Brewis Alexandra A, Han Seung Yong, SturtzSreetharan Cindi L
School of Human Evolution and Social Change, Arizona State University, Tempe, Arizona, 85284-2402.
Obesity Solutions, Arizona State University, Arizona State University, Tempe, Arizona, 85284-2402.
Am J Hum Biol. 2017 Jul 8;29(4). doi: 10.1002/ajhb.22972. Epub 2017 Feb 5.
Obesity consistently predicts depression risk, but the underlying mechanisms are poorly understood. Body concerns are proposed as key. South Korean society is characterized by extremely high levels of explicit weight stigma, possibly the highest globally. Using cross-sectional Korean 2014 National Health Examination Survey (KNHANES) data, we test this proposition in a nationally representative sample of South Korean adults (N = 5,632).
Depressive symptoms (outcome variable), was based on the PHQ-9. Weight status (predictor variable), was based on direct measures of height and weight converted to BMI. Weight concern was self-reported. Mediation analyses tested how weight concern mediated the influence of weight status on depressive symptoms for women and men.
Current weight status influenced depressive symptoms in Korean adults, but not always directly. Concerns of being "fat" mediated that relationship. The effect increased significantly as BMI increased within "normal" and overweight/obese categories for women, and in overweight/obese categories for men. Even though women classified as underweight were significantly more depressed than those in other weight categories, there was no similar mediation effect related to weight concerns.
For South Koreans, the stress of adhering to social norms and avoiding stigma related to body weight seems to explain the relationship between higher body weight and more depressive symptoms. Women are more vulnerable overall, but men are not immune. This study demonstrates that body concerns help explain why weight predicts depression, and more broadly supports the proposition that widespread weight-related stigma is a potentially major, if unrecognized, driver of population-level health disparities.
肥胖一直被认为是抑郁症风险的预测因素，但其潜在机制仍知之甚少。身体方面的担忧被认为是关键因素。韩国社会的特点是存在极高程度的显性体重歧视，可能是全球最高的。利用2014年韩国全国健康检查调查（KNHANES）的横断面数据，我们在韩国成年人的全国代表性样本（N = 5632）中检验了这一观点。
抑郁症状（结果变量）基于患者健康问卷-9（PHQ-9）。体重状况（预测变量）基于身高和体重的直接测量值并转换为体重指数（BMI）。体重担忧通过自我报告获得。中介分析检验了体重担忧如何介导体重状况对男性和女性抑郁症状的影响。
当前体重状况影响韩国成年人的抑郁症状，但并非总是直接影响。对“肥胖”的担忧介导了这种关系。在女性的“正常”和超重/肥胖类别中，以及男性的超重/肥胖类别中，随着BMI的增加，这种影响显著增强。尽管被归类为体重过轻的女性比其他体重类别的女性明显更抑郁，但与体重担忧相关的类似中介效应并不存在。
对于韩国人来说，遵守社会规范和避免与体重相关的歧视所带来的压力似乎解释了较高体重与更多抑郁症状之间的关系。女性总体上更易受影响，但男性也并非不受影响。这项研究表明，身体方面的担忧有助于解释为什么体重能预测抑郁症，更广泛地支持了这样一种观点，即广泛存在的与体重相关的歧视是人口层面健康差距的一个潜在主要驱动因素，尽管尚未得到认识。
