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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