The Obesity Paradox: Associations between the Body Mass Index and Self-Perceived Health, Depression Status, and Pain Level in Older People

Abstract

Population growth and physical inactivity have led to health and social consequences derived from chronic diseases and decreased quality of life in the elderly. Some research suggests that overweight in older people may not be associated with the negative effects on some health indicators. This study analysed the associations between Self-Perceived Health (SPH), Depression status, Pain Level, and Body Mass Index (BMI) in people over 70 years who are residents in Spain, with a final sample composed of 13,895 participants. A cross-sectional study using data from the European Health Surveys in Spain (EHIS2014 and 2020) and the National Health Survey (ENSE2017) was conducted. Dependency associations were observed between SPH, Depression Status, and Pain Level with BMI in the outcomes from the three surveys analysed (p < 0.001). Negative SPH, Depression Status, and Severe/Extreme Pain Degree prevalence were higher in the Underweight groups, being the lowest in Normal-weight and Overweight groups (p < 0.05). High levels of negative SPH, Depression, and Severe/Extreme Pain risks were found in the Underweight compared to the Normal-weight group, but not in Overweight ones. Overweight was not linked with an increased risk of the conditions analysed compared to the Normal-weight groups in older residents in Spain. The Underweight group presented the highest negative SPH prevalence, Depression, and Severe/Extreme Pain. Moreover, Obesity increased the negative SPH, Depression, and Pain Degree risks compared to the Normal-weight and Overweight groups in this population.

Prevalence and associated risk factors for mental health problems among young adults in Fiji Island during COVID-19: a cross-sectional study

“…One theoretical rationale for high BMI being perceived as protective, particularly in some low-income populations, could be related to the “obesity paradox.” This phenomenon suggests that, in certain conditions such as chronic diseases or in older age groups, individuals with a higher BMI might have a survival advantage compared to those with a lower BMI. This paradox has been observed in a previous study where overweight groups exhibited the lowest prevalence of depression ( 75 ). It is often attributed to factors like better nutritional reserves, increased energy stores, and potential protective effects in the face of certain health challenges.…”

The impact of BMI on psychological health in oldest old individuals–Are there differences between women and men?

“…Compared to the subsample with normal weight, male participants with overweight and obesity show significantly greater symptoms of depression, anxiety and somatization. Interestingly, female participants with a BMI below 25 show significantly more anxiety than their counterparts with a BMI of 25 and higher, indicating that the “obesity paradox” described earlier may also account for BMI-related differences in mental health [ 20 , 21 ].…”