The Psychological Impact of Weight Concerns Differs Between the Sexes

From the WebMD Archives

Feb. 1, 2000 (New York) -- Obesity can increase the risk of depression in women but can reduce the risk of depression in men, according to a new study. In fact, underweight men were more likely to be depressed and suicidal than other men, according to a report in the February issue of the American Journal of Public Health.

"We don't know the cause and effect. ... For men, to be underweight and on the scrawny side may not be as desirable in society. Perhaps what we're seeing here is the stigma of being underweight for men in our culture," says co-researcher Myles S. Faith, PhD, of the Obesity Research Center at St. Luke's-Roosevelt Hospital Center and Columbia University in New York.

"In the study, being underweight was not due to a chronic illness. The medical complications of obesity have been well studied and are well known. The results indicate ... that one must consider the psychological costs of obesity as much as weight itself. If [you're] feeling depressed or stigmatized, you might need clinical attention," Faith tells WebMD.

The data was obtained as part of a large national survey that included more than 40,000 men and women. In face-to-face interviews, the people were questioned about symptoms of depression, medical conditions, substance use (legal and illegal drugs, alcohol), and thoughts of suicide and suicide attempts.

"One of our major findings was that there was a relationship between depression and body weight, but the relationship was different for men and women," says Faith.

Obesity was associated with a 37% increased risk of depression among women, but a 25% decreased risk of depression among men. These findings were true for both blacks and whites.

Similar findings were noted for suicidal thoughts and attempts. For women, an elevated BMI (a measurement of height and weight) increased the risk of suicidal thoughts, but for men, an increase in BMI reduced the risk of suicidal thoughts and attempts.

Some of the most intriguing findings were the psychiatric problems associated with being underweight for men. Underweight men were 25% more likely to be depressed, 81% more likely to think about suicide, and 77% more likely to attempt suicide than men of average weight.

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"These are very important findings, but we need to be very careful how we interpret them," David B. Sarwer, PhD, director of education at the weight and eating disorder program at the University of Pennsylvania School of Medicine in Philadelphia, tells WebMD.

"We don't want to fall into the stereotype trap that obesity causes depression. ... Rather, I think we can interpret [the results] as saying that in a society that puts such a premium on being thin, and equates thinness with beauty and success, it is very difficult to be an obese individual. Walking around in such a society may contribute to things like [clinical] depression and suicidal ideation. Being obese can take an emotional toll," says Sarwer, who was not involved in the study.

Linda Korman, MD, a family physician who specializes in weight management, says, "It's exactly what I've seen in my medical practice. Depression is very common in obese women. I feel that depression has a lot to do with the expectations society has of women -- our society is so driven by thinness for women. ... Women must learn to strive to have a healthier body weight, not just an ideal weight." Korman is also affiliated with the Robert Wood Johnson School of Medicine at the University of Medicine and Dentistry of New Jersey.

"I also feel there's such a prejudice against obese individuals. ... Do we poke fun at people with diabetes or cancer? Of course not. So why can we be allowed to make fun of obese individuals? We have to bring obesity into the realm of a medical disorder," says Korman.

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