Psycho-socio-biological correlates of moderate overweight in an industrial population

Disentangling the Drivers of Obesity: An Analytical Framework Based on Socioeconomic and Intrapersonal Factors

Obesity is increasing at exponential rates in developed economies despite the numerous policy interventions being implemented. The causes of obesity are multifactorial demanding a holistic review for targeted intervention. This study, therefore, provides a holistic overview of multiple factors affecting body weights i.e., socioeconomic and intrapersonal factors. We used data from a household and experimental survey carried out in Spain (Barcelona) in 2014. A non-linear path analysis was used considering the non-linear relationships that might exist between these factors and body weight. Results confirm non-linear relationships between some socioeconomic, intrapersonal factors and body weight. Among the intrapersonal factors, obesity is directly influenced by volitional control of obesity, attitude toward obese persons, holding a correct body image and body image dissatisfaction. Socioeconomic factors that have significant influence on obesity were age, education and gender. Risk attitudes do not correlate with obesity.

Are changes in body-mass-index associated with changes in depressive symptoms? Findings of a population-based longitudinal study among older Germans

BACKGROUND

The longitudinal relationship between BMI and depressive symptoms is not well understood. Therefore, we aimed at investigating the long-term association between body-mass-index (BMI) and depressive symptoms among older Germans.

METHODS

Data were derived from a population-based longitudinal study of adults aged 40 and above in Germany (German Ageing Survey, DEAS). Four waves (2002-2014) were used. Depressive symptoms was assessed by the Center for Epidemiologic Studies Depression Scale (CES-D). Linear, quadratic and cubic terms were included for self-reported BMI. Fixed effects regressions were used to estimate the predictors of depressive symptoms.

RESULTS

FE regressions showed a curvilinear effect of BMI on depressive symptoms in the total sample and in women, but not men, with significant gender differences. In sum, the greater the extreme of BMI (either higher or lower), the greater the risk for depressive symptoms in the total sample and in women.

CONCLUSION

Our findings indicate that the effect of BMI on depressive symptoms is by no means simple. The current study highlight the importance of comprehensive treatment of depression, which include management of (extreme) weight to manage depressive symptoms.

Depression and peripheral inflammatory profile of patients with obesity

This narrative review will present and discuss clinical data from 16 cross-sectional and 6 longitudinal studies examining the relationship between body mass index (BMI), symptoms of depression and peripheral inflammation. Our aim is to determine which of obesity and depression contributes best to the peripheral low-grade inflammation frequently associated to both conditions. Studies including a complete evaluation of inflammatory markers are scarce and high levels of interleukin-6 (IL-6) and C-reactive protein (CRP) are the most consistent findings associated with obesity and symptoms of depression. Among the cross-sectional studies, seven studies, including a total of 9421 individuals, pointed to BMI as the major factor associated with systemic low-grade inflammation. However, in four studies, including 16,837 individuals, CRP levels remained associated with the symptoms of depression even after correction for BMI, suggestion that in the absence of overweight or obesity other sources of peripheral inflammation might contribute to presence of depressive symptoms. Additionally, another five studies, including 5569 individuals failed to find an association between depression and peripheral inflammation, reinforcing the heterogeneity of this condition. In the longitudinal data, changes in BMI were associated with a reduction in depressive scores at follow-up, after bariatric surgery or after diet. In four longitudinal studies, high levels of CRP were found to be associated with depression even after adjustment for BMI and weight loss, further corroborating the idea that other sources of peripheral inflammation might contribute to depressive symptoms. Thus it seems that both obesity and depressive symptoms can contribute to peripheral inflammation, and once installed the presence of inflammation can contribute to several behavioral alterations that reinforce the cyclic pattern of co-occurrence observed in patients with obesity and MDD. Future clinical studies should focus on strategic efforts to collect new data and to improve or standardize methods for the evaluation of depression, body composition and a more complete inflammatory profile. These approaches are essential for the development of pharmacological and/or non-pharmacological strategies designed to break this cyclic pattern of co-occurrence.

Body weight, perceived weight stigma and mental health among women at the intersection of race/ethnicity and socioeconomic status: insights from the modified labelling approach

With increasing rates of obesity in the United States, attention to life chances and psychological consequences associated with weight stigma and weight-based discrimination has also intensified. While research has demonstrated the negative effects of weight-based discrimination on mental health, little is known about whether different social groups are disproportionately vulnerable to these experiences. Drawing on the modified labelling theory, the focus of this paper is to investigate the psychological correlates of body weight and self-perceived weight-based discrimination among American women at the intersection of race/ethnicity and socioeconomic status (SES). Analyses use data from the National Health Measurement Study (NHMS), a national multi-stage probability sample of non-institutional, English-speaking adults, ages 35 to 89 in 2005-2006. Our findings demonstrate that the effect of weight-based discrimination on psychological well-being is highly contingent on social status. Specifically, the psychological consequences of discrimination on Hispanic women and women in the lowest household income group is significantly greater relative to White women and women with higher household income, controlling for obesity status and self-rated health. These results suggest that higher social status has a buffering effect of weight stigma on psychological well-being.

The impact of marriage and parenthood on male body mass index: Static and dynamic effects

RATIONALE

Numerous cross-sectional studies investigated the link between marital status and BMI in the context of competing social science theories (marriage market, marriage selection, marriage protection and social obligation), frequently offering conflicting theoretical predictions and conflicting empirical findings.

OBJECTIVE

This study analysed the effects of marriage, divorce, pregnancy, and parenthood on male BMI in a longitudinal setting, avoiding the estimation bias of cross-sectional studies and allowing for an analysis of BMI fluctuation over time and the dynamic effects of these events.

METHOD

Using the Panel Study of Income Dynamics 1999-2013 dataset (N = 8729), this study was the first to employ a dynamic panel-data estimation to examine the static and dynamic effects of marriage, divorce, and fatherhood on male BMI.

RESULTS

The study showed that married men have higher BMI, but marital status changes largely drove this static effect, namely, an increase in BMI in the period following marriage, and a decrease in BMI preceding and following divorce.

CONCLUSIONS

Thus, this study found marked evidence in support of the marriage market and social obligation theories' predictions about male BMI, and supports neither marriage protection theory nor marriage selection theory. Wives' pregnancies had no significant effect on BMI; instead, men tend to have higher BMI in the periods following childbirth. Finally, analyses showed marked contemporaneous correlations between husband and wife BMI over the course of marriage.

Adiposity, hypertension and weight management behaviours in Ghanaian type 2 diabetes mellitus patients aged 20-70 years

OBJECTIVE

This study assessed the prevalence of general and abdominal obesity and hypertension as well the weight management behaviours of type 2 diabetes mellitus patients.

METHODS

It included 378 diabetes patients seeking care from two hospitals in Ghana. Standard methods and tools were used to assess participants' weight, height, waist circumference (WC), blood pressure (BP) and fasting plasma glucose (FPG). Weight management behaviours were measured using a questionnaire.

RESULTS

The prevalence of general obesity, abdominal obesity and hypertension was 20.1%, 46.6% and 67.7% respectively. Abdominal obesity was more likely in participants who: skipped breakfast, engaged in exercise to lose weight and were generally overweight/obese. General overweight and obesity was more likely in participants who: reported receipt of weight management counselling, engaged in exercise to lose weight, had a weight management plan/goal, and were abdominally obese. Hypertension was less likely in participants who had: no formal education, diabetes for ≥5 years and modified their dietary habits to lose weight but more likely in those who skipped breakfast.

CONCLUSION

Abdominal obesity, general overweight/obesity, and hypertension were frequent in this sample and were influenced by weight management behaviours.

Lifestyle risk factors of general and abdominal obesity in students of the school of medicine and health science of the university of development studies, tamale, ghana

This study evaluated the prevalence of general and abdominal obesity among students of the University for Development Studies, School of Medicine and Health Sciences (UDS-SMHS), Tamale, Ghana. Also, lifestyle risk factors for the two obesity indices were investigated. This study was conducted among a sample of 646 students. Anthropometric measures of weight, height, and waist circumference were appropriately assessed. The prevalence of general and abdominal obesity was 1.9% and 4.2%, respectively. Risk factors of general obesity were being female (crude OR = 6.9, 95% CI = 1.85-25.80, P = 0.0021), engaging in light PA (OR = 12.45, 95% CI = 2.96-52.41, P = 0.0006), being aged 28-37 years (OR = 5.37, 95% CI = 1.39-20.68, P = 0.0329), nonintake of coffee (OR = 4.1, 95% CI = 1.10-15.28, P = 0.0357), being married (OR = 5.7, 95% CI = 1.48-22.02, P = 0.0286), and being abdominally obese (OR = 02.7, 95% CI = 25.61-11.60, P < 0.0001). Risk factors for abdominal obesity were being female, being married, having general obesity, and nonintake of coffee. Abdominal obesity was more prevalent than general obesity. Risk factors included being female, married, and generally obese and nonintake of coffee.

Extraverted children are more biased by bowl sizes than introverts

Extraverted children are hypothesized to be most at risk for over-serving and overeating due to environmental cues--such as the size of dinnerware. A within-subject field study of elementary school students found that extraverted children served themselves 33.1% more cereal in larger bowls (16-oz) than in smaller (12-oz) bowls, whereas introverted children were unaffected by bowl size (+5.6%, ns). However, when children were asked by adults how much cereal they wanted to eat, both extraverted and introverted children requested more cereal when given a large versus small bowl. Insofar as extraverted children appear to be more biased by environmental cues, this pilot study suggests different serving styles are recommended for parents and other caregivers. They should serve extraverts, but allow introverts to serve themselves. Still, since the average child still served 23.2% more when serving themselves than when served by an adult, it might be best for caregivers to do the serving whenever possible--especially for extraverted children.

Obesity and depressive symptoms in the elderly: a survey in the rural area of Chizhou, Anhui province

OBJECTIVE

The aim of the present study is to examine the relationship between obesity and depressive symptoms and to test the "Jolly Fat" hypothesis among older Chinese.

METHODS

A total of 736 rural Chinese aged 60 years and older participated in this cross-sectional study. Body mass index (BMI = kg/m(2) ) was calculated from the subjects' measured weight (kg) and height (meter). Depressive symptoms were assessed using the 30-item Geriatric Depression Scale (GDS-30), with a cut-off point of 11.

RESULTS

Among 736 total participants, the prevalence of depressive symptoms was 24.1% in men and 27.9% in women. A trend about depressive symptoms decreased with increasing BMI was found in men (χ(2) trend = 5.74, df = 1, p = 0.01). A weak inverse linear trend between obesity and depressive symptoms was observed among subjects. In men, obese group was less likely to suffer from depressive symptoms compared with normal weight group before or after adjustment for confounders, with odds ratios of 0.32 (95% confidence interval (CI): 0.12-0.85) and 0.28 (95% CI: 0.09-0.85), respectively. However, the association between BMI and depressive symptoms in women showed no significant differences.

CONCLUSIONS

Our results supported the "Jolly Fat" hypothesis only in rural older Chinese men, but not in women. Gender differences existed in the relationship between obesity and depressive symptoms.

Personality and American state differences in obesity prevalence

The study was conducted to determine whether state obesity-prevalence rates can be predicted by state differences in residents' levels on the Big Five personality variables (O. P. John & S. Srivastava, 1999). State obesity prevalence was the mean percentage of the state population from 2000 to 2005 with a body mass index > or = 30.0 as assessed by the Behavioral Risk Factor Surveillance System (Centers for Disease Control and Prevention, 2010), which currently interviews more than 350,000 adults annually. State neuroticism, extraversion, agreeableness, conscientiousness, and openness z scores, based on the responses of 619,397 residents to an Internet survey from 1999 to 2005, were taken from P. J. Rentfrow, S. D. Gosling, and J. Potter (2008). Alaska, Hawaii, and North Dakota had scores outside -3 and +3 standard deviations on at least 1 variable and were excluded as outliers. For the 47 remaining states, state obesity prevalence was significantly correlated with neuroticism (.35), agreeableness (.38), openness (-.44), socioeconomic status (-.74), white percentage (-.34), and urbanization (-.43). Multiple regression analysis showed that socioeconomic status could account for 54.0% of the criterion variance and that agreeableness, neuroticism, and openness together could account for another 17.1%.

Neuropsychiatric adverse effects of centrally acting antiobesity drugs

INTRODUCTION

Central neurochemical systems including the monoamine, opioid, and cannabinoid systems have been promising targets for antiobesity drugs that modify behavioral components of obesity. In addition to modulating eating behavior, centrally acting antiobesity drugs are also likely to alter emotional behavior and cognitive function due to the high expression of receptors for the neurochemical systems targeted by these drugs within the fronto-striatal and limbic circuitry.

METHODS

This paper reviewed the neuropsychiatric adverse effects of past and current antiobesity drugs, with a central mechanism of action, linking the adverse effects to their underlying neural substrates and neurochemistry.

RESULTS

Antiobesity drugs were found to have varying neuropsychiatric adverse event profiles. Insomnia was the most common adverse effect with drugs targeting monoamine systems (sibutramine, bupropion and tesofensine). These drugs had some positive effects on mood and anxiety and may have added therapeutic benefits in obese patients with comorbid depression and anxiety symptoms. Sedation and tiredness were the most common adverse effects reported with drugs targeting the m-opioid receptors (i.e., naltrexone) and combination therapies targeting the opioid and monoamine systems (i.e., Contrave™). Cognitive impairments were most frequently associated with the antiepileptic drugs, topiramate and zonisamide, consistent with their sedative properties. Drugs targeting the cannabinoid system (rimonabant and taranabant) were consistently associated with symptoms of anxiety and depression, including reports of suicidal ideation. Similar adverse events have also been noted for the D₁/D₅ antagonist ecopipam.

CONCLUSION

These findings highlight the need to assess neuropsychiatric adverse events comprehensively using sensitive and validated methods early in the clinical development of candidate antiobesity drugs with a central mechanism of action.

Chronic pain and major depressive disorder in the general population

This study aims (1) to assess the prevalence of Chronic Painful Physical Condition (CPPC) and major depressive disorder (MDD) in the general population; (2) to evaluate their interaction and co-morbidity with sleep and organic disorders; and (3) to investigate their daily functioning and socio-professional consequences. A random sample of 3243 subjects (18years), representative of California inhabitants, was interviewed by telephone. CPPC duration was at least 6months. Frequency, severity, duration and consequences on daily functioning, consultations, sick leave and treatment were investigated. MDD were assessed using DSM-IV criteria. The point prevalence of CPPC was 49% (95% confidence interval: 47.0-51.0%). Back area pain was the most frequent; 1-month prevalence of MDD was at 6.3% (95% CI: 5.5-7.2%); 66.3% of MDD subjects reported at least one CPPC. In 57.1% of cases, pain appeared before MDD. Pain severity was increased by poor sleep, stress and tiredness in MDD subjects. Being confined to bed, taking sick leave and interference of pain with daily functioning were twice as frequent among MDD subjects with CPPC than in non-MDD subjects with CPPC; obese individuals with CP were 2.6 times as likely to have MDD. Pain is highly linked with depressive disorder. It deteriorates physical, occupational and socio-professional activities. Pain and sleep disturbances are a prime motive of consultation rather than depressed mood, underlining the risk of missing a depression diagnosis.

Are body dissatisfaction, eating disturbance, and body mass index predictors of suicidal behavior in adolescents? A longitudinal study

Disordered eating, body dissatisfaction, and obesity have been associated cross sectionally with suicidal behavior in adolescents. To determine the extent to which these variables predicted suicidal ideation and attempts, the authors examined these relationships in a longitudinal design. The study population included 2,516 older adolescents and young adults who completed surveys for Project EAT-II (Time 2), a 5-year follow-up study of adolescents who had taken part in Project EAT (Time 1). Odds ratios for suicidal behaviors at Time 2 were estimated with multiple logistic regression. Predictor variables included Time 1 extreme and unhealthy weight control behaviors (EWCB and UWCB), body dissatisfaction, and body mass index percentile. Suicidal ideation was reported by 15.2% of young men and 21.6% of young women, and suicide attempts were reported by 3.5% of young men and 8.7% of young women. For young women, suicidal ideation at Time 2 was predicted by Time 1 EWCB. The odds ratio for suicide attempts was similarly elevated in young women who had reported EWCB at Time 1. These odds ratios for both suicidal ideation and suicide attempts remained elevated even after controlling for Time 2 depressive symptoms. In young men, EWCB was not associated with suicidal ideation or suicide attempts 5 years later. Body mass index and body dissatisfaction did not predict suicidal ideation or suicide attempts in young men or young women. These results emphasize the importance of EWCB.

Investigating the Validity of Stereotypes About Overweight Employees

Research indicates that overweight job applicants and employees are stereo-typically viewed as being less conscientiousness, less agreeable, less emotionally stable, and less extraverted than their “normal-weight” counterparts. Together, the two reported studies investigate the validity of those stereotypes by examining the relationship between body weight and four relevant personality traits (conscientiousness, agreeableness, emotional stability, extraversion) using three measures of body weight (body mass index [BMI] based on self-reported height and weight, BMI based on clinically assessed height and weight, percentage body fat assessed by bio-impedance technology) in a diverse group of 3,496 adults from the United States. There is substantial convergence between the two studies, with findings tending to refute commonly held stereotypes about the personality traits of overweight employees.

Personality and body mass index: a cross-sectional analysis from the Miyagi Cohort Study

OBJECTIVE

Obesity is an increasingly prevalent public health problem worldwide, and is associated with a higher risk of developing various noncommunicable diseases. To further examine the association between personality and overweight, obesity, or underweight, we conducted a cross-sectional analysis in Japan. We hypothesized that extraversion and psychoticism would have a positive association with overweight, and that neuroticism and lie would have an inverse association with overweight, whereas the association between personality and underweight would be the reverse image of overweight.

METHODS

In 1990, 30,722 subjects (40-64 years of age) completed a self-administered questionnaire including body weight and height and the Japanese version of the Eysenck Personality Questionnaire-Revised Short Form. Multivariate logistic regression analysis was used to calculate odds ratios for overweight [body mass index (BMI)> or =25.0 kg/m2] or underweight (BMI<18.5) relative to each category on the personality subscale.

RESULTS

In men and women, extraversion and psychoticism had positive associations with overweight, whereas neuroticism had an inverse association. Lie had an inverse association with overweight in men. In men and women, only extraversion had an inverse association with underweight and neuroticism had a positive association with underweight.

CONCLUSION

Our findings indicate that personality is associated with both overweight and underweight. These results may provide clues to devising more effective measures for preventing overweight, obesity, or underweight or for weight control intervention.

Epidemiology of depression and its treatment in the general population

This study examines the correlates of a major depressive disorder and its treatment in the general population. The sample was composed of 6694 individuals aged between 18 and 96 years, representative of the general population of the states of California and New York (48 million inhabitants aged 18 years or older). They were interviewed by telephone using the Sleep-EVAL system. The interviews included various sleep and health topics and the assessment of DSM-IV sleep and psychiatric disorders. The 1-month prevalence of a major depressive disorder was 5.2% in the sample, and was higher in women, middle-aged and non-Hispanic white individuals. Obesity (BMI > or =30kg/m(2)), poor health status and smoking were also strongly correlated with a major depressive disorder. A total of 57.7% of depressed subjects were receiving some forms of treatment for depression: 28.3% were taking antidepressants (alone or in combination with psychiatric health care) and 29.4% received psychiatric health care (without antidepressant medication). Severity of depression, ethnicity and weight (overweight or obese) were strongly associated with the presence of treatment. A major depressive disorder is frequent in the general population. Although its identification and treatment have improved over the years, some segments of the population, namely elderly and non-white individuals are less likely to receive appropriate care.

Psychopathology and obesity

Obesity has historically been linked to emotional factors by clinicians and the lay public alike. Early psychiatric studies reinforced the popular perception that psychopathology is common among the overweight and plays an important role in the development of obesity. This notion has been challenged by recent investigations which suggest that psychological disturbances are more likely to be the consequences than the causes of obesity. Emotional difficulties faced by the obese may be largely attributable to an entrenched cultural contempt for the obese and a pervasive preoccupation with thinness.

Depressive mood and obesity in US adults: comparison and moderation by sex, age, and race

OBJECTIVE

Sustained depressive mood is a gateway symptom for a major depressive disorder. This paper investigated whether the association between depressive mood and obesity differs as function of sex, age, and race in US adults after controlling for socio-economic variables of martial status, employment status, income level and education level.

METHODS

A total of 44,800 nationally representative respondents from the 2001 Behavioral Risk Factor Surveillance Survey were studied. Respondents were classified as having experienced a depressive mood if they felt sad, blue, or depressed at least for 1 week in the previous month. The depressive mood was operationalized in terms of duration and sustenance, both defined based on number of days with depressive mood: 7+ and 14+ days. Age groups were classified as young (18-64 years) and old (65+ years). Obesity status was classified as: not overweight/obese (BMI<25); overweight (25<or=BMI<30); obese (BMI>or=30).

RESULTS

Prevalence of prior-month depressive mood was 14.3 and 7.8% for 7+ and 14+ days, respectively. Controlling for race and socio-economic variables, both young overweight and obese women were significantly more likely to have experienced depressive mood than nonoverweight/nonobese women. Young overweight, but not obese, men were significantly more likely to have experienced depressive mood than nonoverweight/nonobese men. Young obese women were also significantly more likely to have a sustained depressive mood than nonoverweight/nonobese women. For old respondents, depressive mood and its sustenance were not associated with obesity in either sex.

DISCUSSION

The relationship between the depressive mood and obesity is dependent upon gender, age, and race. Young obese women, Hispanics in particular, are much more prone to depressive mood than nonobese women. Future studies testing associations between depression and obesity should be sensitive to the influence of these demographic and socio-economic variables.

Depression in adolescent obesity: cultural moderators of the association between obesity and depressive symptoms

OBJECTIVE

Community studies relating depression to obesity in adolescents have generated inconsistent results. It has been argued that the variability in findings is due to effect modification by demographic characteristics that vary across samples. The aim of this study was to test the hypothesis that the strength of the obesity-depression association is moderated by gender, ethnicity and socioeconomic status (SES).

RESEARCH METHODS AND PROCEDURES

Data were from two large, school-based, studies of adolescent health and well-being (n=4320; n=1824). Students completed one of two measures of depressive symptoms (SDQ; CES-D) in school and were weighed and measured. Gender and ethnicity were self-reported and SES was indexed by residential neighbourhood characteristics or individual family deprivation.

RESULTS

There was barely any association between obesity and depressive symptoms in either sample. There was also no evidence that obese participants who were female, white or from higher SES backgrounds were especially vulnerable to depressive symptoms.

DISCUSSION

The results indicate that in community samples of adolescents, regardless of gender, SES or ethnicity, reports of depressive symptoms are not significantly higher in obese than normal-weight groups. The results are discussed in terms of obese adolescents' resilience in the face of multiple social adversities.

Subgrouping in obesity based on Rorschach personality characteristics

Conceptual (a priori) subgroups in obesity based on personality findings from the Rorschach Comprehensive System were suggested for 100 obese patients. The subgroups were further compared in terms of general anamnestic and behavioral data. The largest subgroup was Rorschach characterized by difficulties with emotions and a tendency towards depression. Demographic and behavioral data for this subgroup revealed intermediate or higher education, regular meals, eating disorders like binge eating, periodic variations in eating during the year and experiencing body size as having a psychological meaning. The other subgroup was characterized by coping liabilities and was further associated with a lower socio-economic level and irregular or chaotic meal patterns. For the group with emotional difficulties, the results suggest a more complex psychological pattern, where eating and emotions could be closely related. The group with coping liabilities could have difficulties other than emotional ones concerning food and eating, such as finding a structure for eating and making changes in lifestyle and habits.

Relationship between body-mass index and depressive symptoms in patients with major depression

BACKGROUND

Appetite and weight changes are commonly occurring symptoms of depressive illness. The occurrence of these symptoms may not only be related to depressive mood but may also be related to body weight.

AIM

To examine the relationship between symptoms of depression and body weight.

METHODS

Symptoms of depression were assessed by the Montgomery-Asberg depression rating scale (MADRS) in 1694 patients seeking medical help and fulfilling DSM-IV criteria for a major depressive episode. The level of anxiety was evaluated by Covi's anxiety scale. Body weight was expressed as body-mass index (BMI, kg/m(2)) and treated both categorically and continuously.

RESULTS

The total MADRS score was not statistically different across the four BMI categories (underweight: 32.3 +/- 0.6, normal weight: 30.9 +/- 0.2, grade 1: 30.6 +/- 0.3, and 2 overweight: 30.6 +/- 0.6, P = 0.053 (NS)). In women with BMI <or= 18.5 kg/m(2) MADRS was significantly higher than that in other BMI categories (underweight: 32.4 +/- 0.6, normal weight: 30.6 +/- 0.2, grade 1: 30.6 +/- 0.4, and 2 overweight: 30.6 +/- 0.6: P = 0.036). Increasing BMI was related to a linear decrease in symptoms "Reduced appetite" (P < 0.0001) and "Pessimistic thoughts" (P < 0.003). The presence of melancholic or atypical features was not associated with lower or higher BMI, respectively.

CONCLUSIONS

In patients with major depression higher body weight is likely to be associated with less reduction in appetite and less pessimistic thoughts.

Are the fat more jolly?

Does obesity affect mental health? Two waves of data from a panel study of community residents 50 years and older were used to investigate the association between obesity and eight indicators of mental health: happiness, perceived mental health, life satisfaction, positive affect, negative affect, optimism, feeling loved and cared for, and depression. For none of the eight mental health outcomes examined did we observe a protective effect for obesity. Either no association was observed between obesity and psychological functioning, or the obese were worse off. Using 1994-1999 prospective data, the obese were at increased risk for poorer mental health on five of the outcomes examined using bivariate analyses. However, controlling for mental health problems at baseline and using statistical controls for covariates, the increased relative risk was limited to depression. There has been sufficient disparity of results thus far to justify further research on this question.

Obesity-depression associations in the population

This article summarizes data on the relationship between obesity and depression in the population. Both obesity and depression are increasingly prevalent and associated with numerous health complications including hypertension, coronary heart disease, and increased mortality. There does not appear to be a simple or single association between these disorders. Meta-analytic studies suggest no statistically significant relationship, although pooling all subjects may mask important variables that moderate or mediate potential covariations. Sociodemographic, psychosocial, and genetic factors may render certain obese individuals more prone to depression or vice versa. Physiological and behavioral variables that link obesity and depression have received limited study. There are likely multiple obesity-depression covariations in the population, rather than a single pattern of association. There is a need for longitudinal and mechanistic studies to understand casual pathways and greater collaboration between depression and obesity specialists.

The association between childhood depression and adulthood body mass index

OBJECTIVE

Stress in childhood relates to both childhood depression and elevated adult body mass index (BMI), a measure of relative overweight. However, there are limited data on the association between major depression in childhood and BMI in adulthood. The current study examines this association.

METHOD

Children 6 to 17 years old with major depression (n = 90) or no psychiatric disorder (n = 87) were identified at Columbia Presbyterian Medical Center and followed up 10 to 15 years later. Psychiatric status at intake and follow-up was assessed via standardized psychiatric interviews. BMI during adulthood was recorded so that the association between depression and BMI could be considered over time.

RESULTS

Participants with childhood major depression had a BMI of 26.1 +/- 5.2 as adults, compared with a BMI of 24.2 +/- 4.1 in healthy comparisons (t(175) = 2.7). This association could not be explained by a number of potentially confounding factors, including age, gender, cigarette or alcohol use, social class, and pregnancy or medication history. Although poverty during adulthood also predicted adult BMI, both the association between poverty and adult BMI (t(152) = 2.9), as well as between childhood depression and adult BMI (t(152) = 2.2) were significant in a multivariate model. Finally, duration of depression between childhood and adulthood also emerged as a predictor of adult BMI.

CONCLUSIONS

Depression during childhood is positively associated with BMI during adulthood. This association cannot be explained by various potential confounding variables and may develop over time as children pass into their adult years.body mass index, depression, children, adolescents.

Quality of life, overweight, and body fat distribution in middle-aged men

Measurements of obesity [body mass index (BMI)] and body fat distribution [waist-to-hip ratio (WHR)] were analyzed in 284 51-year-old men in relation to items about social, mental, and physical well-being from the Göteborg Quality of Life Instrument. Overweight participants (BMI > or = 25) reported a better home-family situation, appetite, and self-esteem, but decreased physical fitness and more pain in the legs compared with their leaner counterparts. Men with abdominal obesity (WHR > or = 1.0) experienced impaired health and physical fitness and lower self-esteem compared with those with WHR < 1.0. The abdominally obese participants were more often exhausted and experienced depressive symptoms. Abdominal pain was more frequent among those with WHR > or = 1.0. Overweight and abdominal obesity seem differently associated with social, mental, and physical well-being in men. Impaired quality of life may be causally related to the development of abdominal obesity; the mechanism involved might be increased cortisol secretion, which can redistribute body fat to central adipose tissue depots.

Relationships between obesity and DSM-IV major depressive disorder, suicide ideation, and suicide attempts: results from a general population study

OBJECTIVES

This study sought to test the relationships between relative body weight and clinical depression, suicide ideation, and suicide attempts in an adult US general population sample.

METHODS

Respondents were 40,086 African American and White participants interviewed in a national survey. Outcome measures were past-year major depression, suicide ideation, and suicide attempts diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. The primary predictor was relative body weight, treated both continuously (i.e., body mass index [BMI]) and categorically in logistic regression analyses. Covariates included age, income and education, disease status, and drug and alcohol use.

RESULTS

Relative body weight was associated with major depression, suicide attempts, and suicide ideation, although relationships were different for men and women. Among women, increased BMI was associated with both major depression and suicide ideation. Among men, lower BMI was associated with major depression, suicide attempts, and suicide ideation. There were no racial differences.

CONCLUSIONS

Differences in BMI, or weight status, were associated with the probability of past-year major depression, suicide attempts, and suicide ideation. Longitudinal studies are needed to differentiate the causal pathways and mechanisms linking physical and psychiatric conditions.

Psychiatric symptoms in adolescence as predictors of obesity in early adulthood: a longitudinal study

OBJECTIVES

This study examined the longitudinal relationship between psychopathology and obesity in young adulthood.

METHODS

More than 700 youth in a population-based sample were psychiatrically assessed in 1983 (mean age = 14 years) and 1992 (mean age = 22 years). Self-reported body mass index (BMI) in 1992 was regressed on measures of depression and conduct disorder as well as a set of covariates including indices of physical health, social class, intelligence, and cigarette and alcohol use. Associations were examined with BMI treated as a continuous variable and with a binary index of obesity derived from the BMI distribution in each gender.

RESULTS

BMI in young adults was positively related to a number of covariates. With all covariates controlled, BMI was inversely related to adult depressive symptoms in males but not females. BMI was positively related to adolescent symptoms of conduct disorder in both sexes. Similar associations were found between psychiatric symptoms and obesity.

CONCLUSIONS

Conduct disorder symptoms in adolescence predicted BMI and obesity in early adulthood. These associations remained after controlling for factors that can affect the association between psychopathology and obesity.

Personalities and alimentary behaviors in obese patients

The actual tendency in the care of obese patients is the association of dietetic information with an eating behavior therapy. Studies attempting to attribute the origin of obesity to psychiatric pathologies are contradictory. We studied whether certain eating disorders are more specific to a personality type. We studied eating disorders with the Eating Disorder Inventory (EDI) test in 281 obese women compared to 252 age-matched non-obese women. Both obese patients and non-obese volunteers were divided into four groups depending upon their personality (PERSONA test). This test defines four types of personality, based on the level of emotion (expansive or reserved) and the degree of power (dominant or consenting). According to our study, eating disorders vary between the four personality groups and were significantly higher in the facilitating group (consenting and expansive) compared to the three other obese groups. Neither promoting (expansive and dominant) nor controlling obese patients (dominant and reserved) present eating disorders. The analyzing obese patients (reserved and consenting) are reticent when it comes to consulting (18%) since they distrust others. Analyzing obese patients present an interpersonal distrust and an interoceptive awareness. The group which presents most eating disorders is that of facilitating obese patients (consenting and expansive). These present eating disorders of the compulsive types favored by interoceptive awareness, body dissatisfaction, ineffectiveness, and maturity fears. The diversity, even the absence, of eating disorders brought to evidence by our tests based upon different personality types should allow better understanding of the psychological and behavioral causes of weight gain and the means for improving compliance in the following of an obese patient.

Depressive symptoms in overweight and obese older adults: a test of the "jolly fat" hypothesis

The association between body weight and depressive symptoms in older adults was examined in a population-based study of 2,245 noninstitutionalized men and women aged 50 to 89 years living in Rancho Bernardo, California, U.S.A. The prevalence of Beck Depression Inventory scores > or = 13 was inversely associated with body weight in men, but not in women. Overweight and obese 50- to 69-yr-old women were more depressed than women with a body mass index below 25 kg/m2, but the difference was only marginally significant (p = 0.09). When age, health status and medication use were controlled, the odds of being depressed were 0.34 (p = 0.004) in overweight men and 0.28 (p = 0.09) in obese men, compared to men with a body mass index below 25 kg/m2. In this cohort, depression in men was inversely associated with body weight, supporting the "Jolly Fat" hypothesis. The likelihood that more stigma is attached to excessive weight in women than men may account for the lack of an inverse association between weight and depression in women.

Psychological characteristics of binging and nonbinging obese women

A representative sample from a nonclinical population was drawn to compare bingers and nonbingers across weight categories. Subjects were 112 women drawn from a cross-section of undergraduate classes at a large state university. Four groups were formed: obese bingers, obese nonbingers, normal-weight bingers (bulimics), and normal-weight nonbingers. Bingers, regardless of weight category, suffered higher levels of depression and anxiety and lower levels of self-esteem than nonbingers, regardless of weight category. Obese nonbingers were indistinguishable on these variables from normal-weight nonbingers, with both groups of nonbingers experiencing less emotional distress. Results support the position that the obese population should be conceptualized and treated as a diverse group with different psychological characteristics and needs.

Marital status, fatness and obesity

Marital status is related to morbidity and mortality, with married people healthier and at lower risk of death than those who are unmarried (especially among men). However, the relationship between marital status and obesity is not well established. Role theory suggests through a marital causation model that people in the marital role are more likely to be obese, and through a marital selection model that people in the marital role are less likely to be obese because of stigmatization. The martial causation model was examined using data from the National Survey of Personal Health Practices and Consequences, a cross-sectional national telephone survey of 3025 adults age 20-64 in the United States. Sequential regression analyses revealed that married men were significantly fatter and more likely to be obese than never married or previously married men, even when demographic, social, and physical variables were controlled. By contrast, marital status was not significantly associated with fatness or obesity among women when other variables were controlled. The marital role appears to influence fatness and obesity among men, but not women.

Interrelationships between psychological factors, overweight, and blood pressure in adolescents

Relationships between psychological factors and physical factors such as body mass, overweight, and blood pressure were examined in a sample of black and white adolescents enrolled in health science courses. Black female adolescents were significantly more overweight and obese than either other group. Psychological factors were not significantly associated with body mass (weight/height) for females. A small percentage of the variance in body mass for black (6%) and white (4%) males was explained by Trait Anger, the frequent experience of anger and the intensity of anger (S-Anger-Reaction/TP) in pressure situations. Trait Anger also significantly (p less than 0.01) discriminated between black male adolescents who were normal weight and those 20% overweight for age and height. The relationships between traditional risk factors and blood pressure among adolescents who were 20% underweight, normal weight, and 20% overweight for age and height suggest that few traditional risk factors contribute significantly to the prediction of blood pressure in overweight adolescents. In contrast, psychological measures of suppressed anger (Anger-In, Anger Expression) were significantly (p less than 0.001) associated with blood pressure among overweight adolescents. The findings regarding the associations between overweight and psychological factors are complex. Prospective studies using better measures of overweight are needed to clarify the processes involved.

Psychological features of obesity

The study of obesity from a variety of psychological perspectives has been exciting and inventive, although we still do not understand fully the role of psychological variables in the etiology of obesity. Many of the factors thought to be of etiologic significance--field dependence, lack of impulse control, inability to delay gratification, or a maladaptive eating style--have not been supported by experimental evidence. Other factors once thought to be of importance as causes of obesity, depression and dysphoria, for example, appear, instead, to be consequences of being obese and may serve to maintain and intensify weight-related problems. Dieting behavior in response to weight concerns appears, perversely, to be implicated in increasing overweight and adiposity. Finally, arousability in response to food cues in the environment may play a causal role in some obesities.

Pharmacological treatment of tobacco dependence

Pharmacologically based approaches for the treatment of tobacco dependence are reviewed. The rational basis for pharmacologic treatment approaches is that tobacco dependence is partially, and critically, mediated by the actions of tobacco-delivered nicotine to the central nervous system. These actions include direct reinforcing properties of nicotine itself, tolerance and physiologic dependence, possible beneficial effects of nicotine in the alleviation of anxiety and control of weight, and neurohormonal regulation which can become important to the maintenance of emotional well-being and performance at work. Insofar as tobacco abstinence leads to negative consequences, via these biobehavioral mechanisms, pharmacologic intervention should be able to assist in initial tobacco detoxification and help tobacco abstinent persons to avoid subsequent relapse. The purpose of this review is to survey some of the efforts to develop such interventions, as well as to elucidate some of the issues relevant to such development. Four distinct approaches are discussed: (1) Nicotine replacement, in which physiologic dependence is transferred to a safer and more therapeutically manageable nicotine delivering formulation; this category includes nicotine polacrilex gum; (2) Blockade therapy, in which a drug is taken that blocks the reinforcing properties of nicotine should relapse occur; (3) Nonspecific pharmacotherapy, in which the biobehaviorally mediated correlates of tobacco abstinence are treated on a symptomatic basis; (4) Deterrent therapy, in which a drug is taken prior to smoking such that any tobacco use would produce reliable aversive effects.

Behavior, stress, and psychosocial traits as risk factors

Although psychosocial factors have long been associated with the pathogenesis of heart disease, the independent relation between these variables and coronary heart disease (CHD) is still controversial. However, when experimental, clinical pathological, and epidemiologic studies are taken together, strong evidence is provided that psychosocial and behavioral factors are important in the development and the provocation of clinical CHD manifestations. Heterogeneity in study results is partially due to methodological problems in defining and measuring behavior, stress, and psychosocial traits in population groups as well as in individuals. The difficulties in separating the role of psychosocial factors from the classic risk factors strengthen the importance and need for these factors to be considered in the design of further clinical and epidemiologic studies, not only to explore their independent predictive value but also to study their role in adherence to preventive advice and in the reversibility of risk. In these respects results are presented from a prospective epidemiologic and from a controlled multifactorial intervention study.

Metrological study of psychological questionnaires with reference to social variables: the Belgian Heart Disease Prevention Project (BHDPP)

In the framework of a controlled trial on the multifactorial prevention of coronary heart disease, two measures of type A behavior--determined by the Bortner scale and the Jenkins Activity Survey (JAS)--and one personality questionnaire--the Sandler Hazary Questionnaire and Eysenck Personality Inventory (SHEPI)--were used. Their interrelations and relations with social variables are analyzed. It appears that the Bortner scale and the JAS do not measure the overall syndrome of the coronary-prone behavior pattern (CPBP), but similar and different specific aspects of it. There exists a direct relation of the Bortner score, JAS-AB, JAS'-S, and JAS-J with the study level and the socioprofessional class. Neuroticism or emotional hyperreactivity determined by the SHEPI is highly correlated with these scores. No or small relations of social variables with personality traits are found.

Obesity in relation to socioeconomic status. A population study of women in Göteborg, Sweden

In a population sample of 1462 middle-aged women socioeconomic data were studied in relation to obesity, assessed by a body weight index. Education, annual income, and social class were negatively correlated with weight index (WI). Husband's social class was a stronger determinant of obesity in the woman than her own class. Age of husband and number of children were significantly correlated with WI. There was also a weak correlation between being single and WI. Sick leave was not correlated to WI. Pension was correlated to WI when adjusted for age, but not when allowance was also made for social class. Age, husband's social class, education, husband's income, and number of children were independent predictors of WI among the married women. In the single women, age and own income were independent predictors of WI but not number of children, education or own social class.