The psychological legacy of past obesity and early mortality: evidence from two longitudinal studies

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Abstract

Background

We test a novel ‘weight scarring’ hypothesis which suggests that past obesity is associated with impairments in current psychological well-being and this increases risk of negative physical health outcomes associated with obesity. Across two nationally representative studies, we tested whether past obesity is associated with current psychological outcomes and whether these psychological outcomes explain the association between past obesity and subsequent early mortality.

Methods

Data were from the National Health and Nutrition Examination Survey (NHANES) ( n = 29,047) and the Health and Retirement Study (HRS) ( n = 11,998). Past obesity was defined based on maximum lifetime weight in NHANES and the highest weight from past study waves in the HRS. Across both studies, current depressive symptoms were analysed. A set of 10 additional well-being measures were combined to produce an ‘index of impaired well-being’ in HRS. Subsequent all-cause mortality was examined using National Deaths Index records in NHANES and household interviews in HRS. Linear or logistic regression, Cox proportional hazard regression, and causal mediation models were used.

Results

We found that past obesity was associated with greater current depressive symptoms after controlling for current weight status and in analyses limited to those who were no longer classified as having obesity in NHANES ( β = 0.17; 95% CI: 0.13, 0.22) and HRS ( β = 0.20; 95% CI: 0.08, 0.31). In HRS, past obesity was also associated with a range of current negative psychological outcomes, including an index of impaired psychological well-being ( β = 0.16; 95% CI: 0.05, 0.27). Past obesity was associated with a higher risk of early mortality in both NHANES and HRS (HR = 1.31; 95% CI: 1.16, 1.48 and HR = 1.34; 95% CI: 1.20, 1.50, respectively). Depressive symptoms explained 6% (95% CI: 0.01, 0.10) and 5% (95% CI: 0.01, 0.09) of the association between past obesity and premature mortality in NHANES and HRS, respectively. Impaired psychological well-being partly mediated the association between past obesity and premature mortality by 10% (95% CI: 0.04, 0.16) in HRS.

Conclusions

Our findings suggest that there may be a psychological legacy of past obesity that is associated with raised mortality risk. Ensuring people with obesity receive psychological support even after experiencing weight loss may be important.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12916-023-03148-3.

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Most cited references 82

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Health Effects of Overweight and Obesity in 195 Countries over 25 Years.

Ashkan Afshin, Mohammad Forouzanfar, Marissa Reitsma … (2018)

Background While the rising pandemic of obesity has received significant attention in many countries, the effect of this attention on trends and the disease burden of obesity remains uncertain. Methods We analyzed data from 67.8 million individuals to assess the trends in obesity and overweight prevalence among children and adults between 1980 and 2015. Using the Global Burden of Disease study data and methods, we also quantified the burden of disease related to high body mass index (BMI), by age, sex, cause, and BMI level in 195 countries between 1990 and 2015. Results In 2015, obesity affected 107.7 million (98.7-118.4) children and 603.7 million (588.2- 619.8) adults worldwide. Obesity prevalence has doubled since 1980 in more than 70 countries and continuously increased in most other countries. Although the prevalence of obesity among children has been lower than adults, the rate of increase in childhood obesity in many countries was greater than the rate of increase in adult obesity. High BMI accounted for 4.0 million (2.7- 5.3) deaths globally, nearly 40% of which occurred among non-obese. More than two-thirds of deaths related to high BMI were due to cardiovascular disease. The disease burden of high BMI has increased since 1990; however, the rate of this increase has been attenuated due to decreases in underlying cardiovascular disease death rates. Conclusions The rapid increase in prevalence and disease burden of elevated BMI highlights the need for continued focus on surveillance of BMI and identification, implementation, and evaluation of evidence-based interventions to address this problem.

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Loneliness and social isolation as risk factors for mortality: a meta-analytic review.

Julianne Holt-Lunstad, Timothy B Smith, Mark Baker … (2015)

Actual and perceived social isolation are both associated with increased risk for early mortality. In this meta-analytic review, our objective is to establish the overall and relative magnitude of social isolation and loneliness and to examine possible moderators. We conducted a literature search of studies (January 1980 to February 2014) using MEDLINE, CINAHL, PsycINFO, Social Work Abstracts, and Google Scholar. The included studies provided quantitative data on mortality as affected by loneliness, social isolation, or living alone. Across studies in which several possible confounds were statistically controlled for, the weighted average effect sizes were as follows: social isolation odds ratio (OR) = 1.29, loneliness OR = 1.26, and living alone OR = 1.32, corresponding to an average of 29%, 26%, and 32% increased likelihood of mortality, respectively. We found no differences between measures of objective and subjective social isolation. Results remain consistent across gender, length of follow-up, and world region, but initial health status has an influence on the findings. Results also differ across participant age, with social deficits being more predictive of death in samples with an average age younger than 65 years. Overall, the influence of both objective and subjective social isolation on risk for mortality is comparable with well-established risk factors for mortality.

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Overweight, obesity, and depression: a systematic review and meta-analysis of longitudinal studies.

Floriana Luppino, Leonore de Wit, Paul Bouvy … (2010)

Association between obesity and depression has repeatedly been established. For treatment and prevention purposes, it is important to acquire more insight into their longitudinal interaction. To conduct a systematic review and meta-analysis on the longitudinal relationship between depression, overweight, and obesity and to identify possible influencing factors. Studies were found using PubMed, PsycINFO, and EMBASE databases and selected on several criteria. Studies examining the longitudinal bidirectional relation between depression and overweight (body mass index 25-29.99) or obesity (body mass index > or =30) were selected. Unadjusted and adjusted odds ratios (ORs) were extracted or provided by the authors. Overall, unadjusted ORs were calculated and subgroup analyses were performed for the 15 included studies (N = 58 745) to estimate the effect of possible moderators (sex, age, depression severity). Obesity at baseline increased the risk of onset of depression at follow-up (unadjusted OR, 1.55; 95% confidence interval [CI], 1.22-1.98; P or =60 years) but not among younger persons (aged <20 years). Baseline depression (symptoms and disorder) was not predictive of overweight over time. However, depression increased the odds for developing obesity (OR, 1.58; 95% CI, 1.33-1.87; P < .001). Subgroup analyses did not reveal specific moderators of the association. This meta-analysis confirms a reciprocal link between depression and obesity. Obesity was found to increase the risk of depression, most pronounced among Americans and for clinically diagnosed depression. In addition, depression was found to be predictive of developing obesity.

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Author and article information

Contributors

I Gusti Ngurah Edi Putra:

ORCID: http://orcid.org/0000-0002-1014-6949

i.gusti.ngurah.edi.putra@liverpool.ac.uk , ediputra.ign@gmail.com

Journal

Journal ID (nlm-ta): BMC Med

Journal ID (iso-abbrev): BMC Med

Title: BMC Medicine

Publisher: BioMed Central (London )

ISSN (Electronic): 1741-7015

Publication date (Electronic): 16 November 2023

Publication date PMC-release: 16 November 2023

Publication date Collection: 2023

Volume: 21

Electronic Location Identifier: 448

Affiliations

[1 ]Department of Psychology, Institute of Population Health, University of Liverpool, ( https://ror.org/04xs57h96) Eleanor Rathbone Building, Bedford Street South, Liverpool, L69 7ZA UK

[2 ]Department of Psychology, Maynooth University, ( https://ror.org/048nfjm95) Maynooth, Ireland

[3 ]Department of Behavioral Sciences and Social Medicine, Florida State University College of Medicine, ( https://ror.org/05g3dte14) Tallahassee, USA

[4 ]Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, Faculty of Population Health Sciences, University College London, ( https://ror.org/02jx3x895) London, UK

Author information

I Gusti Ngurah Edi Putra http://orcid.org/0000-0002-1014-6949

Article

Publisher ID: 3148

DOI: 10.1186/s12916-023-03148-3

PMC ID: 10655273

PubMed ID: 37974151

SO-VID: 88a93a2f-8b6e-4ff6-a103-2868930b8b02

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Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

History

Date received : 12 May 2023

Date accepted : 1 November 2023

Funding

Funded by: FundRef http://dx.doi.org/10.13039/501100000269, Economic and Social Research Council;

Award ID: ES/V017594/1

Award Recipient : Eric Robinson

Custom metadata

ScienceOpen disciplines: Medicine

Keywords: psychological distress,depressive symptoms,obesity,mortality,weight scarring,psychological well-being

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ScienceOpen disciplines: Medicine

Keywords: psychological distress, depressive symptoms, obesity, mortality, weight scarring, psychological well-being

The psychological legacy of past obesity and early mortality: evidence from two longitudinal studies

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JAMA Network: Coronavirus

Most cited references 82

Health Effects of Overweight and Obesity in 195 Countries over 25 Years.

Loneliness and social isolation as risk factors for mortality: a meta-analytic review.

Overweight, obesity, and depression: a systematic review and meta-analysis of longitudinal studies.

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