellows: Obesity and depression

America is in the grip of a mental and physical health crisis.

Let us rephrase that: America is in the La-Z-Boy of a mental and physical health crisis. And we're reluctant to get up and do much about it.

We're fatter than ever. Not so coincidentally, we're also more depressed. The bigger the belt size, one massive theory goes, the larger our emotional demons grow.

"They are intertwined and you cannot separate them," Dr. Joseph Abate says of obesity and depression. Abate talks on that topic a lot. As the medical director at Heritage Health in Coeur d'Alene, he's on a mission to tackle the national health care crisis at the local level. There's no place better to start, he believes, than confronting the unhealthy marriage of physical and mental malady.

"There is some evidence that chronic depression actually changes the structure of the brain so that you start to gain weight; you start to feel less likely to be active," says Abate, a cardiologist for 27 years before he joined Heritage Health - formerly known as Dirne Health Clinic - in 2012. "It's just the way the cycle goes: Once you become more overweight and you're not active, then things start to hurt."

And that means mentally, not just physically.

Abate tells the story of a migraine patient who was on his fifth prescription to alleviate pain that refused to go away. Because Heritage Health patients' physical and behavioral health records are available to medical staff - a rare merger of the oddly segregated categories - Dr. Abate examined Mr. Headache's medical records, then his mental health records. He couldn't believe they represented the same patient. Knowing that they did, though, allowed him to help the man where a physician alone or a psychiatrist alone might fail.

There's a third tier of well-being that Abate emphasizes for overall health: Spiritual, to go along with physical and mental. He tells the story of another patient who complained of stress and depression that was nearing the point of debilitation. The man wanted a pill to make the problems go away. But further consultation with the patient unveiled an underlying problem: He was having an affair, and while he expressed no personal remorse or responsibility, he was dreadfully afraid his wife was on the verge of discovering his infidelity.

"I don't think there's a pill for that," Abate says of the spiritual hell some people create for themselves. "I see a lot of people in spiritual crisis, if you really want to pin it down."

That's why Abate has formed a dynamic health triumvirate: Abate, representing the medical side; Dr. David Wait, a Heritage Health psychiatrist addressing the behavioral health side; and Pastor Rodney Wright of Lake City Community Church, doing his uplifting best on the spiritual side.

They know something's got to change or Americans are increasingly going to eat, drink and sin their way to unhappiness and early death.

Much of the unhappiness around here stems from obesity. Medically speaking, Abate estimates nearly 50,000 Kootenai County residents - roughly one third - are obese. Obesity is defined as having a BMI (body mass index) of 30 or more. BMI is determined by calculating an individual's height and weight. Many more residents are on their way to obesity, unfortunately. These people are overweight, meaning their BMI is between 25 and 29.9. One of the areas where bigger BMIs are reflecting an unhealthy community is on the diabetic battle front.

Applying national diabetes ratios to Kootenai County, Abate and Denis Yost, a prominent clinical pharmacist, estimate there are about 15,000 diabetics in our county alone. Those same statistics suggest that, with a two-to-one ratio, another 30,000 Kootenai County residents are pre-diabetic.

"If they don't exercise, 15 to 30 percent of the pre-diabetics will become diabetic over the next five years," Abate cautions.

In addition to coping with poor health, diabetics spend, on average, about $135,000 treating the disease over their lifetime, Yost says, and an additional $25,000 a year for complex cases. If dialysis is needed, the price tag grows another $60,000 to $80,000. Of course, many of those dollars don't come directly from the patients, putting additional stress on state and national health care systems.

Despite all the expense and attention, diabetes has increased tenfold since 1950. Perhaps not coincidentally, since 1960, the average American has gained 24 pounds.

Researchers have a plateful of theories on how America got so fat. Computers and video games have encouraged a culture of stultifying inactivity, if you don't count rapid finger movement. With the advent of No Child Left Behind, physical education was eliminated from many American public schools. A society that swilled Big Gulps found a way to further devolve - along came a thirst for Double Gulps and the 45 teaspoons of sugar each soft drink contains.

"When I see a patient walk in with one of those," Abate says, "I know the patient's in trouble - and I'm in trouble. We have our work cut out for us."

As difficult and expensive as it is to deal with obesity and diabetes, their combined price tags are less than what America spends battling depression. According to the most recent statistics gathered by Abate, the cost of treating obesity is $190 billion annually, or 20 percent of our nation's total medical spending. Treating diabetes costs another $245 billion annually. But the cost of depression is $444 billion a year, with $150 billion of that in direct medical costs.

Talk about depressing: Tomorrow you'll see how Americans prefer to deal with what ails them.

An unbalanced scale

100 million American dieters are spending $60 billion a year trying to lose weight. It's been estimated that to end world hunger would cost $30 billion a year.