The relationship between weight history and psychological health—Differences related to gender and weight loss patterns

PLOS ONE RESEARCH ARTICLE The relationship between weight history and psychological health—Differences related to gender and weight loss patterns Franziska U. C. E. Jung ID1*, Steffi G. Riedel-Heller1‡, Claudia Luck-Sikorski2‡ 1 Institute of Social Medicine, Occupational Health and Public Health, Leipzig University, Leipzig, Germany, 2 SRH University of Applied Health Sciences, Gera, Germany a1111111111 a1111111111 a1111111111 a1111111111 a1111111111 ‡ These authors share last authorship on this work. * Abstract Background OPEN ACCESS Citation: Jung FUCE, Riedel-Heller SG, LuckSikorski C (2023) The relationship between weight history and psychological health—Differences related to gender and weight loss patterns. PLoS ONE 18(2): e0281776. https://doi.org/10.1371/ journal.pone.0281776 Editor: Meng Li, The University of Texas MD Anderson Cancer Center, UNITED STATES Received: April 21, 2022 Accepted: January 31, 2023 Published: February 13, 2023 Peer Review History: PLOS recognizes the benefits of transparency in the peer review process; therefore, we enable the publication of all of the content of peer review and author responses alongside final, published articles. The editorial history of this article is available here: https://doi.org/10.1371/journal.pone.0281776 Copyright: © 2023 Jung et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data Availability Statement: The data that support the findings are available on figshare: DOI 10.6084/ m9.figshare.21581754. The prevalence and burden of obesity continues to grow worldwide. Psychological comorbidities may not only influence quality of life, but may also hinder successful weight loss. The causality between excess weight and mental health issues is still not fully understood. The aim of the study was to investigate whetherweight history parameters, (ie.age of onset) are related to psychological comorbidities. Method The data were derived from a representative telephone survey in Germany, collecting information on weight loss patterns and mental health outcomes among individuals with BMI>30kg/m2. Overall, 787 participants were examined in terms of depressive symptoms (Patient Health Questionnaire, PHQ-9) and anxiety (Generalized Anxiety Disorder Questionnaire, GAD7). In addition, participants were asked about different aspects of their weight history (ie. weight loss patterns and trajectories) over the lifespan. The relationship between weight history and mental health was analyzed using multivariate statistics. Results According to regression analyses, having had more weight loss attempts, a greater weight loss being desired and being a “weight maintainer” was associated with more symptoms of depression (p < 0.001), whereas a greater desired weight loss and being categorized as a “weight maintainer” was associated with more anxiety (p < 0.001). Moroever, the prevalence of depressive symptoms was significantly higher in male individuals who desire to lose more weight or had more weight loss attempts in the past. Conclusion Gender-specific differences were observed in terms of weight history parameters, as well as mental health outcomes. Especially for men, weight loss patterns seem to be related to PLOS ONE | https://doi.org/10.1371/journal.pone.0281776 February 13, 2023 1 / 13 PLOS ONE Funding: This work was supported by the Federal Ministry of Education and Research (BMBF), Germany, FKZ: 01EO1501 and supported by Open Access Publishing Fund of Leipzig University. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Competing interests: The authors have declared that no competing interests exist. The relationship between weight history and psychological health depressive symptoms. Concerning the overall results, it becomes clear that screening for weight history at the beginning of a multidisciplinary weight loss program in the context of gender-specific psychological comorbidities is important. The question remains why some aspects of weight history seem to be more important than others. Introduction Overweight as well as obesity continue to show rising prevalence worldwide, especially in children and adolescents [1,2]. Currently, the coronavirus disease pandemic (COVID-19) has been associated with both poor mental health as well as unfavorable weight-related health behaviors especially in people with obesity [3]. Apart from a rising prevalence, research on obesity has also focused on different facets of weight history and their impact on comorbidities and overall health, especially in terms of widespreading consequences over the lifespan. According to the life course approach, numerous biological, psychosocial, and cognitive factors can have an independent, cumulative, and interacting impact on the likelihood of developing health problems as people age [4,5]. Especially due to the complexity of obesity, patientcentered care has shown to be important to treat obesity and its comorbidities [6]. So far, a clear definition of weight history does not exist, however, it has been described as an evaluation of “historical information on a patient’s weight gain (or loss) pattern and trajectory” and may be useful to identify treatment options and health risks, for instance with regard to psychological health [7]. Epidemiological studies conclude that up to 23.2% of all women with obesity and 11.7% of all men with obesity are affected by depressive symptoms [8]. Obesity and mental disorders such as depression do not only share a high co-morbidity, but also a functional association in terms of biological pathways [8–10]. Previous studies suggest a bi-directional relationship [11]. In other words, depression may lead to obesity later on in life. On the other hand, obesity may also be a risk factor for developing symptoms of depression. In addition, it has been shown that weight management efforts are associated with long-term psychological improvements [12,13]. However, even if weight loss may have many favorable effects on health and overall well-being, weight loss patterns and trajecories over time may also be associated with negative consequences. In general, duration of being overweight as well as time of onset has been shown to predict risks of mortality and morbidity, possibly due to long-term exposure [14]. Even if an early onset is not a preliminary factor for being obese as an adult, studies suggest that becoming obese during childhood is a risk factor for staying obese until adolescence or even adulthood [15]. So far, mental health issues have been identified as a potential consequence of childhood overweight and obesity, especially if individuals continue to have excess weight through adulthood [16]. Studies also suggest that early onset, a (...truncated)