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 Table of Contents  
ORIGINAL ARTICLE
Year : 2015  |  Volume : 2  |  Issue : 2  |  Page : 74-78

Psychiatric Morbidity and Lipid Profile in Patients with Obesity


1 Department of Psychiatry, Government Medical College, Kozhikode, Kerala, India
2 Department of Community Medicine, Government Medical College, Kozhikode, Kerala, India
3 Department of Physical Medicine and Rehabilitation, Government Medical College, Kozhikode, Kerala, India

Date of Submission07-Jul-2014
Date of Decision02-Nov-2014
Date of Acceptance11-Nov-2014
Date of Web Publication7-May-2015

Correspondence Address:
Ayirolimeethal Anithakumari
Department of Psychiatry, Government Medical College, Kozhikode, Kerala - 673 008
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2347-9906.151754

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  Abstract 

Background: The psychosocial impact of obesity is of concern in the present world but remains less studied compared to its physical consequences. There is a lack of sufficient data from Asian and Indian population in particular. Objectives: To study the prevalence of psychiatric morbidity among the obese. To demonstrate the association of psychiatric morbidity with obesity and lipid profile. Settings and Design: A cross-sectional study at a tertiary care center, Kerala, India. Methodology: One hundred and twelve subjects, both male and female, who attended the obesity clinic from May to December 2013 participated in the study. Sociodemographic data and clinical history were collected from each individual. Psychiatric diagnosis was made using MINI-Plus. Hospital Anxiety and Depression Scale (HADS) was rated in all subjects. Statistical Analysis: Done using SPSS version 18 (Chicago IL, USA). Results: Thirty-seven (33%) subjects were assessed to have a psychiatric disorder. Depressive disorder (17.9%) was the most common diagnosis. The mean body mass index (BMI) of the study group was 31.4 ΁ 4.1. No significant association was found for psychiatric disorders with BMI and lipid profile. HADS depression score was significantly associated with triglycerides (TG), low density lipoprotein (LDL) and very low density lipoprotein (VLDL). HADS anxiety score was also found to have significant but weak relationship with VLDL (P = 0.054). Conclusion: Obesity is associated with high risk for psychiatric disorders. Management of obesity requires a multidisciplinary approach. Further explorations are needed to ascertain the cause or effect nature of obesity with psychiatric disorders.

Keywords: Body mass index, lipid profile, obesity, psychiatric morbidity


How to cite this article:
Anithakumari A, Midhun S, Biju G, Roy R C. Psychiatric Morbidity and Lipid Profile in Patients with Obesity. J Obes Metab Res 2015;2:74-8

How to cite this URL:
Anithakumari A, Midhun S, Biju G, Roy R C. Psychiatric Morbidity and Lipid Profile in Patients with Obesity. J Obes Metab Res [serial online] 2015 [cited 2019 Aug 22];2:74-8. Available from: http://www.jomrjournal.org/text.asp?2015/2/2/74/151754


  Introduction Top


Obesity is a major public health concern that is widely prevalent across all age-groups and cultures. The prevalence of obesity varies across the world; 4% in Japan and Korea while 30% or more in US and Mexico. [1] Indian studies showed 15-37% prevalence of overweight/obesity among adult population aged between 20 and 60 years. [2],[3]

In general, obesity is defined on the basis of body mass index (BMI). Individuals with a BMI ≥>30 kg/m 2 are considered obese. [4] Asians have been shown to have a high risk of diabetes mellitus (DM), hypertension (HTN), and hyperlipidemia at a relatively lower BMI. Therefore, people with BMI >25 kg/m 2 are considered obese in the South East Asian population.

The association of obesity and abnormal lipid levels with physical illnesses such as HTN, DM, and ischemic heart disease has been well-documented. [5],[6] In the past, obesity was viewed as a symbol of wealth in some cultures. Now, obese persons are often confronted with social prejudices and discrimination. Obese individuals tend to have emotional problems resulting from various psychosocial and health-related issues. A survey involving 8889 persons has reported low emotional wellbeing among obese individuals. [7] However, the psychological impact and the prevalence of psychiatric disorders among the obese are less studied. Previous studies reported a positive association of obesity with mood disorders, anxiety disorders, eating disorders, and personality disorders. [8],[9] Obesity can cause psychiatric problems and many psychiatric conditions, which in turn may contribute to the development of obesity. This bidirectional association of obesity and psychiatric disorders was observed in a few studies. [10],[11] A study by Luppino et al. noticed a reciprocal relationship between obesity and depression; obese individuals had a 55% increased risk of depression and depressed individuals had 58% increased risk of becoming obese. [9] Grover et al. noticed a 37.2% prevalence of metabolic syndrome in 43 drug-naive depressives compared to normal controls. [12]

A few studies showed a positive association between cholesterol levels and depression, suicide and anxiety disorders. [13],[14],[15] Verma et al. reported low levels of total cholesterol (TC), triglycerides (TG), high-density lipoprotein (HDL), and very low-density lipoprotein (VLDL) in a study among 40 individuals with history of attempted suicide. [16] Suarez observed a significant but negative association for trait measures of depression, anxiety with TC, low-density lipoprotein (LDL), TG, and TC/HDL in a group of 127 healthy adult women. [17]

The inconsistent results reported by various studies and a growing concern about the psychological effects of overweight and obesity warrants more research in this field. Moreover, most of the available data are from the United States and Europe that may not be relevant in the Asian region. To address this issue, we conducted a study to investigate the prevalence of psychiatric morbidity among obese individuals. We also attempted to look into the association between their psychiatric morbidity and the lipid profiles.


  Methodology Top


This study was carried out from May 2013 to December 2013, at the obesity clinic in a tertiary-care teaching hospital. All consecutive patients in the age group 18-65 years who consented to participate were included in the study. Subjects with medical problems other than metabolic syndrome and mental retardation and a preexisting psychiatric illness with ongoing treatment were excluded. Two females refused consent. Sociodemographic data and clinical details were collected from each patient. Height and weight were measured, and BMI was calculated in kg/m 2 . Psychiatric diagnosis was made using MINI-plus by the psychiatrist. All the patients were asked to rate Hospital Anxiety and Depression Scale (HADS) irrespective of their clinical diagnoses. All the participants were tested for fasting lipid profiles within 1-week of interview.

Informed written consent was obtained from all the subjects. The institutional ethics committee for research approved this study.

Statistical analysis

Data were analyzed using SPSS version 18, SPSS Inc, Chicago, IL, USA and quantitative variables are presented as mean ± standard deviation and qualitative variables as frequency and percentages. Chi-square test and t-test were used for the statistical analysis, and a P ≤> 0.05 was considered statistically significant.


  Results Top


This study included 112 subjects (males = 9, females = 103). Mean age was 42.25 ± 10.46 years. The sociodemographic details are shown in [Table 1]. Majority (74.1%) of subjects were below 50 years of age. Eighty-one (72.3%) were from a rural background and 11 (9.8%) from a low-income family. About 58% had a BMI of ≥>30 kg/m 2 . The mean BMI of the study group was 31.4 ± 4.1. Six (5.4%) subjects had history of psychiatric illness and twenty (17.9%) had a family history of mental illness. Family history of obesity was reported by sixty-eight (60.7%) of the study population. The majority (97.3%) did not have a history of substance abuse. About 17% of the subjects were on lipid-lowering agents while twenty (17.9%) were on psychotropic medications, of which 90% were using an antidepressant. Thirty-one (27.7%) had no metabolic co-morbidity.
Table 1: Sociodemographic characteristics of the study subjects

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A current psychiatric diagnosis was made in 37 (33%) of the study group. A diagnosis of depressive disorder or adjustment disorder was observed in 27.7% of the subjects [Table 2]. Twenty-five (22.3%) subjects rated a score of 8 or more on HADS depression scale, and another 34 (30.4%) got a similar score on HADS anxiety scale. More than half (55.6%) of the males were found to have a psychiatric illness compared to 31% of females. This was not statistically significant (P = 0.134). Twenty-three (28.4%) of the rural subjects showed a psychiatric problem while fourteen (45.2%) of the urban patients had a psychiatric disorder. But, no statistical significance was found with regard to domicile and psychiatric illness among the obese (P = 0.091). Furthermore, no statistical significance was observed for the current psychiatric diagnosis and family history (P = 0.75) or history (P = 0.364) of mental illness in our subjects. The lipid profiles of the subjects are shown in [Table 3].
Table 2: Psychiatric diagnoses

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Table 3: Lipid profile

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There was no significant association between a psychiatric disorder, BMI and the lipid profiles among the participants [Table 4]. Similarly, HADS depression score and HADS anxiety score also did not show a significant association with BMI (P = 0.252 and 0.345, respectively). However, HADS depression score showed a significant association with TG, LDL and VLDL, and HADS anxiety score showed a significant association with VLDL levels [Table 5].
Table 4: Association of BMI with psychiatric diagnosis and HADS score

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Table 5: Association of lipid profile and HADS

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  Discussion Top


A high psychiatric morbidity was demonstrated among the obese individuals in the present study. Majority of our subjects were unemployed females. This pattern of attendance in the obesity clinic may be due to the sociocultural reasons. Female preponderance of obesity is well-known. [18] Similar to the previous observation, this study also found a higher prevalence of psychiatric disorders in obese individuals of both genders. [19] Barry et al. noticed higher rates of mood disorders in men and women with obesity. [19] An increased risk of bipolar disorders 1 and 2 and social phobia have been demonstrated among obese women compared to obese men. However, the number of male participants in our study was too small to make a definite gender-specific comparison. Our subjects had a better economic and educational status when compared to another previous study. [20] The low prevalence of substance abuse in our study participants could be due to certain cultural reasons.

A high prevalence (33%) of psychiatric problems among obese subjects was seen in this study. Comparable figures were observed by Lin et al. who reported 42% prevalence of psychiatric disorders in an Asian population where 69% of subjects were females with a mean BMI of 35.7 ± 8.9 kg/m 2 . [14] The observed prevalence of mood disorders in their study was 27.1% that is comparable to our observation (when adjustment disorder with depressed mood and depressive disorders are taken together). Another study showed 37% increase in the probability of depression in obese individuals. [21] Though the prevalence of anxiety disorders was low in this study compared to that of Lin et al. and de Wit et al., significant anxiety symptoms were reported by a major proportion (30.4%) of our subjects. In contrast to many studies, we observed no significant association of BMI with psychiatric disorders including anxiety and depressive disorders. [20],[21],[22],[23],[24],[25],[26],[27] However, this observation is consistent with that of de Wit et al. who found no association when adjusted for the use of psychotropic medications in subjects of 18-65 years with 66% female participants. [20] Our findings are in partial agreement with that of Labad et al. who noticed negative association of obesity with anxiety but positive association with depression. [28] Our observation is against the prospective studies that showed the association of anxiety and depression with weight change and obesity among both men and women. [10],[15] The probable explanation for this disparity is that obese people are less stigmatized in our culture.

Similar to many previous studies, we also observed an increased rate of anxiety and depressive symptoms as reported on HADS. [14],[20],[21] However, we could not find a significant association of either anxiety or depressive symptoms with high BMI.

The LDL, TG, and VLDL fractions of serum cholesterol showed a significant association with depressive symptoms that is in contrast to previous study by Horsten et al. who found no association of TG with depressive symptoms and a significant negative association of HDL with depression among 300 middle-aged women having a mean BMI of 25.6 ± 4.8 kg/m 2 . [29] The higher mean BMI in our subjects (31.4 ± 4.1) may explain this difference. Our observations are also not in agreement with that of Chen and Huang, who reported no significant differences in the concentrations of TC, TG, HDL, VLDL, and TC/HDL among the depressed. [30]

Several previous studies reported inconsistencies in the association of lipid profile with psychiatric disorders. [29],[30],[31] A few researchers reported a positive association between TG, VLDL, HDL and TC, and depression, while others showed a negative association between depression and different lipid fractions. [9],[17],[29],[32] In general, it is difficult to explain the potential association of a specific lipid fraction with a psychiatric disorder among the obese subjects with the available scientific evidence. However, the bidirectional association of obesity and psychological disorders as revealed by many studies cannot be ignored in view of the growing epidemic of obesity and its potential impact on the individuals' psychosocial environment.

This is a cross-sectional study done in a subspecialty clinic at a tertiary care center. Majority of the subjects were females. Twenty of our subjects were getting a psychotropic drug that might have reduced the reporting of the depressive or anxiety symptoms. Totally, 19 subjects were on lipid-lowering agents that may have affected the lipid levels of the study group.


  Conclusions Top


This study observed a substantial rate of mental health disorders among the obese. This may indicate the need for a multidisciplinary approach in the management of obesity. Significant associations, though weak observed for some fractions of lipid profile with depression score and anxiety disorders need to be investigated by further studies.

 
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  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

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