Emotional states of different obesity phenotypes: a sex-specific study in a west-Asian population

Abstract

Background The present study aimed to investigate the associations of obesity phenotypes with depression, anxiety, and stress symptoms among adults in the Tehran Lipid and Glucose Study (TLGS). Methods Depression, anxiety, and stress levels of participants from the TLGS were examined among different obesity phenotypes in this cross-sectional study. Obesity was defined as body mass index (BMI) ≥30 kg/m2, and metabolically unhealthy status based on having metabolic syndrome (MetS) or type 2 diabetes. Four obesity phenotypes were defined: 1) Metabolically Healthy Non-Obese (MHNO), 2) Metabolically Healthy Obese (MHO) 3) Metabolically Unhealthy Non-Obese (MUNO), and 4) Metabolically Unhealthy Obese (MUO). Emotional states of different obesity phenotypes were assessed by the Persian version of depression, anxiety, and stress scale-21 items (DASS-21). Ordinal logistic regression analysis was used to compare sex-specific odds ratios of depression, anxiety, and stress in different obesity phenotypes. Results The mean age of 2469 men and women was 46.2 ± 15.9 and 45.6 ± 14.7, respectively. In total, women were more likely to experience higher levels of depression (30.5%), anxiety (44.2%), and stress (43.5%) symptoms compared to men. After adjusting for potential confounders, compared to MHNO men, the odds of experiencing higher anxiety levels were significantly greater in metabolically unhealthy men whether they were obese (OR: 1.78, 95% CI: 1.25–2.54; P = < 0.001) or non-obese (OR: 1.61, 95% CI: 1.17–2.21; P = < 0.001), and also in MUO women (OR: 1.73, 95% CI: 1.28–2.34; P = < 0.001) compared to MHNO women. Moreover, the odds of experiencing higher stress levels were significantly greater in MUNO men (OR: 1.40, 95% CI: 1.02–1.90; P = 0.04) compared to MHNO men and in MUO women (OR: 1.45, 95% CI: 1.07–1.96; P = 0.02) compared to MHNO women. No difference in depression levels was observed in either sex. Conclusions Our results showed that men and women with various obesity phenotypes experienced different anxiety and stress levels. While MUO women and all metabolically unhealthy men experienced more anxiety and stress levels than MHNO individuals, none of the obesity phenotypes were associated with depression. These findings provide insight into recognizing the psychological consequences of different phenotypes of obesity in both sexes and utilizing future health promotion planning.

Mental health and quality of life in different obesity phenotypes: a systematic review

“…After carefully screening of 453 full texts, we also excluded 435 more studies because they investigated the association between metabolic phenotype with an outcome other than mental health or HRQoL, or were animal or in vitro studies in design, editorial, and reviews. Finally, 18 different studies [ 1 , 4 – 8 , 12 , 22 – 32 ] with a total of 3,929,203 participants, published between 2008 and 2021, were eligible for the systematic review. The flow chart of study selection is presented in Fig.…”

“…The relationship between obesity phenotypes and quality of life (QoL) and mental health has been examined in some literature [ 4 – 7 ]; but, QoL and mental health issues associated with obesity phenotypes have not been studied as thoroughly as physical difficulties [ 8 ]. Despite a previous meta-analysis of prospective studies suggesting that individuals with higher body mass index (BMI) have a greater chance of developing depression [ 9 ], some studies find no relationship between obesity and depression [ 10 ], and one study reported lower mental health risks associated with higher BMI [ 11 ].…”

“…Yet, the impact of obesity phenotypes on QoL and mental health outcomes, including stress, anxiety, and depression, remains unclear. These conditions influence individuals’ moods or feelings, reduce productivity, and lead to an enormous economic burden [ 8 ].…”

Psychological Profiles of Treatment-Seeking Adults with Overweight and Obesity: A Cluster Analysis Approach

“…Although there is no standardized definition of MHO, several characteristics are common to all MHO individuals, including low visceral mass, high insulin sensitivity and normal arterial blood pressure [ 87 ]. Individuals with MHO have lower levels of depressive symptoms [ 88 ], stress and anxiety [ 89 , 90 ] and higher well-being scores [ 90 ] than individuals with metabolically unhealthy obesity. Some studies have even found that individuals with MHO did not differ from the individuals with normal metabolically healthy weights in terms of the risk of depressive symptoms [ 88 , 89 , 90 ].…”

“…Individuals with MHO have lower levels of depressive symptoms [ 88 ], stress and anxiety [ 89 , 90 ] and higher well-being scores [ 90 ] than individuals with metabolically unhealthy obesity. Some studies have even found that individuals with MHO did not differ from the individuals with normal metabolically healthy weights in terms of the risk of depressive symptoms [ 88 , 89 , 90 ]. In their 16-year follow-up study, Hinnouho et al concluded that the metabolic health status predicts depressive symptoms at the start of the follow-up but that obesity predicts a poorer evolution of depressive symptoms over time only in metabolically unhealthy individuals [ 88 ].…”