4

The impact of obesity on quality of life

Valerie H. Taylor, MD, PhD, Associate Professor
a,
*
,
Mary Forhan, PhD, Assistant Professor
b
,
Simone N. Vigod, MD, Assistant Professor
d
,
Roger S. McIntyre, MD, Professor
a
,
Katherine M. Morrison, MD, Associate Professor
c
a
Dept of Psychiatry, University of Toronto, Toronto, ON, Canada
b
Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
c
Dept of Pediatrics, McMaster University, Hamilton, ON, Canada
d
Womens College Research Institute, Dept of Psychiatry, University of Toronto, Toronto, ON, Canada
Keywords:
mental illness
obesity
quality of life
stigma
rating scales
An important association exists between obesity and mental
illness that impacts all aspects of an individuals quality of life. This
association can begin early in the developmental trajectory and we
do not yet completely understand all the mechanisms linking
obesity and mental illness. What we e do know is that physical
health factors that often occur secondary to obesity, combined
with societal attitudes toward those that are obese coupled with
iatrogenic treatment factors linked to psychiatric pharmaco-
therapy and a number of biologic mediators result in an important
and increasing common comorbidity. Recognizing this association
is essential for the proper management of both conditions. The
following review addresses this issue and provides clinical pearls
to help deal with this issue.
2013 Elsevier Ltd. All rights reserved.
Introduction
Quality of life (QoL) is a broad multidimensional concept that usually includes subjective evalua-
tions of both positive and negative aspects of life.
1
Although physical health is one of the important
domains of overall quality of life, other domains such as employment, housing, schools and the broader
* Corresponding author.
E-mail address: Valerie.taylor@wchospital.ca (V.H. Taylor).
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http://dx.doi.org/10.1016/j.beem.2013.04.004
Best Practice & Research Clinical Endocrinology & Metabolism 27 (2013) 139146
environment are also germane.
2
Psychological health is also a salient component of QoL and as health
care providers become increasing aware of the complex interaction of factors beyond a medical
diagnosis on QoL, denitions such as the impact of health or disease on physical, mental, and social
well-being are becoming more accepted for this important gauge of wellness. This type of broad
denition is especially relevant for obesity, as this illness perhaps more than any other is multifaceted
in its etiology and ubiquitous in its impact. In fact, it may be that the ability of this illness to inuence so
many different health care domains is the reason we are grappling with a growing obesity epidemic. It
is essential, therefore, that we attempt to understand the ways in which obesity impacts the mental
and social well-being components of QoL if we are going to impact the physical ones.
Dening obesity in adults utilizing body mass index (BMI) is simple, and according to the World
Health Organization,
1
obesity is conferred by a BMI greater than 30 kg/m
2
; when the BMI is greater
than 40 kg m, obesity is qualied as morbid (National institute of Health1996). Measuring obesity
related quality of life is much more challenging, however. In this paper, we present a comprehensive
overview of issues related to the relationship between obesity and mental health, physical health,
societal stigma and other quality of life domains.
The impact of obesity on mental illness
The association between obesity and mental illness is complicated and bidirectional. We know that
obesity is linked to an increased risk of a psychiatric diagnosis, and that, in turn, mental illness (and
some of its treatments) may precipitate and perpetuate weight gain and obesity. Some evidence has
indicated that the relationship between weight and mental illness is dose dependent.
2
The implication
is that higher BMI increases the susceptibility for incident psychiatric disorder. This is especially
evident in the bariatric surgery population, where participants usually have a BMI of 35 or greater and
rates of psychiatric illness have been documented between 40 and 70 percent.
3,4
Over the last number
of years, there has been increasing interest in the obesitymental illness dyad, and a recent review
found sixteen cross-sectional and nine prospective surveys that rigorously examined relationships
between BMI status and psychopathology.
5
The results of this review are compelling. A number of
cross-sectional studies
2,621
found modest associations
6,8,9,1220
between overweight and/or obesity
and any mood disorder or major depressive disorder (MDD), although, interestingly, some of these
ndings documented this association in women only.
6,9,1215,17,18
Six studies also found associations
between overweight and/or obesity and any anxiety disorder,
2,7,19
including panic disorder,
2,13,17,18
specic phobia,
6,17,18,20
generalized anxiety disorder (GAD),
13,17
and social phobia.
6,13,20
Most pro-
spective studies
2230
on obesity and psychopathology focused on MDD and again this association has
been positive. While individual studies differ in outcome, the overall impression is that for most
common or severe mental disorders, an association between psychopathology and obesity exists.
The impetus to better understand the association between obesity and psychopathology is the
adverse effect each condition has on the other. We know that having a psychiatric illness can impact
the success of weight loss treatments
4,31
and that obesity that co-occurs with a primary psychiatric
diagnosis inuences psychiatric treatment compliance, as many of the medications used in the man-
agement of mental illness cause weight gain.
32
Obesity is also associated with major health problems,
such as cardiovascular disease and diabetes, particularly for those with chronic and severe mental
illness,
33
and we now know that premature mortality among individuals with a chronic mental illness
secondary to medical factors (as opposed to suicide), is higher than is that found in the general pop-
ulation.
34
As a result, there are growing efforts to integrate primary and psychiatric care that focuses on
preventable causes of early death, especially obesity.
35
Obesity, mental illness and chronic disease
Obesity is often comorbid with conditions such as osteoarthritis
36
and lower back pain,
37
illnesses
that can result in functional locomotor limitations.
38
Chronic generalized pain
38,39
is also a common
nding in obese patients secondary to factors such as bromyalgia, osteoarthritis, sleep disorders and
reduced cardio-pulmonary tness.
38
The presence of pain can affect the global sense of well-being, QoL
and overall functional capacity, leading to decreased physical activity. As a consequence, a vicious cycle
V.H. Taylor et al. / Best Practice & Research Clinical Endocrinology & Metabolism 27 (2013) 139146 140
emerges where the presence of factors such as pain and immobility issues limit a persons ability to
engage in activities that are important for personal satisfaction. In a recent study, participation proles
for this group showed that individuals with severe obesity spent most of their time in daily living
activities and less time in work, recreation, and rest activities than did a nonobese population.
40
This
shift in participation may increase an individuals risk for psychiatric illnesses such as major depressive
disorder. Depressive symptoms such as fatigue and feelings of hopelessness then interfere with a
persons ability to engage in other healthy activities such as good nutritional intake and physical ac-
tivity, compounding the burden of both illnesses separately. Obesity alone can impact QoL as much as
any other chronic medical condition. When it is becomes comorbid with other diseases the impact of
this illness is magnied.
The role of stigma and bias in obesity related QoL
Obesity is unfortunately often associated with negative social consequences.
41
Weight-related
stigma has been dened as negative attitudes and discriminatory behaviors directed toward obese
individuals such as critical and insulting comments by others, job discrimination, discrimination in
health care settings, and derogatory media representations.
41
In addition to stigma directed toward
obese individuals by others, research has also identied the presence of self-directed, internalized anti-
obesity attitudes held by obese individuals toward themselves.
42
Work on this self-bias has shown it to
include beliefs about the implications of obesity on multiple life domains including (but not limited to)
social and romantic relationships, self-esteem, attitudes of competence, attractiveness, self-loathing,
and self-value.
42
This type of weight-related stigma has also been found to be associated with emotional distress
including symptoms of anxiety and depression.
41,43
While the mechanisms are still not completely
understood, this association has been documented and in a recent study examining 54 individuals with
overweight or obesity, greater stigmatizing experiences were signicantly related to depression,
suggesting that obese individuals are at considerable risk for psychological complications secondary to
weight-based mistreatment by others and their own responses in coping with the mistreatment.
44
This
type of weight-based self-bias is not just associated with depression, however, and recent work in
obese individuals with schizophrenia or schizoaffective disorder reported weight-based self-bias to the
same extent as non-psychiatric samples that was associated with poorer quality of life after controlling
for negative affect.
45
Two psychosocial models have been posited to explain the temporal relationship from overweight
and obesity to subsequent depression.
45
The self-appraisal perspective posits that stigma toward
overweight and obese individuals (especially women) promotes low self-esteem and negative self-
image leading to depression.
46
Alternatively, the tting norms of appearance perspective argues
that tting the norm for weight is stressful among the obese because dieting is often unsuccessful,
resulting in depression. Women in Western cultures are generally under more pressure to be thin than
men and experience greater body dissatisfaction; factors that may increase their vulnerability to
depression.
47,48
Other factors explaining the observed directionality of the relationship among women
could also, in part, reect gender differences in access to health care and treatment preferences,
48
differential reporting of atypical features (e.g., increased appetite, weight gain) of depression and
biological factors, including genetic variation in susceptibility to both overweight and obesity and
depression.
49
The role of obesity in the QoL of children
A 2006 reviewof secular trends in childhood overweight/obesity concluded that its prevalence had
increased over the last two to three decades in most industrialized countries and in several lower
income countries, particularly in urban areas.
50
If trends continue we will soon have the rst gener-
ation of children with a shorter life expectancy than their parents because pediatric obesity is asso-
ciated with multiple health risks, including Type 2 diabetes and fatty liver disease. While this is an
important research and clinical concern, we are nowbecoming aware that mental health comorbidities
also exist in this population and that they too need to be a priority focus.
51,52
While clinic- and
V.H. Taylor et al. / Best Practice & Research Clinical Endocrinology & Metabolism 27 (2013) 139146 141
population-based studies are not always consistent,
5357
obese children and adolescents have
repeatedly been reported to have lower health-related quality of life (HRQOL), increased depression,
and lower self-esteem as compared to their healthy weight counterparts.
5862
The exact determinants
of depression and HRQOL have not been thoroughly studied in this population.
63,64
While it has been
suggested that depression increases with age and pubertal development amongst obese youth,
65,66
in a
systematic reviewby Tsiros et al. (2009), lower HRQOL was reported in childrenwho are prepubertal or
in early adolescence compared to mature youth in both treatment-seeking and community-dwelling
populations.
58
Clearly this relationship is complicated, and factors such as lower socioeconomic sta-
tus (SES), extent of obesity, and family history of depression have been associated with increased
depression and lower HRQOL in children and youth in some studies
6770
but not others.
56,61,64
The role of bias and discrimination is also clearly evident in this population, indicating that both
externalizing and internalizing behaviors start early. Weight prejudice has been described in 3 to 5-
year-old pre-school children who judged an overweight child to be more mean and an undesirable
playmate compared to an average weight child who was ascribed positive attributes
71
while negative
feelings toward individuals with overweight and obesity have been documented among children as
young as 3 years of age.
72
Weight-based stigma was also studied among 7 to 9-year-olds, and again,
depictions of thin children were rated more positively than those of larger children, regardless of
childrens ownweight.
73
Other work shows that elementary school age children believe obese children
are ugly, selsh, lazy, stupid, have few friends, lie and get teased, whereas average weight targets are
considered clever, healthy, attractive, kind, happy, have more friends, and are a desirable playmate.
74
This type of behavior is not newand unfortunately seems to be enduring, with recent work validating a
40 year-old study where school children ranked obese children last among children with crutches, in a
wheelchair, with an amputated hand, and with a facial disgurement in terms of who they would most
like for a friend.
75,76
Measurement of health-related QoL in an obese population
Precisely dening how to measure QoL in this population is important, especially given research
indicating that some commonly used QoL scales may not be appropriate for this population. The SF-36,
for example, is a widely used multi-purpose, short-form health survey that has been documented in
over 4000 publications. It yields an 8-scale prole of functional health and well-being scores as well as
psychometrically-based physical and mental health summary measures but although it is a generic
measure, as opposed to one that targets a specic age, disease, or treatment group, it is often used in
disease specic research.
77
This application may be problematic in certain medical conditions such as
obesity, a complex, multifactorial disease whose etiology involves genetic, metabolic, social, behav-
ioral, and cultural factors.
78
This was illustrated by a study that specically examined the construct
validity of the SF-36 and its relationship with BMI in obese patients that concluded that the peculiar
clustering of some SF-36 items and their relationship with BMI suggest that the health-related quality
of life prole of subjects belonging to that population may be better described with alternative ag-
gregations of the SF-36 items or with disease-tailored questionnaires.
79
Only 2 reviews on obesity
specic QoL instruments are currently available and while they concluded that these instruments are
much more robust in an obese population,
80,81
there are still caveats to their use. Some scales were
developed specically to be used as evaluative instruments in clinical trials and of 11 scales the reviews
identied, only three targeted populations with morbid obesity.
Measuring psychological distress is also complicated in an obese population. The Beck Depression
Inventory (BDI)
82
in one of its 3 forms, the original published in 1961,
83
which was revised in 1978 to the
BDI-IA
84
and the BDI-II published in 1996
82
are the most frequently used scale to measure depressive
symptoms within areas of mental health
85
and are often used both in clinical populations and research
protocols. While the BDI is well validated in normal and psychiatric populations,
86
the validity of using
the scale for a range of different medical illnesses still remains uncertain.
87,88
It has been suggested that
there is difculty in determining an appropriate cutoff in the medically ill due to a potential overlap of
symptoms between depression and medical illnesses.
88,89
Available research suggests that the BDI may
overestimate the prevalence and severity of symptoms of depression in the medically ill.
8890
The
concern is that a number of criteria used as positive indicators for depression by the BDI tools that
V.H. Taylor et al. / Best Practice & Research Clinical Endocrinology & Metabolism 27 (2013) 139146 142
focus onweight, appetite, sleep and fatigue will skew results and over diagnose individuals with obesity.
This was conrmed by results froma recent study that concluded that the BDI-IA should not be used as a
tool to measure depressive symptomatology in obese bariatric surgery candidates as over 20% of patients
were misclassied.
91
The Hospital Depression and Anxiety Index, a self-assessment scale found to be a
reliable instrument for detecting states of depression and anxiety in the setting of an hospital medical
outpatient clinic
92
may be a better choice, as it has been shown to be reliable in a number of medical
settings
93
including obesity,
94
but vigorous validity testing in that population is still lacking.
Conclusion
An important association exists between obesity and mental illness that impacts all aspects of an
individuals QoL. This association can begin early in the developmental trajectory. While we do not yet
completely understand all the mechanisms linking obesity and mental illness, we know that physical
health factors that often occur secondary to obesity, together with societal attitudes toward those that
are obese, iatrogenic treatment factors linked to psychiatric pharmacotherapy and a number of biologic
mediators result in an important and increasingly common comorbidity. Recognizing this association is
essential for the proper management of both conditions and it is important to recognize a few key
clinical pearls to ensure this association is not missed.
References
1. WHO. The World Health Organization quality of life assessment (WHOQOL). Development and psychometric properties.
Social Science & Medicine 1988; 46: 15691585.
2. Simon GE, Von Korff M, Saunders K et al. Association between obesity and psychiatric disorders in the US adult population.
Archives of General Psychiatry 2006; 63(7): 824830.
3. Muhlhans B, Horbach T & de Zwaan M. Psychiatric disorders in bariatric surgery candidates: a review of the literature and
results of a German prebariatric surgery sample. General Hospital Psychiatry 2009; 31(5): 414421.
4. Livhits M, Mercado C, Yermilov I et al. Preoperative predictors of weight loss following bariatric surgery: systematic re-
view. Obesity Surgery 2012; 22(1): 7089.
*5. Pickering RP, Goldstein RB, Hasin DS et al. Temporal relationships between overweight and obesity and DSM-IV substance
use, mood, and anxiety disorders: results from a prospective study, the National epidemiologic survey on alcohol and
related conditions. Journal of Clinical Psychiatry 2011; 72(11): 14941502.
6. Barry D, Pietrzak RH & Petry NM. Gender differences in associations between body mass index and DSM-IV mood and
anxiety disorders: results from the National epidemiologic survey on alcohol and related conditions. Annals of Epidemi-
ology 2008; 18(6): 458466.
Practice points
1. It is necessary to be aware of the fact that obesity and psychiatric illness are often comorbid
with each other. This is especially important when planning treatment programs for each
condition separately, since weight issues can impact compliance with psychiatric treatments
and psychiatric illness can inuence adherence to interventions designed to address weight
management.
2. It is important to recognize that medical issues such as chronic pain and impaired mobility
can mediate the association between obesity and psychiatric illness, impacting QoL.
3. The role of weight bias and stigma cannot be ignored in this population. It is important to
ensure patients are aware of it and their own reactions to it. It is also essential to help in-
dividuals with obesity learn healthy coping strategies to try to mitigate the impact of bias and
stigma on their own QoL.
4. Be aware that the association between obesity and mental illness can begin in childhood.
Stigma is an important factor in this association and it is important to ensure efforts are made
to prevent this type of behavior from developing at a young age.
5. Ensure that proper scales are used to measure QoL and psychological distress in an obese
population. The multifaceted etiology of this illness, coupled with its many comorbidities,
require time is spent to choose the best measurement instruments to use in this population.
V.H. Taylor et al. / Best Practice & Research Clinical Endocrinology & Metabolism 27 (2013) 139146 143
7. Becker ES, Margraf J, Turke V et al. Obesity and mental illness in a representative sample of young women. International
Journal of Obesity Related Metabolic Disorder 2001; 25(Suppl. 1): S5S9.
8. Bruffaerts R, Demyttenaere K, Vilagut G et al. The relation between body mass index, mental health, and functional
disability: a European population perspective. Canadian Journal of Psychiatry 2008; 53(10): 679688.
9. Carpenter KM, HasinDS, AllisonDBet al. Relationships betweenobesityandDSM-IVmajor depressive disorder, suicideideation,
and suicide attempts: results from a general population study. American Journal of Public Health 2000; 90(2): 251257.
10. Hach I, Ruhl UE, Klose M et al. Obesity and the risk for mental disorders in a representative German adult sample. European
Journal of Public Health 2007; 17(3): 297305.
11. Lamertz CM, Jacobi C, Yassouridis A et al. Are obese adolescents and young adults at higher risk for mental disorders? A
community survey. Obesity Research 2002; 10(11): 11521160.
12. Ma J & Xiao L. Obesity and depression in US women: results from the 2005-2006 National Health and Nutritional Ex-
amination Survey. Obesity (Silver Spring) 2010; 18(2): 347353.
13. Mather AA, Cox BJ, Enns MWet al. Associations of obesity with psychiatric disorders and suicidal behaviors in a nationally
representative sample. Journal of Psychosomatic Research 2009; 66(4): 277285.
14. McIntyre RS, Konarski JZ, Wilkins K et al. Obesity in bipolar disorder and major depressive disorder: results from a national
community health survey on mental health and well-being. Canadian Journal of Psychiatry 2006; 51(5): 274280.
15. McLaren L, Beck CA, Patten SB et al. The relationship between body mass index and mental health. A population-based
study of the effects of the denition of mental health. Social Psychiatry and Psychiatric Epidemiology 2008; 43(1): 6371.
16. Onyike CU, Crum RM, Lee HB et al. Is obesity associated with major depression? Results from the Third National Health and
Nutrition Examination Survey. American Journal of Epidemiology 2003; 158(12): 11391147.
17. Petry NM, Barry D, Pietrzak RH et al. Overweight and obesity are associated with psychiatric disorders: results from the
National Epidemiologic Survey on Alcohol and Related Conditions. Psychosomatic Medicine 2008; 70(3): 288297.
18. Pickering RP, Grant BF, Chou SP et al. Are overweight, obesity, and extreme obesity associated with psychopathology?
Results from the national epidemiologic survey on alcohol and related conditions. Journal of Clinical Psychiatry 2007;
68(7): 9981009.
19. Scott KM, Bruffaerts R, Simon GE et al. Obesity and mental disorders in the general population: results from the world
mental health surveys. International Journal of Obesity (London) 2008; 32(1): 192200.
20. Scott KM, McGee MA, Wells JE et al. Obesity and mental disorders in the adult general population. Journal of Psychosomatic
Research 2008; 64(1): 97105.
21. John U, Meyer C, Rumpf HJ et al. Relationships of psychiatric disorders with overweight and obesity in an adult general
population. Obesity Research 2005; 13(1): 101109.
22. Hasler G, Lissek S, Ajdacic V et al. Major depression predicts an increase in long-term body weight variability in young
adults. Obesity Research 2005; 13(11): 19911998.
23. Hasler G, Pine DS, Kleinbaum DG et al. Depressive symptoms during childhood and adult obesity: the Zurich Cohort Study.
Molecular Psychiatry 2005; 10(9): 842850.
24. Hasler G, Pine DS, Gamma A et al. The associations between psychopathology and being overweight: a 20-year prospective
study. Psychological Medicine 2004; 34(6): 10471057.
25. Kasen S, Cohen P, Chen H et al. Obesity and psychopathology in women: a three decade prospective study. International
Journal of Obesity (London) 2008; 32(3): 558566.
26. Pine DS, Cohen P, Brook J et al. Psychiatric symptoms in adolescence as predictors of obesity in early adulthood: a lon-
gitudinal study. American Journal of Public Health 1997; 87(8): 13031310.
27. Richardson LP, Davis R, Poulton R et al. A longitudinal evaluation of adolescent depression and adult obesity. Archives of
Pediatrics & Adolescent Medicine 2003; 157(8): 739745.
28. Roberts RE, Deleger S, Strawbridge WJ et al. Prospective association between obesity and depression: evidence from the
Alameda County Study. International Journal of Obesity Related Metabolic Disorder 2003; 27(4): 514521.
29. Roberts RE, Strawbridge WJ, Deleger S et al. Are the fat more jolly? Annals of Behavioral Medicine 2002; 24(3): 169180.
30. Roberts RE, Kaplan GA, Shema SJ et al. Are the obese at greater risk for depression? American Journal of Epidemiology 2000;
152(2): 163170.
*31. Taylor VH, Stonehocker B, Steele M et al. An overview of treatments for obesity in a population with mental illness. Ca-
nadian Journal of Psychiatry 2012; 57(1): 1320.
32. Dent R, Blackmore A, Peterson J et al. Changes in body weight and psychotropic drugs: a systematic synthesis of the
literature. PLoS One 2012; 7(6): e36889.
*33. Allison DB, Mentore JL, Heo M et al. Antipsychotic-induced weight gain: a comprehensive research synthesis. American
Journal of Psychiatry 1999; 156(11): 16861696.
34. Piatt EE, Munetz MR & Ritter C. An examination of premature mortality among decedents with serious mental illness and
those in the general population. Psychiatric Services 2010; 61(7): 663668.
35. Gibson M, Carek PJ & Sullivan B. Treatment of co-morbid mental illness in primary care: how to minimize weight gain,
diabetes, and metabolic syndrome. International Journal of Psychiatry in Medicine 2011; 41(2): 127142.
36. Felson DT, Anderson JJ, Naimark A et al. Obesity and knee osteoarthritis. The Framingham Study. Annals of Internal
Medicine 1988; 109(1): 1824.
37. Flamme CH. Obesity and low back painbiology, biomechanics and epidemiology. Der Orthopade 2005; 34(7): 652657.
38. Larsson UE & Mattsson E. Perceived disability and observed functional limitations in obese women. International Journal of
Obesity Related Metabolic Disorder 2001; 25(11): 17051712.
39. Patucchi E, Fatati G, Puxeddu A et al. Prevalence of bromyalgia in diabetes mellitus and obesity. Recenti Progressi Medicina
2003; 94(4): 163165.
40. Forhan MA, Law MC & Taylor VH. Factors associated with the satisfaction of participation in daily activities for adults with
class III obesity. Oxford Transitional Justice Research 2012; 32(3): 7078.
*41. Puhl RM & Heuer CA. The stigma of obesity: a review and update. Obesity (Silver Spring) 2009; 17(5): 941964.
42. Durso LE & Latner JD. Understanding self-directed stigma: development of the weight bias internalization scale. Obesity
(Silver Spring) 2008; 16(Suppl. 2): S80S86.
V.H. Taylor et al. / Best Practice & Research Clinical Endocrinology & Metabolism 27 (2013) 139146 144
43. Zhao G, Ford ES, Li C et al. Serious psychological distress and its associations with body mass index: ndings from the 2007
Behavioral Risk Factor Surveillance System. International Journal of Public Health 2009; 54(Suppl. 1): 3036.
44. Koball AM & Carels RA. Coping responses as mediators in the relationship between perceived weight stigma and
depression. Eating and Weight Disorders 2011; 16(1): e17e23.
45. Barber JA, Palmese L, Reutenauer EL et al. Implications of weight-based stigma and self-bias on quality of life among
individuals with schizophrenia. Journal of Nervous and Mental Disease 2011; 199(7): 431435.
*46. Puhl RM & Brownell KD. Psychosocial origins of obesity stigma: toward changing a powerful and pervasive bias. Obesity
Reviews 2003; 4(4): 213227.
47. Smolak L & Murnen SK. In Striegel-Moore RH & Smolak L (eds.). Gender and eating problems. Washington, DC: American
Psychological Association, 2002.
*48. McElroy SL, Kotwal R, Malhotra S et al. Are mood disorders and obesity related? A review for the mental health profes-
sional. Journal of Clinical Psychiatry 2004; 65(5): 634651. quiz 730.
49. Comings DE, Gade R, MacMurray JP et al. Genetic variants of the human obesity (OB) gene: association with body mass
index in young women, psychiatric symptoms, and interaction with the dopamine D2 receptor (DRD2) gene. Molecular
Psychiatry 1996; 1(4): 325335.
50. Wang Y & Lobstein T. Worldwide trends in childhood overweight and obesity. International Journal of Pediatric Obesity
2006; 1(1): 1125.
51. Goran MI, Ball GD & Cruz ML. Obesity and risk of type 2 diabetes and cardiovascular disease in children and adolescents.
Journal of Clinical Endocrinology & Metabolism 2003; 88(4): 14171427.
*52. Daniels SR. Complications of obesity in children and adolescents. International Journal of Obesity (London) 2009; 33(Suppl.
1): S60S65.
53. Britz B, Siegfried W, Ziegler A et al. Rates of psychiatric disorders in a clinical study group of adolescents with extreme
obesity and in obese adolescents ascertained via a population based study. International Journal of Obesity Related
Metabolic Disorder 2000; 24(12): 17071714.
54. Kolotkin RL, Zeller M, Modi AC et al. Assessing weight-related quality of life in adolescents. Obesity (Silver Spring) 2006;
14(3): 448457.
55. Williams J, Wake M, Hesketh K et al. Health-related quality of life of overweight and obese children. Journal of the
American Medical Association 2005; 293(1): 7076.
56. Schwimmer JB, Burwinkle TM & Varni JW. Health-related quality of life of severely obese children and adolescents. Journal
of the American Medical Association 2003; 289(14): 18131819.
57. Wardle J & Cooke L. The impact of obesity on psychological well-being. Best Practice & Research: Clinical Endocrinology &
Metabolism 2005; 19(3): 421440.
58. Tsiros MD, Olds T, Buckley JD et al. Health-related quality of life in obese children and adolescents. International Journal of
Obesity (London) 2009; 33(4): 387400.
59. Riazi A, Shakoor S, Dundas I et al. Health-related quality of life in a clinical sample of obese children and adolescents.
Health and Quality of Life Outcomes 2010; 8: 134.
60. Goldeld GS, Moore C, Henderson K et al. Body dissatisfaction, dietary restraint, depression, and weight status in ado-
lescents. Journal of School Health 2010; 80(4): 186192.
61. Hillman JB, Dorn LD & Bin H. Association of anxiety and depressive symptoms and adiposity among adolescent females,
using dual energy X-ray absorptiometry. Clinical Pediatrics (Philadelphia) 2010; 49(7): 671677.
62. Swallen KC, Reither EN, Haas SA et al. Overweight, obesity, and health-related quality of life among adolescents: the
National Longitudinal Study of Adolescent Health. Pediatrics 2005; 115(2): 340347.
63. Zeller MH& Modi AC. Predictors of health-related quality of life in obese youth. Obesity (Silver Spring) 2006; 14(1): 122130.
64. Pratt KJ, Lamson AL, Swanson MS et al. The importance of assessing for depression with HRQOL in treatment seeking obese
youth and their caregivers. Quality of Life Research 2012; 21(8): 13671377.
65. Richardson LP, Garrison MM, Drangsholt M et al. Associations between depressive symptoms and obesity during puberty.
General Hospital Psychiatry 2006; 28(4): 313320.
66. Boutelle KN, Hannan P, Fulkerson JA et al. Obesity as a prospective predictor of depression in adolescent females. Health
Psychology 2010; 29(3): 293298.
67. Twenge JM & Nolen-Hoeksema S. Age, gender, race, socioeconomic status, and birth cohort differences on the childrens
depression inventory: a meta-analysis. Journal of Abnormal Psychology 2002; 111(4): 578588.
*68. Janicke DM, Marciel KK, Ingerski LM et al. Impact of psychosocial factors on quality of life in overweight youth. Obesity
(Silver Spring) 2007; 15(7): 17991807.
69. Pinhas-Hamiel O, Singer S, Pilpel N et al. Health-related quality of life among children and adolescents: associations with
obesity. International Journal of Obesity (London) 2006; 30(2): 267272.
70. Arslan G, Ayranci U, Unsal A et al. Prevalence of depression, its correlates among students, and its effect on health-related
quality of life in a Turkish university. Upsala Journal of Medicine Sciences 2009; 114(3): 170177.
71. Cramer P & Steinwert T. Thin is good, fat is bad: how early does it begin? Journal of Applied Developmental Psychology 1998;
19(3): 429451.
72. Brylinsky JA & Moore JC. The identication of body build stereotypes in young children. Journal of Research in Personality
1994; 28(2): 170181.
73. Kraig KA & Keel PK. Weight-based stigmatization in children. International Journal of Obesity Related Metabolic Disorder
2001; 25(11): 16611666.
74. Wardle J, Volz C & Golding C. Social variation in attitudes to obesity in children. International Journal of Obesity Related
Metabolic Disorder 1995; 19(8): 562569.
75. Richardson SA, Goodman N, Hastorf AH et al. Cultural uniformity in reaction to physical disabilities. American Sociological
Review 1961; 26(2): 241247.
76. Latner JD & Stunkard AJ. Getting worse: the stigmatization of obese children. Obesity Research 2003; 11(3): 452456.
77. Garratt A, Schmidt L, Mackintosh A et al. Quality of life measurement: bibliographic study of patient assessed health
outcome measures. BMJ 2002; 324(7351): 1417.
V.H. Taylor et al. / Best Practice & Research Clinical Endocrinology & Metabolism 27 (2013) 139146 145
*78. NIH. The practical guide: identication, evaluation, and treatment of overweight and obesity in adults. Bethesda, MD: NIH, 2000.
79. Corica F, Corsonello A, Apolone G et al. Construct validity of the Short Form-36 Health Survey and its relationship with BMI
in obese outpatients. Obesity (Silver Spring) 2006; 14(8): 14291437.
80. Duval K, Marceau P, Perusse L et al. An overview of obesity-specic quality of life questionnaires. Obesity Reviews 2006;
7(4): 347360.
81. Stucki A, Borchers M, Stucki G et al. Content comparison of health status measures for obesity based on the international
classication of functioning, disability and health. International Journal of Obesity (London) 2006; 30(12): 17911799.
82. Beck AT, Steer RA & Brown GK. Manual for Beck depression inventory II (BDI-II). San Antonio, TX: Psychology Corporation,
1996.
83. Beck AT, Ward CH, Mendelson Met al. An inventory for measuring depression. Archives of General Psychiatry 1961; 4: 561571.
84. Beck AT & Steer RA. Manual for the Beck depression inventory. San Antonio, TX: Psychological Corporation, 1993.
*85. Mechanick JI, Kushner RF, Sugerman HJ et al. American Association of Clinical Endocrinologists, The Obesity Society, and
American Society for Metabolic & Bariatric Surgery medical guidelines for clinical practice for the perioperative nutri-
tional, metabolic, and nonsurgical support of the bariatric surgery patient. Obesity (Silver Spring) 2009; 17(Suppl. 1): S1
S70 [v].
86. Beck AT, Steer RA & Garbin MG. Psychometric properties of the Beck Depression Inventory: twenty-ve years of evalu-
ation. Clinical Psychology Review 1988; 8(1): 77100.
87. Krukowski RA, Friedman KE & Applegate KL. The utility of the Beck Depression Inventory in a bariatric surgery population.
Obesity Surgery 2010; 20(4): 426431.
88. Plumb MM & Holland J. Comparative studies of psychological function in patients with advanced cancerI. Self-reported
depressive symptoms. Psychosomatic Medicine 1977; 39(4): 264276.
89. Grant D, Almond MK, Newnham A et al. The Beck Depression Inventory requires modication in scoring before use in a
haemodialysis population in the UK. Nephron Clinical Practice 2008; 110(1): c33c38.
90. Smith MD, Hong BA & Robson AM. Diagnosis of depression in patients with end-stage renal disease. Comparative analysis.
American Journal of Medicine 1985; 79(2): 160166.
91. Hayden MJ, Brown WA, Brennan L et al. Validity of the Beck Depression Inventory as a screening tool for a clinical mood
disorder in bariatric surgery candidates. Obesity Surgery 2012; 22(11): 16661675.
92. Zigmond AS & Snaith RP. The hospital anxiety and depression scale. Acta Psychiatrica Scandinavica 1983; 67(6): 361370.
93. Bjelland I, Dahl AA, Haug TT et al. The validity of the Hospital Anxiety and Depression Scale. An updated literature review.
Journal of Psychosomatic Research 2002; 52(2): 6977.
94. Lopez-Alvarenga JC, Vazquez-Velazquez V, Arcila-Martinez D et al. Accuracy and diagnostic utility of the Hospital Anxiety
and Depression Scale (HAD) in a sample of obese Mexican patients. Revista de Investigacin Clnica 2002; 54(5): 403409.
V.H. Taylor et al. / Best Practice & Research Clinical Endocrinology & Metabolism 27 (2013) 139146 146