Objectives. Obesity & mental health. Aboriginal peoples in Canada. Obesity & Mental Health in Aboriginal Populations 6/28/2012

Transcription

1 Obesity & Mental Health in Populations Piotr Wilk PhD* Setareh Hooshmand BSc* Martin Cooke PhD** *Department of Epidemiology and Biostatistics, Western University ** School of Public Health and Health Systems, University of Waterloo Objectives Obesity and mental health Past research among populations General associations between weight status and 4 mental health indices: Distress Feelings of depression Anxiety disorders Mood disorders Comparisons between and non- populations Obesity & mental health Community studies yield mixed results: Positive association (Baumeister & Härter,2007; Ohayon,2007) Negative association (Crisp et al.,1980; Palinkas et al.,1996) No association (Kress et al.,2006; Ohayon & Hong,2006) No examination of the association among peoples: Higher rates of both obesity and mental illness Evidence tends to focus on on-reserve First Nations and Inuit, exclude urban and off-reserve peoples in Canada 1.2 million people (First Nations, Inuit and Métis) identified in the 2006 census 54% living in urban centres in 2006 (80% for non- Canadians) Median age 27 years in 2006 (40 years for non- Canadians) 48% under 25 years old (31% for non- Canadians) 1

2 peoples & obesity Higher rates of overweight and obesity among adults and children: 33.5% of the off-reserve population overweight, 58.2% overweight or obese 1.8 times the risk of obesity of the Canadian population peoples & mental health Limited data on the mental health of peoples, most from particular First Nations or Inuit communities: Evidence of generally high levels of mental illness in communities 13.2% of the off-reserve population reported a major depressive episode in 2000/1; 1.8x the risk of the non- population (Tjepkema,2002) Evidence of under-diagnosis (Dalyrimple et al.,1995) Obesity, mental health & peoples Limited previous research From the First Nations Regional Health Survey (RHS; onreserve only): Association between physical activity and reported balance of mind, spirit and body Significant relationship between diet and reported balance No significant relationship between BMI and perceived balance Indigenous perspectives on health and illness There is a great deal of cultural diversity among First Nations, Inuit and Métis in Canada (at risk of overgeneralising): Traditional views of health are generally more holistic, seeing spiritual, emotional mental and physical health are interconnected (Cooke and Long,2010) The health of individuals and social, environmental, and political well-being of communities are connected (AFN,2007) 2

3 Indigenous perspectives on health and illness Implications for research and practice: Recognition of diversity and that associations observed might reflect the dominant framework (Kumanyika,1993) There may be different upstream determinants that are important in the etiology of illness for peoples Cultural difference in the perception of obesity and the acceptance of body size We cannot assume that associations between mental health and obesity found in the non- population hold for people Methods - Data Canadian Community Health Survey (CCHS) cycles 2002, 2004, 2006, 2008: Allows comparisons between (off-reserve) and non- Canadians 17,335, 333,890 non- Aged 19-64, from all provinces and territories Methods - Instruments Self-report height and weight to calculate BMI: BMI by Status Weight status: underweight (<18.50), normal weight ( ), overweight ( ), obese class I ( ), obese class II ( ), and obese class III ( 40.00) Mental health measures: 24.5 Feelings of depression or loss of interest (binary) Distress (subset of items from Composite International Diagnostic Interview) Mood disorders (binary) and anxiety disorders (binary) Analyses included descriptive and bivariate measures of association, and multiple linear regression

4 Weight Status by Status Underweight 2.4% 2.7% Normal 38.9% 47.9% Overweight 32.7% 33.1% Obese % 11.7% Obese 2 6.0% 3.1% Obese 3 2.6% 1.4% Weight Status by Status & Sex (male) (female) (male) (female) Distress by Status Depression by Status % 9.0%

5 Depression by Status & Sex Anxiety Disorders by Status % 5.03% Male Female 11.72% 16.07% 7.09% 10.99% Anxiety Disorders by Status & Sex Mood Disorders by Status % 6.5% Male Female 7.68% 11.9% 3.51% 6.54% 5

6 Mood Disorders by Status & Sex 1 Depression by Weight Status 2 1 Male Female 7.68% 11.9% 3.51% 6.54% 24.49% 12.94% 12.17% 13.04% 17.56% 17.82% 13.86% 9.02% 7.98% 9.93% 11.79% 14.60% Distress by Weight Status Anxiety Disorders by Weight Status % 6.96% 6.11% 8.31% 10.63% 13.25% 7.07% 4.64% 4.40% 5.83% 8.03% 10.09% 6

7 Mood Disorders by Weight Status 2 1 Conclusions peoples have higher rates of overweight and mental health conditions Men are more likely to be obese, women are more likely to report mental health problems The association between weight status and mental health conditions follows a j-shape pattern for both peoples and non-s 12.28% 7.76% 8.42% 9.32% 16.10% 21.26% 7.38% 5.45% 5.93% 8.66% 12.35% 15.72% Limitations Cross-sectional design Self-reported assessment of BMI and mental health Treatment of peoples as a homogenous group Future Research Exploration of causal mechanism linking obesity and mental health More detailed examination of sex and age differences (possible interaction effects) Incorporation of indigenous determinants of both obesity and their relation to mental health Need to examine the specific determinants and risk factors for First Nations, Inuit and Métis 7

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