Obesity and loneliness. Findings from a longitudinal population-based study in the second half of life in Germany

Investigating the relationship between early cardiovascular disease markers and loneliness in young adults

Loneliness is recognised as a risk factor for cardiovascular disease development. However, it is unclear whether loneliness itself or other closely related mental health symptoms, such as depression and social anxiety, are associated with the development of cardiovascular disease. In the present study, we examined the relationship between loneliness and several early cardiovascular disease markers in young adults, after controlling for depression and social anxiety. Sixty-six young adults (18-35 years old, Mage = 22.70; 75.8% females) completed psychological questionnaires and took part in several physiological tests assessing cardiovascular health (e.g., vascular function). Results revealed higher loneliness was significantly associated with shorter pulse transit time (β = - 0.70, p = 0.002; shorter pulse transit time is a subclinical marker for arterial stiffness). Additionally, results show that while loneliness and depression were both related to vascular dysfunction in young adults, the underlining physiological mechanisms through which they affect vascular function may be different. Specifically, higher loneliness was associated with increased arterial stiffness, whereas depression was associated with increased endothelial dysfunction (β = - 0.43, p = 0.04). Our findings indicate that presence of loneliness and depression in young adults may be accompanied by early indicators of poor cardiovascular health, such as arterial stiffness and endothelial dysfunction. Results from the study further support the link between loneliness and cardiovascular disease development.

Health behaviors and mental health among adolescents: A comparison based on BMI using the 2021 Korea Youth Risk Behavior Survey

Background

Obesity and underweight can have adverse effects on adolescents. However, previous obesity management program conducted in Korea for adolescents with obesity showed low effectiveness, and there are few studies on underweight Korean adolescents.

Objective

This study aims to analyze differences in the health behaviors and mental health of adolescents based on their body mass index (BMI).

Methods

Data from the 2021 Korea Youth Risk Behavior Survey were examined. The health behaviors and mental health of 53,445 adolescents were analyzed according to BMI using SAS version 9.4 with the Rao-Scott χ2 test and logistic regression analysis.

Results

Regarding the difference in health behaviors according to BMI, a higher proportion of participants who are drinking alcohol and are exposed to secondhand smoke were in the underweight group than in the obesity group. The rate of obesity among those engaged in physical activity was higher than that among those involved in non-physical activity. In addition, the obesity group used smartphones more than the underweight group, while the quality of sleep was better among the underweight group than the obesity group.

Conclusion

While the health behaviors and mental health of adolescents according to BMI are similar to those of previous studies, there are also distinct aspects. Consequently, further exploration of health behaviors and mental health based on BMI is crucial for developing and implementing targeted nursing intervention programs for adolescents with different weights.

The Association of Loneliness with Diabetes Is Mediated by Physical Activity and BMI but Not Diet Quality

Loneliness is considered a predictor of poor health through numerous pathways. Mediators of this association has not been extensively explored. The study objective was to determine if diet quality and physical activity are parallel mediators with body mass index (BMI) as the third mediator in the association of loneliness with diabetes. The sample, middle-aged and older African American and White adults, 36-77 years, participated in the second follow-up wave of the prospective Healthy Aging in Neighborhoods of Diversity across the Life Span study, 2013-2017. Loneliness was measured by the UCLA 3-item loneliness scale. Participants were categorized as not diabetic, pre-diabetic, or diabetic based on fasting blood glucose, self-reports, or taking medication for diabetes. The Mean Healthy Eating Index-2010 score was calculated from two 24 h dietary recalls collected using the USDA automated multiple pass method. Physical activity was derived from the Baecke questionnaire. The Hayes PROCESS macro, model #80, was used to perform the mediational analysis. Covariates were age, sex at birth, race, income, alcohol intake, and education. Loneliness was inversely and significantly associated with diet quality and physical activity. The only significant indirect path was loneliness > physical activity > BMI > diabetes. Better understanding of modifiable lifestyle behaviors when developing interventions may improve mental health, thereby improving health.

The relationship between weight self-stigma, depression and loneliness in people with obesity

The research was conducted to determine the level of weight self-stigma, depression loneliness and whether is there a relationship between them. This was a descriptive correlational study. The study was conducted in a diet outpatient clinic of a university hospital. Participants had moderate weight self-stigma, depression and loneliness. Weight self-stigma sub-dimensions self-devaluation (β=0.28; p<0.001) and fear of enacted stigma (β=0.28; p<0.001) equally predicted depression. Fear of enacted stigma predicted social loneliness negatively (β=-.44; p<0.001). Fear of enacted stigma (β =.16, p<.005) and depression (β =.44, p<.001) predicted emotional loneliness positively. Weight self-stigma was positively correlated with depression and loneliness (p<0.001).

Evaluating the impact of loneliness and social isolation on health literacy and health-related factors in young adults

Objectives

In current study, we aim to extend previous research by investigating the unique impact of loneliness on health literacy and health-related factors of young adults, after controlling for social isolation, depressive symptomology, and social anxiety, as well as evaluate how social isolation and loneliness differ in their impact on health literacy, and health-related factors among young adults, after accounting for abovementioned concomitant variables.

Methods

Using a cross-sectional study design, 521 young adults completed an online survey in 2020, where they self-reported their loneliness, social isolation, health-related factors, and health literacy data.

Results

Increased loneliness was associated with decrease in several health literacy domains (e.g., poorer social support for health, lower appraisal of health information, among others) and increase in some health-related factors (e.g., higher perceived stress, higher negative affect), among young adults, even after controlling for social anxiety, depressive symptomology, and social isolation. Contrastingly, increase in social isolation was associated with changes in some health-related factors - more somatic health complaints, higher alcohol use, poorer cognitive and physical functioning, and lower scores for only one health literacy domain (i.e., social support for health) among young adults, after adjusting for the influence of social anxiety, depressive symptomology, and loneliness.

Conclusion

Even after accounting for the influence of several co-occurring social and mental health symptoms, higher loneliness was associated poorer health literacy and health-related factors in young adults. We also found loneliness and social isolation may differ in the mechanisms through which they impact health literacy and health-related factors in young adults.

Loneliness, Depression, and Genetics in the Elderly: Prognostic Factors of a Worse Health Condition?

Loneliness is considered a prognostic factor for poorer health status in the elderly. It is proposed to analyze the role of loneliness in health status in terms of various factors. A total of 1747 individuals from the pilot survey of the Aging in Spain Longitudinal Study (ELES-PS) were reviewed. ELES is a cross-sectional study for collecting health variables, food habits, socioeconomic data, and cognitive and functional capacities, which was carried out on a Spanish representative sample of noninstitutionalized persons of 50 years of age or older. Moreover, since telomere shortening is associated with cellular senescence, 35 telomere-related SNPs and cognitive impairments were analyzed. The results characterize the "solos" as males of 50-60 years, who were overweight and had lower levels of hemoglobin and neutrophils. There is also an association between five SNPs related to telomere length and BDNF. A group of people with loneliness and depression was identified with poorer health and cognitive status, poorer perception of their quality of life, poorer quality of sleep, and lower physical activity. Therefore, it follows that telomeres and BDNF play a role as intermediaries between loneliness and depression and their relationship with a worse state of health.

Height dissatisfaction and loneliness among adolescents: the chain mediating role of social anxiety and social support

Previous research on body dissatisfaction has mainly focused on the dissatisfaction with weight and appearance. Limited research has examined the dissatisfaction with another major body feature that is important to our social relationships and personal well-being, namely, body height. We hypothesized that height dissatisfaction would predict more intense loneliness among adolescents, and that this relationship is mediated by greater social anxiety and reduced social support. Participants of this study were 515 Chinese high school students. The Shortness subscale of the Negative Physical Self Scale, Social Anxiety Scale for Adolescents, Perceived Social Support Scale, and ULS-8 were integrated into a paper-and-pencil survey. The results revealed that adolescents with high levels of height dissatisfaction reported higher levels of loneliness. A chain mediation model showed that the relationship between height dissatisfaction and loneliness could be both sequentially mediated by social anxiety and social support, and mediated by social anxiety. However, no mediating role of social support was found. We also found that body height did not predict social anxiety or social support, but can predict loneliness. The current findings provide novel insights into the occurrence of loneliness among adolescents, and indicate that negative self-perceptions of body height and the resulting social anxiety can lead to loneliness.

Social support and health-related quality of life among the oldest old - longitudinal evidence from the multicenter prospective AgeCoDe-AgeQualiDe study

PURPOSE

The aim of this study was to examine the longitudinal within-association between social support and health-related quality of life among the oldest old.

METHODS

Longitudinal data (follow-up waves 7 to 9) were used from the multicenter prospective cohort study "Needs, health service use, costs and health-related quality of life in a large sample of oldest-old primary care patients (85 +)" (AgeQualiDe). n = 648 individuals were included in the analytical sample. At FU wave 7, mean age was 88.8 years (SD: 2.9 years, from 85 to 99 years). Social support was quantified using the Lubben Social Network Scale (6-item version). Health-related quality of life was assessed using the EQ-5D-3L including problems in five health dimensions, and its visual analogue scale (EQ VAS). It was adjusted for several covariates in conditional logistic and linear fixed effects regressions.

RESULTS

Intraindividual decreases in social support were associated with an increased likelihood of developing problems in 'self-care', 'usual activities', 'pain/discomfort' and 'anxiety/depression' (within individuals over time). In contrast, intraindividual changes in social support were not associated with intraindividual changes in the EQ VAS score.

CONCLUSION

Findings indicate a longitudinal intraindividual association between social support and problems, but only in some health dimensions. Further research in this area based on longitudinal studies among the oldest old (from different countries) is required.

Asymmetric effects of obesity on loneliness among older Germans. Longitudinal findings from the Survey of Health, Ageing and Retirement in Europe

OBJECTIVES

The aim of this longitudinal study was to examine whether the onset and the end of obesity was associated with loneliness.

METHOD

Nationally representative longitudinal data from Germany were taken from the Survey of Health, Ageing and Retirement in Europe (wave 5 to wave 7; n = 10,446 observations in the analytical sample). Using the three item loneliness scale (UCLA), loneliness was measured. According to the WHO thresholds, obesity was defined as BMI ≥ 30 kg/m². Asymmetric fixed effects (FE) regressions were used.

RESULTS

Conventional FE regression analysis revealed that changes in obesity status were associated with changes in loneliness (men: β = -.19, p < .05; women: β = .19, p < .05). Asymmetric FE regressions showed that in men the onset of obesity was associated with a decrease in loneliness (β = -.31, p < .05), whereas the end of obesity was not associated with loneliness. Asymmetric FE regressions showed that in women, the onset of obesity was associated with an increase in loneliness (β = .33, p < .01), whereas the end of obesity was not associated with loneliness.

CONCLUSION

Findings showed that the onset of obesity has different consequences in terms of loneliness for older women and men in Germany, whereas the end of obesity was not associated with changes in loneliness scores. We recommend that future studies should distinguish between the onset and the end of obesity - which comes along with important practical implications. When older women report transitions to obesity, efforts to prevent loneliness may be of importance.

Healthcare Professionals' Perceptions of Loneliness amongst Older Adults: A Qualitative Study

BACKGROUND

Loneliness amongst older adults is linked to poor health outcomes and constitutes a public health issue worldwide. Healthcare professionals' perceptions could influence the strategies they implement in order to prevent, detect and manage loneliness amongst older adults. The aim of this study was to describe and understand healthcare professionals' perceptions of loneliness amongst older adults.

METHODS

A descriptive qualitative study. Twenty-six Spanish healthcare professionals with experience caring for older adults participated in the study. Data were collected between November 2019 and September 2020 using focus groups and in-depth interviews. Data were analysed following a content analysis method using ATLAS.ti software.

RESULTS

Healthcare professionals' perceptions of loneliness amongst older adults is represented by three themes: (1) "when one's personal life and social context lead to loneliness"; (2) "from abandonment to personal growth: the two faces of loneliness"; and (3) "loneliness as a health issue that needs to be addressed".

CONCLUSIONS

Healthcare professionals perceive loneliness as a multifactorial, subjective experience that can trigger different coping mechanisms and negatively affect older people's health. Healthcare professionals consider that a greater involvement of the whole society is needed in order to fight loneliness amongst older adults as a public health issue.

Aging, Social Distancing, and COVID-19 Risk: Who is more Vulnerable and Why?

Perceived social support represents an important predictor of healthy aging. The global COVID-19 pandemic has dramatically changed the face of social relationships and revealed elderly to be particularly vulnerable to the effects of social isolation. Social distancing may represent a double-edged sword for older adults, protecting them against COVID-19 infection while also sacrificing personal interaction and attention at a critical time. Here, we consider the moderating role of social relationships as a potential influence on stress resilience, allostatic load, and vulnerability to infection and adverse health outcomes in the elderly population. Understanding the mechanisms how social support enhances resilience to stress and promotes mental and physical health into old age will enable new preventive strategies. Targeted social interventions may provide effective relief from the impact of COVID-19-related isolation and loneliness. In this regard, a pandemic may also offer a window of opportunity for raising awareness and mobilizing resources for new strategies that help build resilience in our aging population and future generations.

Loneliness in Primary Care Patients: Relationships With Body Mass Index and Health Care Utilization

Purpose

Rates of loneliness and obesity have increased in recent decades. Loneliness and obesity independently have been found to be risk factors for negative physical and mental health outcomes. This study examined the rates and interrelationships of loneliness, body mass index (BMI), and health care utilization in a primary care setting.

Methods

A cross-sectional survey of adult patients presenting for outpatient care at 7 family medicine clinical practices in Pennsylvania was conducted. Survey questions included self-reported measures of loneliness, height/weight, number of health care visits, and potential confounders (eg, sociodemographic variables, health status). Bivariate and multivariable linear regression models were used to analyze associations among loneliness, BMI, and health care utilization.

Results

In all, 464 eligible patients returned surveys for an overall response rate of 26%. Mean (standard deviation) loneliness score was 4.2 (1.7), mean BMI was 30.4 (7.6), and mean number of visits in year prior was 2.7 (3.6). On bivariate analysis, BMI was positively associated with loneliness (effect estimate: 0.50; P=0.03). On multivariable analysis, BMI was negatively associated with attending religious services and self-reported physical health and positively associated with self-reported mental health (P<0.05 for all), but not associated with loneliness. While not associated with loneliness, health care utilization was negatively associated with Hispanic ethnicity, marital status, and self-reported physical health (P<0.05 for all).

Conclusions

Given the detrimental effects loneliness and obesity have on health outcomes, it might be prudent for health care providers to prioritize health concerns for their patients by assessing loneliness and counseling regarding associated risks, particularly in patients with obesity.

Does obesity lead to loneliness and perceived social isolation in the second half of life? Findings from a nationally representative study in Germany

AIM

Little is known about the link between obesity and loneliness as well as perceived social isolation. Therefore, the objective of this longitudinal study is to clarify whether the onset and the end of obesity is associated with changes in perceived social isolation as well as loneliness (stratified by sex) in older age.

METHODS

Longitudinal data were used from wave 5 (year 2014) and 6 (year 2017) of the German Ageing Survey - a nationally representative sample of community-dwelling individuals aged ≥40 years in Germany. Established tools were used to quantify loneliness and perceived social isolation. A body mass index ≥30 kg/m² was used to classify individuals as being obese. Asymmetric fixed effects regressions were used.

RESULTS

Regressions showed that the end of obesity was associated with decreases in perceived social isolation among women (β = -0.24, P = 0.01), but not in men (with significant sex differences). The onset of obesity was not associated with changes in perceived social isolation. Neither the beginning of obesity nor the end of obesity was associated with changes in loneliness.

CONCLUSIONS

Our findings emphasize the importance of overcoming obesity for women in the second half of life. As most of the existing studies were conducted in Germany, studies from other countries are of importance to understand this association better. Geriatr Gerontol Int 2021; 21: 836-841.

The Association Between Obesity and Social Isolation as Well as Loneliness in the Adult Population: A Systematic Review

PURPOSE

Obesity is associated with adverse health outcomes and can result in feelings of loneliness or social isolation, for example due to stigmatization. These factors are in turn associated with morbidity and mortality. Thus far, a systematic review is lacking with regard to the association between obesity, social isolation and loneliness. Therefore, our aim was to fill this gap in knowledge.

MATERIALS AND METHODS

Three established electronic databases (PubMed, PsycInfo, as well as CINAHL) were searched. Observational studies examining the link between obesity and loneliness or social isolation were included. Disease-specific samples were excluded.

RESULTS

In sum, six studies have been included. While some studies point to an association between obesity and increased loneliness levels, it should be acknowledged that findings are mixed. Study quality was quite high.

CONCLUSION

This systematic review showed that the literature is inconclusive and incomplete. Further research is required to shed further light on these associations. Moreover, studies from countries outside Europe, based on longitudinal data and using objective assessments of obesity, are urgently required. Gender differences should be further explored.

Prevalence Of, and Factors Associated with, Obesity among the Oldest Old. A Study Protocol for a Systematic Review

Some empirical studies have identified the prevalence of, and factors associated with, obesity among the oldest old. However, there is a lack of a systematic review synthesizing the existing evidence. Therefore, the purpose of our upcoming systematic review is to provide an overview of the evidence provided by observational studies. The current paper presents the protocol for this systematic review. We will search four electronic databases (Medline, PsycINFO, CINAHL, and Cochrane Library). Furthermore, we will perform a manual search (searching reference lists of included studies). Cross-sectional and longitudinal observational studies identifying the prevalence and preferably the factors associated with obesity among the oldest old (80 years and over) will be included. Data extraction will concentrate on study design, assessment of obesity and its associated factors, statistical analysis, sample characteristics, and key findings. We will evaluate the quality of the included studies. Two individuals will perform study selection, data extraction, and evaluation of study quality. We will present the results in figures, summary tables and narrative summaries. If data permits, a meta-analysis will be conducted.

Which factors contribute to loneliness among older Europeans? Findings from the Survey of Health, Ageing and Retirement in Europe: Determinants of loneliness

BACKGROUND

While previous studies have examined the determinants of loneliness (i) using a longitudinal approach and (ii) using data from nationally representative samples, only few studies have done both at once. Hence, the purpose of our study was to clarify which factors are associated with loneliness longitudinally based on nationally representative data.

METHODS

Data were taken from wave 5 to 7 of the "Survey of Health Ageing, and Retirement in Europe "(SHARE; covering 27 European countries and Israel in total) (in our analytical sample, n = 101,909 observations). Loneliness was assessed using the three-item loneliness scale. As explanatory variables, we included age, marital status, income, self-rated health, depressive symptoms, functional decline, cognitive functioning and chronic diseases. Exploiting the features of panel data and mitigating the problem of unobserved heterogeneity, linear FE regressions were used.

RESULTS

FE regressions showed that loneliness increased with increasing age (β = .02, p < .001), changes from married and living together with spouse/registered partnership to another marital status (β=-.71, p < .001), decreases in log income (β=-.01, p < .05), worsening self-rated health (β = .04, p < .001), functional decline (β = .09, p < .001), increases in depressive symptoms (β = .13, p < .001) and decreases in cognitive functioning (β=-.01, p < .001), whereas it was not associated with changes in chronic diseases.

CONCLUSION

Our longitudinal study based on nationally representative SHARE data contributed to identify the determinants of loneliness among older Europeans using panel data methods. Tackling the identified risk factors may assist in avoiding loneliness in older adults living in Europe.

Prevalence and factors associated with obesity among the oldest old

PURPOSE

To determine the prevalence of overweight and obesity, and to identify factors associated with obesity, among the oldest old.

METHODS

For this study, data from follow-up (FU) wave 7 and FU wave 8 of the "Study on Needs, Health Service Use, Costs and Health-Related Quality of Life in a Large Sample of Oldest-Old Primary Care Patients (85+)" (AgeQualiDe) were used. At FU wave 7, the mean age was 88.9 years (SD: 2.9; 85-100 years). Body-mass-index (BMI) categories were defined according to the World Health Organization (WHO) thresholds: underweight (BMI < 18.5 kg/m²), normal weight (18.5 kg/m² ≤ BMI < 25 kg/m²), overweight (25 kg/m² ≤ BMI < 30 kg/m²), and obesity (BMI ≥ 30 kg/m²). Longitudinal regression analysis was used to determine factors associated with obesity.

RESULTS

At FU wave 7, 3.0 % were underweight, 48.9 % were normal weight, 37.9 % were overweight, and 10.2 % were obese. Regressions showed that the probability of obesity decreased with age (OR: 0.77 [95 % CI: .593-.999]) and less chronic conditions (OR: 1.32 [95 % CI: 1.11-1.57]). The probability of obesity was not associated with sex, educational level, marital status, social isolation, visual impairment, hearing impairment, depression, and dementia.

CONCLUSION

Nearly half of the individuals in very late life had excess weight. Thus, excess weight remains a major challenge, even in very old age. Given the demographic ageing in upcoming decades, this is an issue which we should be aware of.