Research has drawn a clear line between obesity and depression — a patient with obesityis 33% more likely to have the condition. What’s unclear is which is the chicken and which is the egg. But in either case, exercise is a proven strategy for improving both the patient’s physical and mental health.

While exercise has long been a go-to approach for physical health, a new meta-analysis demonstrates that it is equally as effective for mental health, too. The authors found that exercise may be moderately more effective than a control intervention for reducing depression symptoms.

The reason?

“It boosts brain chemistry just like medications do,” said Ulrick Vieux, DO, director of the Behavioral Health Sports and Performance Clinic at Hackensack University Medical Center in Hackensack, New Jersey. “When you’re active, you activate endorphins and serotonin, which bring on a sensation of well-being. It also reduces stress hormones.”

Exercise also has a positive impact on the brain’s plasticity. A depressed patient likely has a less plastic brain than patients who are not affected by the mental illness. Exercise can boost brain plasticity, which can be powerful in and of itself. As the brain gains plasticity, it adapts and changes, which can lead to improved mood and even help foster an appreciation for what exercise can do. 

It’s worthwhile, then, to prescribe exercise to your patients with obesity who also have depression. But this can be tricky: This is a population that already understands they should exercise. Telling them this won’t necessarily help. Instead, you need a toolkit to help motivate your patients to get out the door — or even into their home gym.

Touching on a Touchy Subject 

Most people with obesity know they should exercise, and in fact, hear that advice often from their medical practitioners, family, and friends. And when anyone ties that advice to the negative consequences of their size, it likely leads to pushback or shutdown.

“It’s very common to use pressure words with this population,” said Brad Donohue, PhD, a distinguished professor in the department of psychology at the University of Nevada, Las Vegas. “Words like ‘you should,’ or ‘you must’ can backfire for many people.” 

Tying negative consequences to your language, even if they are true, may be the wrong approach. Telling patients that if they don’t exercise and lose weight, they will experience heart disease or diabetes, or that they’re more likely to experience a shortened lifespan, often doesn’t serve as motivation. For some patients, this might feel like a parent scolding them for bad behavior. Just like children, adults often respond better to positive reinforcement.

To switch your language with patients, flip the script, said Donohue. Remind your patients that they’ll have a better chance at living longer or enjoying their hobbies if they implement exercise into their routines. Consider using “choice” words, such as “going to” or “want to” with your patients. 

Along with the right language, it can help to encourage patients to find replacement behaviors, said Laurie Singer, a licensed psychotherapist and behavior analyst who leads a private practice in California. 

“Go positive with your patients,” she said. “Tell them they can turn things around, but that they’ll need to find replacement behaviors to do it.”

A replacement behavior can take on many forms, but if a patient has a habit of grabbing a bag of chips when feeling down, for instance, suggest they replace that habit with a 5-minute walk whenever the chip-eating urge kicks in. Or if hitting snooze in the morning is a regular behavior, encourage them to hit it once, then get out of bed and do a gentle yoga routine.

The key is for the patient to recognize the signals that often trigger a detrimental behavior and then replace it before it begins. 

Singer is also a fan of accountability groups, which exist in spades now thanks to the Internet. From Facebook to Overeaters Anonymous and more, there are plenty of free resources for patients to tap into. 

“They can connect with a walking partner, for instance, or an accountability partner to call if they have the urge to overeat,” she said. “When patients feel a connection with someone else going through similar struggles, that can help.”

One factor that can be a significant hurdle, however, is a patient’s family situation. 

“If this is a family of overweight individuals, it can be tough for a patient to go it alone,” said Singer. “In this situation, if you can bring in the whole family to discuss changing their environment, that can make the situation much easier for your patient.” 

Encourage Incremental Progress 

Setting a goal to “lose weight” is vague and can be overwhelming. Instead, encourage your patients to take their weight loss journey in small increments. “Rome wasn’t built in a day,” said Vieux. “Help your patients focus on their small wins.” 

This might mean starting with 5 minutes of exercise three times a week and then increasing that to 10 minutes the following week. The end goal is consistency, so making small jumps can be an avenue to reaching that. In that vein, helping patients find the sport that keeps them going back is useful, too.

“I’m a big fan of walking and swimming,” said Vieux. “And if a patient can get outside in the fresh air, that can help their mental health, too.” 

Nature-based interventions are well proven to help lower anxiety and depression. A simple walk in a park or even gardening can provide a beneficial effect. When patients enjoy their time outdoors, they’re more likely to continue the practice. 

Donohue likes the idea of patients focusing on process goals or controlling what they can. “They have control of how they think and act,” he said. “They can’t control their feelings so much, however. So, instead of focusing them on the outcome, help them figure out how to accomplish their goal.”

For instance, creating an incremental game plan and writing it down may help a patient take the steps they need to achieve a goal. “Help them think about the positives of what they’re achieving,” said Donohue. “Once they get into a routine and start having fun, they’ll be more likely to keep going.”

Solving the obesity and depression equation isn’t simple, but by giving patients the right tools to make incremental gains, you can help set them on the right path to improve both conditions. Exercise is one solution that works on both at once. “Your job as a physician is to provide them with insights,” said Vieux. “Give patients the information that will make them want to make healthy choices.”