Obesity-associated Psychological Distress: Who is most impacted?

While the cause of obesity can be simply defined as an imbalance of energy intake and expenditure, recent studies have outlined a complex cyclical relationship between obesity and psychological distress. In this complex cycle, multiple stressors can increase the risk for and perpetuate obesity, including the social drivers of health, poor self-perception of body image and obesity stigma. However, the association between obesity and psychological distress remains under-explored in young adults aged 18-26, who are at a pivotal stage in development in which psychosocial and economic stressors are prevalent. Potential variations in the obesity and psychological distress relationship based on gender and race/ethnicity are also under-researched.

The study involved analyzing data from the 2013 to 2018 National Health Interview Survey and grouping individuals, aged 18-26 years, into distinct BMI groups based on the following ranges: normal weight (18.5 to <25 kg/m2), overweight (25 to <30 kg/m2), class I obesity (30 to <35 kg/m2), class II obesity (35 to <40 kg/m2) and class III obesity (≥40 kg/m2). Individuals were further grouped into six domains using Healthy People 2030 and the Kaiser Family Foundation’s Social Determinants of Health (SDoH) frameworks: economic stability, neighborhood/physical environment, community and social context, food insecurity, education, and health care system. Each respondent’s SDoH variable was scored 0 or 1 (favorable or unfavorable). Other covariates included age, sex (men and women), race/ethnicity (non-Hispanic white, non-Hispanic Black, and Hispanic), and comorbidities. The study’s primary outcomes were Kessler Psychological Distress Scale (K6) scores, which assess how frequently in the past 30 days respondents felt nervous, hopeless, restless, or fidgety; experienced such deep depression that nothing could uplift their spirits; believed that everything was an effort; or felt worthless. Responses were gauged on a four-point scale (none of the time, a little of the time, most of the time or all the time).

Of the 20,954 participants representing more than 35 million U.S. adults, 27% were overweight, and 24% were obese. The average K6 score was higher in individuals with obesity than those of a healthy weight, and the prevalence of mild/moderate and severe psychological distress was higher among the obese group compared to healthy-weight individuals. After controlling for age, sex, race, comorbidities and SDoH, psychological distress remained significantly elevated for all obesity classes. Most notably, researchers found that individuals with class III obesity are 1.4 times more likely to experience psychological distress than their healthy-weight counterparts. Psychological distress was also significantly elevated in non-Hispanic white and female groups, but not in Hispanic, non-Hispanic Black, and male subgroups. “This finding may be potentially explained by different coping mechanisms for body image and obesity perception among young adults from different racial and ethnic groups,” explained Javed, Assistant Research Professor of Cardiology. “There is some prior work that suggests Black and Hispanic individuals may have stronger coping responses to stressors than their non-Hispanic white counterparts, which may include stress coping for obesity and body image.” Nasir added that stigmatization of mental health among racial and ethnic groups may also discourage individuals from self-reporting mental health concerns. “Since the data we used is self-reported in a survey and not clinically assessed by a provider, this may have attenuated the observed effect among racial and ethnic minorities,” he said. “This evidence should be refined specifically for the 18–26-year age group via additional studies.” Nevertheless, Nasir and Javed’s study is novel in that it unpacks how age, gender, and race intersect with the obesity-psychological distress relationship. For instance, the study confirms that females with obesity have higher levels of psychological distress compared to obese males—a finding likely fueled by Western beauty standards and obesity stigma. The study also suggests that obesity severity increases the risk for psychological distress, which may contribute to maladaptive behavior that perpetuates obesity. “Our results add a layer of complexity and depth to the current understanding of the subject, providing valuable insights for both research and practical applications,” Javed noted. “In addition to the biological aspects of obesity, public health interventions should target the underlying social drivers that contribute to this condition and its associated psychological distress.”