Comparison of Obesity/Psychological Disorders Comorbid between Older and Younger Adult Women

doi:10.4236/psych.2013.411A001

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Psychology

2013. Vol.4, No.11A, 1-3

Published Online November 2013 in SciRes (http://www.scirp.org/journal/psych) http://dx.doi.org/10.4236/psych.2013.411A001

Open Access 1

Comparison of Obesity/Psychological Disorders Comorbid

between Older and Younger Adult Women

Soodeh Razeghi Jahromi1,2, Maryam Abolhasani2,3*, Maryam Bidadian2, Leila Kouti4

1Geriatric Group, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran

2Obesity Group, Endocrine and Metabolic Research Center, Sina Hospital, Tehran University of

Medical Sciences, Tehran, Iran

3Sports Medicine Group, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran

4School of Pharmacy, Ahvas Jundishapour University of Medical Science, Ahvas, Iran

Email: *[email protected]

Received July 28th, 2013; revised September 1st, 2013; accepted October 3rd, 2013

Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium,

provided the original work is properly cited.

Introduction: Epidemiologic data proposed a relationship between obesity and depression in older adults.

We conducted this study to evaluate the association between obesity and depressive disorders, as well as a

range of eating disorders in old women. Methods: From a total of 1477 clients referred to an outpatient

clinic, 212 obese persons (97 persons 60+ and 115 persons 40 - 59 years of age) were enrolled. Data of

demographics, comorbidities, anthropometrics, physical activity level, and diet, as well as, depressive and

eating disorders were collected. Depressive and eating disorders were assessed using diagnostic structural

interview based on DSM-IV-TR (Diagnostic Statistical Manual of Mental Disorder—fourth edition—

Text version). BMI more than or equal to 30 was considered as obesity. Results: The prevalence of dyst-

hymic disorder was significantly lower in older women compared to younger (p = 0.026). Comparable but

not significant results were observed for major depression disorder, Bulimia Nervosa, and eating disorders

not otherwise specified. Conclusion: Our findings suggest that obese older women were less likely to suf-

fer from Comorbid dysthymic disorder/obesity compared to younger.

Keywords: Dysthymic Disorder; Obesity; Elderly

Introduction

In recent decades obesity and depressive disorders including

major depression and dysthymic disorder have become notable

public health problems (Chan & Woo, 2010; Sartorius, 2010).

A growing body of clinical-based and population-based studies

supports the association between obesity and depressive disor-

ders (De Wit et al., 2010; LaCoursiere, 2011; Spitzer et al.,

2012). The data from 2005 National Health Interview survey on

over 30,000 American adults confirmed the correlation (r = 0.8)

between obesity and depression (Blaine, 2008). There are some

causal models that explained the obesity and depression co-

morbidity. One well known model, weight-related stigma, sug-

gests that stigmatizing has prominent role that causes obese

patients to also suffer from co-morbid depression. According to

this model obesity is a deeply stigmatizing attribute that

prompts negative stereotyping and discrimination in others,

which, in turn, causes depression and other negative psycho-

logical and social outcomes (Puhl, Brownell, Schwartz, & Rudd,

2005; Puhl, Moss-Racusin, Schwartz, & Brownell, 2008). The

other casual model recognizes that depression can exert causal

effects on obesity. A third model combines the two mentioned

model. This model suggests negative body image stigmatiza-

tion of obese individuals could lead to low self esteem and

psychological distress generally (Puhl et al., 2005; Puhl et al.,

2008). It’s supposed that the older obese are less likely to suffer

from depressive symptoms, known as “jolly fat” hypothesis

(Crisp & McGuiness, 1976). One of the potential explanations

for this hypothesis could be the higher concentration of estro-

gen in women with higher level of adipose tissue. Estrogen

might protect against the development of depression (Kim et al.,

2010). Although different studies were dedicated to assessing

the relationship between obesity and depression in the elderly,

limited data are available on the obesity and dysthymic disorder

relation as well as its relationship with eating disorder. Hence

in this study we aimed to assess the correlations between obe-

sity, eating and depressive disorders in the elderly compared to

middle-aged individuals.

Methods

Study Design and Sampling

In this cross-sectional study, participants were randomly se-

lected from a total of 1477 women referred to the outpatient

overweight and obesity clinic of Sina University hospital be-

tween Jan 2008 and Jan 2012. Individuals were invited to par-

ticipate in the study by telephone call. The individuals, who

accepted to participate, received a comprehensive health screen

by sport medicine specialist, nutritionist, and psychologist.

Patients with dementia, Alzheimer and other neurodegenerative

disease, psychiatric disorders, and malignancies were excluded.

*Corresponding author.

S. R. JAHROMI ET AL.

212 women were enrolled including 97 persons over 60 (62.26

± 5.32) and 115 individuals between 40 and 59 years (49.97 ±

5.52). An informed written consent was obtained.

Measurements

Basic Data

Sociodemgraphic and clinical data including educational

level, status, age, marital status, smoking habit, and regular

exercise were collected. Educational status was classified into

≤5 years, 6 - 12 years (college education level), ≥13 years.

Smoking was categorized as nonsmoker, regular smoker, and

habitual smoker.

Disease history including diabetes, hypertension, cardiovas-

cular disease, hyperlipidemia, thyroid diseases, hepatocellular

and gastrointestinal disorders, genitourinary disease, osteoar-

ticular disease, as well as respiratory and lung disease were

reported by clients.

Anthropometry

Body weight was measured to the nearest 0.1 kg using Seca

755 Dial Column Medical Scale. Height was measured to the

nearest 0.1 cm using a standard stadiometer. Body Mass Index

(BMI) was calculated by dividing weight in kilograms by

height in square meters. BMI ≥ 30 was defined as obesity.

Waist circumference was measured by the standard tape meter

at the maximal narrowing of the waist from anterior view. Hip

circumference was measured at the point of maximal gluteal

protuberance from the lateral view. Waist to hip ratio was cal-

culated by dividing the waist circumference to hip circumfer-

ence.

Fat percent and fat free mass (FFM) by Body composition

analyzer type BC-418 MA TANITA. The participants were

asked not to eat or drink within 4 hours, and not to exercise

within 12 hours of the test. They have completely voided the

bladder within 30 minutes of the test and have had minimal

consumption of diuretic agents.

Physical Activity Level

The global physical activity questionnaire (GPAQ) was used

to assess physical activity level. This questionnaire is valid and

reliable for Iranian population. The Global Physical Activity

Questionnaire was developed by WHO for physical activity

assessment.

It collects information on physical activity level in three set-

tings and sedentary behaviour.

These settings are:

1) Activity at work,

2) Travel to and from places,

3) Recreational activities (Herrmann, Heumann, Der Ananian,

& Ainsworth, 2013).

Depressive and Eating Disorders

Depressive and eating disorders were assessed using a diag-

nostic structural interview based on DSM-IV-TR (Diagnostic

Statistical Manual of Mental Disorder-fourth edition-Text ver-

sion) consist of anorexia nervosa, bulimia and non otherwise

specified (NOS) (American psychiatric Association, 2000).

Statistical Analysis

For descriptive analysis of quantitative data, the Mean and

Standard deviation were used. For qualitative data, frequency

percentage was reported. To evaluate the association between

obesity, depressive and eating disorders OR with 95% CI was

used. Statistical package for the Social Sciences, version 17.0

(SPSS, Chicago, IL, USA) was used to analyze the data.

Results

Sociodemographic characteristics of the study population and

the prevalence of depressive and eating disorders were pre-

sented in Table 1. Also the physical activity in both groups was

in low active range or sedentary. Table 2 demonstrated the

obesity indices and Table 3 presents OR for depressive and

eating disorders. As presents in Table 3, obese aged women

were less likely to have dysthymic disorder compared to mid-

dle-aged obese women 0.27 (95% CI: 0.083 - 0.9).

Table 1.

Sociodemographic characteristics of the study population and the

prevalence of depressive and eating disorders.

<60 years

Number

(percent)

≥60 years

Number

(percent)

Single 4 (3.6) 1 (1)

Married 96 (86.5) 74 (77.1)

Divorced 8 (7.2) 4 (4.2)

Marital

status

Widowed 3 (2.7) 17 (17.7)

≤5 years 32 (28.6) 59 (61.5)

6 - 12 years 61 (54.4) 30 (31.2)

Educational

level

≥12 years 19 (17) 7 (7.3)

Diabetes 16 (15) 22 (23.2)

Hyperlipidemia 18 (16.8) 39 (40.6)

Hypertension 32 (29.9) 48 (50)

Cardiovascular diseases 13 (12.1) 34 (35.4)

Respiratory diseases 26 (24.3) 22 (22.9)

Hepatocellular and

gastrointestinal disorders 57 (50.9) 29 (30.2)

Genitourinary diseases 17 (17.3) 14 (14.6)

Thyroid diseases 30 (32.7) 19 (19.8)

Chronic

conditions

Osteoarticular diseases 65 (67) 66 (68.8)

Nonsmoker 89 (77.4) 79 (82.3)

Regular smoker 4 (3.2) 2 (2.1)

Smoking

Recreational smoker 22 (19.4) 15 (15.6)

Major depression 43 (37.7) 30 (31)

Depressive

disorders Dysthymic disorder 33 (28.3) 9 (9.8)

Bulimia Nervosa 4 (3.7) 7 (7.3)

Eating

disorders Disorders not

otherwise specified 23 (16.7) 4 (4.9)

Open Access

S. R. JAHROMI ET AL.

Open Access 3

Table 2.

Obesity indices in middle-aged women and the elderly.

<60 years

Mean ± SD

≥60 years

Mean ± SD

Weight (kg) 90.7 ± 17.65 82.9 ± 12.25

Height (cm) 157.8 ± 5.3 156.6 ± 9.3

Body Mass Index (BMI) 36.65 ± 7.1 33.77 ± 5.77

Waist circumference (cm) 109.9 ± 14.05 110.7 ± 13.37

Hip circumference (cm) 121.7 ± 13.8 118.7 ± 12.5

Fat% 43.3 ± 4.5 39.17 ± 9.6

Fat free mass (kg) 51.09 ± 7.1 49.16 ± 6.95

Table 3.

The association between obesity, depressive and eating disorders

OR (95% CI) P. value

Depressive

disorders Major depression 0.83 (0.35 - 1.93) 0.657

Dysthymic disorder 0.27 (0.083 - 0.9) 0.026

Eating

disorders Bulimia nervosa 0.56 (0.47 - 0.68) 0.219

Disorders not

otherwise specified 0.26 (0.052 - 1.27) 0.075

Discussion

We found that older obese women were less likely to suffer

from dysthymic disorder than their middle-aged compartments.

The inverse association between dysthymic disorder and

obesity among elderly Iranian women support the “Jolly Fat’’

hypothesis (Crisp & McGuiness, 1976). Our results were fairly

in consistent with the previously reported findings in two Asian

populations. Elderly Japanese women with chronic medical

conditions were less likely to suffer from depressive symptoms

(Kuriyama et al., 2006). An inverse relationship was also re-

ported in elderly Chinese women compared to normal weight

(Li et al., 2004).

However, in contrast to the studies in elderly Asians, in eld-

erly Caucasians obesity was reported to be positively related to

depressive symptoms (Carpenter, Hasin, Allison, & Faith,

2000). Li et al. hypothesized that this difference might be due

to the fact that being a little fat in Asian cultures is not regarded

unhealthy, rather showed the wealth of an individual ( Li et al.,

2004). Therefore, obesity might increase self steam in older

adults. On the other hand, in western societies the stigma at-

tached to being obese might cause people to suffer lower self

esteem and to have more negative self-images, perhaps result-

ing in higher levels of depression.

This inverse relationship in women might also have biologi-

cal origin, as in Postmenopausal statues, elderly women with

higher levels of adipose tissue have higher levels of estrogen,

which might protect against the depressive symptoms (Kim et

al., 2010). Our study was limited to women. Also, the cross-

sectional of the study made us unable to assess whether obesity

is a cause or consequence of depressive symptoms. Neverthe-

less, this study has several advantages. We compare the depres-

sive disorders including dysthymic disorder between middle-

aged and older adults and using random sampling.

In conclusion, we found an inverse relationship between

dysthymic disorder and obesity in Iranian elderly women, in

consistent with the “Jolly Fat” hypothesis. Public health work-

ing against obesity should be cautioned about the potential side

effect of depressive symptoms in the elderly women. Prospec-

tive studies in middle-aged women are warranted for better

understanding of this inverse relationship.

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