Obesity and mental disorders in the general population: results from the world mental health surveys

Understanding the relationship between quality of life, anthropometric measures and mental health in individuals with obesity

BACKGROUND

Obesity is a chronic medical condition caused by an excessive accumulation of body fat that represents a major risk factor for public health. The relationship between obesity, quality of life (QoL) and mental health has been examined in some previous literature. However, the studies found have not linked anthropometric variables with QoL factors, as they have used generic questionnaires.

OBJECTIVE

The present study aimed to analyse the influence of anthropometric variables on the QoL of people with obesity and examine its relationship with psychological variables.

METHODS

It was a cross-sectional study composed of 77 Spanish participants adults (M = 45.12 years; SD = 10.29) collected from two different research projects. The measurements were carried out in the Faculty of Health Sciences of the University of Alicante (Spain), including sociodemographic variables, anthropometric data and psychological questionnaires.

RESULTS

The finding demonstrated the relationship between anthropometric variables and all QoL factors. Also, individuals with lower QoL exhibit more symptoms of depression, anxiety and stress and are more prone to emotional eating.

CONCLUSIONS

The findings highlight the necessity of integrating psychological support into obesity treatment strategies, as well as the importance of using QoL questionnaires specific to people with obesity.

Dietary linoleic acid supplementation protects against obesity-induced microglial reactivity in mice

We investigated whether linoleic acid (LA) supplementation could modulate emotional behavior and microglia-related neuroinflammation. For that, male mice of C57BL/6J genetic background fed either a high-fat diet (HFD) or a standard diet (STD) for 12 weeks, were treated with a vehicle or LA solution for 5 weeks before being evaluated for emotional behavior using a battery of behavioral tests. The animals were subsequently sacrificed and their brains collected and processed for immunofluorescence staining, targeting microglia-specific calcium-binding proteins (IBA-1). Neuroinflammation severity was assessed in multiple hypothalamic, cortical and subcortical brain regions. We show an anxio-depressive-like effect of sustained HFD feeding that was neither alleviated nor worsened with LA supplementation. However, increased IBA-1 expression and microgliosis in the HFD group were largely attenuated by LA supplementation. These observations demonstrate that the anti-neuroinflammatory properties of LA are not restricted to hypothalamic areas but are also evident at the cortical and subcortical levels. This study discloses that neuroinflammation plays a role in the genesis of neuropsychiatric disorders in the context of obesity, and that LA supplementation is a useful dietary strategy to alleviate the impact of obesity-related neuroinflammation.

The Association Between Mental Health, Substance Use Disorder, and Outcomes After Total Joint Arthroplasty

BACKGROUND

Prior studies suggest that distressed patients or those who have poor mental health have inferior postoperative outcomes when compared to nondistressed patients. However, these studies typically do not account for substance use or other comorbidities often found in this population, which can independently contribute to postoperative complications. This study sought to control for these factors and assess if a diagnosis of a mental health condition is directly associated with worse outcomes after total joint arthroplasty.

METHODS

A retrospective chart review was performed for 3,182 patients who underwent a total hip arthroplasty and 4,430 patients who underwent a total knee arthroplasty. Diagnosis of the mental health disorders included depression, anxiety disorder, adjustment disorder, bipolar disorder, trauma, stressor-related disorder, and schizophrenia or schizoaffective disorder. Multivariable analyses were performed to control for alcohol use, drug use, tobacco use, body mass index, and a comorbidity index.

RESULTS

When controlling for body mass index and Charlson comorbidity index, no statistically significant associations were found between a diagnosis of any mental health condition or a specific diagnosis of depression or anxiety, and 90-day readmission, reoperation, or 1 year mortality for patients undergoing total knee arthroplasty or total hip arthroplasty.

CONCLUSIONS

When accounting for confounding factors, there does not appear to be a direct association between diagnosis of any of the psychiatric conditions we studied and outcomes after primary total joint arthroplasty. While prior studies suggest addressing the mental health condition may improve outcomes, this study suggests that preoperative medical optimization and potentially addressing substance use may be more effective strategies.

Mental disorders and discrimination: A prospective cohort study of young twin pairs in Germany

Background

Mental disorders and perceived discrimination share common risk factors. The association between having a mental disorder and experiencing discrimination is well-known, but the extent to which familial factors, such as genetic and shared environmental factors, might confound this association, including sex differences in familial confounding, remains unexplored.

Aims

We investigated potential unmeasured familial confounding in the association between mental disorders and perceived discrimination using a matched twin study design.

Method

We examined data from 2044 same-sex twin pairs (n = 4088) aged 16-25 years from the German population-based study 'TwinLife'. We applied random-effects logistic regression to within-individual and within-and-between pair models of the association between mental disorder and perceived discrimination, and used likelihood ratio tests (LRTs) to compare these models. Multivariable models were adjusted for body mass index, educational attainment, and life satisfaction.

Results

There were 322 (8.1%) participants with a diagnosed mental disorder, and 15% (n = 604) of the cohort reported having experienced discrimination in the previous 12 months. Mental disorder and discrimination were associated in the adjusted within-individual model (adjusted odds ratio = 2.19, 95% confidence interval: 1.42-3.39, P<0.001). However, the within-and-between pair model showed that this association was explained by the within-pair mean (aOR = 4.24, 95% CI: 2.17-8.29, P<0.001) and not the within-pair difference (aOR = 1.26, 95% CI: 0.70-2.28, P = 0.4) of mental disorder. Therefore, this association was mostly explained by familial confounding, which is also supported by the LRTs for the unadjusted and adjusted models (P<0.001 and P = 0.03, respectively). This familial confounding was more prominent for males than females.

Conclusions

Our findings show that the association between mental disorder and discrimination is at least partially explained by unmeasured familial factors. Designing family-based healthcare models and incorporating family members in interventions targeted at ameliorating mental ill-health and experiences of discrimination among adolescents may improve efficacy.

The impact of acute and chronic resistance training on appetite and energy intake: A scoping review examining resistance exercise and comparisons with other exercise modalities

PURPOSE

The effects of exercise on appetite have recently been systematically evaluated with a focus on endurance training (ET). However, resistance training (RT) may induce different adaptations than ET. This scoping review aimed to examine the acute and chronic effects of isolated RT and comparisons with other exercise modalities on appetite-related variables and energy intake.

RESULTS

17 acute studies were identified, six examining isolated RT, while 11 focused on RT intensity, amount of exercise, targeted muscle groups, or comparison with ET and combined training (RT plus ET; CT). Nine chronic studies were identified. Three investigated isolated RT vs control and six manipulated the amount of RT exercise, types of RT, or comparison with ET and CT.

CONCLUSIONS

Acute RT compared to control conditions appears to induce responses favoring appetite inhibition. While the amount of RT exercise may acutely play a role in the suppression of appetite, while ET seems to have more potential to suppress appetite. Chronic RT does not seem to stimulate compensatory mechanisms; however, there is not clear evidence regarding the role of RT intensity or other exercise modalities. Chronic ET and CT may be more prone to favor appetite inhibition than RT. More comprehensive evaluations including the exploration of multiple appetite-related factors are needed for future studies.

Defining and Diagnosing Obesity in India: A Call for Advocacy and Action

The prevalence of overweight and obesity has more than doubled since 1980, and it is predicted that around two-thirds of the global burden of the disease will be attributed to chronic non-communicable diseases. Developing countries are experiencing a more dramatic rise in the prevalence of obesity in recent years. As per National Family Health Survey-5 (NFHS-5), one in every four Indians is now having obesity. It has been reported that being overweight and obese is a significant problem among different socioeconomic spectrums of men and women in India, especially among the elderly, people residing in urban regions, and diverse socioeconomic strata. There is an urgent need to identify obesity as a chronic disease requiring immediate attention, mandating timely screening, timely treatment, and economical ways of achieving and managing weight loss across the country. In this review, the authors have discussed various aspects of overweight and obesity and critically appraised the current status of obesity in India, its public health implications, the significance of screening, the role of BMI and other parameters in diagnosing obesity, and the need for treatment and cost-effective prescriptions.

Urinary incontinence in women who have undergone bariatric surgery

INTRODUCTION

Obesity is a known risk factor for urinary incontinence (UI). As bariatric surgery can result in significant and sustainable weight loss, many chronic diseases closely linked to obesity have likewise shown improvement after surgical weight loss. We propose that bariatric surgery may significantly improve obesity-related UI symptoms as well as improve quality of life.

METHODS AND PROCEDURES

This is an interim analysis of an ongoing, prospective, single-institution observational study looking at UI in women enrolled in a bariatric surgery program. Participants completed the Pelvic Floor Distress Inventory (PFDI-20), International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI-SF), King's Health Questionnaire (KHQ), and Patient Global Impression of Improvement (PGI-I). Questionnaires were administered upon enrollment, pre-operatively, and at 3, 6, and 12 months post-operatively. Demographic data were collected at each interval and analyzed with descriptive statistics.

RESULTS

At analysis, 108 patients had enrolled in the study and 60% had progressed to surgery. We analyzed the following surveys: enrollment (n = 108), pre-operative (n = 43), 3-month (n = 29), 6-month (n = 26), and 1-year (n = 27). Mean BMI decreased from 49.8 to 31.1 at 1-year. All surveys showed significant improvement in UI symptoms over time. Overall, UI symptoms (PDFI-20) are correlated with BMI at time of survey and %TBWL (p = 0.03, p = 0.019). Additionally, perception of symptom improvement with surgery (PGI-I) improved over time (3-month p = 0.0289, 6-month p = 0.0024, 12-month p = 0.0035). Quality of life related to UI symptoms (KHQ) significantly improved after surgery (p = 0.0047 3-month, p = 0.0042 6-month, p = 0.0165 1-year).

CONCLUSIONS

Although the relationship is complex and likely depends on many factors, weight loss after bariatric surgery is associated with improvement in UI symptoms and UI-related quality of life. Bariatric surgery can play a role in the long-term treatment of UI in women with obesity that may negate the need for further invasive UI procedures.

Effect of gender on the association between cumulative cardiovascular risk factors and depression: results from the US National Health and Nutrition Examination Survey

Background

The comorbidity of cardiovascular disease (CVD) and depression has been well established, as depression usually presents simultaneously with CVD risk factors. However, the potential association between cumulative exposure to CVD risk and depression remains unclear, so we conducted the current investigation. To our knowledge, this is the first study that employs the cumulative risk model to examine the effect of CVD risk factors on depression using nationally representative population and gender, age and CVD status-stratified subpopulations.

Aims

To systematically study the possible individual and cumulative effect of 18 CVD risk factors on depression.

Methods

A cross-sectional, secondary analysis investigated associations between 18 CVD risk factors and depression. The interaction effect between CVD risk factors and age, gender and CVD status was also examined. Enrolment included 20 816 participants from the US National Health and Nutrition Examination Survey 2005-2016. Participants with Patient Health Questionnaire-9 scores over 15 or who were using an antidepressant were considered depressive; 18 known cardiovascular risk factors were incorporated in the present study.

Results

At the individual risk factor level, smoking, drinking, living alone, sleep quality, body mass index, waist circumference and diabetes status had differential associations with depression risk according to the gender, age or CVD status of the participants. Most importantly, gender-stratified cumulative risk analysis indicated that similar depression risk was found in both genders with a small number of CVD risk factors (odds ratio (OR)adjusted=1.32; 95% confidence interval (CI): 0.87 to 1.99), but females had a significantly higher depression risk compared with males under high cumulative risk exposure (ORadjusted=2.86; 95% CI: 1.79 to 4.59).

Conclusions

Clarifying the association of numerous CVD risk factors with depression according to gender, age and overall CVD status may be beneficial for risk stratification and the prevention of depression in clinical practice. Moreover, the observed novel evidence of high cumulative risk exposure-mediated gender disparities in depression risk may shed light on the underlying mechanism of females' greater vulnerability to depression.

The role of physical activity in obesity: let's actively manage obesity

Obesity, physical inactivity and sedentary behaviour are major public health concerns. A complex interaction of many factors leads to obesity, which requires an individualised multicomponent management strategy. As new interventions become available to help individuals manage obesity, it is essential that physical activity remains a core part of the approach. Here, we summarise current evidence regarding the benefits of physical activity as part of a management strategy of obesity. Additionally, we discuss current methods for increasing physical activity levels in individuals with obesity and outline the role of sport and exercise medicine physicians as part of the multidisciplinary team.

Examining the relationship of concurrent obesity and tobacco use disorder on the development of substance use disorders and psychiatric conditions: Findings from the NESARC-III

Background

Multimorbidity is linked to worse health outcomes than single health conditions. However, recent studies show that obesity may reduce the risk of developing substance use disorders (SUDs), particularly in vulnerable populations. We investigated how comorbid obesity and tobacco use disorder (TUD) relate to the risk of SUDs and psychiatric conditions.

Methods

Data was used from 36,309 individuals who completed the National Epidemiological Survey on Alcohol and Related Conditions - Wave III. Individuals who met the DSM-5 criteria for TUD in the last year were defined as the TUD group. Obesity was defined as having a body mass index (BMI) greater than 30 kg/m2. Using this information, individuals were grouped into categories, with people being identified as either having obesity, TUD, both obesity and TUD, or not having either obesity or TUD (comparison). Groups were compared against their comorbid diagnoses of either an additional SUD or psychiatric conditions.

Results

Controlling for demographic characteristics, we found that individuals with obesity including those individuals with TUD, had lower rates of comorbid SUD diagnosis than individuals with TUD alone. Additionally, individuals with combined TUD and obesity, and those with TUD alone, had the highest rates of comorbid psychiatric disorder diagnosis.

Conclusions

The current study aligns with previous research suggesting that obesity may reduce risk of substance use disorders, even in individuals who have other risk factors promoting harmful substance use (e.g., tobacco use). These findings may inform targeted intervention strategies for this clinically relevant subpopulation.

The role of dieting, happiness with appearance, self-esteem, and bullying in the relationship between mental health and body-mass index among UK adolescents: a longitudinal analysis of the Millennium Cohort Study

Background

Mental illness and obesity are among the biggest challenges to population health, they are linked, and may be modifiable during adolescence. We aimed to determine intervening pathways between mental health and BMI z-score symptoms across adolescence.

Methods

In this longitudinal cohort study, we used path models to examine self-reported dieting, happiness with appearance, self-esteem and bullying at 14 years as potential mediators of the cross-lagged relationship between mental health (via the Strengths and Difficulties Questionnaire) and Body Mass Index (BMI) z-score at 11 and 17 years by sex in the UK Millennium Cohort Study, a prospective cohort study of 18,818 children born in the UK between September 1st, 2000, and January 31st, 2002. Full, incomplete data on all singleton children still participating in the study by age 11 years were analysed in GSEM via maximum likelihood estimation (N = 12,450).

Findings

We found happiness with appearance and self-esteem, but not dieting or bullying, mediated the relationship between BMI age 11 and mental health age 17. Each increase in BMI z-score at 11 years was associated with 0.12 increase for boys and a 0.19 increase for girls in scores of unhappiness with appearance (boys: b 0.12, 95% C.I.; girls b 0.19, C.I. 0.14 to 0.23) and a 16% increase for boys and a 22% increase for girls in odds of low self-esteem (boys OR 1.16, 95% C.I. 1.07 to 1.26; girls: OR 1.22, 95% C.I. 1.15 to 1.30) at 14 years. In turn, for both boys and girls, being unhappy with appearance and low self-esteem at 14 years were associated with a greater likelihood of emotional and externalizing symptoms at 17 years.

Interpretation

Early prevention strategies to encourage healthy physical and mental development of children need to focus on the promotion of positive body-mage and self-esteem.

Funding

The National Institute for Health and Care Research (NIHR) School for Public Health Research (SPHR).

BMI Trends for Veterans Up to 10 Years After VA Enrollment Following Military Discharge

BACKGROUND

Obesity (body mass index [BMI]≥30kg/m2) among US adults has tripled over the past 45 years, but it is unclear how this population-level weight change has occurred.

OBJECTIVE

We sought to identify distinct long-term BMI trajectories and examined associations with demographic and clinical characteristics.

DESIGN

The design was latent trajectory modeling over 10 years of a retrospective cohort. Subgroups were identified via latent class growth mixture models, separately by sex. Weighted multinomial logistic regressions identified factors associated with subgroup membership.

PARTICIPANTS

Participants were a retrospective cohort of 292,331 males and 62,898 females enrolled in VA.

MAIN MEASURES

The main outcome measure was 6-month average VA-measured BMI over the course of 10 years. Additional electronic health record measures on demographic, clinical, and services utilization characteristics were also used to characterize latent trajectories.

KEY RESULTS

Four trajectories were identified for men and for women, corresponding to standard BMI categories "normal weight" (BMI <25), "overweight" (BMI 25-29.99), and "with obesity" (BMI ≥30): "normal weight" and increasing (males: 28.4%; females: 22.8%), "overweight" and increasing (36.4%; 35.6%), "with obesity" and increasing (33.6%; 40.0%), and "with obesity" and stable (males: 1.6%) or decreasing (females: 1.6%). Race, ethnicity, comorbidities, mental health diagnoses, and mental health service utilization discriminated among classes.

CONCLUSIONS

BMI in the 10 years following VA enrollment increased modestly. VA should continue prioritizing weight management interventions to the large number of veterans with obesity upon VA enrollment, because the majority remain with obesity.

Gender differences in the associations between body mass index, depression, anxiety, and stress among endocrinologists in China

BACKGROUND

Depression, anxiety, and stress symptoms have been found to be associated with overweight or obesity, but the gender differences in the associations have not been well-examined. Based on a national sample of endocrinologists in China, we examined such associations with a focus on gender differences.

METHODS

Data were collected from endocrinologists in China using an online questionnaire, which included demographic data, body weight, and height. Depression, anxiety, and stress symptoms were assessed using the Depression, Anxiety, and Stress Scale-21 (DASS-21).

RESULTS

In total, 679 endocrinologists (174 males and 505 females) completed the survey. One-fourth (25.6%) were classified as overweight, with a significant gender difference (48.9% in males vs. 17.6% in females, p < 0.05). Overall, 43.4% of the participants endorsed probable depressive symptoms (54.6% in males and 39.6% in females, p = 0.004), 47.6% for anxiety (51.7% in males vs. 46.1% in females, p = 0.203), and 29.6% for stress symptoms (34.5% in males vs. 27.92% in females, p = 0.102). After controlling for confounders, in the whole group, male gender (aOR = 4.07, 95% CI:2.70-6.14, p < 0.001), depression (aOR = 1.05, 95% CI:1.00-1.10, p = 0.034) and age (aOR = 1.03, 95% CI:1.00-1.05, p = 0.018) were positively associated with overweight. In males, depression (aOR = 1.14, 95% CI:1.05-1.25, p = 0.002), administration position (aOR = 4.36, 95% CI:1.69-11.24, p = 0.002), and night shifts/month (aOR = 1.26, 95% CI:1.06-1.49, p = 0.008) were positively associated with overweight, while anxiety (aOR = 0.90, 95% CI:0.82-0.98, p = 0.020) was negatively associated with overweight. In females, only age (aOR = 1.04, 95% CI:1.01-1.07, p = 0.014) was significantly associated with overweight status, while depression and anxiety were not associated with overweight. Stress symptoms were not associated with overweight in either gender.

CONCLUSIONS

One-fourth of endocrinologists in China are overweight, with a rate in males nearly triple the one in females. Depression and anxiety are significantly associated with overweight in males but not females. This suggests possible differences in the mechanism. Our findings also highlight the need to screen depression and overweight in male physicians and the importance of developing gender-specific interventions.

Excess BMI in early adolescence adversely impacts maturating functional circuits supporting high-level cognition and their structural correlates

BACKGROUND/OBJECTIVES

Adverse effects of excess BMI (affecting 1 in 5 children in the US) on brain circuits during neurodevelopmentally vulnerable periods are incompletely understood. This study investigated BMI-related alterations in maturating functional networks and their underlying brain structures, and high-level cognition in early adolescence.

SUBJECTS/METHODS

Cross-sectional resting-state fMRI, structural sMRI, neurocognitive task scores, and BMI from 4922 youth [median (IQR) age = 120.0 (13.0) months, 2572 females (52.25%)] from the Adolescent Brain Cognitive Development (ABCD) cohort were analyzed. Comprehensive topological and morphometric network properties were estimated from fMRI and sMRI, respectively. Cross-validated linear regression models assessed correlations with BMI. Results were reproduced across multiple fMRI datasets.

RESULTS

Almost 30% of youth had excess BMI, including 736 (15.0%) with overweight and 672 (13.7%) with obesity, and statistically more Black and Hispanic compared to white, Asian and non-Hispanic youth (p < 0.01). Those with obesity or overweight were less physically active, slept less than recommended, snored more frequently, and spent more time using an electronic device (p < 0.01). They also had lower topological efficiency, resilience, connectivity, connectedness and clustering in Default-Mode, dorsal attention, salience, control, limbic, and reward networks (p ≤ 0.04, Cohen's d: 0.07-0.39). Lower cortico-thalamic efficiency and connectivity were estimated only in youth with obesity (p < 0.01, Cohen's d: 0.09-0.19). Both groups had lower cortical thickness, volume and white matter intensity in these networks' constituent structures, particularly anterior cingulate, entorhinal, prefrontal, and lateral occipital cortices (p < 0.01, Cohen's d: 0.12-0.30), which also mediated inverse relationships between BMI and regional functional topologies. Youth with obesity or overweight had lower scores in a task measuring fluid reasoning - a core aspect of cognitive function, which were partially correlated with topological changes (p ≤ 0.04).

CONCLUSIONS

Excess BMI in early adolescence may be associated with profound aberrant topological alterations in maturating functional circuits and underdeveloped brain structures that adversely impact core aspects of cognitive function.

A Systematic Review on the Association between Obesity and Mood Disorders and the Role of Gut Microbiota

Obesity is a complex health condition that increases the susceptibility to developing cardiovascular diseases, diabetes, and numerous other metabolic health issues. The effect of obesity is not just limited to the conditions mentioned above; it is also seen to have a profound impact on the patient’s mental state, leading to the onset of various mental disorders, particularly mood disorders. Therefore, it is necessary to understand the mechanism underlying the crosstalk between obesity and mental disorders. The gut microbiota is vital in regulating and maintaining host physiology, including metabolism and neuronal circuits. Because of this newly developed understanding of gut microbiota role, here we evaluated the published diverse information to summarize the achievement in the field. In this review, we gave an overview of the association between obesity, mental disorders, and the role of gut microbiota there. Further new guidelines and experimental tools are necessary to understand the microbial contribution to regulate a balanced healthy life.

Sex differences in the relationship between hepatic steatosis, mood and anxiety disorders

OBJECTIVE

To investigate the association between non-alcoholic fatty liver disease (NAFLD), alcoholic liver disease (ALD), mental symptoms (mood, anxiety disorders and distress) by sex.

METHODS

This a cross-sectional study performed in working-age adults from a Health Promotion Center (primary care) in São Paulo, Brazil. Self-reported mental symptoms from rating scales (21-item Beck Anxiety Inventory, Patient Health Questionnaire-9, and K6 distress scale) were evaluated by hepatic steatosis (NAFLD and ALD). Logistic regression models estimated the association between hepatic steatosis subtypes and mental symptoms by Odds ratios (OR) adjusted by confounders in the total sample and sex stratified.

RESULTS

Among 7241 participants (70.5% men, median age: 45 years), the frequency of steatosis was of 30.7% (25.1% NAFLD), being higher in men than women (70.5% vs. 29.5%, p < 0.0001), regardless of the steatosis subtype. Metabolic risk factors were similar in both subtypes of steatosis, but not mental symptoms. Overall, NAFLD was inversely associated with anxiety (OR = 0.75, 95%CI 0.63-0.90) and positively associated with depression (OR = 1.17, 95%CI 1.00-1.38). On the other hand, ALD was positively associated with anxiety (OR = 1.51; 95%CI 1.15-2.00). In sex-stratified analyses, only men presented an association of anxiety symptoms with NAFLD (OR = 0.73; 95%CI 0.60-0.89) and ALD (OR = 1.60; 95%CI 1.18-2.16).

CONCLUSIONS

The complex association between different types of steatosis (NAFLD and ALD), mood and anxiety disorders indicates the need for a deeper understanding of their common causal pathways.

The role of preoperative toxicology screening in patients undergoing bariatric surgery

BACKGROUND

Some programs and insurers may require patients to undergo toxicology screening despite lack of evidence that this practice affects postoperative outcomes.

OBJECTIVES

To understand the prevalence of screening positive on toxicology testing in the bariatric surgical population and to examine the association between testing positive and important surgical outcomes.

METHODS

We performed a retrospective review of patients who underwent laparoscopic sleeve gastrectomy or Roux-en-Y gastric bypass from an academic health system from 2017-2020. We described the rate of preoperative toxicology positivity as determined by serum and urine testing. We examined the association between toxicology positivity and outcomes of preoperative length, 30-day complications (bleeding, venous thromboembolism, leak, wound infection, pneumonia, urinary tract infection, and myocardial infarction), readmissions, and 1-year weight loss using chi-square and t-test analysis.

RESULTS

Of 1057 patients, there were 134 patients (12.7%) who had positive toxicology testing. Of these, 37 (28%) were positive for opiates and 21 (16%) were positive for cotinine. Mean preoperative length was 381.8 days (standard deviation [SD], 222.5) for patients with positive testing versus 287.8 days (SD, 151.5; P = 1.00) for negative testing. Toxicology positivity was not associated with readmissions (5.2% versus 4.3%, X² = 0.22; P = .64). The loss to follow-up at 1 year was 32.5%. There was no association with 1-year mean change in body mass index (mean of loss 12.23kg/m² [SD, 5.61]) versus mean of loss 12.74 (SD, 6.44; P = .20)].

CONCLUSIONS

Our study is the first to describe preoperative toxicology positivity rates. We found no association between toxicology positivity and preoperative length, readmissions, or weight loss. Given its lack of impact on outcomes, toxicology testing prior to bariatric surgery may be an unnecessary burden on patients and healthcare, with regard to cost and wait times.

Reduced grip strength potentially indicates depression: Investigating multicontinental databases

BACKGROUND

Multi-national studies in the association between handgrip strength and depression in middle and older aged adults are limited. Hence, Brazil, China, Europe, Korea, United Kingdom (UK) and United States (US) datasets were utilized to investigate this association.

METHODS

A cross-sectional study was conducted with 51,285 participants aged >45 years. Handgrip strength scores were divided into quartiles, groups 1 (highest) to 4 (lowest) in each database, and depression measures converted to binary scores.

RESULTS

Males in China and UK reported higher adjusted odds ratios (aORs) of depression for groups 2, 3, and 4 than for group 1. Brazil, US, and Korea reported greater aORs in groups 3 and 4 whereas Europe demonstrated increased aORs for group 4 only. Among females, China, Brazil, US, and Korea showed high aORs across all groups, while UK and Europe reported increased aORs for group 4 only. Highest ORs were reported from Korea in group 4 for males (aOR: 3·09; 95 % CI: 2·15-4·43; p < 0·001) and females (aOR: 3·74; 95 % CI: 2·78-5·03; p < 0·001). When removing the regional factor, aORs were higher in lower groups, with the highest reported from group 4 for males (aOR: 2·32; 95 % CI: 2·09-2·58; p < 0·001) and females (aOR: 2·11; 95 % CI: 1·95-2·29; p < 0·001).

LIMITATIONS

Being a cross-sectional study, the results were not able to establish the causal direction between handgrip strength and depression.

CONCLUSION

Lower handgrip strength was associated with an increased likelihood of depression. Early assessment of handgrip strength may identify populations at-risk for depression among middle and older aged adults.

Does obesity related eating behaviors only affect chronic diseases? A nationwide study of university students in China

The primary aims of this study are to examine associations between obesity-related eating behaviors (OEB) and chronic and infectious diseases, and mental disorders. A representative nationwide survey was used to collect information among 11,659 medical students from 31 universities in China. Multiple variable logistic regression analysis was conducted to examine the associations between OEB and the diseases. The multiple variable logistic regression model found that OEB was significantly associated with chronic disease (OR (Odds Ratio): 1.74 < 95 % C.I (Confidence Interval): 1.45, 2.65 > ), infectious disease (OR: 3.37 < 95 % C.I: 1.04, 1.81 > ), and mental disorder (OR: 1.87(<95 % C.I: 1.55, 2.25 > ). These findings underscore the importance of addressing OEB in programs and policies to promote health and prevent disease among university students.

I Don't Want to Be Thin! Fear of Weight Change Is Not Just a Fear of Obesity: Research on the Body Mass Anxiety Scale

Anxiety is one of the psychological factors associated with body weight experienced by people attempting to live up to expectations of an ideal body shape. The stigma of excessive or too low body weight and the stigmatization of people because of it is becoming a widespread problem with negative psychological and social consequences. One effect of the strong social pressure of beauty standards dependent on low body weight is the development of eating disorders and negative societal attitudes toward overweight or obese people. Research conducted to date has mainly focused on one dimension of weight-related anxiety-the fear of getting fat. Ongoing research has also revealed the other side of weight-related anxiety-fear of weight loss. Therefore, the purpose of the present project was to develop a two-dimensional scale to diagnose the level of weight-related anxiety and to preliminarily test the psychometric properties of the emerging constructs. Results: the BMAS-20 weight-related anxiety scale in both Polish and English versions was developed and its psychometric properties were confirmed. The components of body weight-change anxiety that emerged were: anxiety about getting fat and anxiety about losing weight. It was found that both AGF and ALW may have a protective function related to awareness of the negative consequences of poor eating and the health risks associated with it. Above-normal levels of anxiety may be a predictor of psychopathology. Both AGF and ALW are associated with symptoms of depression.

Use of behavioural change taxonomies in systematic reviews and meta-analyses regarding obesity management

We investigated the prevalence of behavioural change taxonomies in systematic reviews and meta-analyses related to obesity management. In addition, we analysed the funding sources, author conflicts of interest statements, risk of bias, and favorability of the results in such studies to determine if there was a relationship between methodological quality and taxonomy use. We searched several databases including MEDLINE, Epistemonikos, Cochrane EDSR, Pubmed and Embase for systematic reviews and meta-analyses regarding the behavioural treatment of obesity. Screening and data extraction was performed in a masked, duplicate fashion. We performed statistical analyses to determine any significant association between use of taxonomy and study characteristics. Fifteen (of 186; 8.06%) systematic reviews used a taxonomy-nine used the BCTTv1, three used OXFAB, two used the CALO-RE and one used "Taxonomy of choice architecture techniques." Most interventions that referenced a taxonomy were self-mediated (6/60, 10%). Behavioural change taxonomies were mentioned in 10 (of 87, 11.49%) studies with a public funding source. Of the studies with favourable results, 14 studies (of 181, 7.73%) referred to a taxonomy. We found no statistically significant relationships between use of taxonomy and study characteristics. We found that systematic reviews regarding the management of obesity rarely mention a behavioural change taxonomy. Given the global burden of obesity, it is crucial that behavioural change techniques are reproducible and translatable. We recommend that researchers look further into how taxonomies affect the quality and reproducibility of behavioural interventions in an effort to improve patient outcomes.

Prefrontal cortical protease TACE/ADAM17 is involved in neuroinflammation and stress-related eating alterations

Childhood traumatic stress profoundly affects prefrontal cortical networks regulating top-down control of eating and body weight. However, the neurobiological mechanisms contributing to trauma-induced aberrant eating behaviors remain largely unknown. Traumatic stress influences brain immune responses, which may, in turn, disrupt prefrontal cortical networks and behaviors. The tumor necrosis factor alpha-converting enzyme / a disintegrin and metalloproteinase 17 (TACE/ADAM17) is a sheddase with essential functions in brain maturation, behavior, and neuroinflammation. This study aimed to determine the role of TACE/ADAM17 on traumatic stress-induced disruption of eating patterns. We demonstrate a novel mechanistic connection between prefrontal cortical TACE/ADAM17 and trauma-induced eating behaviors. Fifty-two (52) adolescent Lewis rats (postnatal day, PND, 15) were injected intracerebrally either with a novel Accell™ SMARTpool ADAM17 siRNA or a corresponding siRNA vehicle. The RNAscope Multiplex Fluorescent v2 Assay was used to visualize mRNA expression. Observation cages were used to monitor ethological behaviors in a more naturalistic environment over long periods. We found that traumatic stress blunts startle reactivity and alter eating behaviors (increased intake and disrupted eating patterns). We also found that the rats that received prefrontal cortical TACE/ADAM17 siRNA administration exhibited decreased eating and increased grooming behaviors compared to controls. These changes were associated with decreased AIF-1 expression (a typical marker of microglia and neuroinflammation). This study demonstrates that prefrontal cortical TACE/ADAM17 is involved in neuroinflammation and may play essential roles in regulating feeding patterns under stress conditions. TACE/ADAM17 represents a promising target to ameliorate inflammation-induced brain and behavior alterations.

Factors Associated with Symptoms of Depression among People with Obesity: Analysis of a 3-Year-Peruvian National Survey

INTRODUCTION

Obesity and depression contribute to the global burden of economic cost, morbidity, and mortality. Nevertheless, not all people with obesity develop depression.

OBJECTIVE

To determine the factors associated with depressive symptoms among people aged 15 or older with obesity from the National Demographic and Family Health Survey (ENDES in Spanish 2019-2021).

METHODS

Cross-sectional analytical study. The outcome of interest was the presence of depressive symptoms, assessed using the Patient Health Questionnaire-9 (PHQ-9). Crude (cPR) and adjusted (aPR) prevalence ratios were estimated using GLM Poisson distribution with robust variance estimates.

RESULTS

The prevalence of depression symptoms was 6.97%. In the multivariate analysis, a statistically significant association was found between depressive symptoms and female sex (PRa: 2.59; 95% CI 1.95-3.43); mountain region (PRa: 1.51; 95% CI 1.18-1.92); wealth index poor (PRa: 1.37; 95% CI 1.05-1.79, medium (PRa: 1.49; 95% CI 1.11-2.02), and rich (PRa: 1.65; 95% CI 1.21-2.26); daily tobacco use (PRa: 2.05, 95% CI 1.09-3.87); physical disability (PRa: 1.96, 95% CI 1.07-3.57); and a history of arterial hypertension (PRa: 2.05; 95% CI 1.63-2.55).

CONCLUSION

There are several sociodemographic factors (such as being female and living in the Andean region) and individual factors (daily use of tobacco and history of hypertension) associated with depressive symptoms in Peruvian inhabitants aged 15 or older with obesity. In this study, the COVID-19 pandemic was associated with an increase in depressive symptoms.

Evaluation of Excessive Daytime Sleepiness, Anxiety and Depression Symptomatologies in Obesity

Aim: In this study, it was aimed to evaluate the excessive daytime sleepiness, anxiety and depression symptomatology in normal-weight, overweight and obese individuals. Methods: In the study, 605 people who applied to the family medicine outpatient clinic between 2020 November 25 and 2021 March 5 were included. The questionnaire form evaluating the sociodemographic characteristics of the participants, the Hospital Anxiety and Depression Scale and the Epworth Sleepiness Scale were administered using a face-to-face interview technique. Results: Overweight status in primary school, high school/adolescence, and university/twenties were higher in obese than in overweight. Additionally, it was higher in overweight than in normal weight. The risk of being overweight was 2.19 times higher and the risk of being obese was 6.07 times higher than those with obesity in their family compared to those who did not. Excessive daytime sleepiness was 2.95 times higher in obese than in normal weight. Anxiety symptoms were 1.97 times higher in obese than in normal weight. Depression symptoms were 2.77 times more in overweight and 2.99 times more in obese compared to normal-weight individuals. Conclusion: As a result of this study, it was revealed that excessive daytime sleepiness, anxiety and depression symptomatologies are more common in obese compared to normal weight. Keywords: obesity, overweight, depression, anxiety, disorders of excessive somnolence

Psychophysiological Adaptations to Yoga Practice in Overweight and Obese Individuals: A Topical Review

Physical activity has been documented as a foundational approach for weight management and obesity, improving several cardiometabolic and mental health indices. However, it is not clear whether yoga practice can induce beneficial improvements in anthropometric and body composition parameters, performance, metabolic health, and well-being among overweight/obese people. The aim of this topical review was to catalog training studies examining the psychophysiological responses to yoga interventions in order to detect which outcomes have been investigated, the research methods applied, and the conclusions. The inclusion/exclusion criteria were met by 22 published articles involving 1178 (56% female) overweight/obese participants. This brief review on yoga-induced adaptations demonstrates that this widely used meditative movement activity can meaningfully improve the vast majority of the selected markers. These beneficial alterations are focused mostly on various anthropometric and body composition variables, cardiovascular disease risk factors, physical fitness parameters, quality of life, and stress in previously inactive overweight/obese individuals. Instead, yoga-based physical exercise interventions investigating anxiety, depression, mood state, exercise enjoyment, affect valence, and adherence were limited. Further research should focus on the yoga intervention configuration and potential mechanisms behind favorable changes in various psychophysiological indices through large-scale, rigorously designed randomized controlled trials implementing long-term interventions in overweight/obese individuals.

Association of mental distress with chronic diseases in 1.9 million individuals: A population-based cross-sectional study

OBJECTIVE

Mental distress has a high global prevalence and is associated with poor health outcomes. This study aimed to estimate the relationship between mental distress and the risk of 10 chronic diseases using data from the Behavioral Risk Factor Surveillance System (BRFSS).

METHODS

Cross-sectional data from the 2013, 2014, 2015, 2016 and 2017 BRFSS were analyzed. The association between mental distress based on the number of days of poor mental health and the risk of 10 chronic diseases, namely obesity, diabetes, asthma, chronic obstructive pulmonary disease (COPD), arthritis, kidney disease, coronary heart disease (CHD), stroke, skin cancer, and other cancers, were assessed by logistic regression models to calculate odds ratios and 95% confidence intervals. Subgroup analyses stratified by age and sex were also conducted.

RESULTS

Positive associations between mental distress and chronic diseases were observed. We also found a dose-response gradient between mental distress levels and the risk of all chronic diseases except skin cancer. In respondents aged 18-44 years reporting ≥23 days/month of mental distress, there has the largest odds ratio between mental distress levels and each chronic disease. Moreover, mental distress was associated with higher risks of obesity and arthritis in women relative to men.

CONCLUSIONS

Mental distress was positively associated with chronic diseases. Age and sex are crucial in this relationship. Further studies with longitudinal data are needed to clarify the direction of this association.

Relation of Depression and Anxiety Disorders in Choosing Obesity Management in Obese Patients

BACKGROUND

Obesity is a chronic medical illness with a higher risk of physical and mental cascade. People who seek obesity treatment were reported to have some psychiatric disorders affecting their disease and selection of management.

AIMS OF THE STUDY

This study aims to estimate the prevalence of depressive and anxiety disorders in obese patients seeking obesity management and explore the relationship between common psychiatric disorders (depression and anxiety disorders) and selection of the type of obesity management (surgical or non-surgical).

METHODS

Patients were recruited from Alazhar Universityhospitals, Egypt, and the total number completing the study was 1115 patients. All subjects underwent psychiatric interview through Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders (SCID-5 for DSM-5) for diagnosis of psychiatric disorders and completed two questionnaires, Hamilton Rating Scale for Depression (HRSD) and Hamilton Rating Scale for Anxiety (HRSA).

RESULTS

The prevalences of depressive and anxiety disorders were 29.23% and 25.56%, respectively, in all subjects. The most prevalent diagnoses were dysthymic disorder (20.7%), general anxiety disorder (16.95%), major depressive disorder (13.04%), and social phobia (12.4%). Our sample was divided into two groups (surgical and non-surgical). Dysthymia was more common in the surgical group (21.4% versus 19.8% P = 0.560), whereas major depressive disorder was more common in the non-surgical group (7.4% versus 5.4 P = 0.593); also, the non-surgical group was more likely to have "anxiety disorders" (29.23% versus 22.4%, P = 0.840), but severity of anxiety was higher in the surgical group according to HRSA score with a highly significant difference.

CONCLUSIONS

A high prevalence of depression and anxiety disorders was found among patients who sought obesity treatment. Severity of anxiety was higher in the surgical group according to HRSA score with a highly significant difference, which may affect selection of treatment, so psychiatric evaluation and management are needed before and after obesity management to improve the outcome.

Psychophysiological Adaptations to Pilates Training in Overweight and Obese Individuals: A Topical Review

The prevalence of overweightness and obesity has been documented as a major public health issue since it has increased at an alarming rate worldwide. Structured physical exercise programs have been reported as an essential strategy for preventing, managing, and treating obesity, inducing critical improvements in various physiological and psychological markers. However, it is unclear whether Pilates training can elicit positive changes in body composition, physical fitness, cardiometabolic health, and well-being among overweight and obese populations. The purpose of this topical review was to catalog studies investigating the physiological and psychological adaptations to Pilates training in order to identify what outcomes have been assessed, the research methods used, and the results. The inclusion/exclusion criteria were met by 14 published articles involving 582 participants (83% female) who were overweight or obese. The present topical review on Pilates training-induced adaptations shows that this widely used exercise type can significantly improve the majority of the selected indicators. These beneficial changes are frequently focused on anthropometric parameters, body composition, glucose, and lipid metabolism, as well as blood pressure in sedentary overweight or obese women. Specialized equipment-based Pilates interventions and trials investigating various mental health indices were limited. Further research is warranted in this area, emphasizing the Pilates training configuration and potential mechanisms behind positive alterations in several psychophysiological markers through large-scale randomized controlled trials with superior methodological quality, implementing long-term interventions in various populations that are overweight and obese.

BMI and Disordered Eating in Black College Women: The Potential Mediating Role of Body Appreciation and Moderating Role of Ethnic Identity

Multiple studies indicate Black American women have disproportionately higher rates of obesity compared with other groups in United States. Although body image is associated with obesity, this relation is understudied among Black women. The purpose of the current study was to (1) examine the relations among body appreciation, body dissatisfaction and disordered eating; (2) assess body appreciation as a mediator of the relation between body mass index (BMI) and disordered eating, and (3) explore ethnic identity as a moderator in this association. Participants were 191 Black women recruited from a mid-Atlantic university. Participants' mean age was 19.16 years (SD = 1.95). Body appreciation partially mediated the relation between BMI and disordered eating behaviors and attitudes, such that women with higher BMIs reported lower body appreciation, which was associated with greater disordered eating symptoms. Ethnic identity was not a significant moderator of the association between BMI and body appreciation. Results support screening Black women with higher BMIs for disordered eating symptomatology and suggest it might be helpful to include body appreciation in interventions for Black women.

Social Influence on Fad Diet Use: A Systematic Literature Review

Background: A fad diet is a broad term used to describe dieting methods that recommend altering the intake of macronutrients to specific proportions or instruct people to intake or avoid particular foods, often with the goal of rapid weight loss. Previous literature reviews report social influence impacts general diet behaviour, but have yet to examine fad diets, specifically. Therefore, the purpose of this systematic review was to synthesize literature related to social influence on an individual's fad diet use and understand the sociocultural factors related to diet use. Methods: Using PRISMA guidelines, Medline, PsycInfo, Embase, CINAHL, and CENTRAL databases were searched to identify articles investigating the impact of social on fad diet use. Covidence was used to manage the review process and Garrard's Matrix Method was used to extract data from reviewed articles (n   =   13). Results: A majority of reviewed studies examined interpersonal influence (62%) and reported social influence impacting a variety of fad diet behaviours (92%). Interpersonal and media influence were highlighted as motivating factors for adopting unhealthy dieting methods (54%), and studies showed interpersonal support impacted adoption and maintenance of fad diet use (23%). Also, social norms were reported to influence unhealthy weight control behaviours (15%). Discussion: This review revealed social influence is associated with the adoption, adherence, and termination of fad diets. The prevalence of fad diets in society and the lack of research on this topic warrants further examination of factors related to fad diets use and the spread among interpersonal networks.

Body Mass Index and risk for onset of mood and anxiety disorders in the general population: Results from the Netherlands Mental Health Survey and Incidence Study-2 (NEMESIS-2)

BACKGROUND

Examine the onset of a clinical diagnosis of mood (major depression, dysthymia and bipolar disorder)- and anxiety disorders (panic disorder, agoraphobia without panic disorder, social phobia, specific phobia and generalized anxiety disorder) by Body Mass Index levels at baseline in the general adult population over three years.

METHODS

Data are from NEMESIS-2, a representative psychiatric cohort study in the Netherlands. A total of 5303 subjects aged 18-64 were interviewed with the CIDI (3.0 based on DSM-IV) in two waves, with an interval of three years. The first wave was performed from November 2007 to July 2009, the second wave from November 2010 to June 2012.

RESULTS

Persons with obesity at baseline had a significantly increased risk of the onset of any mood -or anxiety disorder adjusting for covariates compared to persons with a normal Body Mass Index (OR = 1.71; 95% CI: 1.11-2.62). The odds ratio of the underweight category was non-significant. A dose-response effect of the continuous BMI scores on the onset of any mood or anxiety disorder was found (OR = 1.06; 95% CI: 1.02 = 1.10; p < 0.01).

CONCLUSIONS

Obesity at baseline is a risk for the onset of mood -and anxiety disorders at three year follow up.

Investigating the association between infertility and psychological distress using Australian Longitudinal Study on Women's Health (ALSWH)

Infertility affects millions of people globally. Although an estimated 1 in 6 couples in Australia are unable to conceive without medical intervention, little is known about the mental health impacts of infertility. This study investigated how infertility impacts the mental health of women. The study used nationally representative Australian Longitudinal Study on Women's Health (ALSWH) data. We analysed data from survey periods 2-8 conducted every three years between 2000 and 2018 for 6582 women born in 1973-78. We used a Generalised Equation Modelling (GEE) method to investigate the association of primary, secondary and resolved fertility status and psychological distress over time. Multiple measures were used to measure psychological distress: the (1) the mental health index subscale of the 36-item short form survey (SF-36), (2) the Center for Epidemiological Studies Depression Scale (CESD-10), (3) the Goldberg Anxiety and Depression Scale (GADanx) anxiety subscale; and a (4) composite psychological distress variable. About a third (30%) of women reported infertility at any of the survey rounds; a steady increase over 18 years from 1.7% at round 2 to 19.3% at round 8. Half of the women reporting primary or secondary infertility reported psychological distress, with the odds of having psychological distress was higher in women reporting primary (odds ratio (OR) 1.24, 95% confidence interval (CI) 1.06-1.45), secondary (OR 1.27, 95% CI 1.10-1.46) or resolved infertility (OR 1.15, 95% CI 1.05-1.26) compared to women reporting normal fertility status. Women with partners, underweight or higher BMI, smoking, and high-risk alcohol use had higher odds of psychological distress, whereas women in paid work had significantly lower odds of psychological distress (p < 0.001). Diabetes, high blood pressure, asthma, and other chronic physical illness were independently associated with higher odds of psychological distress. Infertility has a significant impact on mental health even after it is resolved. Frequent mental health assessment and a holistic approach to address the lifestyle factors should be undertaken during the treatment of infertility.

Time and gender measurement invariance in the modified Calderon depression scale

Background

Assessing change and comparing groups requires high quality and invariant scales. However, there is limited evidence of simultaneous longitudinal and gender measurement invariance for depression scales. This evidence is even more scant with long-established panel studies from low and middle-income countries.

Methods

In this paper, we used three waves (years 2002, 2005, and 2009) of a nationally representative panel study to examine the psychometric properties of the modified Calderon Depression Scale (CAL-DM)—a one-item exclusion of a depression scale designed for a population residing in a middle-income country (i.e., Mexico). Our analytical sample included 16,868 participants: 7,696 men and 9,172 women. Using Confirmatory Factor Analysis (CFA), we first examined overall fit in each wave, and then we tested time, gender, and time-gender measurement invariance across three waves. We also estimated and compared depression score means by gender and time. Finally, we examined the association between depression scores and self-rated health.

Results

Our analyses indicated the CAL-DM is a robust scale, suitable for time, gender, and time by gender comparisons. Mean comparisons exemplified how the scale can be used as a latent variable or a summative score. Women have higher depression scores than men and the gap is narrowing from 3.4 in 2002 to 2.5 in 2009.

Conclusions

The CAL-DM is a reliable instrument to measure depression in the Mexican general population that can be used for epidemiological research. Our results will contribute to a burgeoning line of research that examines the social determinants of depression, and the risk factors associated with different individuals’ depression trajectories over the life course.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12955-022-02007-8.

Obesity and COVID-19 in Children and Adolescents: Reciprocal Detrimental Influence—Systematic Literature Review and Meta-Analysis

The dramatic lifestyle changes forced by COVID-19-related lockdown promoted weight gain, with a stronger impact on obese subjects, at higher risk of severe infection. The PubMed database was searched to identify original studies assessing: (1) the extent and risk factors of lockdown-induced weight increase; and (2) the impact of obesity on the risk of hospital admission in children and adolescents. A systematic literature review and meta-analyses were performed. Twenty out of 13,986 identified records were included. A significant weight increase was reported in the majority of subjects, with no apparent gender or age differences. It was induced by a higher consumption of hypercaloric/hyperglycemic/junk food and/or the reduction of physical activity, often associated with an altered sleep–wake cycle. On the other hand, obesity increased the risk of hospitalization (OR = 4.38; 95% C.I. 1.46–13.19; p = 0.009; I² = 96%) as compared to the normal weight population. COVID-19 and obesity represent epidemic conditions with reciprocal detrimental impact. Urgent public health interventions, targeting the various age and social strata, and involving governmental authorities, health care personnel, teachers and families are warranted to increase awareness and actively promote healthy lifestyles to contrast pediatric obesity and its detrimental consequences at a global level.

Psychological Adaptations to High-Intensity Interval Training in Overweight and Obese Adults: A Topical Review

Regular exercise has been reported as a fundamental piece of the management and treatment puzzle of obesity, playing a vital role in numerous psychological indicators. However, it is unclear whether high-intensity interval training (HIIT) can improve critical psychological health markers such as adherence, exercise enjoyment, affective responses, health-related quality of life, anxiety, and depression in overweight and obese adults. The purpose of this topical review was to catalogue studies investigating the psychological responses to HIIT in order to identify what psychological outcomes have been assessed, the research methods used, and the results. The inclusion/exclusion criteria were met by 25 published articles investigating either a traditional, single-component (84%) or a hybrid-type, multi-component (16%) HIIT protocol and involving 930 participants with overweight/obesity. The present topical review on HIIT-induced psychological adaptations shows that this popular exercise mode, but also demanding for the masses, can meaningfully increase the vast majority of the selected mental health-related indices. These improvements seem to be equal if not greater than those observed for moderate-intensity continuous training in overweight and obese adults. However, further research is needed in this area, focusing on the potential mechanisms behind positive alterations in various psychological health parameters through larger samples and high-quality randomized controlled trials.

Gut microbiota and BMI throughout childhood: the role of firmicutes, bacteroidetes, and short-chain fatty acid producers

Childhood obesity is a risk factor for numerous health conditions. A critical factor in the etiology of obesity appears to be the gut microbiota, which is the microbial community that resides in the human gut. The ratio of the phyla Firmicutes and Bacteroidetes (F/B) and gut bacterial genera that produce short-chain fatty acids (SCFA) have been suggested to contribute to obesity. The current study investigated (1) whether differences in F/B ratio can be observed in infancy and childhood in relation to zBMI in healthy children, and (2) whether an innovative proxy measure adds evidence to a relationship between SCFA producers and the etiology of obesity. Stool samples were collected at five time points, and zBMI was assessed at eight time points throughout the first 12 years of life. Our confirmatory analyses with Bayesian multilevel models showed no relationship between the F/B ratio and zBMI. Also, a proxy measure constructed from known SCFA producers was unrelated to zBMI throughout the first 12 years of life. Exploratory analyses using multilevel and random forest models suggest that the relative abundances of Firmicutes and Bacteroidetes were independently negatively associated with zBMI from infancy through childhood, and the SCFA producing genera Subdoligranulum and Alistipes were negatively related to future BMI in childhood.

Comorbid depression and obesity among adults in Germany: Effects of age, sex, and socioeconomic status

BACKGROUND

Depression and obesity are common health problems with major public health implications. These conditions frequently co-occur, adversely affecting the course of the other. The sociodemographic and socioeconomic risk factors for comorbid depression and obesity in the German adult population have not yet been reported.

METHODS

We analyzed the prevalence and sociodemographic and socioeconomic correlates of comorbid depression and obesity using cross-sectional data from the national German health interview and examination survey for adults (DEGS1; n = 7987) and its mental health module (DEGS1-MH; n = 4493). The Composite International Diagnostic Interview was used to diagnose major depressive disorder (CIDI-MDD). Sensitivity was analyzed using the self-reported depression measure and current depressive symptoms measured by Patient Health Questionnaire-9 (PHQ-9). Obesity was defined by body mass index calculated from measured data.

RESULTS

Prevalence of comorbid depression and obesity was 1.3% (95% CI 0.8-2.0) in men and 2.0% (95% CI 1.3-3.0) in women. We found significant sex differences in results from the self-reported depression measure and the PHQ-9, but not from the CIDI-MDD. Low socioeconomic status and poor social support were linked to a higher prevalence of comorbid depression and obesity among women.

LIMITATIONS

Severe depression may have been underreported.

CONCLUSIONS

Depression is statistically more prevalent in women than in men, which accounts for many of the sex differences in the prevalence of comorbid depression and obesity in our models. Targeted public health strategies need to be developed to prevent and treat comorbid depression and obesity in women with a low socioeconomic position.

Quality of life outcomes in two phase 3 trials of setmelanotide in patients with obesity due to LEPR or POMC deficiency

Introduction

Individuals with proopiomelanocortin (POMC) or leptin receptor (LEPR) deficiency are young and experience severe obesity, hyperphagia, and comorbidities, which can impair quality of life (QOL).

Methods

Two pivotal Phase 3 trials explored the effect of setmelanotide on body weight and hunger in individuals with obesity due to POMC (NCT02896192) or LEPR (NCT03287960) deficiency. QOL and depression were investigated in parallel using the disease-specific, age-appropriate Impact of Weight on Quality of Life-Lite (IWQOL-Lite), Pediatric Quality of Life Inventory (PedsQL), and Patient Health Questionnaire-9 (PHQ-9).

Results

In total, the POMC and LEPR trials enrolled 21 patients. Adults (≥ 18 years old; n = 7) had moderate-to-severe impairment in QOL at baseline, with mean (standard deviation [SD]) IWQOL-Lite total score 60.3 (13.2; maximum IWQOL-Lite total score = 100). The effect of setmelanotide on IWQOL-Lite total score was observed as soon as Week 5. Among those with scores at Week 52, 5 of 6 adults experienced a clinically meaningful improvement, with mean (SD) total scores increased from baseline by 24.2 (12.1) points. Children (6–12 years old; n = 2) and adolescents (13–17 years old; n = 4) had impaired QOL at baseline, with mean (SD) self-reported PedsQL total scores 53.3 (6.2) and 63.3 (29.1), respectively (maximum PedsQL total score = 100). Three of 5 patients experienced clinically meaningful improvement in PedsQL, with 2 children whose PedsQL total score increased by 28.3 and 3.3 points and 3 adolescents whose mean (SD) total score increased from baseline by 5.8 (18.3) points. Baseline mean (SD) PHQ-9 score (in those ≥ 12 years old) was 5.3 (3.8) and was generally maintained through Week 52.

Conclusions

Patients with POMC or LEPR deficiency had impaired, and in some cases severely impaired, QOL before setmelanotide treatment. Setmelanotide improved QOL in patients as early as Week 5, with some patients no longer experiencing impaired QOL at Week 52. Improvements in QOL may be related to a reduction in hunger and body weight associated with setmelanotide. Because of the highly complex psychological consequences of rare genetic diseases of obesity, some patients may require a long period of treatment to improve QOL and benefit from interdisciplinary care.

Does tibolone treatment have favorable effects on obesity, blood pressure, and inflammation? A meta-analysis of randomized controlled trials

The clinical effects of tibolone on cardiometabolic markers are an underlying question in postmenopausal women. We aimed to meta-analyze the effects of tibolone on anthropometric indicators of obesity, blood pressure (BP), and on C-reactive protein (CRP) levels in postmenopausal women. Two independent reviewers searched Scopus, Web of Science, PubMed/Medline, and Embase up to until 20 April 2021. Weighted mean differences (WMDs) and 95% confidence interval (CI) were calculated through the DerSimonian and Laird random-effect models between the tibolone and the control groups. Data from 20 eligible included showed that tibolone treatment increased the body mass index (BMI) by 0.23 kg/m² (95% CI: 0.017 to 0.45, p = 0.03) but did not significantly increase body weight (WMD: 1.128 kg, 95% CI: -1.76 to 4.02, p = 0.44) or waist circumference (WC) (WMD: 0.64 cm, 95% CI: -3.18 to 4.48, p = 0.74). Also, tibolone treatment neither changed the systolic BP (WMD: 2.60 mmHg, 95% CI: -2.52 to 7.72, p = 0.31) nor the diastolic BP (WMD: 0.711 mmHg, 95% CI: -2.52 to 3.94, p = 0.66), but increased CRP levels by 0.44 mg/L (95% CI: 0.10 to 0.78, p = 0.01). Tibolone treatment administered in postmenopausal women increased BMI and CRP but did not change body weight, WC, and SBP. Diastolic BP decreased after the tibolone intervention only in the studies lasting 26 weeks versus ˃26 weeks.

Living conditions, lifestyle habits and health among adults before and after the COVID-19 pandemic outbreak in Sweden - results from a cross-sectional population-based study

BACKGROUND

Studies on the public health consequences of COVID-19 pandemic showing data based on robust methods are scarce. The aim of this study was to investigate mental and physical health as well as living conditions and lifestyle habits in the general population before and after the COVID-19 outbreak in Sweden.

METHODS

The study is based on 2273 persons 16-84 years who responded to the national public health survey in February-May 2020 in Värmland county (overall response rate 45%). The differences between early respondents (before the outbreak, n = 1711) and late respondents (after the outbreak, n = 562) were studied using multivariate logistic regression, adjusting for background characteristics: age, gender, educational level, and country of birth. The same analyses were also completed in the corresponding survey carried out in February-June 2018.

RESULTS

Statistically significant differences between the groups were obtained for economic difficulties and worry about losing one's job, which were more common among late respondents, and for sleeping difficulties, which were more common among early respondents after adjusting for background characteristics. There were no differences in other living conditions nor in lifestyle factors. Prevalence of good self-rated health, high blood pressure, aches in shoulders or neck, anxiety or worry and stress did not differ between the groups. In 2018, the only statistically significant difference between early and late respondents concerned economic difficulties.

CONCLUSIONS

Very few differences in living conditions, lifestyle factors and health were observed in the study population before and after the COVID-19 outbreak. The results suggest that, in addition to a possible decrease in sleeping difficulties, the prevalence of being worried about losing one's job increased among the employed after the outbreak.

Weight Location Moderates Weight-Based Self-Devaluation and Perceived Social Devaluation in Women

Overweight and obese (“heavyweight”) people devalue themselves because, it has been proposed, they are socially devalued. However, for women, social valuation depends not only on how much weight they carry but also on where on their bodies they carry it. Here, we investigated whether weight-based self-valuation and perceived social valuation similarly depend on body shape. Study 1, using a nationally representative sample from National Health and Nutrition Examination Survey (NHANES; N = 1,093 reproductive-aged women), showed that, controlling for body fat, weight labeling (by self and others) and wanting to lose weight depended on body shape. Study 2, in a direct test of predictions using an undergraduate sample of women ( N = 215), showed that with increased body fat, women with an abdominal weight distribution reported more self-devaluation (e.g., lower self-esteem) and perceived social devaluation (e.g., higher perceived weight discrimination); women with a gluteofemoral weight distribution, however, were shielded—partially or fully—from these adverse effects of increased body fat.

Mental Disorders Associated with COVID-19 Related Unemployment

In response to the COVID-19 pandemic, restrictions on economic activities have resulted in a sharp rise of unemployment. The purpose of this research is to explore mental disorders associated with COVID-19 related unemployment using a large, nationally representative dataset, the 2020 COVID-19 Household Pulse Survey. ANOVA with post hoc tests (Tukey HSD) are utilized to reveal the mean difference of mental disorders between various employment status, as well as between reasons of unemployment. Binary logit model is used to investigate the potential effect of different reasons of unemployment on mental disorders. Individuals who were not working during the pandemic due to involuntary reasons had higher probabilities of mental disorders than those who were working and those who voluntarily separated from work. Among respondents who were not working due to COVID-19 related reasons, respondents whose employer went out of business were the most likely to experience mental disorders. Household job uncertainty in the next four weeks positively contributed to mental disorders. Government should consider measures to contain the spread of virous while keeping as many people employed as possible. Government should also consider providing adequate financial and counseling assistance to individuals who are in the greatest need for such support.

Role of BMI in the Relationship Between Dietary Inflammatory Index and Depression: An Intermediary Analysis

Introduction: This study investigated this association and the role of BMI in the inflammatory process in a large population-based observational study.

Methods: A total of 1,865 elderly people (≥55 years) were followed from the Community Cohort Study of Nervous System Diseases (CCSNSD) cohort study from 2018 to 2019 (Mean [SD] age, 66.31 [0.32] years; 716 [38.4%] males). The semi-quantitative FFQ and geriatric depression scale (GDS) were used to evaluate the diet and depressive symptoms of the elderly, respectively. The multivariable logistic regression model estimated the OR and 95% CI between Empirical Dietary Inflammatory Index (E-DII) and depression. The interaction of E-DII and BMI on depressive events was tested, and the mediation analysis of BMI was performed.

Results: As measured by E-DII, the mean (SE) value of the inflammatory potential of the diet in our study was 1.56 (0.12). E-DII ranged from 5.23 to 5.58. In comparison with the first quartile, the elderly from the second quartile (OR: 1.15 [95% CI: 1.09, 1.28]) to the fourth quartile (OR: 1.31 [95% CI: 1.16, 1.42]) have a higher risk of depression before adjustment for BMI. An interaction was observed between E-DII and BMI in terms of the risk of depression (P_Interaction < 0.001). The whole related part is mediated by BMI (31.06%).

Conclusion: Our findings indicate that the higher pro-inflammatory potential of diet is associated with a higher risk of depression, and this association may be mediated by BMI. Further research is needed to verify our findings and clarify the latent mechanism.

Identification of Mood and Body Mass Index as Modifiable Factors for Health Improvement in Spinal Cord Injury

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Higher body mass index (BMI) is associated with lower positive affect in individuals with spinal cord injury (SCI).

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Women with SCI are at higher risk of developing increased negative affect than men.

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Older individuals with SCI have a greater chance of developing higher BMI.

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Premorbid personality traits with respect to mood and BMI are essential to interpret the association of BMI and positive affect.

Objective

Design

Setting

Participants

Interventions

Main Outcome Measures

Results

Conclusions

Impact of bariatric surgery on urinary incontinence in morbidly obese individuals

BACKGROUND

There is scanty evidence on the impact of bariatric surgery on urinary incontinence (UI) in the Asian population.

METHODOLOGY

Patients who underwent bariatric surgery from June 2018 to June 2019 were screened using the International Consultation on Incontinence Questionnaire-Urinary Incontinence-Short Form (ICIQ-UI-SF) questionnaire. Patients having UI were identified and followed until 1 year of surgery using the ICIQ-UI-SF. These were classified as having stress, urge, or mixed type of UI. The prevalence, change in scores, and the number of pads used were compared at baseline and at follow-up.

RESULTS

A total of 148 patients underwent bariatric surgery of whom, 41 patients (M = 2, F = 39) had UI. Stress incontinence was seen in 70.7%, 19.5% had urge incontinence, and rest had the mixed type. Using logistic regression, it was found that female gender was the most important predictor of having UI (OR: 8.33). The prevalence of UI decreased from 27.7% at baseline to 8.1% at 6 months and 3.4% at 12 months. The mean ICIQ-UI-SF score improved from 8.76 (SD = 3.2) at baseline to 0.66 (SD = 2.1) at 12 months of follow-up. The proportion of patients with UI using any number of pads decreased from 92.7% at baseline to 9.8% at 12 months. There was a decrease in the number of patients having moderate to very severe UI from 35 (85.4%) at baseline to 2 (4.9%) at 12 months. Proportion of patients showing resolution was highest among the stress incontinence group at 96.5%. Presence or absence of comorbidities did not significantly influence the ICIQ-UI-SF scores.

CONCLUSION

Bariatric surgery leads to profound improvement in UI in obese individuals which is well sustained until 1 year of follow-up. Resolution rates might be higher in Asian population.

The association between obesity and quality of life: a retrospective analysis of a large-scale population-based cohort study

BACKGROUND

The relationship between obesity and health-related quality of life (HRQoL) may be confounded by factors such as multimorbidity. The aim of the study was to explore this relationship, controlling for long-term conditions and other health, lifestyle and demographic factors in a general adult population. There was specific interest in the impact of high weight status, measured by body mass index (BMI) levels (obesity, morbid obesity) compared with individuals of normal weight.

METHODS

Health, lifestyle and demographic data were collected from 64,631 individuals aged 16 years and over registered in the Yorkshire Health Study; a long-term cohort study. Data were collected in 2 waves: from patients attending GP surgeries in the South Yorkshire region; and using online recruitment across the entire Yorkshire and Humber area. Univariable and multivariable regression methods were utilised to identify factors associated with HRQoL as measured by the EQ-5D summary score. Long-term conditions were tested as both covariates and mediating factors on the causal pathway between obesity and HRQoL.

RESULTS

Increasing levels of obesity are associated with reduced HRQoL, although this difference is negligible between those of normal weight and those who are overweight. Individuals with obesity and morbid obesity score 4.9 and 11.3 percentage points less on the EQ-5D summary scale respectively than those of normal weight. Concurrent physical, and particularly mental health-related long-term conditions are substantively related to HRQoL: those with 3 or more reported mental or physical health conditions score 29.8 and 14.6 percentage points less on the EQ-5D summary scale respectively than those with fewer conditions. Long-term conditions can be conceptualised as lying on the causal path between obesity and HRQoL, but there is weak evidence for a partial mediating relationship only.

CONCLUSIONS

To conclude, in agreement with the established literature we have found a clear inverse relationship between increasing weight status and decreasing HRQoL and confirmed the mediating role of long-term conditions in the reduction of HRQoL in people with obesity. Nevertheless, a high BMI remains independently related to HRQoL, suggesting that 'healthy people with obesity' may be in transition to an unhealthy future.

Impact of using wearable devices on psychological Distress: Analysis of the health information national Trends survey

AIM

This study explores the possible impact of wearables on psychological distress and their implications on designs.

METHOD

The study conceptualizes and tests two exploratory models by analyzing the US-based Health Information National Trends Survey of 2019 and 2020. Six variants from the databases were used in the study as predictors. We used models 4 and 6 of the Hayes PROCESS macros to test our conceptual parallel and sequential mediation models, respectively.

RESULTS

The finding indicates significant and negative indirect effects of 'Use of wearable device' on 'Psychological distress.' In parallel mediation models, 'self-care' and 'health perception' were noted to be significant mediators. Wearable devices were associated with improved 'Health perception,' 'Self-care,' and longer 'workout duration,', which in turn helped reduce 'psychological distress' (better mental health). The sequential mediation model captured the indirect effect of 'Use of wearable device' on 'Psychological distress' when sequentially mediated by 'workout duration,' 'BMI,' 'self-care,' and 'health perception' in the given order.

CONCLUSION

As the adoption of digital wearables is increasing due to their growing potential to augment physiological and psychosocial health, it is critical that these technologies are designed to address the needs of users from diverse backgrounds (race, education level, age).

Obesity and Mental Health: A Longitudinal, Cross-Cultural Examination in Germany and China

The present study examines the relationship between obesity and mental health using longitudinal data. Participants with data at baseline and one-year follow-up were included from two countries: Germany (364) and China (9007). A series of structural equation models with three mediators and one moderator were conducted separately for female and male students in Germany and China. Zero-order correlations indicated that overweight/obesity was significantly related to later depression and anxiety in Chinese males. Additional effects of obesity on later mental health flowed through effects on attractiveness (Chinese and German females, and Chinese males), physical health (Chinese males), and life satisfaction (German females). Though overweight/obesity is related to mental health across many other studies, results in this study yield total effects between overweight/obesity and follow-up mental health only in Chinese males. The relationship between overweight/obesity and follow-up mental health was significantly mediated by follow-up attractiveness, or health state, or life satisfaction in German females, Chinese females, and Chinese male students, with no significant indirect effects found in German male students. This highlights the possible importance of culture in examining these effects.

Body weight and premature retirement: population-based evidence from Finland

BACKGROUND

Health status is a principal determinant of labour market participation. In this study, we examined whether excess weight is associated with withdrawal from the labour market owing to premature retirement.

METHODS

The analyses were based on nationally representative data from Finland over the period 2001-15 (N ∼ 2500). The longitudinal data included objective measures of body weight (i.e. body mass index and waist circumference) linked to register-based information on actual retirement age. The association between the body weight measures and premature retirement was modelled using cubic b-splines via logistic regression. The models accounted for other possible risk factors and potential confounders, such as smoking and education.

RESULTS

Excess weight was associated with an increased risk of premature retirement for both men and women. A closer examination revealed that the probability of retirement varied across the weight distribution and the results differed between sexes and weight measures.

CONCLUSION

Body weight outside a recommended range elevates the risk of premature retirement.