The Relationship Between Obesity and Depression

Transcription

1 Available online at Procedia - Social and Behavioral Sciences 84 ( 2013 ) rd World Conference on Psychology, Counselling and Guidance (WCPCG-2012) The Relationship Between Obesity and Jafar Askari a, Afsaneh Hassanbeigi b*, Hassan Mozaffari Khosravi c, Mehdi Malek d, Dordaneh Hassanbeigi e, Zahra Pourmovahed f, Maryam Alagheband g a Department of Clinical Psychology, Shahid Sadoughi University of Medical Sciences, Yazd, Iran b Mental Hospital, Shahid Sadoughi University of Medical Sciences, Yazd, Iran c Department of Nutrition, Shahid Sadoughi University of Medical Sciences, Yazd, Iran d Department of Medical Physics, Shahid Sadoughi University of Medical Sciences, Yazd, Iran e Plant Protection Center, Agriculture and Plant Protection Office, Shiraz, Iran f Nursing College, Shahid Sadough University of Medical Sciences, Yazd, Iran g Department of General Psychology, Payam Noor University, Tehran, Iran Abstract Objective: The porpuse of present study was to investigate the relationship between obisity and depression. Material & methods: In this study a sample of 400 subjects aged including 200 obese individuals with Body Mass Index (BMI) higher than 30 and 200 normal weight individuals with BMI around were chosen from among those who had referred to Yazd health centers in Iran. Body Mass Index (BMI) formula was used to assess obesity and Beck Inventory (BDI) was used to measure depression. The data were analized through variance analysis. Results: The finding of the present study showed that obesity does not lead to a statistically significant increase in depression rate. Conclusion: Although some other studies indicate the presence of some relationship between obesity and depression, the present study did not confirm this, so it seems that the relationship between these disorders is not a simple one and is under the influence of sociodemographic, psychosocial and cultural factors The Authors. Published by Elsevier Ltd. Open access under CC BY-NC-ND license. Selection 2013 Published and peer-review by Elsevier under responsibility Ltd. Selection of and Prof. peer Dr. review Huseyin under Uzunboylu the responsibility & Dr. Mukaddes of Dr. Demirok, Melehat Near Halat East University, Cyprus Keywords: obesity, depression, sociodemographic factors, psychosocial and cultural factors 1. Introduction Obesity is the most common chronic physical illness in modern society, and depression is the most prevalent psychological condition (Dixon, Dixon, & O'Brien, 2003). The increasing prevalence of overweight and obesity is a major public health concern. Among US adults, prevalence of obesity (defined as a body mass index [BMI, calculated as weight in kilograms divided by the square of height in meters] of 30) increased from approximately 23% in 1990 to 31% in 2000 (Simon, et al. 2006). Obesity is increasingly prevalent and associated with numerous health complications including hypertension, coronary heart disease, and increased mortality (Faith, Matz & Jorge, * Corresponding author. Tel.: ; fax: address: af1672@yahoo.com The Authors. Published by Elsevier Ltd. Open access under CC BY-NC-ND license. Selection and peer-review under responsibility of Prof. Dr. Huseyin Uzunboylu & Dr. Mukaddes Demirok, Near East University, Cyprus doi: /j.sbspro

2 Jafar Askari et al. / Procedia - Social and Behavioral Sciences 84 ( 2013 ) ).On the other hand according to the World Health Organization (WHO), depression is among the leading causes of disability and affecting about 121 million people globally at each moment in time (De Wit et al., 2010) and it is causing huge burden of disease and enormous economic costs, worldwide (Druss, Rosenheck, & Sledge, 2000). Longitudinal studies have found that obesity predicts the subsequent onset of depression (Roberts, Deleger, Strawbridge & Kaplan, 2003). Obese children and adolescents are subjected to social rejection, discrimination and negative stereotyping and such experiences could be expected to lead to negative consequences in terms of selfimage, self-esteem and mood, and there is a widespread assumption that obesity has profound psychological costs (Wardle & Cooke, 2005). Many studies have shown an increase in the prevalence of depression and psychological illness in obese subjects although the nature of the relationship remains unclear (Carpenter, Hasin, Allison & Faith, 2000, Goldstein, Goldsmith, Anger & Leon, 1996). For example Roberts and his colleagues (Roberts et al. 2003) found that obesity at baseline was associated with being depressed at follow-up 5 years later. They demonstrated that obesity was able to predict subsequent depression and their findings suggest a probable causal relationship between obesity and subsequent depression, but didn't support the idea that depression predicts subsequent obesity. To evaluate the relationship between obesity and a range of mood, anxiety, and substance use disorders in the US general population, Simon and his colleagues (Simon et al. 2006) found that obesity is associated with an approximately 25% increase in odds of mood and anxiety disorders and they demonstrated that variation across demographic groups suggests that social or cultural factors may moderate or mediate the association between obesity and mood disorder. To look for predictors of any change in the Beck Inventory (BDI) score after Lap-Band surgery, Dixon and his colleagues (Dixon et al. 2003) used paired preoperative and 1-year data from the 262 available patients who have completed the preoperative and 1-year postoperative questionnaires to identify predictors of change in BDI score with weight loss. e BDI score was greater excess weight loss. In a study the association between obesity and mental disorders in the general populations was examined (Scott et al. 2008). Depressive disorders were assessed with the Composite International Diagnostic Interview (CIDI 3.0), a fully structured diagnostic interview. Obesity was defined as a body mass index (BMI) of 30 kg/m 2 or greater; severe obesity as BMI 35+. Persons with BMI less than 18.5 were excluded from analysis. The findings showed a relationship between obesity and emotional disorders. This relationship is concentrated among those with more severe obesity (BMI 35+). On the basis of demographic variables (education, sex, and age) first, for education, the results indicate that the relationship between obesity and depressive disorder only occurs in those with more education, rather than in the group with less education, second, the relationship between obesity and depressive disorder is only significant among females, and third, there are no significant effects of age. To examine the association between body size and depression in a longitudinal setting and to explore the connection between obesity and depression in young adults at the age of 31 years Herva and his colleagues (Herva et al. 2006) found that obesity at 14 years associated with depressive symptoms at 31 years. However, some researchers have not found any relationship between obesity and depression (Kress, Peterson, & Hartzell, 2006, Ohayon & Hong, 2006, Friedman & Brownell, 1995, Wyatt, Henter, Mojtabai, Bartko, & Height, 2003). With regard to this contradiction the aim of this study was to find the relationship between obesity and depression under the influence of sex and age variables. 2. Materials and Methods This is a historical cohort study in which 400 subjects aged including 200 obese males and females with Body Mass Index (BMI)>30 and 200 normal weight males and females with the BMI of were investigated. The normal weight group was matched with the obese one in terms of sex, age, marital status, education and employment. Table 1 shows the demographic characteristics of the two groups. Body Mass Index (BMI) formula was used to assess obesity and Beck Inventory (BDI) was applied to measure rate of depression. Data were analyzed using Analysis of Variance (ANOVA).

3 798 Jafar Askari et al. / Procedia - Social and Behavioral Sciences 84 ( 2013 ) Results The results revealed no significant difference in depression rate of two obese and normal weight groups. Table 2 indicates the evaluation of the depression rate of the two groups. Table 3 represents the evaluation of the depression rate of the two groups on the basis of sex variable. As it is shown, the depression rate discrepancy between the two groups is not statistically significant and gender variable has no any effect on this difference. Table 4 indicates the evaluation of the depression rate of the two groups in terms of age variable. Also on the basis of this variable, there is no any significant difference between the two groups. Table 1. demographic characteristics of the participants Characteristics Sex Age Marital Status Not Married Married Education High School or Lower College Degree or Higher Employment Working Studying Unemployment Body Mass Index (BMI) 50% 33.2(8.2) 28% 72% 48% 52% 64.5% 19.5% 16% 22.7 (1.5) 50% 33.5(7.8) 23.5% 76.5% 51% 49% 62% 14.5% 23.5% 31.9 (2.4) Table 2. The evaluation of the difference in depression rate in the obese and normal weight groups. BDI Score (7.23) (8.83) Table 3. The evaluation of the difference in depression rate in the obese and normal weight groups based on sex. BDI Score (Women) BDI Score (Men) (7.22) 9.87 (7.36) (8.73) (8.94)

4 Jafar Askari et al. / Procedia - Social and Behavioral Sciences 84 ( 2013 ) Table 4. The evaluation of the difference in depression rate in the obese and normal weight groups based on age. BDI Score (Ages 16-25) BDI Score (Ages 26-30) BDI Score (Ages 31-35) BDI Score (Ages 36-40) BDI Score (Ages 41-50) (8.41) (8.57) (5.67) (7.67) 9.63 (5.77) (9.81) (6.88) (10.13) (9.46) (6.96) 4. Discussion Although many surveys indicate a higher depression level among obese individuals, this study did not show any significant difference in the depression rate of the obese and normal weight individuals. It was also revealed that sex and age could not have a significant effect. Certainly, in some other researches also no such relationship has been affirmed (Kress et al. 2006, Ohayon & Hong, 2006, Friedman & Brownell, 1995, Wyatt et al. 2003). An important part of the problem and complexity in associating depression and obesity is derived from the some differences between treatment-seeking obese persons and nontreatment-seeking obese persons or community samples (Fitzgibbon, Stolley, & Kirschenbaum, 1993). Despite, relationships between obesity and psychopathology have been found among obese persons seeking treatment but there is no certainty regarding the relationship between depression and obesity in community studies (Stunkard, Faith, & Allison, 2003). Having reviewed the most recent studies in this area, Wardle & Cooke (2005) conclude that whilst levels of body dissatisfaction are higher in community samples of overweight and obese children and adolescents than in their normal-weight counterparts, few are significantly depressed or have low self-esteem. There does not appear to be a simple or single association between obesity and depression (Faith, et al. 2002). The findings of many researches showed that various factors such as severity of depression, severity of obesity, gender, socioeconomic status (SES), gene-by-environment interactions, childhood experiences, eating and physical activity, teasing, and stress may influence the relationships among these disorders (Friedman, Reichmann, Costanzo, & Musante, 2002, Stunkard, et al. 2003). For example the study of Boutelle, Hannan, Fulkerson, Crow, & Stice (2010) demonstrated that obesity is a risk factor for depressive symptoms, but not for clinical depression. There is evidence that the association between depression and obesity may be strongest only among the most obese individuals (Stunkard, et al. 2003). Some studies also suggest a stronger relationship in girls and women than boys and men (Erickson, Robinson, Haydel, & Killen, 2001, Carpenter, et al. 2000, De Witet et al. 2010). Furthermore, there is evidence that socioeconomic status (SES) influences the association and survey data suggest a stronger association between obesity and depression only among those with higher socioeconomic status (Scott et al. 2008, Simon et al. 2006). In this regard, psychosocial and cultural factors can have a considerable importance so it seems that in more traditional communities in which individualism, sense of superiority and competitiveness are not of high value, obesity will not deprive people of social benefits. In addition, in such societies physical appearance is not of paramount importance due to religious and moral beliefs. Thus obesity resulting no psychological pressure and consequently depression. Attitude toward clothing especially in women also can have an important role, so that in the countries enjoying freedom clothing, an obese patient may be negatively evaluated in terms of physical appearance whereas in societies with no such clothing freedom this problem is less conspicuous. Finally, in regard with the fact that individuals with a BMI of 35 to 40 or higher may suffer more from reactive depression, so it is suggested employing these subjects in the future studies. Concerning this subject that sociodemographic, psychosocial, and genetic factors may render certain obese individuals more prone to depression or vice versa and there are likely multiple obesity-depression covariations in

5 800 Jafar Askari et al. / Procedia - Social and Behavioral Sciences 84 ( 2013 ) the population, rather than a single pattern of association, therefore, there is a need for longitudinal and mechanistic studies to understand casual pathways and greater collaboration between depression and obesity specialists (Faith, et al. 2002). As most knowledge about the relationship between these two disorders results from research devoted to other topics, a systematic exploration of this relationship would help to elucidate causal mechanisms and opportunities for prevention and treatment (Stunkard et al., 2003). Obviously, an understanding of the relationship between obesity and depression requires a comprehensive investigation specifically via controlling intervening variables. References Boutelle, K.N., Hannan, P., Fulkerson, J. A., Crow, S. J.,Stice, E., (2010). Obesity as a prospective predictor of depression in adolescent females. Health Psychology, 29(3), Carpenter KM, Hasin DS, Allison DB, Faith MS. (2000). Relationships between obesity and DSM-IV major depressive disorder, suicide ideation, and suicide attempts: results from a general population study. American Journal of Public Health. 90, De Wit, L., Luppino, F., van Straten, A., Penninx, B., Zitman, F., Cuijpers, P. (2010). and obesity: A meta-analysis of communitybased studies. Psychiatry Research, 178, Dixon, J. B., Dixon, M. E.; O'Brien, P. E. (2003). in association with severe obesity: Changes With Weight Loss. Archives of Internal Medicine. 163, Druss, B.G., Rosenheck, R.A., Sledge, W.H., (2000). Health and disability costs of depressive illness in a major US corporation. American Journal of Psychiatry, 157, Erickson S.J., Robinson T.N., Haydel K.F., Killen J.D. (2001). Are overweight children unhappy? Body mass index, depressive symptoms, and overweight concerns in elementary school children. Archives of Pediatrics & Adolescent Medicine. 155(4), Faith MS, Matz PE, Jorge MA. (2002). Obesity-depression associations in the population. Journal of Psychosomatic Research, 53(4): Fitzgibbon M.L., Stolley M.R., Kirschenbaum D.S. (1993). Obese people who seek treatment have different characteristics than those who do not seek treatment. Health Psychology, 12, Friedman, K.E., Reichmann S.K., Costanzo P.R., Musante G.J. (2002). Body image partially mediates the relationship between obesity and psychological distress. Obesity Research, 10(1), Friedman, M.A., Brownell, K.D., (1995). Psychological correlates of obesity: moving to the next generation. Psychological Bulletin, 117, Goldstein LT, Goldsmith SJ, Anger K, Leon AC. (1996). Psychiatric symptoms in clients presenting for commercial weight reduction treatment. International Journal of Eating Disorder.20, K., & Joukamaa, M. (2006). Obesity and depression: results from the longitudinal Northern Finland 1966 Birth Cohort Study. International Journal of Obesity, 30, Kress, A. M. Peterson, M. R. Hartzell, M. C. (2006) Association between obesity and depressive symptoms among U.S. Military active duty service personnel, 2002, Journal of Psychosomatic Research, 60, Ohayon, M.M., Hong, S.C., (2006). Prevalence of major depressive disorder in the general population of South Korea. Journal of Psychiatric Research, 40, Roberts RE, Deleger S, Strawbridge WJ, Kaplan GA. (2003). Prospective association between obesity and depression: evidence from the Alameda County Study. International Journal of Obesity and Related Metabolic Disorders. 27, Scott, K.M., Bruffaerst, R., Simon, G.E., Alonso, J., Angermeyer, M., de Girolamo, G., Demyttenaere, K., Gasquet, I., Haro, J.M., Karam, E., Kessler, R.C., Levinson, D., Medina Mora, M.E., Oakly Brown, M.A., Ormel, J., Villa, J.P., Uda, H., Von Korff, M., (2008). Obesity and mental disorders in the general population: results from the world mental health surveys. International Journal of Obesity, 32, Simon GE, Von Korff M, Saunders K, Miglioretti DL, Crane PK, van Belle G, Kessler RC. (2006). Association between obesity and psychiatric disorders in the US adult population. Archives of General Psychiatry.63(7), Stunkard A.J., Faith M.S., Allison K.C. (2003). and obesity. Biological Psychiatry, 54(3), Wardle, J., Cooke, L. (2005). The impact of obesity on psychological well-being. Best Practice & Research Clinical Endocrinology & Metabolism, 19(3), Wyatt RJ, Henter ID, Mojtabai R, Bartko JJ (2003). Height, weight and body mass index (BMI) in psychiatrically ill US Armed Forces personnel, Psychological Medicine, 33(2),