O que vem primeiro: a obesidade ou a depressão?
Manter o bom humor frente a qualquer doença crônica é muito difícil. Assim também ocorre com a obesidade. Na maioria das vezes, a doença vence o paciente pelo cansaço e impõe um enfrentamento com limitações, fraquezas e até com o próprio desconhecimento da medicina de como tratar individualmente cada caso de obesidade, já que eles são tão diferentes entre si.
“Médicos e pacientes, muitas vezes, se constrangem frente à impossibilidade de resolver o problema, pois a derrota, quando ela ocorre, é de todos nós”, afirma a endocrinologista Ellen Simone Paiva, diretora do Citen, Centro Integrado de Terapia Nutricional.
A cada dia, mais endocrinologistas atendem obesos deprimidos nos consultórios. Nos divãs dos analistas é grande a incidência de obesos também. “Não há dúvida quanto a associação das duas doenças. Aproximadamente 30% das pessoas que procuram tratamento para emagrecer apresentam depressão. Além é claro dos inúmeros casos de melancolia e tristeza em lidar com algo tão difícil, gerado pela rotina de ter que lutar contra a balança, de se policiar sempre, de não poder se soltar nunca. Nas consultas médicas que tratam o assunto, o choro é a regra”, revela Ellen Paiva.
A idéia que temos de nós mesmos é um grande impulso para o sucesso ou para a derrota em todos os embates da vida. Os obesos carregam “o peso” de que não são capazes de vencer a guerra contra a balança, principalmente após inúmeras tentativas frustradas de emagrecer. “Eles até continuam tentando perder peso, mas sem nenhuma confiança de que isso seja possível. Quando eles vêm ao consultório, o grande desafio dos profissionais ligados ao tratamento da obesidade é fazê-los acreditar que podem perder peso”, diz a médica.
Um ciclo pouco virtuoso
As primeiras dietas são sempre coroadas de êxitos. A perda de peso que ocorre na maioria das primeiras tentativas de perda de peso é facilmente compreendida pelo maior engajamento dos pacientes nas dietas propostas e nas várias mudanças de estilo de vida que eles se dispõem a fazer.“Como a manutenção de peso ainda é o calcanhar de Aquiles dos tratamentos para a obesidade, os pacientes voltam a engordar. E novas dietas são implementadas trazendo à tona a noção da fragilidade da perda de peso. A explicação dada pelos pacientes de que as dietas vão ficando mais difíceis porque eles vão envelhecendo não procede. Na verdade, eles se tornam mais e mais descrentes da possibilidade de emagrecer e mais e mais propensos à depressão”, contextualiza a endocrinologista.
As frustrações em relação à imagem corporal começam no enfrentamento da criança obesa com os vários apelidos na escola, avançam pela puberdade, onde já existe uma insatisfação com as formas corporais e alcançam o adulto que sofre preconceitos velados e dificuldades reais como se posicionar em assentos públicos, comprar roupas adequadas à sua numeração e em se enxergar tão fora dos rigorosos padrões de beleza corporal. Tudo isso concorre para uma atitude de isolamento social e baixa auto-estima.
Apesar de muitas vezes não ser perceptível, a obesidade infantil afeta a auto-estima e a sociabilidade da população infanto-juvenil. Pesquisas recentes sugerem que há três variáveis psicossociais que podem afetar negativamente a qualidade de vida das crianças obesas, podendo inclusive dificultar mudanças em seus estilos de vida, como fazer dieta ou praticar atividade física. Essas dificuldades impostas pela obesidade podem coexistir na vida de muitas delas, embora elas se sintam relutantes em discutir o assunto com os pais, professores ou profissionais de saúde envolvidos em seus tratamentos. São elas:
Dificuldade de enfrentarem gozações e brincadeiras de seus colegas relacionadas ao seu peso corporal, o que causa estresse psicológico intenso, piora da auto-estima e piora da sua auto-avaliação da imagem corporal;
Isolamento social, redução considerável da capacidade de fazer amigos e de aproveitar as oportunidades de praticar atividade física em grupos, com o consequente aumento do consumo de alimentos;
Depressão, que pode ocorrer como causa ou consequência da obesidade na infância e adolescência.
“As consequências da obesidade na infância e na adolescência não param por aí. Outras pesquisas têm documentado alterações comportamentais até então desconhecidas como influenciadas pela obesidade. Parece que a obesidade na população infanto-juvenil está ligada ao comprometimento do desempenho escolar, à maior vulnerabilidade para os transtornos alimentares do tipo bulimia, a comportamentos de risco como tabagismo, alcoolismo, atividade sexual prematura e a práticas nutricionais erradas e sedentarismo”, alerta a endocrinologista Ellen Simone Paiva. Várias atitudes de risco e de desorganização na vida pessoal têm maior propensão de se agruparem na criança e nos adolescente obesos.
O surgimento do transtorno alimentar
A associação da obesidade com a depressão, principalmente entre jovens, traz consigo o fantasma dos transtornos alimentares. É mesmo muito preocupante o grau de insatisfação corporal entre os adolescentes em todo o mundo. Mais de 25% dos meninos e 50% das meninas desejam perder peso, incluindo estatísticas de povos orientais. O mais impressionante de tudo isso é que 81% deles são considerados de baixo peso ou de peso normal e 20% deles recorrem a métodos inadequados para alcançar seus objetivos de peso ideal, como dietas restritivas, medicamentos para emagrecer e a prática de vômitos auto-induzidos.
“O que vem primeiro: a obesidade ou a depressão? Muitas vezes, a depressão leva à obesidade, principalmente quando a depressão se acompanha de grande ansiedade e compulsão alimentar. As pessoas comem não somente por fome. Comem por prazer de comer, mas, muitas vezes, para compensar o desprazer e a tristeza. Comem como forma de presentear-se. Além disso, a maioria dos medicamentos utilizados para o tratamento da depressão leva ao ganho de peso e isso não pode ser desconsiderado na avaliação desses pacientes”, alerta Ellen Paiva.
Os sintomas depressivos também podem estar mascarados pelos sintomas da obesidade. É comum entre os obesos sinais de apatia, sonolência, dores no corpo, desânimo e fadiga, muito frequentes também nos quadros depressivos. Um dos sintomas mais frequentes da depressão é o desânimo, o que dificulta qualquer atitude em relação à prática de atividade física, que poderia mudar o prognóstico de ambas as doenças. “Depressão e obesidade podem se beneficiar dessa prática, uma vez que ela está associada ao aumento do gasto calórico, mas, muito mais que isso, a uma atitude positiva e otimista que as pessoas se engajam quando incorporam a atividade física à sua prática diária”, defende endocrinologista Ellen Paiva.
Fonte: Citen
Enviado: Ana Cláudia Barbalho
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