Psychiatric Medications and The Fat and Happy Paradox

May 24, 2011 Becky Oberg

In taking psychiatric medications, people with mental illness must consider if you would rather be fat and happy, or thin and sick-psychotic-suicidal?

Yesterday, I sought medical treatment after suffering some severe dizziness. After some tests, the doctor told me that the dizzy spells and difficulty walking were a result of a medication-related drop in blood pressure. The problem--the psychiatric medication responsible allows me to sleep without nightmares. It was my decision--psych symptoms or physical problem.

"The Fat and Happy Paradox?" I asked.

"Exactly," he replied.

Should You Take Psychiatric Medication and Be Fat and Happy?

The Fat and Happy Paradox is familiar to many people on psychiatric medications, and especially disturbing to people with borderline personality disorder (BPD). Basically, it's a decision about whether or not to take the medications prescribed: Would you rather be fat and happy, or thin and miserable/psychotic/suicidal?

It seems like it would be an easy decision. However, American culture is downright cruel to people with obesity. As Kelly Osbourne observed, "I took more [expletive] for being fat than I did for being an absolute raging drug addict. I will never understand that."

This stigma makes the decision considerably more complicated to a person with BPD, who may already have a fragile sense of self-image.

For my work, I wrote about a study revealing that obese people who feel discriminated against suffer more health problems than those who don't. I interviewed Peggy Howell of the National Association for the Advancement of Fat Acceptance (NAAFA) via e-mail, and she wrote about the link between psychiatric medications and the obesity epidemic.

"Another reason [for the rising obesity rate] is the growing number of people on medications that have weight gain as a side effect," she wrote in an e-mail. "Mood altering drugs are in this category and now we have hundreds of thousands of children and adults on drugs to calm them down or change their moods."

Where's the Understanding?

Study co-leader Kenneth J. Ferraro said in a statement: "We've seen considerable progress to address racial and gender discrimination in the United States, but the iceberg of weight discrimination still receives relatively little attention . . .. This is an interesting paradox because as the rates of obesity rise in this country, one might expect that anti-fat prejudice would decline."

According to the Obesity Action Coalition, this stigma can even exist in therapy. Studies report that psychologists view obese clients as more ill than thin patients, with more severe symptoms, more negative attributes and a worse prognosis in treatment. This attitude is often detected and becomes a self-fulfilling prophecy: if the therapist believes these negative things, the client may reason, it must be true.

A Rice University professor, Mikki Hebl, observed: "This stigma is so severe that it is no wonder that the prevalence of eating disorders continues to increase and the fear of fat is part of young women's normative discontent."

There is considerable co-occurance of BPD and eating disorders. It is easy to see how this could negatively impact treatment.

Psychiatric Medication Benefits vs. Side Effects

I can count on one finger the number of people with BPD I've known who aren't on some sort of psychiatric medication. If my experience is anything to go by, many of us are familiar with the Fat and Happy Paradox. Ultimately, it's up to the patient to make the decision, and each person has their own individual factors in this decision.

I choose to take the medication. First, it's easier for me to deal with life--including my weight--when I'm not hearing voices or depressed all the time. Second, the medication enables me to look at my weight rationally: while I'm not happy about my obesity, I understand that it's a side effect of the psychiatric medication that enables me to live a somewhat normal life.

To me, it's easier and more enjoyable to be fat and happy instead of thin and sick.

APA Reference
Oberg, B. (2011, May 24). Psychiatric Medications and The Fat and Happy Paradox, HealthyPlace. Retrieved on 2024, July 20 from

Author: Becky Oberg

March, 24 2022 at 12:33 pm

Well that was all pretty unhelpful. Anyone have an answer yet? It's 2022 and I hate myself and have been on meds for 20 years. What's the point in any of this

Estefana Martensen
January, 23 2013 at 12:09 am

My greatest weakness in weight loss is bread! It is an every day fight for me!

June, 12 2011 at 6:27 pm

When I was diagnosed Bi-polar w/Major depressive disorder in Feb 2001, I too was tried on many different meds, including Zyprexa, depakote, haldol, prozak, effexor, risperdal, etc. Within 4-6 months my weight went from 125 to 175.(I also became incontinent.Another side-effect). My maintenance regimin included Neurontin, Wellbutrin, Prozak, Zyprexa, and Risperdal. Over the years when I had relapses, at my request my meds were changed and I tried MANY other combos. In 2005 I began having panic attacks, was diagnosed with anxiety disorder and put on buspar and xanax....Around this time I was determined to get my weight down. I went on a strict low carb diet and walked at least 2 miles every day. After 6 months I had only lost about 20#. I was proud of even this small accomplishment, but eased up on my diet and exercise and it didn't take long and the weight came back on. In 2006 I ended up in the psych unit...more med adjustments, increased Risperdal and added some new the summer of 2009 I was up to 195# and had developed heel spurs. Foot doctor said I needed to lose weight. I talked to my psychiatrist. She said, "Your current meds are not condusive to weight loss." "OK, how do I get off them?" "At this time I wouldn't advise that." My son got married in Nov. and when I saw the wedding pictures, I was so embarassed. I decided I desperately needed to lose weight & I had to do it on my own, so I slowly (very slowly) began reducing my dosages and using vitamins & supplements as alternatives until in March 2010I was only taking Wellbutrin 150 mg/day and an occassional Xanax. I did low impact aerobics with a DVD 3-4 times a week and practiced portion control, but not a really strict diet. By May I had lost 18#. By August I had lost 32# and was down to 163#. My Family doctor told me I was the right weight for my height, but I'm only 5'6". I told her my goal was 140#. Late October I was at 152#, but started to have psych problems, so my Wellbutrin was upped, Neurontin added, and Xanax 2xdaily. I became manic the end of Feb with uncontrollable intrusive thoughts, voices, and insomnia, but I refused to go on Risperdal again (when I stopped taking it I was no longer incontinent-another side effect I am not willing to put up with), so I was started on Seroquel. In no time (beg of April) I was up to 156 and I started counting carbs. Now (June), I am barely eating, exercising every day, and I'm up to 165. I've gain 2# in just the last week!! What's the answer??? I gave away all my XL clothes and vowed to never be that size again. I am very concerned, almost obsessed, with my weight and what I eat. Lately, I feel myself slipping into depression again and I don't even want to tell my psychistrist, because it will mean more drugs....and more unwanted pounds. I've been seeing a psychologist off and on all these years and regularly since Oct. She's a great help, but not a total replacement for my meds....Fat & Happy or Thin & Psychotic??? Do I really have a choice? Do I sacrifice my physical health to be mentally healthy? Is there a happy medium?

June, 12 2011 at 6:37 am

I have Bipolar I Disorder and gained 40 pounds in 3 weeks on zyprexa and then continued to gain another 50 pounds on various other meds over the course of the next few years until I reached 215. I was just put on Topomax to help shed some of the weight. I have been on it for a few weeks now and have lost 10 bs. It really seems to help with my appetite...I am not constantly hungry like I was before. Just wanted to put it out there because I thought it might be something that would help someone else. One thing to keep in mind---right now I am appealing my insurance company because they denied covering it due to the reason I was taking it which was for Bipolar and medication-induced weight gain. It is indicated for migraines and seizures but I guess not for Bipolar yet, though I am not totally sure about that. In any case, had I known this before I would have gone to my primary care doc and told her I was having migraines and gotten the prescription from her--then it would have been covered with no problem.

Wendy from Australia
June, 10 2011 at 5:27 pm

I'm dammed both ways. I have Bipolar Disorder among other things and have been on mood stabiliser/anti-psychotics for about 8 years. 8 years ago I was 60kg and I topped out recently at 125kg. And I am five foot one and a tiny frame under all this blubber. The worst of the drugs was the most recent -Seroquel, which made me ravenously hungry 24/7 - eating large amounts in the middle of the night. I have been begging psychiarists to take me off it but have been refused - the "smother the patient with meds as a risk management and cover the arse of the doctor syndrome". Well I had a new psych agree to take me off it or at least reduce it massively. I lost 12 kg easily within a few weeks without exercising.
For me it wasn't a decision between fat or happy, as these drugs have harmed me more than helped me, and all I've ended up was being morbidly obese and now having the beginning of all the obesity related conditions - the first being my skeletal frame beginning to crumble with bone on bone arthritis in my foot and maybe stress fractures in the same foot - nuclear scans to come back next week.
It's a disaster and I have had much worse issues with other meds that nearly took me to my death. Blaaaaaaaaaa.

Dr Musli Ferati
June, 7 2011 at 9:51 am

The medication of psychiatric disorders apart many benefits has some side undesirable effects. Among others side effects, the fat is most common phenomenon that causes a rank of metabolic disorders, like diabetes as most dangerous complication. Meanwhile, it should be cautious in prescription of psychiatric drugs, in order to diminish side effect of psychopharmacotherapy as wideness approach in current treatment of psychiatric entities. There are many protocols in safe psychiatric medication that enable to patient in overcoming the undesirable side effect of this kind of treatment. The main principle of successful and safety medication in psychiatry is to use minimal dose of medication with its maximal therapeutic effect. This intention could to accomplish if the psychiatrist uses mostly monotherapy than polypragmasy. Beside this, it should take into account the individual characteristic of respective psychiatric patient like age, gender, profession, level of education, psycho-social and socio-economic status etc. At least it ought to use any form of psychosocial intervention in purpose to administrate minimal dose of medication. This kind of treatment was given positive results in my psychiatric practice, against enormous recommended dose from pharmaceutic producers.

Deborah Warren
June, 4 2011 at 6:11 pm

I am 52 yrs old and have been on a huge cocktail of psych meds since I was in my mid 20's. I weighed in on average around 125lbs at nearly 6' tall when I was in my 20's to mid 30's. In my mid 30's I was introduced to Depakote. I gained over 100 lbs in ONE year! In the years to follow my psych cocktail grew. I have weighed close to 300 lbs in the last five years. It is an on going battle at attempting to loose weight, but a loosing one. I spent an entire year working out two hours a day, five days a week and lost NOTHING!!! Dieted, the work outs, nothing dropped the pounds. I have felt so cursed by both my bipolar and depression and the meds to help control the two. I now have grown daughters and they refuse to take psych meds due to seeing all the physical side affects the drugs have had on me. So I see that as another curse. What does this say of the psych treatments of today that the younger set would rather suffer than take meds to help them feel better, but at the same time, have a massive weight gain as a result. I have recently lost some of the weight. Med changes here and there are what made those results. Nothing I do to work out or diet is ever enough to make a difference. I have become very self conscience about my weight now more than I ever have. I have seen both my daughters wed, and been fat at both of their weddings. The last I was so over weight, I had problems walking down the isle at the outdoor wedding. What few pics I am in I have destroyed. I suffered such low self esteem at my daughter's wedding. I wanted to look as proud as I felt for my daughter. Instead, I was so bloated and fat, I just was miserable. My marriage of 32 years is too precious to get off all my many meds and risk a down fall with my depression and bipolar. it gets tough enough at times to handle the depression even with the meds. So I feel trapped. So trapped and depressed that I have no alternatives for anything else to improve my life but psych meds that I often wonder are really worth it. My husband keeps telling me I'm beautiful and that I'm worth it. If nothing else. i want to be mentally balanced at all times, but what about all the many health problems I'm having now as a result of the obesity? Where does it end? Now I'm on a bigger cocktail of meds to include diabetic and cholesterol meds. Just one more pill to save the day and make me more miserable! Why can't today's pharmaceutical companies come up with an answer to these problems/side affects when there are so many other major scientific breakthroughs in the human body? I'm so discouraged, i want to quit it all. Time will tell. As for now, I'm through with the working out and dieting that have no results. And not one of my health professionals even pretends it's a major problem to have these side affects as long as I stay on their med routine for me! As long as I do what everyone else tells me to do, then Everyone Else is happy! Damn it all! I want to feel good about myself and be happy. Not just numbed out and miserable because there are no other alternatives! Why can't some one help us?!

In reply to by Anonymous (not verified)

Becky Oberg
June, 5 2011 at 8:02 am

I think in time that we as a society will find a way to treat a psychiatric condition with medication that doesn't have a side effect of obesity. Too many people are gaining weight as a result of these medications for it to be written off much longer. Trust me, I hope that day is soon! In the meantime, I do what I can to keep the weight gain under some degree of control: I walk as a form of transportation, and I try to eat responsibly (I'll admit a weakness for ice cream).
There are simply too many people who now have problems with obesity for it to be ignored much longer.

Cathy Sikorski
May, 27 2011 at 7:47 am

I have been on a bevy of cocktails for BPD over the last five years or so.
I went from 125 lbs to 165 lbs as a direct result of various medications but especially zyprexa. I got immediate relief from zyprexa and started putting on the lbs. I have been working out and dieting to lose the lbs
I put on and its slow-going. My meds have been reduced but that is not what is taking off the lbs. Everyone must weigh both the good and the bad when dealing with BPD.

In reply to by Anonymous (not verified)

Becky Oberg
June, 5 2011 at 8:05 am

Same thing happened to me--I went from 125 to almost 200, lost about 50, and have slowly gained back 20. I'm sick of my weight yo-yo-ing, but I'll take that over the voices and suicidal thinking any day.
Zyprexa is notorious for weight gain, but I've never been on that. All I know is that once I went on these meds, my weight shot up.

May, 25 2011 at 8:29 am

It's a crap shoot for sure ... especially over the long term. I have been taking an SSRI for major depression since the mid-1990s, and one of the 'side effects' that has become a long-term concern is an appetite that has been all but destroyed. It may be that some disorders of appetite, when considered in the context of long-term psychotropic use, are disorders of metabolism that are caused in some part by the medications themselves.

In reply to by Anonymous (not verified)

Becky Oberg
June, 5 2011 at 8:07 am

It's entirely possible that metabolic disorders are aggravated by psychotropic medications. An interesting fact is that serotonin plays a role in digestion, which is why I believe that there's a connection. How we can create SSRIs without the side effect of weight gain is a question to be solved by wiser minds than mine. I believe, however, that it's a matter of time--there are simply too many people becoming obese as a result of psych meds.

May, 25 2011 at 8:12 am

I've been on and off meds for depression. When I'm fat, it makes me depressed. So I end up being a fat depressed person on expensive medication that gives me other side effects plus is a nightmare to try and get off. I'd rather be skinny and depressed than fat and depressed.

Natasha Tracy
May, 24 2011 at 10:55 am

I'm always amazed that people don't understand this. For everything in life there is a price, you have to decide if you want to pay it. It's very simple. It's just like a 7-11. Sure, the cough drops are more, but where else are you going to find them at 3am?
(Of course, the trouble comes when you're fat and not happy. That's kind of the nasty bit.)
- Natasha

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