For many South Africans struggling with their weight, the numbers on the scale tell only part of the story. Behind every kilogram gained – or lost – lies a complex web of emotions, stress responses, and mental health challenges that traditional "diet and exercise" approaches often fail to address.

The vicious cycle

Recent research reveals a stark truth: there's a bidirectional relationship between obesity and mental health conditions such as depression and anxiety, with emotional eating playing a key mediating role. This creates a self-perpetuating cycle that's difficult to break without addressing both components simultaneously.

Up to 55–95% of people with eating disorders also have at least one psychiatric disorder, most commonly depression and anxiety. When people use food to manage difficult emotions, they often experience temporary relief followed by guilt and shame – worsening their mental health and creating a cycle that feels impossible to escape.^[1][2]

The hidden burden of weight stigma

Perhaps even more damaging than obesity's physical effects is the psychological toll of weight stigma. Weight stigma has significant psychological consequences that are often more detrimental than the physical health impacts of obesity itself.

Perceived stress mediates a substantial portion (37%) of the relationship between weight stigma and poor mental health outcomes, creating chronic stress that makes weight management even more challenging.^[3][4]

When stress becomes weight

Understanding stress's role requires looking at what happens inside our bodies during difficult times. Chronic stress triggers cortisol release, a hormone that increases appetite and drives cravings for high-fat, sugary "comfort foods".

This isn't about willpower. People with higher cortisol reactivity consume more calories, especially from fat and sugar-rich snacks when stressed, and elevated cortisol levels are specifically linked to increased abdominal fat storage.^[5][6]

Breaking the cycle: Integrated treatment

When mental health and weight management are addressed together, outcomes improve dramatically. Integrated approaches combine cognitive-behavioural therapy (CBT) and mindfulness-based interventions within a comprehensive, personalised framework.

CBT for obesity focuses on modifying dysfunctional thoughts about food, developing healthy coping strategies beyond emotional eating, and building self-monitoring skills.

Mindfulness interventions enhance distress tolerance, reduce emotional eating, and improve awareness of hunger and satiety cues.^[7][3]

Practical steps forward

• Screen for mental health issues: Untreated psychiatric conditions can hinder weight-loss efforts
• Address emotional eating: Learn to identify triggers and develop alternative coping strategies
• Build support networks: Strong social relationships can mitigate psychological distress associated with weight stigma
• Consider professional help: Multidisciplinary teams often achieve the best outcomes

Weight management isn't just about calories – it's about addressing the emotional, psychological, and social factors that influence our relationship with food and our bodies. When we treat obesity as the complex condition it is, we create space for sustainable, compassionate, and effective healing.