ORIGINAL ARTICLE |
https://doi.org/10.5005/jp-journals-11001-0081 |
Exploring the Relationship between Abdominal Obesity and Common Psychiatric Disorders among Students of Northern India
1-3Department of Psychiatry, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
4Department of Psychiatry, Mahadeva Neuro Psychiatry Center, Varanasi, Uttar Pradesh, India
Corresponding Author: Sonali Dixit, Department of Psychiatry, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India, Phone: +91 9717317743, e-mail: sonali9369@gmail.com
Received on: 05 June 2024; Accepted on: 13 September 2024; Published on: 16 November 2024
ABSTRACT
Background: Previous studies have shown an association between obesity and psychiatric disorders, primarily focusing on adults and the elderly. However, limited research has been conducted on students in this area. This study aimed to investigate the relationship between psychiatric disorders in students and obesity, as measured by body mass index (BMI).
Materials and methods: This retrospective cross-sectional study utilized data from the Child and Adolescent Excellence Health Centre and the student care center at the Center of Excellence for Adolescent Health and Development, SS Hospital, IMS, BHU. A total of 7,548 students from both centers were enrolled between April 2018 and June 2022, of which 1,795 met the selection criteria and were included in the study. The final diagnosis of psychiatric disorders was based on the tenth revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10) diagnostic criteria for research (DCR) criteria. Obesity status was determined using BMI and waist circumference (WC). Double-tailed tests were employed to assess the correlation between age, BMI, gender, depression, and anxiety.
Results: The mean age of the participants was 18.81 ± 4.01 years, with a majority being males (n = 931, 51.9%) compared to females (n = 864, 48.1%). Variables such as age (p < 0.001), marital status (p < 0.001), and education (p < 0.001) were significantly associated with BMI. A significant difference was observed in the mean BMI scores between participants with and without depression and anxiety. BMI showed a positive correlation with age, depression, and anxiety.
Conclusion: Obesity appears to be associated with a higher likelihood of depression and anxiety among students compared to individuals with underweight or normal BMI.
How to cite this article: Yadav JS, Prakash S, Dixit S, et al. Exploring the Relationship between Abdominal Obesity and Common Psychiatric Disorders among Students of Northern India. East J Psychiatry 2024;24(2):45-50.
Source of support: Nil
Conflict of interest: None
Keywords: Adolescent, Anxiety, Depression.
INTRODUCTION
The relationship between obesity and psychiatric disorders is well established and complex, with both conditions frequently influencing each other in both directions. This indicates that obesity can increase the likelihood of developing psychiatric disorders, while psychiatric disorders can result in unhealthy behaviors that contribute to obesity. One such association is that between obesity and depression, in which obese individuals have a greater risk of developing depression, and depressed individuals may have a greater risk of becoming obese. Complex biological, psychological, and social factors may contribute to this relationship. Additionally, biological factors contribute to the association between obesity and psychiatric disorders. Examples of potential biological mechanisms include hormonal imbalances, chronic inflammation, and neurotransmitter deregulation. Recognizing and addressing the bidirectional relationship between obesity and psychiatric disorders is crucial for the development of effective prevention and treatment strategies. To promote comprehensive wellness, approaches must address not only physical health but also psychological well-being and emotional coping mechanisms. Over the past few decades, there has been a significant increase in the consumption of junk food among children, adolescents, and young adults. This trend can be attributed to the easy availability of such foods. The fast-food industry has been growing at a rapid rate, with an average annual growth of 40%.1 Studies conducted in India have highlighted the high consumption of packaged foods and sweetened beverages among children. For example, a survey conducted by the Centre for Science and Environment (CSE) revealed that a majority of children (93%) consumed packaged food, while a significant percentage (68%) consumed packaged sweetened beverages more than once a week. Furthermore, a considerable portion (53%) consumed these products on a daily basis. The study reported that approximately 25% of school-going children in India consumed ultra-processed foods with high levels of sugar, salt, and fat from fast food outlets.2
These unhealthy eating habits have led to a range of detrimental effects on health, with obesity being a major concern. Junk food consumption has been linked to obesity, which, in turn, increases the risk of various medical conditions such as diabetes, joint pain, heart diseases, and other noncommunicable diseases.3,4 Moreover, obesity can have negative impacts on overall well-being, including reduced immunity, susceptibility to oral and systemic diseases, impaired physical and mental growth, and decreased efficiency.5 In addition to the physical health implications, obesity is also associated with several psychological and behavioral issues. It exhibits complex relationships with mood disorders, affective temperamental dimensions (especially cyclothymia), eating disorders, and attention-deficit/hyperactivity disorder (ADHD)-related executive, emotional, and motivational dysfunctions. To address these concerns, it is crucial to promote healthier dietary habits among students and young adults. Additionally, a multidisciplinary approach that includes education, counseling, and support from healthcare professionals is necessary to tackle the interplay between unhealthy eating habits, obesity, and related health complications. This study aimed to investigate the relationship between body mass index (BMI) and common psychiatric disorders, mainly anxiety and depression, in students.
AIM
To study the relationship between BMI and common psychiatric disorders in students.
OBJECTIVES
This study was planned with the objective of assessing the correlation between abdominal obesity and common psychiatric disorders, as well as determining the BMI of both genders and exploring its relationship with psychiatric disorders in students.
MATERIALS AND METHODS
Study Setting
The sample was drawn from the Child and Adolescent Excellence Health Center at the Center of Excellence for Adolescent Health and Development, SS Hospital, IMS, BHU.
Study Design
This was a retrospective cross-sectional study.
Measures
Sociodemographic information from all subjects who applied for certification was gathered using a semi-structured proforma. The diagnosis was made using the tenth revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10) Diagnostic Criteria for Research (DCR).6 Obesity status was determined using BMI and waist circumference (WC).
Ethical Considerations
The study received ethical approval from the Ethics Review Committee of the Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India, and written consent was obtained from the parents of minors and subjects aged 20–24 years.
Statement of Human and Animal Rights
Ethical standards for experiments involving human subjects were followed in accordance with the Helsinki Declaration of 1975, as revised in 2000.
Procedure
The study made use of data obtained from the Child and Adolescent Excellence Health Center and the student health center located at the Center of Excellence for Adolescent Health and Development, SS Hospital, IMS, BHU. Over the course of the study, which took place from April 2018 to June 2023, a total of 7,548 students were initially enrolled. Among them, 1,795 individuals fulfilled the specific selection criteria and were ultimately included in the study. Diagnoses were established using ICD-10 DCR. The obesity status of the participants was assessed by measuring both BMI and WC.
Statistical Analysis
To evaluate the correlation between age, BMI, gender, depression, and anxiety, double-tailed tests were utilized. These tests were used to determine the significance of the associations between these variables.
RESULTS
The investigation involved 1,795 children and adolescents with an average age of 18.81 years. Fifty-one point nine percent of the participants were male, while forty-eight point one percent were female. The gender distribution was nearly balanced, with fifty-one point nine percent male and forty-eight point one percent female participants. A significant majority of participants were unmarried (91.4%). Education-wise, the majority were attending school (40.3%), followed by college attendees (35.6%). The majority of participants were students not currently earning (80.3%), while a smaller percentage engaged in coaching (2.2%), part-time jobs (2.4%), and online employment (15.2%). In terms of religious affiliation, the majority identified as Hindu (92.8%), with a smaller percentage being Muslims (7.0%). The participants were categorized into different groups: general (34.8%), scheduled caste (SC) (13.1%), and scheduled tribe (ST) (52.1%). Geographically, a larger portion resided in rural areas (74.7%), with the remaining 25.3% living in urban settings (Table 1).
| Characteristics | Participants | |
|---|---|---|
| Number | % | |
| Age-groups (years) | ||
| 10–15 16–19 20–24 |
408 527 860 |
22.7 29.4 47.9 |
| Mean age (years) | 18.81 ± 4.01 | |
| Gender | ||
| Male Female |
931 864 |
51.9 48.1 |
| Marital status | ||
| Married Unmarried |
150 1,645 |
8.4 91.4 |
| Education | ||
| School going College going Coaching Distant learning School drop |
723 639 275 122 36 |
40.3 35.6 15.3 6.8 2.0 |
| Occupation | ||
| Coaching Part time Online job Student not earning |
39 43 272 1,441 |
2.2 2.4 15.2 80.3 |
| Religion | ||
| Hindu Muslim Others |
1,665 125 5 |
92.8 7.0 0.3 |
| Category | ||
| General Scheduled caste (SC) Scheduled tribe (ST) |
625 235 935 |
34.8 13.1 52.1 |
| Residence | ||
| Rural Urban |
1,341 454 |
74.7 25.3 |
The distribution of BMI categories (underweight, normal, overweight, obese) varied among the different age-groups. The analysis employing the Chi-squared test unveiled a significant connection between age-groups and BMI categories (p < 0.001). In contrast, the distribution of BMI categories remained consistent between males and females, and the Chi-squared test did not indicate a substantial association. Regarding marital status, a significant association emerged with BMI categories (p = 0.032), implying distinctions in BMI distribution between married and unmarried participants. Education also displayed a notable connection with BMI categories (p < 0.001), with discernible differences among various educational groups. Surprisingly, occupation did not show a substantial association with BMI categories, as indicated by the Chi-squared test. Similarly, no significant association was detected between religion and BMI categories. Moreover, category affiliation did not demonstrate a significant link with BMI categories. The distinction in BMI categories between rural and urban participants was negligible, and the association was not considered significant (Table 2).
| Variables | BMI | Chi-square value | df | p-value | |||||||
|---|---|---|---|---|---|---|---|---|---|---|---|
| Underweight | Normal | Overweight | Obese | ||||||||
| No. | % | No. | % | No. | % | No. | % | ||||
| Age-groups (years) | |||||||||||
| 10–15 16–19 20–24 |
100 82 95 |
24.5 15.6 11.0 |
249 364 601 |
61.0 69.1 69.9 |
42 62 139 |
10.3 11.8 16.2 |
17 19 25 |
4.2 3.6 2.9 |
44.105 | 6 | <0.001 |
| Gender | |||||||||||
| Male Female |
140 137 |
15.0 15.9 |
638 576 |
68.5 66.7 |
126 117 |
13.5 13.5 |
27 34 |
2.9 3.9 |
1.837 | 3 | 0.607 |
| Marital status | |||||||||||
| Married Unmarried |
13 264 |
8.7 16.04 |
102 1,112 |
68.0 67.6 |
28 215 |
18.7 13.1 |
7 54 |
4.7 3.3 |
8.813 | 3 | 0.032 |
| Education | |||||||||||
| School going College going Coaching Distant learning School drop |
148 68 37 16 8 |
20.5 10.6 13.5 13.1 22.2 |
462 463 180 88 21 |
63.9 72.5 65.5 72.1 58.3 |
84 89 48 16 6 |
11.6 13.9 17.5 13.1 16.7 |
29 19 10 2 1 |
4.0 3.0 3.6 1.6 2.8 |
36.066 | 12 | <0.001 |
| Occupation | |||||||||||
| Coaching Part time Online Not earning |
6 6 41 224 |
15.4 14.0 15.1 15.5 |
28 27 179 980 |
71.8 62.8 65.8 68.0 |
4 9 43 187 |
10.3 20.9 15.8 12.98 |
1 1 9 50 |
2.6 2.3 3.3 3.5 |
4.179 | 9 | 0.899 |
| Religion | |||||||||||
| Hindu Muslim Others |
251 25 1 |
15.1 20.0 20.0 |
1,133 80 1 |
68.0 64.0 20.0 |
223 18 2 |
13.4 14.4 40.0 |
58 2 1 |
3.5 1.6 20.0 |
11.820 | 6 | 0.066 |
| Category | |||||||||||
| General SC ST |
93 39 145 |
14.9 16.6 15.5% |
412 167 635 |
65.9 71.1 67.9 |
96 21 126 |
15.4 8.9 13.5 |
24 8 29 |
3.8 3.4 3.1 |
6.837 | 6 | 0.336 |
| Residence | |||||||||||
| Rural Urban |
214 63 |
16.0 13.9 |
901 313 |
67.2 68.9 |
177 66 |
13.2 14.5 |
49 12 |
3.7 2.6 |
2.575 | 3 | 0.462 |
df, degree of freedom; Bold value is applied for (p < 0.001), indicating a very strong level of significance, for age groups and education, where significant associations with BMI categories were found; (p = 0.032) for marital status, as this value is below the threshold of 0.05, showing a statistically significant relationship
Further analysis revealed a significant relationship between depression and BMI categories (p = 0.004), with variations in BMI distribution among participants with different depression statuses. Interestingly, no significant connection was observed between anxiety and BMI categories (Table 3).
| Variables | BMI | Chi-square value | df | p-value | |||||||
|---|---|---|---|---|---|---|---|---|---|---|---|
| Underweight | Normal | Overweight | Obese | ||||||||
| No. | % | No. | % | No. | % | No. | % | ||||
| Depression | |||||||||||
| Absent Present |
247 30 |
89.2 10.8 |
1080 134 |
89.0 11.0 |
205 38 |
84.4 15.6 |
46 15 |
75.4 24.6 |
13.525 | 3 | 0.004 |
| Anxiety | |||||||||||
| Absent Present |
231 46 |
83.4 16.6 |
977 237 |
80.5 19.5 |
199 44 |
81.9 18.1 |
48 13 |
78.7 21.3 |
1.584 | 3 | 0.663 |
df, degree of freedom; p = 0.004 is bold, indicates a significant relationship between depression and BMI, as this value is below the 0.05 threshold
On average, participants with depression and anxiety displayed slightly higher BMIs compared to those without (21.71 vs 20.60 for depression and 21.19 vs 20.63 for anxiety). These disparities were statistically meaningful, as validated by the t-test outcomes (p < 0.001 for depression and p = 0.019 for anxiety) (Table 4).
| Variables | n | Mean | SD | t-value | p-value | |
|---|---|---|---|---|---|---|
| BMI (kg/m2) | Depression | |||||
| Absent Present |
1,578 217 |
20.60 21.71 |
3.72 5.43 |
–3.848 | <0.001 | |
| Anxiety | ||||||
| Absent Present |
1,455 340 |
20.63 21.19 |
3.94 4.13 |
–2.356 | 0.019 | |
kg, kilogram; m, meter; SD, standard deviation; Bold value is applied for (p < 0.001) for the mean BMI difference related to depression, signifying strong significance; (p = 0.019) for the mean BMI difference related to anxiety, which is also statistically significant
A positive correlation between BMI and age was evident (r = 0.407, p < 0.01), along with a weak positive correlation between BMI and anxiety (r = 0.056, p < 0.05). However, no substantial correlations were identified between age and depression, age and anxiety, or depression and anxiety (Table 5). The findings of this study indicate that abdominal obesity, as measured by BMI, is associated with an increased risk of depression and anxiety in students.
| Age | BMI | Depression | Anxiety | |
|---|---|---|---|---|
| Age | 1 | 0.407** | 0.089** | 0.004 |
| BMI | 0.407** | 1 | 0.090** | 0.056* |
| Depression | 0.089** | 0.090** | 1 | –0.044 |
| Anxiety | 0.004 | 0.056* | –0.044 | 1 |
*Correlation is significant at the 0.05 level (2-tailed); **Correlation is significant at the 0.01 level (2-tailed)
DISCUSSION
This study aimed to explore the relationship between psychiatric disorders, specifically depression and anxiety, in children and adolescents, and abdominal obesity measured by BMI. Over the past three decades, the prevalence of obesity among children and young adults has become a significant public health concern, and its potential contribution to psychological disorders is gaining attention. Depression is a major public health issue, with the occurrence rate of major depressive disorder among adolescents between the ages of 13 and 18 found to be 5.6%.7 Similarly, anxiety affects approximately 6.5% of children worldwide, while the prevalence of childhood depression is estimated to be around 2.6%.8 These statistics highlight the importance of understanding the link between psychiatric disorders and obesity in young populations.
The relationship between obesity and psychiatric disorders is well-established and complex, with both conditions frequently influencing each other in both directions. This indicates that obesity can increase the likelihood of developing psychiatric disorders, while psychiatric disorders can result in unhealthy behaviors that contribute to obesity. One such association is that between obesity and depression, in which obese individuals have a greater risk of developing depression, and depressed individuals may have a greater risk of becoming obese. Complex biological, psychological, and social factors may contribute to this relationship. Emotional eating is a common coping mechanism among people with psychiatric disorders, particularly mood disorders such as depression. As a coping mechanism, emotional eaters turn to unhealthy, high-calorie comfort foods, resulting in excessive consumption and weight gain, which contributes to obesity. The present study included participants with an average age of 18.81 years, with a slight majority of males (51.9 vs 48.1%).
In this study, we found that the prevalence of both common psychiatric problems, such as depression and anxiety, were 11.0 and 19.5%, respectively, in normal weight students. These findings suggest that depression and anxiety are more prevalent among students than among normal children and adolescents, where studies have reported 6.2% depression and 6.5% anxiety worldwide in adolescents.9 These controversial findings might be due to the fact that our study focused on normal weight students. In our study, we also found that the percentage of anxiety was lower in underweight students than in normal weight students. An Indian study revealed a significant correlation between deviations from normal weight—whether in the form of underweight or overweight/obesity—and the occurrence of depression (p < 0.001) and anxiety (p < 0.001) scores.10 The findings of this study are similar to those of our study, wherein both overweight and obese students had significantly higher percentages of depression and anxiety. In a different systematic review and meta-analysis, a notable discrepancy emerged regarding the prevalence of depression and anxiety symptoms between overweight/obese children/adolescents and their nonoverweight/nonobese counterparts. The study demonstrated a significantly higher occurrence of depression in overweight/obese children/adolescents compared to those who were not overweight/nonobese (21.73 vs 17.96%, with an odds ratio (OR) of 1.46, 95% confidence interval (CI): 1.14, 1.87, p = 0.003). Similarly, anxiety symptoms were notably more prevalent in the overweight/obese group (39.80 vs 13.99%, OR = 1.47, 95% CI: 1.21, 1.79, p < 0.001).11 The findings of this study closely align with our findings in overweight and obese students, where the percentages of depression were 15.6 and 24.6%, respectively (p = 0.004), and anxiety was 18.1 and 21.3%, respectively (p = 0.663).
Through two-tailed tests, the researchers investigated the relationship between age, BMI, gender, and anxiety. The findings indicated a significant relationship between age, marital status, level of education, and BMI. Additionally, the results of the present study indicated that the risk of depression was higher among participants with overweight and obesity. These findings are similar to another study conducted in Gujarat, India.12 There was a notable difference in mean BMI scores between participants with depression and anxiety compared to those without these disorders. Other factors were also identified in previous studies that could potentially impact the association between obesity, anxiety, and depression. These factors include low physical activity, unhealthy diet, and sleep disturbances, all of which have been linked to both depression and obesity. The study’s results demonstrated a correlation between BMI and age, depression, and anxiety. Participants with depression exhibited significantly higher mean BMI scores compared to those without depression. Similarly, individuals with anxiety showed higher mean BMI scores, although the association did not reach statistical significance. Previous research has also indicated a co-occurrence of depressive disorders among overweight and obese children and adolescents.13
Overall, this study highlights the association between childhood obesity, as measured by BMI, and an increased likelihood of experiencing depression and anxiety. It underscores the importance of addressing both physical and mental health concerns in this population, emphasizing the promotion of healthier dietary habits and providing comprehensive support through education, counseling, and healthcare interventions. Additional studies have identified the potential psychosocial problems associated with overweight and obesity in children and adolescents. These problems include lower self-esteem, body image issues, reduced quality of life, poor school performance, discrimination from peers and the public, and even neuropsychological dysfunctions, particularly depression. The changing lifestyle of Indian children, influenced by increased academic pressure and competitive stress, has led to more sedentary behavior and emotional overeating as a coping mechanism. Furthermore, stress has been recognized as a significant psychosocial contributor to obesity, with stressed children being more prone to engaging in emotional overeating.
In summary, this study sheds light on the relationship between psychiatric disorders, specifically depression and anxiety, and abdominal obesity in children and adolescents. It emphasizes the need for a holistic approach that addresses both physical and mental health, promotes healthier lifestyles, and provides comprehensive support to this vulnerable population.
Limitations
This study has several limitations. The retrospective design limits the establishment of causality between abdominal obesity and psychiatric disorders. The study’s sample was drawn from a single health center, which may limit the generalizability of the findings. The reliance on self-report was another limitation.
CONCLUSION
The findings of this study indicate a significant association between obesity and psychiatric disorders, specifically depression and anxiety, among students. The study demonstrated that students with higher BMIs are more likely to experience depression and anxiety compared to those with normal or lower BMIs. Specifically, both overweight and obese students showed higher percentages of depression and anxiety, with statistically significant differences noted in the mean BMI scores between those with and without these psychiatric conditions.
Findings also revealed significant correlations between BMI and various sociodemographic factors such as age, marital status, and education level. The positive correlation between BMI and psychiatric disorders underscores the importance of addressing both physical and mental health in student populations. The study highlights the need for comprehensive intervention strategies that encompass not only physical health measures but also psychological support to effectively manage and prevent obesity and its associated mental health issues among students.
Overall, this study emphasizes the critical need for early intervention and prevention programs that integrate physical and mental health approaches to enhance the well-being and quality of life of children and adolescents. By promoting healthier dietary habits and providing adequate mental health support, we can mitigate the adverse effects of obesity and psychiatric disorders in this vulnerable population.
ORCID
Shiv Prakash https://orcid.org/0000-0002-0380-9804
Sonali Dixit https://orcid.org/0009-0006-4149-095X
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