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Depression and low self-esteem are often associated with obesity.

Research shows that physical activity can reduce depression.

Exercise may make it easier to improve eating behaviors.

I hate to admit it, but Steve was right. Years ago, I directed a hospital-based weight-loss program. In addition to the nutritional advice from the hospital dietitian and the psychology groups and individual counseling sessions I provided, the program included a beginning aerobic class for the participants. Steve, a personal trainer at the hospital-owned gym, was tasked with leading the twice-weekly “aerobics for beginners” class.

My group meetings and individual counseling sessions had two parts: changing eating behaviors and overcoming the emotional issues, typically including depression and low self-esteem, that are associated with obesity. I disagreed with Steve when he said that physical activity would lift mood and improve self-esteem. Now, several decades later, research shows that Steve was right.

A paper in the British journal, BMJ, reviewed 218 studies that included over 14,000 participants. They found that, compared with control subjects, walking or jogging, yoga, strength training, mixed aerobic activities, and tai chi or qigong were associated with moderate reductions in depression. The reviewers noted that the effects on mood were proportional to the intensity of the activity; a short walk or light yoga session might not have much practical effect. The researchers concluded that walking, jogging, yoga, and strength training were most effective, especially when intensity is increased. Also, they found that exercise was equally effective for people with different degrees of depression.

Although this review revealed the benefits of exercise in treating depression, the authors didn’t suggest that it could replace other treatments. Rather, they conclude that exercise should be included with psychotherapy and or antidepressants as core treatments for depression.

While physical activity can lift depression, the studies reviewed didn’t see if there were any changes in eating and weight following the improved mood with exercise. Many other studies have found a complex link between obesity and depression. For example, a study of 65,000 nurses followed up over ten years found increased risk of obesity among the depressed women, although the linkage could be bidirectional. Depression might contribute to obesity, or being obese might make people depressed.

In my experience with the weight loss program, several women seemed depressed at the start of the program. I didn’t know if being depressed contributed to their obesity or being obese caused the depression. But what I did know was that participating in the exercise program lifted their mood. A few participants volunteered that, despite their initial reservations, they actually enjoyed the aerobics. The improved mood increased their motivation to follow through on the behavior changes that I discussed in the group meetings.

Exercise has many well-established health benefits, but there’s also a fringe benefit. It can help spur the behavioral changes needed for permanent weight loss.

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Noetel, M., Sanders, T. et al. Effect of exercise for depression: systematic review and network meta-analysis of randomised controlled trials. BMJ 2024;384:e075847

Pan, A., Sun, Q., et al. (2012). Bidirectional association between depression and obesity in middle-aged and older women. International Journal of Obesity, 36, 595-602.

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