Gender Differences in Associations Between Body Mass Index and DSM-IV Mood and Anxiety Disorders: Results from the National Epidemiologic Survey on Alcohol and Related Conditions
Introduction
Health risks associated with overweight and obesity are well documented. Diabetes, cardiovascular disease, arthritis, and certain cancers are more prevalent among overweight and obese individuals than among those of normal weight 1, 2, 3, and risks for these disorders increase with body mass 2, 4, 5. Recent evidence suggests increased prevalence of mood and anxiety disorders among individuals who are overweight or obese compared to those with weight in the normal range (6). Among those seeking weight loss treatment, rates of depressive and bipolar disorders are elevated 7, 8, 9. Conversely, rates of overweight and obesity are elevated among individuals seeking treatment for psychiatric disorders, particularly mood disorders 8, 10, 11, 12.
Epidemiological studies are the “gold standard” for establishing comorbidity rates because they are not confounded by treatment seeking status, and they allow for investigation of demographic variables that may influence relationships. Few epidemiological studies examining the relationship between body mass index (BMI) and psychopathology exist. Most find that the risk of major depression significantly increases with BMI even when controlling for demographic characteristics and other risk factors 6, 13. Obesity also appears to be associated with increased odds of anxiety disorders (6).
Rates of overweight and obesity differ for men and women. Men are more likely to be overweight (14), but women are more likely to be obese (15). In the population as a whole, women are more likely than men to experience mood or anxiety disorders (16). Relationships between psychiatric disorders and BMI also appear to differ for men and women. In an epidemiological sample divided into obese (BMI >30) and non-obese (BMI <30) categories, obesity was associated with elevated risk for mood and anxiety disorders in women and men (6). When overweight and obesity are categorized separately, both have been associated with greater likelihood of reporting symptoms of depression or anxiety in women 17, 18, but one study found that these relationships did not hold for men (18), and another found they applied to overweight but not to obese men (17). Women but not men who report a lifetime history of major depression or bipolar disorder have elevated odds of obesity (19). Adolescent females and young adult women classified as obese are more likely to report anxiety disorders than their normal weight counterparts, a relationship not observed in males (20).
Some recent studies suggest that overweight may actually be associated with better mental health among men. Overweight and obese men are less likely to attempt or commit suicide compared to underweight or normal weight men 21, 22. In contrast, increased BMI is associated with higher rates of suicidal ideation among women (23).
The purpose of this study was to clarify and corroborate findings of previous studies suggesting interactions between BMI and gender in predicting risk for mood and anxiety disorders using a large, recently collected, representative sample of the U.S. population. The National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) (24) is the largest psychiatric epidemiology study conducted to date. The National Institute on Alcohol and Alcoholism (NIAAA) collected NESARC data from a representative sample of the U.S. population in 2001 and 2002. The primary goals of NESARC were to determine the prevalence of alcohol use and alcohol use disorders and to examine associated physical and emotional disabilities. Self-reported height and weight were obtained from respondents, and a range of mood and anxiety disorders were diagnosed on the basis of DSM-IV criteria. The NESARC sample therefore appeared to be ideally suited to the task of examining associations between BMI and psychopathology, and the large size of the sample allowed for categorization of respondents into normal weight, overweight, and obese groups and for analysis of interactions between BMI and gender.
Section snippets
NESARC Sample
Non-institutionalized civilians aged 18 years and over were the target population of NESARC, and participants were drawn from all 50 states and the District of Columbia. African American and Hispanic individuals were oversampled to each constitute approximately 20% of the total sample. Young adults, aged 18 to 24 years, were also oversampled at a 2.25:1 ratio. The sample was later weighted based on characteristics of the sampling methods, to account for the selection of one person from each
Demographic Characteristics
Table 1 shows demographic characteristics of the sample stratified by BMI category and gender. All demographic features differed significantly across the six categories. Subsequent analyses therefore controlled for all these demographic features.
Prevalence of DSM-IV Mood and Anxiety Disorders
Fig. 1, Fig. 2 depict lifetime and past-year prevalence of mood and anxiety disorders, adjusted to reflect population demographics, for each gender in the three BMI categories. Women, particularly obese women, tended to have higher rates of mood
Discussion
This study found that obesity was associated with many DSM-IV mood and anxiety disorders in both genders and that gender interacted with BMI to increase risk of certain disorders. Women who were either overweight or obese had increased odds of any lifetime mood disorder and of lifetime and past-year bipolar disorder, whereas overweight men were not at elevated risk for any lifetime or past-year mood disorder. Similar interactions between gender and BMI were noted to affect the risk for anxiety
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Preparation of this report was supported in part by National Institutes of Health grants R01-MH60417, R01-MH60417-Supp, R01-DA13444, R01-DA018883, R01-DA14618, R01-DA016855, P50-AA03510, and P50-DA09241. We thank the National Institute on Alcohol Abuse and Alcoholism and the U.S. Census Bureau field representatives who administered the NESARC interview.