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Urdapilleta I, El Khoury L, Catheline JM, Lahlou S, Demarchi S. Mediating factors explain anxiety experienced by women with obesity during the Covid-19 pandemic. PLoS One 2023; 18:e0295034. [PMID: 38117823 PMCID: PMC10732381 DOI: 10.1371/journal.pone.0295034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 11/14/2023] [Indexed: 12/22/2023] Open
Abstract
The Covid-19 pandemic could be a source of great anxiety, especially for those at higher risk, such as women experiencing obesity. The aim of this study was to measure how some personal characteristics such as BMI (from underweight to class 3 obesity), bariatric surgery (yes or no), comorbidities, or age (as antecedent variables), and mediating factors impacted state anxiety during the Covid-19 Pandemic. Mediating factors were related to subjective knowledge or attitudes (e.g. interest or beliefs and practices around Covid-19, subjective health perception, and confidence in the government). French women (N = 532) were invited to take part in a voluntary online health survey during lockdown in Paris and its suburbs. Results showed that women with higher BMI had higher anxiety scores, primarily because they feel less healthy than other people. Secondly, the larger the body size of the participants was (BMI), the less they reported that information about Covid-19 held their attention. This lack of interest resulted in feelings of anxiety not being generated. Thirdly, the larger their body size was, the less confidence they had in the effectiveness of the proposed measures by the government and therefore, the more anxious they were. Finally, older age predicted higher interest in the pandemic, higher subjective health, and higher confidence in the government. Identifying obesity as a potential risk factor for anxiety disorders is crucial, but measuring the relationship between state anxiety and personal characteristics (e.g. BMI) requires considering mediating variables (e.g. subjective health perception). To reduce anxiety in women with obesity, it appears necessary to focus on psychological programs that can help them improve their perception of their health, as well as the confidence they may have in institutions, especially for younger women.
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Affiliation(s)
- Isabel Urdapilleta
- Department of Psychology, Laboratoire Cognitions Humaine et Artificielle (CHArt—EA 4004), Université Paris 8, Vincennes-Saint-Denis, France
| | - Lionel El Khoury
- Digestive Surgery Department, Delafontaine Hospital, Saint-Denis, France
| | | | - Saadi Lahlou
- Department of Psychological and Behavioural Science, London School of Economics and Political Science, London, United Kingdom
- Paris Institute for Advanced Study, Paris, France
| | - Samuel Demarchi
- Department of Psychology, Laboratoire Cognitions Humaine et Artificielle (CHArt—EA 4004), Université Paris 8, Vincennes-Saint-Denis, France
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Yoon SJ, Jung JG, Ahn SK, Kim JS, Hong JH. Non-linear relationship between body mass index and self-rated health in older Korean adults: body image and sex considerations. Epidemiol Health 2023; 45:e2023061. [PMID: 37402412 PMCID: PMC10667579 DOI: 10.4178/epih.e2023061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 06/05/2023] [Indexed: 07/06/2023] Open
Abstract
OBJECTIVES The purpose of this study was to investigate the association between body mass index (BMI) and self-rated health (SRH) in older adults aged over 65 years while examining the influence of self-perceived body image (SBI) and sex. METHODS Raw data were obtained from the Korea Community Health Survey, which included BMI measurements of Koreans aged over 65 years (n=59,628). Non-linear relationships between BMI and SRH were analyzed separately for each sex using restricted cubic splines while controlling for SBI and other confounding variables. RESULTS Men showed a reverse J-shaped association, while women showed a J-shaped association between BMI and poor SRH. However, including SBI in the model changed this association for men to an inverted U-shape showing a negative direction, with the highest risk of poor SRH observed in the underweight to overweight range. For women, a nearly linear positive relationship was observed. Regardless of BMI, those who perceived their weight as not "exactly the right weight" had a higher risk of poor SRH than those who perceived their weight as "exactly the right weight" in both men and women. Older men who thought they were much too fat or too thin had similar highest risks of poor SRH, whereas older women who thought they were too thin had the highest risk of poor SRH. CONCLUSIONS The findings of this study emphasize the importance of considering sex and body image perceptions when assessing the relationship between BMI and SRH in older adults, especially in men.
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Affiliation(s)
- Seok-Joon Yoon
- Department of Family Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - Jin-Gyu Jung
- Department of Family Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - Soon-Ki Ahn
- Department of Preventive Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - Jong-Sung Kim
- Department of Family Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - Jang-Hee Hong
- Clinical Trial Center, Biomedical Research Institute, Chungnam National University Hospital, Daejeon, Korea
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Gong WJ, Fong DYT, Wang MP, Lam TH, Chung TWH, Ho SY. Worsening trends in self-rated health and correlates in Chinese adolescents in Hong Kong: a population-based panel study from 1999/2000 to 2014/15. BMJ Open 2022; 12:e055842. [PMID: 35165111 PMCID: PMC8845170 DOI: 10.1136/bmjopen-2021-055842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES To examine the 15-year secular trends of self-rated health (SRH) and correlates in Chinese adolescents in Hong Kong. DESIGN A territory-wide population-based panel data study. SETTING Anonymised records of the annual health examination from the Student Health Service, Department of Health in Hong Kong. PARTICIPANTS 397 324 students in Secondary 2 (US grade 8), 335 902 in Secondary 4 and 113 892 in Secondary 6 during the academic year 1999/2000 and 2014/15. OUTCOME MEASURES SRH and lifestyles were self-reported using standardised questionnaires. Sex-standardised and age-standardised prevalence of very poor/poor SRH and its secular annual changes across sex, grade, weight status, breakfast habits, and frequency/duration of aerobic exercises were examined. Their disparities over time were examined by interactions with the academic year in generalised estimating equations. RESULTS The overall prevalence of very poor/poor SRH increased from 9.3% (95% CI: 8.9% to 9.7%) in 1999/2000 to 15.5% (15.1% to 15.8%) in 2014/15. Very poor/poor SRH was more prevalent in girls (adjusted OR: 1.02), in those having unemployed parents (1.29), being overweight (1.42) or obese (2.62), eating breakfast away from home (1.27) and skipping breakfast (1.49) or doing <1 time/week or ≤60 min/week aerobic exercises (1.78 and 1.88, respectively) than others. The corresponding disparities increased over time (ratios of OR: 1.006-1.042). CONCLUSIONS Increasing prevalence of very poor/poor SRH from 1999/2000 to 2014/15 was found among Hong Kong Chinese adolescents, which was greater in girls, adolescents being overweight/obese and those having unemployed parents or unhealthy lifestyles. Strategies to reduce health inequality should consider multiple factors, especially modifiable factors including lifestyles.
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Affiliation(s)
- Wei Jie Gong
- School of Nursing, The University of Hong Kong, Hong Kong SAR, China
- School of Public Health, The University of Hong Kong, Hong Kong SAR, China
| | | | - Man Ping Wang
- School of Nursing, The University of Hong Kong, Hong Kong SAR, China
| | - Tai Hing Lam
- School of Public Health, The University of Hong Kong, Hong Kong SAR, China
| | | | - Sai Yin Ho
- School of Public Health, The University of Hong Kong, Hong Kong SAR, China
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Froelicher JH, Forjaz G, Rosenberg PS, Chernyavskiy P. Geographic disparities of breast cancer incidence in Portugal at the district level: A spatial age-period-cohort analysis, 1998-2011. Cancer Epidemiol 2021; 74:102009. [PMID: 34399245 DOI: 10.1016/j.canep.2021.102009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 08/06/2021] [Accepted: 08/07/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Breast cancer is the most common malignancy in women world-wide and the most common cause of cancer deaths, which can often be managed with early diagnosis and subsequent treatment. Here, we focus on geographic disparities in incidence within Portugal for three age groups of women (30-49; 50-69; 70-84 years). METHODS Age-period-cohort (APC) models are widely used in cancer surveillance, and these models have recently been extended to allow spatially-varying effects. We apply novel spatial APC models to estimate relative risk and age-adjusted temporal trends at the district level for the 20 districts in Portugal. Our model allows us to report on country-wide trends, but also to investigate geographic disparities between districts and trends within districts. RESULTS Age-adjusted breast cancer incidence was increasing over 1998-2011 for all three age groups and in every district in Portugal. However, we detect spatially-structured between-district heterogeneity in relative risk and age-adjusted trends (Net Drifts) for each of the three age groups, which is most pronounced in the highly-screened (50-69yo) and late-onset (70-84yo) groups of women. CONCLUSIONS We present evidence of disparities in breast cancer incidence at a more granular geographic level than previously reported. Some disparities may be due to latent risk factors, which cannot be accounted for by age, birth year, and geographic location alone. IMPACT Our study motivates resuming data collection for breast cancer incidence at the district level in Portugal, as well as the study of exogenous risk factors.
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Affiliation(s)
- Joseph H Froelicher
- Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, CO, USA.
| | - Gonçalo Forjaz
- Data Analytics Branch, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA.
| | - Philip S Rosenberg
- Biostatistics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA.
| | - Pavel Chernyavskiy
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA.
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Forjaz de Lacerda G, Kelly SP, Bastos J, Castro C, Mayer A, Mariotto AB, Anderson WF. Breast cancer in Portugal: Temporal trends and age-specific incidence by geographic regions. Cancer Epidemiol 2018; 54:12-18. [PMID: 29544153 DOI: 10.1016/j.canep.2018.03.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 02/02/2018] [Accepted: 03/07/2018] [Indexed: 01/08/2023]
Abstract
BACKGROUND Female breast cancer incidence rates have been increasing in Portugal for years. We, therefore, conducted the first nationwide breast cancer study to assess regional differences. METHODS Cases were obtained from population-based cancer registries covering the country's Mainland (South, North, Centre), as well as the two Autonomous Regions (Azores and Madeira), for the time-period 1998 through 2011. Analyses were restricted to ages 30-84 years and stratified by region. We used the age-period-cohort (APC) framework to complement standard descriptive techniques and to forecast future trends. Estimable APC parameters included net drift, longitudinal age-specific incidence rate curves, and fitted age-specific incidence rate ratios. RESULTS There were 71 545 breast cancer cases diagnosed in Portugal at ages 30-84 years from 1998 to 2011. The South presented the highest age-standardized rate (155.8/100 000), while the North presented the fastest rate of increase (3.6%/year). Age-specific statistical interactions were observed between regions. Younger women in the North revealed a decreased risk of developing breast cancer compared to women from the same age group in the South and Centre, while that risk was reversed in older women (p < 0.05). We estimate that from 2014 onwards, the North might rank first among all regions. CONCLUSION The variant patterns observed could be due to a combination of different screening practices and/or exposure to risk factors across regions. Disease heterogeneity among younger and older women may also explain part of the differences in age-specific rates. These results justify continued monitoring of breast cancer incidence by region.
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Affiliation(s)
- Gonçalo Forjaz de Lacerda
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA; Azores Region Cancer Registry, Azores Oncological Centre, Portugal.
| | - Scott P Kelly
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Joana Bastos
- Centre Region Cancer Registry, Portuguese Institute of Oncology, Coimbra, Portugal
| | - Clara Castro
- Northern Region Cancer Registry, Portuguese Institute of Oncology, Porto, Portugal
| | - Alexandra Mayer
- Southern Region Cancer Registry, Portuguese Institute of Oncology, Lisbon, Portugal
| | - Angela B Mariotto
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - William F Anderson
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
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Tang K, Zhao Y, Li C. The association between self-rated health and different anthropometric and body composition measures in the Chinese population. BMC Public Health 2017; 17:317. [PMID: 28407795 PMCID: PMC5390392 DOI: 10.1186/s12889-017-4249-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2016] [Accepted: 04/08/2017] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND To analyze the strength of association between self-rated health and six anthropometric and body composition measures to explore the best indicator. METHODS Analyses were based on the cross-sectional data from the China Kadoorie Biobank Study and approximately 300,000 adults were analyzed. Logistics regression was used to analyze the association between self-rated health (good or poor) and anthropometric and body composition measures (height, weight, body mass index (BMI), waist circumference (WC), hip circumference (HC) and body fat percentage, waist-to-hip ratio and waist-to-height ratio). Stratified analyses were undertaken to understand the effect modification of socioeconomic status on the association. RESULT Odds ratio of self-rated better health had an inverted U-shape association with weight, BMI, WC and body fat, with weight levels increasing until around 73.8 and 65.7 kg for male and female, BMI around 26.8 kg/m2, WC around 85.8 and 87.6 cm, body fat around 24.3 and 36.3%, and then declining thereafter. Height and HC also indicated a slightly inverted U-shape association. The strongest association was observed after adjustment was weight, with one standard deviation greater weight associated with 10.2% and 10.6% increased odds in male and female. CONCLUSIONS Being underweight and overweight are both risk factors for poor self-rated health in males and females, and weight is the best indicator of self-rated health compared with other measures.
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Affiliation(s)
- Kun Tang
- Department of Global Health, Peking University, Beijing, China
| | - Yingxi Zhao
- Institute for Medical Humanities, Peking University, Beijing, China
| | - Chunyan Li
- School of Public Health, Peking University, Beijing, China
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Cullinan J, Gillespie P. Does Overweight and Obesity Impact on Self-Rated Health? Evidence Using Instrumental Variables Ordered Probit Models. HEALTH ECONOMICS 2016; 25:1341-1348. [PMID: 26140325 DOI: 10.1002/hec.3215] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Revised: 05/21/2015] [Accepted: 06/08/2015] [Indexed: 06/04/2023]
Abstract
This paper, for the first time, presents estimates of the causal impact of overweight and obesity on self-rated health (SRH) using instrumental variables (IV) econometric methods. While a number of previous studies have sought to better understand the determinants of SRH, there is no consensus in relation to the impact of overweight and obesity. Using data from a large nationally representative sample of Irish parents and their children, we estimate a range of ordered probit models to isolate the causal effect of overweight and obesity on SRH. Our data includes independently and objectively recorded weight and height measures for parents and their children and we instrument for parental body mass index (BMI) status using the BMI of a biological child. After controlling for a range of individual, socioeconomic, health and lifestyle related variables, we find that being overweight has a negligible impact on SRH, while being obese has a practically and statistically significant negative impact on SRH, with these effects most pronounced for those who are most obese. We find only minor differences in these effects across gender. Copyright © 2015 John Wiley & Sons, Ltd.
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Affiliation(s)
- John Cullinan
- Discipline of Economics, National University of Ireland, Galway, Ireland
| | - Paddy Gillespie
- Discipline of Economics, National University of Ireland, Galway, Ireland
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N'Goran AA, Studer J, Deline S, Henchoz Y, Baggio S, Mohler-Kuo M, Daeppen JB, Gmel G. Bidirectional relationship between the body mass index and substance use in young men. Subst Abus 2015; 37:190-6. [DOI: 10.1080/08897077.2015.1013204] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Johansson SE, Midlöv P, Sundquist J, Sundquist K, Calling S. Longitudinal trends in good self-rated health: effects of age and birth cohort in a 25-year follow-up study in Sweden. Int J Public Health 2015; 60:363-73. [PMID: 25650292 DOI: 10.1007/s00038-015-0658-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Revised: 01/16/2015] [Accepted: 01/22/2015] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES Although average life expectancy has increased considerably in Sweden, there is less evidence for improved self-rated health (SRH). We analyzed longitudinal trends in SRH between 1980/1981 and 2004/2005 in age and birth cohort subgroups. METHODS 2,728 males and 2,770 females, aged 16-71 years, were interviewed every eighth year. Mixed models with random intercepts were used to estimate changes in SRH within different age groups and birth cohorts, adjusting for potential confounders. RESULTS During the 25-year follow-up, SRH improved in individuals aged ≥48 years, but became poorer or was unchanged in those aged 16-47 years. All birth cohorts showed poorer SRH with increasing age, with an adjusted odds ratio (95% confidence interval) of 0.94 (0.93-0.95) in males and 0.92 (0.91-0.93) in females. CONCLUSIONS While SRH in the older age groups improved, SRH became poorer in the youngest. Poorer SRH is deeply worrying for the affected individuals, and may also have a negative impact on the health care system. Although mental illness, socioeconomic factors, and lifestyle may be potential mechanisms, future studies are needed to investigate the reasons behind this trend.
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Affiliation(s)
- Sven-Erik Johansson
- Department of Clinical Sciences in Malmö, Center for Primary Health Care Research, Lund University, Malmö, Sweden
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van der Starre RE, Coffeng JK, Hendriksen IJM, van Mechelen W, Boot CRL. Associations between overweight, obesity, health measures and need for recovery in office employees: a cross-sectional analysis. BMC Public Health 2013; 13:1207. [PMID: 24359267 PMCID: PMC3890611 DOI: 10.1186/1471-2458-13-1207] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Accepted: 12/16/2013] [Indexed: 11/16/2022] Open
Abstract
Background With both a high need for recovery (NFR) and overweight and obesity being a potential burden for organizations (e.g. productivity loss and sickness absence), the aim of this paper was to examine the associations between overweight and obesity and several other health measures and NFR in office workers. Methods Baseline data of 412 office employees participating in a randomised controlled trial aimed at improving NFR in office workers were used. Associations between self-reported BMI categories (normal body weight, overweight, obesity) and several other health measures (general health, mental health, sleep quality, stress and vitality) with NFR were examined. Unadjusted and adjusted linear regression analyses were performed and adjusted for age, education and job demands. In addition, we adjusted for general health in the association between overweight and obesity and NFR. Results A significant positive association was observed between stress and NFR (B = 18.04, 95%CI:14.53-21.56). General health, mental health, sleep quality and vitality were negatively associated with NFR (p < 0.001). Analyses also showed a significant positive association between obesity and NFR (B = 8.77, 95%CI:0.01-17.56), but not between overweight and NFR. Conclusions The findings suggest that self-reported stress is, and obesity may be, associated with a higher NFR. Additionally, the results imply that health measures that indicate a better health are associated with a lower NFR. Trial registration The trial is registered at the Dutch Trial Register (NTR) under trial registration number: NTR2553.
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Affiliation(s)
| | | | | | | | - Cécile R L Boot
- Department of Public and Occupational Health, EMGO + Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
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Ul-Haq Z, Mackay DF, Martin D, Smith DJ, Gill JMR, Nicholl BI, Cullen B, Evans J, Roberts B, Deary IJ, Gallacher J, Hotopf M, Craddock N, Pell JP. Heaviness, health and happiness: a cross-sectional study of 163066 UK Biobank participants. J Epidemiol Community Health 2013; 68:340-8. [PMID: 24336235 DOI: 10.1136/jech-2013-203077] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Obesity is known to increase the risk of many diseases and reduce overall quality of life. This study examines the relationship with self-reported health (SRH) and happiness. METHODS We conducted a cross-sectional study of the 163 066 UK Biobank participants who completed the happiness rating. The association between adiposity and SRH and happiness was examined using logistic regression. SRH was defined as good (excellent, good), or poor (fair, poor). Self-reported happiness was defined as happy (extremely, very, moderately) or unhappy (moderately, very, extremely). RESULTS Poor health was reported by 44 457 (27.3%) participants. The adjusted ORs for poor health were 3.86, 2.92, 2.60 and 6.41 for the highest, compared with lowest, deciles of Body Mass Index, waist circumference, waist to hip ratio and body fat percent, respectively. The associations were stronger in men (p<0.001). Overall, 7511 (4.6%) participants felt unhappy, and only class III obese participants were more likely to feel unhappy (adjusted OR 1.33, 95% CI 1.15 to 1.53, p<0.001) but the associations differed by sex (p<0.001). Among women, there was a significant association between unhappiness and all levels of obesity. By contrast, only class III obese men had significantly increased risk and overweight and class I obese men were less likely to be unhappy. CONCLUSIONS Obesity impacts adversely on happiness as well as health, but the association with unhappiness disappeared after adjustment for self-reported health, indicating this may be mediated by health. Compared with obese men, obese women are less likely to report poor health, but more likely to feel unhappy.
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