Download - Proposal defence ugrp
The relationship between
Body Mass Index and Mental
Health Status
A proposal submitted in fulfilment of the requirements for the Bachelor of
Human Sciences in Psychology
Nuramal Hayati bt Mohd Amron (1126844)
Supervisor: Dr. Syarifah Azizah bt Wan Ahmadul Badwi
Department of Psychology
Kulliyyah of Islamic Revealed Knowledge and
Human Sciences
How you developed an interest in your
research topic
There are various research that scrutinized the relationship between Body
Mass Index (BMI) and mental health status.
However, there were lack of research on this particular issue conducted in
Malaysia.
The Problem
Malaysia has been rated as the highest among Asian countries for obesity (The
Star, 2014).
The Science Advisor to the Prime Minister, Tan Sri Zakri Abdul Hamid, said new
findings from British medical journal, The Lancet, showed that 49% of women
and 44% of men in this country were found to be obese (The Star, 2014).
World Health Organization (2000) reported among adult age 18 to 60 years in
Malaysia, 4.7% of men and 7.9% of women were found to have BMI above 30.
Plentiful of research stated that obesity can lead to several numbers of
mental health (Lee et al., 2014; Doll et al., 2000; Mumford, Liu, Hair & Yu,
2013). For example, psychological status which is significant with unhealthy
weight are depression (Mumford, 2013; Lee et al., 2014; Mukamal, Kawachi,
Miller & Rimm, 2007) as well as anxiety (Lee et al., 2014; Mumford et al.,
2013; Mukamal et al., 2007; Zhao, Ford, Dhingra, Li1, Strine & Mokdad, 2009)
and stress (Lee et al., 2014; Mumford et al., 2013; Zhao et al., 2009).
Body Mass Index (BMI)
Obesity is defined as a condition of abnormal or excessive fat accumulation in
adipose tissue, to the extent that health may be impaired Jokela (2012).
The most common measure used to determine relative body weight is body
mass index (BMI) which is calculated as body weight in kilograms divided by
the square of body height in metres (kg/m²) (Lee & Yen, 2014).
According to World Health Organization (WHO), BMI is categorized into four
groups which are underweight, normal weight, overweight, and obese. For
adults with the age of 18 years or older, underweight is defined as BMI below
18.5, normal weight between 18.5 and 24.9, overweight between 25 and
29.9, and obesity as BMI of 30 or higher.
The cut off value for obesity (BMI≥30kg/m²) was based primarily on the
reported associations between BMI and mortality. For individuals younger than
18 years, age and sex-specific cut-off values for overweight and obesity are
used.
Depression
Depression leads to obesity:
Depressed mood, mainly in adolescents, also increases the risk for subsequent obesity even after controlling for baseline body weight. Individual who in the state of depression may gain weight faster than people than who are not in the state of depression. (Ladwig et al., 2006).
There was also research conducted on veterans which showed that veterans with PTSD and depression were at the highest risk to either be obese without weight loss or overweight or obese and continuing to gain weight (Maguen et al., 2013).
People who already with higher levels of depressive symptoms, experienced a quicker rate of raising in BMI than did those who reported fewer symptoms of depression (Needham, 2010).
Obesity leads to depression:
Obese individuals have a positive association in declining their mental health which turn to depression (Mumford, 2013).
Those who had higher baseline BMI, were more likely to report lifetime depression, and were more likely to smoke (Kubzansky et al, 2013).
Obesity is often accompanied with psychological consequences, such as depression, somatization, interpersonal problems, low social adjustment and low self-esteem (Lykouras, 2011).
Anxiety
Obesity leads to anxiety:
People who are in the state of obese experienced the most frequent mental health statuses
reported were mood, anxiety and somatoform disorders (Baumeister and Ha¨rter, 2007).
Young women who are in the state of obese is related to increased rates of mental
disorders, most notably anxiety disorders. Most importantly, obese women suffered from an
anxiety disorder significantly more often than women who were not obese. (Becker et al,
2001).
Obese women are more socially discriminated than men which lead to anxiety disorders
(Lykouras & Michopoulos, 2011).
Stress
Stress leads to obesity:
Experience of PTSD symptoms is associated with an increased risk of
becoming overweight or obese, and PTSD symptom onset alters BMI
trajectories over time. (Kubzansky et al, 2013).
In term of weight gain, greater numbers of PTSD symptoms were associated
with greater BMI increases over time. Compared with women with trauma
exposure and no PTSD symptoms, women with 1 to 3 symptoms and with at
least 4 symptoms demonstrated faster rates of BMI increase during follow-up
(Kubzansky et al., 2013).
Obesity leads to stress:
Excessing weight over a long period of time resulted to physical stress (WHO,
2000; pp. 156).
LITERATURE REVIEW
BMI and mental health status
(Obesity leads to mental
health illness)
Obesity and Mental Illness in a Representative
Sample of Young Women (Becker et al., 2010)Author: Becker et al. (2010).
Sample:
2064 young women with the range of age between 18 to 25 years old who living in Dresden, Germany.
Measurement:
BMI were reported verbally, meanwhile psychological status was measured by structured clinical interview.
Result:
The result found that there is a connection between psychological disorder and body mass index. Overall, women who are in the state of obese had the highest rate of mental disorders.
Plus, they also had higher rates of all subgroups of mental disorders, although many differences were not statistically significant. Most importantly, obese women suffered from an anxiety disorder significantly more often than women who were not obese. The observed differences were independent of socioeconomic status. Among the young women, obesity is related to increased rates of mental disorders, most notably anxiety disorders. Future longitudinal research will have to determine the causal relationships behind this correlation.
A study that investigated the relationship between psychological status and
weight, especially obesity in German by Becker et al. (2001). This study conducted
on 2064 young women with the range of age between 18 to 25 years old who living
in Dresden, Germany. BMI were reported verbally, meanwhile psychological status
was measured by structured clinical interview. The result found that there is a
connection between psychological disorder and body mass index. Overall, women
who are in the state of obese had the highest rate of mental disorders. Plus, they
also had higher rates of all subgroups of mental disorders, although many
differences were not statistically significant. Most importantly, obese women
suffered from an anxiety disorder significantly more often than women who were
not obese (x2 (1) = 10.05, P = 0.018). The observed differences were independent
of socioeconomic status. Among the young women, obesity is related to increased
rates of mental disorders, most notably anxiety disorders. Future longitudinal
research will have to determine the causal relationships behind this correlation.
Obesity and Mental Illness in a Representative Sample of Young Women
Becker et al. (2010)
SAMPLE
2064 young women with the range of age
between 18 to 25 years old who living in
Dresden, Germany.
DESIGN: Epidemiological study of mental
disorders with a representative sample of
young women.
MEASUREMENT
BMI were reported verbally, meanwhile
psychological status was measured by
structured clinical interview.
RESULT
• The result found that there is a connection between
psychological disorder and body mass index.
• Women who are in the state of obese had the highest rate
of mental disorders.
• Plus, they also had higher rates of all subgroups of mental
disorders, although many differences were not
statistically significant.
• Most importantly, obese women suffered from an anxiety
disorder significantly more often than women who were
not obese. The observed differences were independent of
socioeconomic status. Among the young women, obesity is
related to increased rates of mental disorders, most
notably anxiety disorders. Future longitudinal research
will have to determine the causal relationships behind
this correlation.
AIM
investigated the relationship between
psychological status and weight.
Concurrent Trajectories of BMI and Mental Health Patterns in Emerging Adulthood
Mumford et al.(2013)
SAMPLE
They used the data from 13
rounds (1997 to 2009) of the
National Longitudinal Surveys of
Youth-1997 cohort (NLSY97), a
nationally representative, non-
institutional household-based
sample (including oversamples of
Hispanics and non-Hispanic blacks)
of youth ages 12 to 16 as of
January 1, 1997 (born between
1980 and 1984).
DESIGN
This design is an accelerated
longitudinal design which allows
us to evaluate mental health
across ages 15 to 27
MEASUREMENT
Participants’ data of BMI
were collected by using self-
reported, whereas their
mental health status was
assessed by using the 5-item
Mental Health Inventory
(MHI-5).
Mental health information
were collected via self-
administrated questionnaire
implemented in even rounds,
beginning with round 4, and
is thus available for five
rounds in the year of 2000,
2002, 2004, 2006, and 2008.
RESULTThe findings showed there
were relationship between
mental health and BMI. Obese
individuals have a positive
association in declining their
mental health which turn to
depression. The risk of
developmental trajectories of
poor mental health and BMI
outcomes is greater for
females, blacks, Hispanics,
and individuals living below
the poverty line.
AIM
To examine
between
concurrent
trajectories
of BMI and
mental health
patterns
specifically in
depression
and anxiety in
emerging
adulthood.
LITERATURE REVIEW
BMI and mental health status
(Mental health illness leads to
obesity)
Trajectories of change in obesity and symptoms of depression
Needham et al. (2010)
SAMPLE
It was a longitudinal study of a
biracial (Black and White)
respondents of aged 18 to 30
years at their initial in-person
examination.
DESIGN
The study used latent growth
curve modeling and the data
examined from years 5, 10, 15,
and 20 of the Coronary Artery
Risk Development in Young
Adults study
MEASUREMENT
Depressive
symptom was
assessed by
using Center for
Epidemiological
Studies
Depression scale
RESULTThe result showed that
respondents who already with
higher levels of depressive
symptoms (mean of intercept
= 0.16; P<.001), experienced
a quicker rate of raising in
BMI (for White only) (mean of
intercept = –0.14; P<.001)
than did those who reported
fewer symptoms of
depression in year 5.
AIM
to investigate
the association
of obesity with
the changes of
depressive
symptoms or if
depression are
associated
with the
change in body
mass index
Mental disorders in patients with obesity in comparison with healthy probands
Baumeister & Ha¨rter (2007)
SAMPLE
The surveys investigated subjects
with obesity (n=910) and
overweight (n=1550), as well as
physically healthy probands (n=495)
DESIGN
The study compared between three
states of BMI which are obese,
overweight and physically healthy
pro bands, Correlates of the
associations are examined. The
study adjusted in 4-week, 12-
month, and lifetime prevalence
rates of the patients. Prevalence
rates were calculated from two
large epidemiological surveys from
both the general population of
Germany and inpatient centers.
MEASUREMENT
The occurrence rates
were based on the
Munich-composite
international
diagnostic interview,
a standardized
interview for the
assessment of mental
disorders. Correlates
of mental disorders
in obese individuals
were assessed using
self-report
questionnaires and
medical
examinations.
RESULTThe most frequent mental health
statuses reported were mood,
anxiety and somatoform
disorders. The result showed that
adjusted odds ratios (OR) of obese
patients were expressively raised,
compared with healthy probands
in the periods of 4-week (OR: 2.2;
2.3), 12-month (OR: 1.8; 2.7) and
lifetime (OR: 1.4; 2.0) periods.
There is a strong relationship
between obesity and mental
disorders.
AIMto explore the
association
between mental
health illnesses
and body
weight among
patient with
mental health
illnesses
The relationship between body mass index and mental health among Iraq and Afghanistan veterans
Maguen et al. (2013)
SAMPLE
Total participants
was 496,722 which
consisted of male
(n=59,790) and
female
(n=436,932),
among Iraqi and
Afghanistan
veterans
DESIGN
Retrospective,
longitudinal cohort
analysis of
veterans’ health
records
MEASUREMENT
The data of BMI
were recorded at the
Department of
Veterans Affairs (VA)
at least once after
the end of their last
deployment and
whose first post-
deployment
outpatient encounter
at the VA was at least
1 year prior to the
end of the study
period.
RESULT
• The findings showed 75% of Iraq and Afghanistan veterans
were either overweight or obese at the baseline.
• The trajectory observed were four which are “stable
overweight” represented the largest class; followed by
“stable obese;” “overweight/obese gaining;” and “obese
losing.”
• The finding showed that veterans with PTSD and
depression were at the highest risk to either be obese
without weight loss or overweight or obese and
continuing to gain weight.
• In addition, there is difference between the gender
which is obese men has correlation with PTSD, whereas
obese women has correlation with depression.
• During the 3-year follow-up period, those with PTSD and
depression in particular were at the greatest risk of being
either obese without weight loss or overweight or obese
and continuing to gain weight.
AIM
-To explore
the
relationship
between BMI
and
posttraumati
c stress
disorder
(PTSD)
-To evaluate
trajectories
of change in
BMI over 3
years
Aim/Purpose & Research Questions
Aim/Purpose
This study aimed to investigate the association between BMI and mental health
status which includes depression, anxiety and stress and to assess the level of
mental health status among IIUM students.
Research Question
1. How does BMI can be related to mental health status?
2. What is the level of mental health of IIUM students?
Hypothesis
Participants
The participants of this research was enrolled from local student of IIUM
specifically undergraduate students.
There is 100 students which are 50 in the state of normal weight and 50 in the
state of overweight/obese.
The participant will be recruited by using convenience sampling design.
Participants must be in the range of age from 20 to 26 years old.
The participants also must be a single people which means not getting
married yet.
Instruments - Body Mass Index (BMI)
Body weight and height data will be collected by using self-report.
BMI will be calculated by using calculator (weight [kg]/ height x height [m]).
According to World Health Organization (WHO Expert Consultation) classified
BMI cut-off points for body weight classification for Malaysian adult
population in seven classes which are “underweight”, “normal weight”,
“overweight”, “pre-obese”, “obese class I”, “obese class II” and “obese class
III”.
Body weight
classification
BMI cut-off points
definition (kg/m2)
Comorbidities risk BMI cut-off points
for public health
action
Underweight <18.5 <18.5
Normal weight 18.5 to 24.9 Low 18.5 to 24.9
Overweight 25.0 25.0
Pre-obese 25.0 to 29.9 Moderate 25.0 to 29.9
Obese class I 30.0 to 34.9 High 30.0 to 34.9
Obese class II 35.0 to 39.9 Very High 35.0 to 39.9
Obese class III 40.0 40.0
Instruments – Mental Health Status
(DASS21)
DASS 21 is a brief version the scale of DASS 42 which measure depression, anxiety and stress emotional states over the
past week.
DASS 21 contain 21 items which used four-point evaluation scale (0: Did not apply to me at all, 1: Applied to me to
some degree, or some of the time, 2: Applied to me to a considerable degree, or a good part of time, 3: Applied to me
very much, or most of the time) to assess the level of mental health status which focus more on depression, anxiety
and stress.
In order to obtain the scores of the depression, anxiety and stress scale, the relevant of seven items should be sum up.
This scale is suitable to use as it has been used on which it was used on northern Vietnamese women (Tran, Tran &
Fisher, 2013).
The internal consistency (Cronbach’s alpha) of each subscale is high (DASS21-D subscale 0.72; DASS21-A subscale 0.77;
and DASS21-Ssubscale 0.70). The overall score, which includes all items, also had high consistency (Cronbach’s alpha =
0.88).
The higher the scores, the severe the emotional status.
the present study will use DASS 21 as the inventory as it is shorter and convenience to be answered by the participants.
Moreover, DASS 21 also comprehensive and highlighting important aspects on mental health status and psychological
well-being.
Procedure
1. The study will be divided into two parts: data collection part and data analysis part.
2. Before the data collection period, researcher should determine the potential risk upon this research either it is no risk research, minimal risk research or full review risk research.
3. Before collecting the data, participants will be informed consents the purpose of the research, expected duration and procedures.
4. Participants also will be informed that they have rights to decline to participate and to withdraw from the research once it has started.
5. After that, the researcher will collect the BMI data by taking self-report from the participants itself and distributing DASS 21 to the participants afterwards.
6. After done collecting data, participants will be debriefed. During this stage, the research questions will be addressed and any misconception will be discussed.
7. Participants also will be briefed that their details and information are private and confidential. It will not be exposed and disclosed to the public as it will against the ethics of research.
8. After data collection finished, the researchers will analyse the data by using Statistical Package for Social Science (SPSS).
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