|Year : 2008 | Volume
| Issue : 1 | Page : 52-58
Psychiatric correlates of obesity in women and its impact on quality of life
Ram K Solanki1, Abhay Paliwal2, Paramjeet Singh1, Mukesh K Swami1, Aarti Midha3
1 Dept. of psychiatry, SMS medical college, Jaipur, India
2 Dept. of psychiatry, MGM Medical College, Indore, India
3 Dept. of Psychiatry, SDMH, Jaipur, India
Ram K Solanki
D-840, Malviya nagar, Jaipur
Source of Support: None, Conflict of Interest: None
| Abstract|| |
To find out Sociodemographic profile of obese & overweight females and compare their psychiatric profile, eating behavior & quality of life.
Methods and Material:
The study was conducted at obesity clinic (specialty clinic) at SMS hospital, Jaipur. Females meeting the inclusion criteria were divided in 3 group obese, overweight & normal weight according to BMI. After collecting Sociodemographic data they were subjected to Hindi version of MHQ, Eating attitude test-26 & short form health survey.
Statistical analysis used: mean, standard deviation, chi square test & ANOVA
In obese subjects, scores on subscale of MHQ were significantly different except for hysterical subscale. The obese females scored higher on EAT-26, showing more abnormal behavior. There was significant difference on all domains of quality of life except social functioning & role impairment due to emotional factors.
Clinically obese and overweight females are vulnerable to psychological ill health. They also show different Sociodemographic characteristic, impaired quality of life and eating attitude. These aspects should be considered, so that obesity can be managed in a better way.
Keywords: obesity, quality of life, depression, eating behavior, BMI.
|How to cite this article:|
Solanki RK, Paliwal A, Singh P, Swami MK, Midha A. Psychiatric correlates of obesity in women and its impact on quality of life. Indian J Psychol Med 2008;30:52-8
|How to cite this URL:|
Solanki RK, Paliwal A, Singh P, Swami MK, Midha A. Psychiatric correlates of obesity in women and its impact on quality of life. Indian J Psychol Med [serial online] 2008 [cited 2019 Sep 18];30:52-8. Available from: http://www.ijpm.info/text.asp?2008/30/1/52/43135
| Introduction|| |
Obesity, also called Corpulence, or Fatness, is defined as excessive accumulation of body fat, usually caused by the consumption of more calories than the body can use.  It is a condition of abnormal or excessive fat accumulation in adipose tissue, to the extent that the health may be impaired.  For adults, overweight and obesity ranges are determined by using weight and height to calculate the "body mass index" (BMI). BMI is used because, for most people, it correlates with their amount of body fat. The World Health Organization (WHO) defines "overweight" as a BMI equal to or more than 25, and "obesity" as a BMI equal to or more than 30. WHO's latest projections indicate that globally in 2005 approximately 1.6 billion adults (age 15+) were overweight & at least 400 million adults were obese. WHO further projects that by 2015, approximately 2.3 billion adults would be overweight and more than 700 million would be obese. 
Recently conducted National Family Health Survey (NFHS)-3 has shown the problem of increasing proportion of overweight and obese, especially among women. Obesity among women is a growing problem in India, with the percentage of ever-married women age 15-49 who are overweight or obese increasing from 11 percent in NFHS-2 to 15 percent in NFHS-3. Overweight and obesity have become substantial problems among several groups of women in India, particularly older women, women living in urban areas, women who are well educated, women in households in the highest wealth quintile, and Sikhs. 
Multiple factors influence weight, including genetic factors, endocrine levels, activity levels, metabolic rates, eating patterns, and stress. The distinctive way of life of a nation and the individual's behavioral and emotional reaction to it may contribute significantly to widespread obesity. The World Health Organization (WHO) has recognized obesity as a worldwide epidemic and paradoxically coexisting with undernutrition in both developing and industrialized countries. 
The medical complications of overweight and obesity are known well. ,, The psychological correlates of carrying excess weight are documented less well. It is assumed that obesity is either a cause or a consequence of emotional disturbance or psychiatric disorder. Earlier it was conceptualized that obesity is the manifestation of underlying psychopathology and suboptimal development.  But the idea was not supported by further studies. Studies relating obesity and psychopathology have provided conflicting results, while some showing that the overweight experienced greater psychological distress,  other showed lower rates of psychiatric disorder at higher body weights.  Different studies ,, have suggested that the relationship differs between sexes, such that obese men are at no greater risk of depression than non obese men, but obese women are significantly more likely to be depressed than their average-weight counterparts. Extremely obese individuals are at particular risk of clinically significant mood disturbance.  Epidemiological studies have suggested that the onset of obesity precedes the onset of depression in adults, and that the opposite is true in children and adolescents. ,
While examining relationship between obesity and depression, Carpenter et al found that obesity appeared to have a protective effect for men while it was related to poorer mental health among women. 
Studies , have suggested that several characteristics of dietary behavior such as eating frequency, the temporal distribution of eating events across the day, breakfast skipping, and the frequency of meals eaten away from home, together referred to as "eating patterns," may influence body weight.
Ma et al found that eating patterns are associated with obesity even after controlling for total energy intake and physical activity.  obesity-related patterns of eating are frequently irregular and/or disorganized.  Increased frequency of eating food, while doing another activity such as watching television is associated with a greater probability of being both overweight and obese.  It is suggested that high levels of dietary disinhibition and low levels of dietary restraint may be important contributors to the current high levels of adult weight gain and maintenance of that excess weight. 
The present study is an attempt to compare the eating behavior, psychological aspect & quality of life of obese & overweight females.
| Methodology|| |
The study was conducted at obesity clinic at SMS hospital, jaipur. After general physical examination and weight -height measurement (to calculate BMI) female subjects of 20-40 age group were included in the study after consent. Subjects with BMI <25, uneducated, pregnant or lactating females, with history of psychiatric illness or currently on treatment from psychiatrist or endocrinologist were excluded from the study.
Subjects were grouped in obese (n=30; BMI >30 kg/m 2 ) & overweight (n=30; BMI 25-30 kg/m 2 ). For the purpose of preliminary analysis consecutive females with normal BMI (n=30; BMI 18-25 kg/ m 2 ) of 20-40 age group were included as control group. The control group was selected from the females accompanying the obese & overweight subjects.
Sociodemographic data including age, education, occupation, marital status, economic status, type of family were collected through a Performa. Then psychiatric profile, eating attitude & quality of life of the subjects were assessed by a series of three tests- Middlesex hospital questionnaire (MHQ; Hindi version, Bhat & Shrivastava 1974), Eating attitude test-26 (EAT-26)  & short form health survey (SF-36). 
For statistical analysis mean, standard deviation, chi square test & ANOVA was used.
| Results|| |
In Sociodemographic variables, there was no significant difference between the groups on age & marital status .Regarding educational status there was significant difference between the groups, showing higher education among obese & overweight subjects. There was no significant difference in the occupational status between the groups. Monthly family income between the groups was significantly different, with obese & overweight women having lower monthly family income. In reference to family type results were insignificant between the groups. [Table 1]
On MHQ there was significant difference between the groups on all, except one subscale (hysterical). Free floating anxiety, phobic anxiety Obsessional trait, somatic symptom and depressive symptoms were significantly different. [Table 2]
Eating behavior of three groups was significantly different, the obese & overweight showing more abnormal eating behavior. [Table 3]
Groups have shown significant difference on physical functioning, role impairment due to physical functioning, bodily pain ,general health & mental health subscale variables of SF36.Differance on vitality was only weakly significant. While on social functioning & role impairment due to emotional factors subscale no significant difference between the groups was found. [Table 4]
| Discussion|| |
Since most of the females in our study were married, we did not found significant difference between the groups on this variable.
Regarding the educational status we found significant difference between the groups. In contrast to earlier studies which state that educational level shows an inverse relation with obesity ,,, , our sample shows higher education among overweight and obese subject. This was so because our sample was not representative of community.
Moreover highly educated subjects seem to be more aware of their weight related problems and seek help.
We did not found any significant difference in the occupational status between the groups but this should be interpreted with caution since it does not give any idea of physical work involved in the occupation. If we had classified the groups according to the physical work involved, the findings would have been different.
In our study, monthly family income between the groups was significantly different, overweight and obese females showing lower family income. Our finding matches with earlier studies ,, and it may be due to the fact that high earning groups of the society are more cosmetically aware as well as their nutritional habits differ from that of lower earning groups.
On MHQ the groups have shown significant difference on free floating anxiety, phobic anxiety Obsessional trait, somatic symptom and depressive symptoms. But the difference on hysterical subscale was insignificant. Similar findings are reported in earlier studies , .Nichole H Falkner et al  found that obese girls were more likely to report serious emotional problem and attempt suicide. Greater psychopathology could be result of teasing by other people. Wolman  described psychopathology behind obesity, he stated that depression is suffered by many obese individual due to lack of self confidence, self blame, self loathing feeling of isolation. Due to poor mental and physical health obese and overweight people have a pessimistic outlook on the life and feel exhausted or agitated. Often they dwell on past event, exaggerating them, which cause more depression and overeating. Continuous dieting failures give rise to more cycles of depression, bingeing and perhaps purging  . When a person gets deep into depression the chance of suicide is always a possibility. , Researchers have suggested that more extremely obese individuals experience greater prejudice and discrimination than do less obese persons, and that the increase in experienced bias may account for the higher risk of depression. 
Martin et al  reported the association of cerebral asymmetry and HPA axis reactivity to the obesity. They found that subjects with hyper reactive HPA axis scored higher on stress related psychological measures and cerebral asymmetry was causal in the obesity acquisition. Thus different psycho endocrinal characteristic may be the possible cause of increased neurotic traits in the obese subjects.
Similar to the earlier studies ,,, we found that obese people have a poorer quality of life, in our study obese females scored significantly lesser on physical functioning, role impairment due to physical functioning, bodily pain, general health & mental health. Poor quality of life (both physical and mental) may be due to bias against obese people and increased likelihood of medical disorder affecting physical and mental functioning. Researchers have uncovered bias against obese individuals not only in social situations, but also in educational and occupational settings  Health care professionals also have been found to hold negative attitudes toward obese persons ,
Studies have indicated that the extent to which physical health interferes with daily functioning is related positively to BMI and symptoms of depression. ,,, Preliminary evidence suggests that impaired health-related quality of life (HRQL) may account for poorer psychosocial outcomes among extremely obese individuals.  In a study Fabricatore et al suggest that poorer HRQL mediates the relationship between increasing obesity severity and symptoms of depression. 
F Corica et al found that Psychological well-being is the most important correlate of HRQL in obesity, both in the physical and in the mental domains, whereas the features of metabolic syndrome correlate only to some extent with the physical domain of HRQL. 
We found that eating behavior of three groups was significantly different, the obese and overweight females scored higher on EAT-26 showing more abnormal eating behavior. However due to lack of cutoff scores for Indian population, we were unable to diagnose specific disorder. Thus different eating behavior in obese may be a part of partial eating disorder. Our findings were similar to earlier studies. 
Zipfel et al suggested that approximately 20-30% of overweight person seeking help at weight loss programs are classified as binge eaters. They also recommended the importance of screening of eating behavior and comorbid conditions such as depression and anxiety in obese & overweight subjects.  The presence of binge eating disorder (BED) is associated with a higher incidence of depression and anxiety.  Comorbid psychopathology also have implication in treatment of obesity, some may necessitate a delay in initiating weight loss treatment, while others may be improved or even exacerbated as a result of treatment.  Riva et al found that psychopathological aspects and depression in particular, are strongly linked to the eating attitude of clinically obese subjects and highlighted the need for psychological support in diet therapy to intervene on the psychological perceptions and experiences of the patient.  MJ Mond et al suggested that in women, weight and shape concerns are an important mediator of the relationship between obesity and impairment in psychosocial functioning, whereas binge eating may not be of primary importance. 
J Y Kim et al found that it is necessary to make a careful evaluation of depressive tendency and eating disorders when obese women seek for medical help. The combination of medical treatment and psychological approach for obese women would result in higher quality of life. 
In the study, it can be concluded that clinically obese and overweight females are vulnerable to psychiatric morbidity. Besides being different Sociodemographically, they also have impaired quality of life and aberrant eating attitude. An attempt should be made to deal with psychiatric comorbidity, quality of life and eating related problems so that obesity can be managed in a better way.
| References|| |
|1.||Obesity. (2008). Encyclopaedia Britannica. Encyclopaedia Britannica 2007 Ultimate Reference Suite. Chicago: Encyclopaedia Britannica. |
|2.||Garrow JS. Obesity and related diseases. London, Churchill Livingstone, 1988:1-16. |
|3.|| http://www.who.int/mediacentre/factsheets/fs311/en/index.html |
|4.||International Institute for Population Sciences (IIPS) and Macro International. 2007. National Family Health Survey (NFHS3), 2005-06, India: Key Findings. Mumbai: IIPS. |
|5.||Nutritional disease. (2008). Encyclopaedia Britannica. Encyclopaedia Britannica 2007 Ultimate Reference Suite. Chicago: Encycloaedia Britannica. |
|6.||National Institutes of Health/National Heart, Lung, and Blood Institute. Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults: the evidence report. Obes Res 1998; 6:51S-210S. |
|7.||Calle EE, Thun MJ, Petrelli JM, et al. Body mass index and mortality in a prospective cohort of US adults. N Engl J Med 1999; 341:1097-105. [PUBMED] [FULLTEXT]|
|8.||Arya SN, Kumar R. Obesity. Journal, Indian academy of clinical medicine.2004; 5(2): 166-181. |
|9.||Bychowski G. On neurotic obesity. Psychoanal Rev 1950; 37:301-19. [PUBMED] |
|10.||Moore ME, Stunkard AJ, Srole L. Obesity, social class and mental illness. JAMA 1962; 181: 962-6. |
|11.||Stewart AL, Brook RH. Effects of being overweight. Am J Public Health 1983; 73:171-8. [PUBMED] [FULLTEXT]|
|12.||Istvan J, Zavela K, Weidner G. Body weight and psychological distress in NHANES I. Int JObes 1992;16:999-1003. |
|13.||Carpenter KM, Hasin DS, Allison DB, et al. Relationships between obesity and DSM-IV major depressive disorder, suicide ideation, and suicide attempts: results from a general population study. Am J Public Health 2000; 90:251-7. [PUBMED] [FULLTEXT]|
|14.||Onyike CU, Crum RM, Lee HB, et al. Is obesity associated with major depression? Results from the third National Health and Nutrition Examination Survey. Am J Epidemiol 2003; 158:1139-47. |
|15.||Wadden TA, Womble LG, Stunkard AJ, et al. Psychosocial consequences of obesity and weight loss. In: Wadden TA, Stunkard AJ, editors. Handbook of obesity treatment. New York: Guilford Press; 2002. p. 144-69. |
|16.||Roberts RE, Deleger S, Strawbridge WJ, et al. Prospective association between obesity and depression: evidence from the Alameda County Study. Int J Obes 2003; 27:514-21. |
|17.||Goodman E, Whitaker RC.A prospective study of the role of depression in the development and persistence of adolescent obesity. Pediatrics 2002; 110:497-504. [PUBMED] [FULLTEXT]|
|18.||Keim NL, Van Loan MD, Horn WF, et al. Weight loss is greater with consumption of large morning meals and fat-free mass is preserved with large evening meals in women on a controlled weight reduction regimen. J Nutr 1997; 127:75-82. [PUBMED] [FULLTEXT]|
|19.||Fabry P. The frequency of meals: its relation to overweight, hypercholesterolemia and decreased glucose tolerance. Lancet 1964; 2:614-15. |
|20.||Ma Y et al. Association between Eating Patterns and Obesity in a Free-living US Adult Population. Am J Epidemiol 2003; 158:85- 92. |
|21.||Blundell JE, Gillett A. Control of food intake in the obese. Obes Res 2001; 9(Suppl 4): 263S-270S. [PUBMED] [FULLTEXT]|
|22.||Liebman M et al. Dietary intake, eating behavior, and physical activity related determinants of high body mass index in rural communities in Wyoming, Montana, and Idaho. International Journal of Obesity 2003; 27: 684-692. |
|23.||Hays NP et al. Eating behavior correlates of adult weight gain and obesity in healthy women aged 55-65 y Am J Clin Nutr 2002;75:476-83. |
|24.||Nehra R et al. assessment of psychometric properties of eating attitude test (EAT-26) in a targeted population. Indian journal of clinical psychology 2001; 28(2):241-45. |
|25.||Ware et al. SF-36 health survey manual and interpretation guide, p. p. B 19-24. Bosten health institute, New England medical center (1993). |
|26.||Aranceta J, perez Rodrigo C et al. prevalence of obesity in Spain: the SEEDO 97 study. Spanish collaborative group for the study of obesity. Med clin (barc) 1998; 111(12):441-5. |
|27.||Galobardes B, Morabia A, Bernstein MS. The differential effect of education and occupation on body mass and overweight in a sample of working people of the general population. Ann epidemiology 2000; 10(8):532-7. |
|28.||Wardle J, Waller J, Jarvis MJ. Sex differences in the association of socioeconomic status with obesity. Am J Public Health 2002; 92(8):1299-1304. |
|29.||Woo J et al. influence of educational level on dietary intake obesity and other cardiovascular risk factors in a Hongkong Chinese population. Eur J Clin Nutr 1999; 53(6):461-7. |
|30.||Monterio CA, Conde WL, Popkin BM. Independent effect of income and education on the risk of obesity in the Brazilian adult population. J Nutr 2001; 131(3):881s-886s. |
|31.||Sarlio-lahteenkorva S, Lahelma E. The association of body mass index with social and economic disadvantage in women and men. Int J Epidemiol 1999; 28(3):445-9. |
|32.||Gortmaker SL et al. social and economic consequences of overweight in adolescent and young adulthood. N Engl J Med1993; 329(14):1008-12. |
|33.||Becker ES et al. obesity and mental illness in a representative sample of young women. Int J Obes Relat Metab Disord 2001; 25(suppl 1):s5-9. |
|34.||Rosmond R et al .mental distress, obesity and body fat distribution in middle aged men. Obesity research 1996; 4:245-52. |
|35.||Falkner NH et al. social, educational and psychological corralates of weight status in adolescent. Obesity research 2001; 9:32-42. |
|36.||Wolman B .B: psychological aspect of obesity: a hand book. Van Nostrand Reinhold co.: NY 1982 |
|37.||Davison GC, Neale J. M: abnormal psychology. NY: John wiely & sons. (1990) |
|38.||Nakken C: P: the addictive personality. US : Hazelden foundation(1988) |
|39.||Martin Du Pan RC, Heraief E. ten questions on the causes and consequences of obesity: stress hormone. Rev Med Suisse Romande 2001; 121(1); 51-5. |
|40.||Larsson U, Karlsson J, Sullivan M. impact of overweight and obesity on health related quality of life - a Swedish population study. Int J obes Relat metab disord 2002; 26(3):417-24. |
|41.||Barofsky I, Fontain KR, Cheskin LJ. Pain in the obese: impact on health related quality of life. Ann Behav Med 1998; 19(4):408-10. |
|42.||Fontaine KR, Bartlett SJ, Barofsky I. health related quality of life in obese person seeking and not currently seeking treatment. Int j Eat Disord 2000; 27(1):101-5. |
|43.||Duval K, Marceau P et al. Health-related quality of life in morbid obesity. Obes Surg. 2006 May; 16(5):574-9. |
|44.||Puhl R, Brownell KD. Bias, discrimination, and obesity. Obes Res 2001; 9:788-805. |
|45.||Harris JE, Hamaday V, Mochan E. Osteopathic family physicians' attitudes, knowledge, and self-reported practices regarding obesity. J Am Osteopath Assoc 1999; 99:358-65. |
|46.||Schwartz MB, Chambliss HO, Brownell KD, et al. Weight bias among health professionals specializing in obesity. Obes Res 2003; 11:1033-9. |
|47.||Doll HA, Petersen SEK, Stewart-Brown SL. Obesity and physical and emotional well-being: associations between body mass index, chronic illness, and the physical and mental components of the SF-36 questionnaire. Obes Res 2000; 8:160- 70. |
|48.||Fontaine KR, Cheskin LJ, Barofsky I. Health-related quality of life in obese persons seeking treatment. J Fam Pract 1996; 43:265-70. |
|49.||Kolotkin RL, Crosby RD, Williams GR. Health-related quality of life varies among obese subgroups. Obes Res 2002; 10:748- 56. |
|50.||Dixon JB, Dixon ME, O'Brien PE. Depression in association with severe obesity: changes with weight loss. Arch Intern Med 2003; 163:2058-65. |
|51.||Berkowitz RI, Fabricatore AN. Obesity, Psychiatric Status, and Psychiatric Medications Psychiatr Clin N Am 28 (2005) 39-54 |
|52.||Fabricatore AN, Wadden TA, Sarwer DB. Depressive symptoms as a function of body mass index and health-related quality of life in treatment-seeking obese adults. Obes Res 2003; 11:A10. |
|53.||Corica F, Corsonello A et al . Metabolic syndrome, psychological status and quality of life in obesity: the QUOVADIS Study. International Journal of Obesity (2008) 32, 185-191. |
|54.||Darby A, Hay P et al. Disordered eating behaviours and cognitions in young women with obesity: relationship with psychological status International Journal of Obesity (2007; 31: 876-882. |
|55.||Zipfel S et al. Eating behavior, eating disorder and obesity. Ther Umsch Aug 2000; 57(8): 504-10. |
|56.||Marcus MD, Wing RR, Hopkins J. Obese binge eaters: affect, cognitions, and response to behavioral weight control. J Consult Clin Psychol 1988; 56:433-9. |
|57.||Mitchell JE, Myers TC. Behavioral Assessment and Treatment Overview Psychiatr Clin N Am 28 (2005) 105-116. |
|58.||Riva G, Ragazzoni P, Molinari E. Obesity, psychopathology and eating attitudes: are they related? Eat Weight Disord. 1998; 3(2):78-83. |
|59.||Mond JM, Rodgers B et al. Obesity and impairment in psychosocial functioning in women: the mediating role of eating disorder features. Obesity 2007 Nov;15(11):2769-79 |
|60.||Kim JY, Oh DJ et al. The impacts of obesity on psychological well-being: a cross-sectional study about depressive mood and quality of life. J Prev Med Pub Health. 2007 Mar; 40(2):191-5 |
[Table 1], [Table 2], [Table 3], [Table 4]