Original Article: The relationship between body mass index and depression, anxiety, body image, and eating attitudes in adolescents in Iran

Authors

1 Department of Pediatric, Shahrekord University of Medical Sciences. Metabolic Liver Disease Research Center, Isfahan University of Medical reference to ideal or acceptable standards, Sciences, Isfahan, Iran

2 Department of Pediatric, Shahrekord University of Medical Sciences

3 Modelling in Health Research Center, Shahrekord University of Medical Sciences

4 Department of Psychiatry, Clinical Research Development Unit, Hajar Hospital, Sahrekord University of Medical Sciences, Shahrekord

Abstract

Background: The aim of this study was to investigate the relationship between body mass index (BMI) and depression, anxiety, body image, and eating attitudes in 12- to 16-year-old adolescents. Materials and Methods: In this descriptive-analytical study on 437 students in Shahrekord, Iran, selected by two-step random sampling (selection of schools and students), participants were divided into normal weight (BMI: 5–85th), overweight (BMI: 85–95th), and obese (BMI >95th) groups and completed the questionnaires and data were analyzed by SPSS version 23. Results: BMI had a positive correlation with anxiety, depression, and dysfunctional eating attitudes, and negative correlation with body image in adolescents. Mean scores of depression and anxiety in both overweight and obese groups were significantly higher than those in normal weight adolescents but scores of body image and eating attitudes were not different between overweight and normal weight groups. Conclusion: Obesity and overweight may have adverse effects on mental health of adolescents and more attention to psychological aspect of obesity can help us to provide better health services to overweight and obese adolescents.

Keywords

1.
Weir CB, Jan A. BMI classification percentile and cut off points. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2021. Available from: https://www.ncbi.nlm.nih.gov/books/NBK541070/. [Last updated on 2021 Jun 29].  Back to cited text no. 1
    
2.
Mazidi M, Banach M, Kengne AP, Lipid and Blood Pressure Meta-analysis Collaboration Group. Prevalence of childhood and adolescent overweight and obesity in Asian countries: A systematic review and meta-analysis. Arch Med Sci 2018;14:1185-203.  Back to cited text no. 2
    
3.
Barzin M, Aryannezhad S, Serahati S, Beikyazdi A, Azizi F, Valizadeh M, et al. Incidence of obesity and its predictors in children and adolescents in 10 years of follow up: Tehran lipid and glucose study (TLGS). BMC Pediatr 2018;18:245.  Back to cited text no. 3
    
4.
Rankin J, Matthews L, Cobley S, Han A, Sanders R, Wiltshire HD, et al. Psychological consequences of childhood obesity: Psychiatric comorbidity and prevention. Adolesc Health Med Ther 2016;7:125-46.  Back to cited text no. 4
    
5.
Kansra AR, Lakkunarajah S, Jay MS. Childhood and adolescent obesity: A review. Front Pediatr 2020;8:581461.  Back to cited text no. 5
    
6.
Sanyaolu A, Okorie C, Qi X, Locke J, Rehman S. Childhood and adolescent obesity in the United States: A public health concern. Glob Pediatr Health 2019;6:1-11.2333794X19891305.  Back to cited text no. 6
    
7.
Bourdier L, Fatseas M, Maria AS, Carre A, Berthoz S. The psycho-affective roots of obesity: Results from a French study in the general population. Nutrients 2020;12:2962.  Back to cited text no. 7
    
8.
Uchôa FN, Uchôa NM, Daniele TM, Lustosa RP, Garrido ND, Deana NF, et al. Influence of the mass media and body dissatisfaction on the risk in adolescents of developing eating disorders. Int J Environ Res Public Health 2019;16:1508.  Back to cited text no. 8
    
9.
Jankauskiene R, Baceviciene M. Body image concerns and body weight overestimation do not promote healthy behaviour: Evidence from adolescents in Lithuania. Int J Environ Res Public Health 2019;16:864.  Back to cited text no. 9
    
10.
Radwan H, Hasan HA, Ismat H, Hakim H, Khalid H, Al-Fityani L, et al. Body mass index perception, body image dissatisfaction and their relations with weight-related behaviors among university students. Int J Environ Res Public Health 2019;16:1541.  Back to cited text no. 10
    
11.
Nguyen DT, Wright EP, Dedding C, Pham TT, Bunders J. Low self-esteem and its association with anxiety, depression, and suicidal ideation in Vietnamese secondary school students: A cross-sectional study. Front Psychiatry 2019;10:698.  Back to cited text no. 11
    
12.
Hay P. Current approach to eating disorders: A clinical update. Intern Med J 2020;50:24-9.  Back to cited text no. 12
    
13.
Gianini L, Liu Y, Wang Y, Attia E, Walsh BT, Steinglass J. Abnormal eating behavior in video-recorded meals in anorexia nervosa. Eat Behav 2015;19:28-32.  Back to cited text no. 13
    
14.
Weinberger NA, Kersting A, Riedel-Heller SG, Luck-Sikorski C. Body dissatisfaction in individuals with obesity compared to normal-weight individuals: A systematic review and meta-analysis. Obes Facts 2016;9:424-41.  Back to cited text no. 14
    
15.
Bouzas C, Bibiloni MD, Tur JA. Relationship between body image and body weight control in overweight ≥55-year-old adults: A systematic review. Int J Environ Res Public Health 2019;16:1622.  Back to cited text no. 15
    
16.
Hosseini SN, Emdadi S, Jalilian F, Karami Matin B, Ataee M, Mirzaei Alavijeh M. Fitness intention and its relationship with eating attitudes: A cross-sectional study of Iranian female medical college students. Iran J Psychiatry Behav Sci 2016;10:e4307.  Back to cited text no. 16
    
17.
Rouzitalab T, Pourghassem Gargari B, Amirsasan R, Asghari Jafarabadi M, Farsad Naeimi A, Sanoobar M. The relationship of disordered eating attitudes with body composition and anthropometric indices in physical education students. Iran Red Crescent Med J 2015;17:e20727.  Back to cited text no. 17
    
18.
Chung S. Body mass index and body composition scaling to height in children and adolescent. Ann Pediatr Endocrinol Metab 2015;20:125-9.  Back to cited text no. 18
    
19.
Fisher S. Body Experience in Fantasy and Behavior. 1st ed. USA: Appleton-Century-Crofts; 1970.  Back to cited text no. 19
    
20.
Khazai K. Correlation between body image and coping styles with severity of primary dysmenorrhea. J Fundam Ment Health 2012;14:55-344.  Back to cited text no. 20
    
21.
Yazdani N, Hosseini SV, Amini M, Sobhani Z, Sharif F, Khazraei H. Relationship between body image and psychological well-being in patients with morbid obesity. Int J Community Based Nurs Midwifery 2018;6:175-84.  Back to cited text no. 21
    
22.
Gargari B, Kooshavar D, Sajadi N, Karami S, Shahrokhi H. Risk of eating disorders among high school females of Tabriz in 2007. Med J Tabriz Univ Med Sci 2008;30:21-6.  Back to cited text no. 22
    
23.
Sahebi A, Asghari MJ, Salari RS. Validation of Depression Anxiety and Stress Scale (DASS-21) for an Iranian Population; 2005.  Back to cited text no. 23
    
24.
Rajan TM, Menon V. Psychiatric disorders and obesity: A review of association studies. J Postgrad Med 2017;63:182-90.  Back to cited text no. 24
[PUBMED]  [Full text]  
25.
Lavallee KL, Zhang XC, Schneider S, Margraf J. Obesity and mental health: A longitudinal, cross-cultural examination in Germany and China. Front Psychol 2021;12:712567.  Back to cited text no. 25
    
26.
Milano W, Ambrosio P, Carizzone F, De Biasio V, Di Munzio W, Foia MG, et al. Depression and obesity: Analysis of common biomarkers. Diseases 2020;8:23.  Back to cited text no. 26
    
27.
Hach I, Ruhl UE, Klose M, Klotsche J, Kirch W, Jacobi F. Obesity and the risk for mental disorders in a representative German adult sample. Eur J Public Health 2007;17:297-305.  Back to cited text no. 27
    
28.
Lindberg L, Hagman E, Danielsson P, Marcus C, Persson M. Anxiety and depression in children and adolescents with obesity: A nationwide study in Sweden. BMC Med 2020;18:30.  Back to cited text no. 28
    
29.
Wang S, Sun Q, Zhai L, Bai Y, Wei W, Jia L. The prevalence of depression and anxiety symptoms among overweight/obese and non-overweight/non-obese children/adolescents in China: A systematic review and meta-analysis. Int J Environ Res Public Health 2019;16:340.  Back to cited text no. 29
    
30.
Hashemipou M, Kelishadi R, Roohafza H, Pourarian S. Assessment of anxiety in 12-18 years old overweight and obese. J Inflamm Dis 2005;9:104-8.  Back to cited text no. 30
    
31.
Golian S, Ghiyasvand M, Mirmohamad Ali M, Mehran A. The relationship between body image of obese adolescent girls and depression, anxiety and stress. Health Monit J Iran Inst Health Sci Res 2014;13:433-40.  Back to cited text no. 31
    
32.
Hayes JF, Fitzsimmons-Craft EE, Karam AM, Jakubiak J, Brown ML, Wilfley DE. Disordered eating attitudes and behaviors in youth with overweight and obesity: Implications for treatment. Curr Obes Rep 2018;7:235-46.  Back to cited text no. 32
    
33.
Moya T, Fleitlich-Bilyk B, Goodman R. Brief report: Young people at risk for eating disorders in Southeast Brazil. J Adolesc 2006;29:313-7.  Back to cited text no. 33
    
34.
Blodgett Salafia EH, Jones ME, Haugen EC, Schaefer MK. Perceptions of the causes of eating disorders: A comparison of individuals with and without eating disorders. J Eat Disord 2015;3:32.  Back to cited text no. 34
    
35.
Izydorczyk B, Truong Thi Khanh H, Lizińczyk S, Sitnik-Warchulska K, Lipowska M, Gulbicka A. Body dissatisfaction, restrictive, and bulimic behaviours among young women: A Polish-Japanese comparison. Nutrients 2020;12:666.  Back to cited text no. 35