2013. Vol.4, No.11A, 1-3
Published Online November 2013 in SciRes (
Open Access 1
Comparison of Obesity/Psychological Disorders Comorbid
between Older and Younger Adult Women
Soodeh Razeghi Jahromi1,2, Maryam Abolhasani2,3*, Maryam Bidadian2, Leila Kouti4
1Geriatric Group, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
2Obesity Group, Endocrine and Metabolic Research Center, Sina Hospital, Tehran University of
Medical Sciences, Tehran, Iran
3Sports Medicine Group, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
4School of Pharmacy, Ahvas Jundishapour University of Medical Science, Ahvas, Iran
Email: *
Received July 28th, 2013; revised September 1st, 2013; accepted October 3rd, 2013
Copyright © 2013 Soodeh Razeghi Jahromi et al. This is an open access article distributed under the Creative
Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium,
provided the original work is properly cited.
Introduction: Epidemiologic data proposed a relationship between obesity and depression in older adults.
We conducted this study to evaluate the association between obesity and depressive disorders, as well as a
range of eating disorders in old women. Methods: From a total of 1477 clients referred to an outpatient
clinic, 212 obese persons (97 persons 60+ and 115 persons 40 - 59 years of age) were enrolled. Data of
demographics, comorbidities, anthropometrics, physical activity level, and diet, as well as, depressive and
eating disorders were collected. Depressive and eating disorders were assessed using diagnostic structural
interview based on DSM-IV-TR (Diagnostic Statistical Manual of Mental Disorder—fourth edition—
Text version). BMI more than or equal to 30 was considered as obesity. Results: The prevalence of dyst-
hymic disorder was significantly lower in older women compared to younger (p = 0.026). Comparable but
not significant results were observed for major depression disorder, Bulimia Nervosa, and eating disorders
not otherwise specified. Conclusion: Our findings suggest that obese older women were less likely to suf-
fer from Comorbid dysthymic disorder/obesity compared to younger.
Keywords: Dysthymic Disorder; Obesity; Elderly
In recent decades obesity and depressive disorders including
major depression and dysthymic disorder have become notable
public health problems (Chan & Woo, 2010; Sartorius, 2010).
A growing body of clinical-based and population-based studies
supports the association between obesity and depressive disor-
ders (De Wit et al., 2010; LaCoursiere, 2011; Spitzer et al.,
2012). The data from 2005 National Health Interview survey on
over 30,000 American adults confirmed the correlation (r = 0.8)
between obesity and depression (Blaine, 2008). There are some
causal models that explained the obesity and depression co-
morbidity. One well known model, weight-related stigma, sug-
gests that stigmatizing has prominent role that causes obese
patients to also suffer from co-morbid depression. According to
this model obesity is a deeply stigmatizing attribute that
prompts negative stereotyping and discrimination in others,
which, in turn, causes depression and other negative psycho-
logical and social outcomes (Puhl, Brownell, Schwartz, & Rudd,
2005; Puhl, Moss-Racusin, Schwartz, & Brownell, 2008). The
other casual model recognizes that depression can exert causal
effects on obesity. A third model combines the two mentioned
model. This model suggests negative body image stigmatiza-
tion of obese individuals could lead to low self esteem and
psychological distress generally (Puhl et al., 2005; Puhl et al.,
2008). It’s supposed that the older obese are less likely to suffer
from depressive symptoms, known as “jolly fat” hypothesis
(Crisp & McGuiness, 1976). One of the potential explanations
for this hypothesis could be the higher concentration of estro-
gen in women with higher level of adipose tissue. Estrogen
might protect against the development of depression (Kim et al.,
2010). Although different studies were dedicated to assessing
the relationship between obesity and depression in the elderly,
limited data are available on the obesity and dysthymic disorder
relation as well as its relationship with eating disorder. Hence
in this study we aimed to assess the correlations between obe-
sity, eating and depressive disorders in the elderly compared to
middle-aged individuals.
Study Design and Sampling
In this cross-sectional study, participants were randomly se-
lected from a total of 1477 women referred to the outpatient
overweight and obesity clinic of Sina University hospital be-
tween Jan 2008 and Jan 2012. Individuals were invited to par-
ticipate in the study by telephone call. The individuals, who
accepted to participate, received a comprehensive health screen
by sport medicine specialist, nutritionist, and psychologist.
Patients with dementia, Alzheimer and other neurodegenerative
disease, psychiatric disorders, and malignancies were excluded.
*Corresponding author.
212 women were enrolled including 97 persons over 60 (62.26
± 5.32) and 115 individuals between 40 and 59 years (49.97 ±
5.52). An informed written consent was obtained.
Basic Data
Sociodemgraphic and clinical data including educational
level, status, age, marital status, smoking habit, and regular
exercise were collected. Educational status was classified into
5 years, 6 - 12 years (college education level), 13 years.
Smoking was categorized as nonsmoker, regular smoker, and
habitual smoker.
Disease history including diabetes, hypertension, cardiovas-
cular disease, hyperlipidemia, thyroid diseases, hepatocellular
and gastrointestinal disorders, genitourinary disease, osteoar-
ticular disease, as well as respiratory and lung disease were
reported by clients.
Body weight was measured to the nearest 0.1 kg using Seca
755 Dial Column Medical Scale. Height was measured to the
nearest 0.1 cm using a standard stadiometer. Body Mass Index
(BMI) was calculated by dividing weight in kilograms by
height in square meters. BMI 30 was defined as obesity.
Waist circumference was measured by the standard tape meter
at the maximal narrowing of the waist from anterior view. Hip
circumference was measured at the point of maximal gluteal
protuberance from the lateral view. Waist to hip ratio was cal-
culated by dividing the waist circumference to hip circumfer-
Fat percent and fat free mass (FFM) by Body composition
analyzer type BC-418 MA TANITA. The participants were
asked not to eat or drink within 4 hours, and not to exercise
within 12 hours of the test. They have completely voided the
bladder within 30 minutes of the test and have had minimal
consumption of diuretic agents.
Physical Activity Level
The global physical activity questionnaire (GPAQ) was used
to assess physical activity level. This questionnaire is valid and
reliable for Iranian population. The Global Physical Activity
Questionnaire was developed by WHO for physical activity
It collects information on physical activity level in three set-
tings and sedentary behaviour.
These settings are:
1) Activity at work,
2) Travel to and from places,
3) Recreational activities (Herrmann, Heumann, Der Ananian,
& Ainsworth, 2013).
Depressive and Eating Disorders
Depressive and eating disorders were assessed using a diag-
nostic structural interview based on DSM-IV-TR (Diagnostic
Statistical Manual of Mental Disorder-fourth edition-Text ver-
sion) consist of anorexia nervosa, bulimia and non otherwise
specified (NOS) (American psychiatric Association, 2000).
Statistical Analysis
For descriptive analysis of quantitative data, the Mean and
Standard deviation were used. For qualitative data, frequency
percentage was reported. To evaluate the association between
obesity, depressive and eating disorders OR with 95% CI was
used. Statistical package for the Social Sciences, version 17.0
(SPSS, Chicago, IL, USA) was used to analyze the data.
Sociodemographic characteristics of the study population and
the prevalence of depressive and eating disorders were pre-
sented in Table 1. Also the physical activity in both groups was
in low active range or sedentary. Table 2 demonstrated the
obesity indices and Table 3 presents OR for depressive and
eating disorders. As presents in Table 3, obese aged women
were less likely to have dysthymic disorder compared to mid-
dle-aged obese women 0.27 (95% CI: 0.083 - 0.9).
Table 1.
Sociodemographic characteristics of the study population and the
prevalence of depressive and eating disorders.
<60 years
60 years
Single 4 (3.6) 1 (1)
Married 96 (86.5) 74 (77.1)
Divorced 8 (7.2) 4 (4.2)
Widowed 3 (2.7) 17 (17.7)
5 years 32 (28.6) 59 (61.5)
6 - 12 years 61 (54.4) 30 (31.2)
12 years 19 (17) 7 (7.3)
Diabetes 16 (15) 22 (23.2)
Hyperlipidemia 18 (16.8) 39 (40.6)
Hypertension 32 (29.9) 48 (50)
Cardiovascular diseases 13 (12.1) 34 (35.4)
Respiratory diseases 26 (24.3) 22 (22.9)
Hepatocellular and
gastrointestinal disorders 57 (50.9) 29 (30.2)
Genitourinary diseases 17 (17.3) 14 (14.6)
Thyroid diseases 30 (32.7) 19 (19.8)
Osteoarticular diseases 65 (67) 66 (68.8)
Nonsmoker 89 (77.4) 79 (82.3)
Regular smoker 4 (3.2) 2 (2.1)
Recreational smoker 22 (19.4) 15 (15.6)
Major depression 43 (37.7) 30 (31)
disorders Dysthymic disorder 33 (28.3) 9 (9.8)
Bulimia Nervosa 4 (3.7) 7 (7.3)
disorders Disorders not
otherwise specified 23 (16.7) 4 (4.9)
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Table 2.
Obesity indices in middle-aged women and the elderly.
<60 years
Mean ± SD
60 years
Mean ± SD
Weight (kg) 90.7 ± 17.65 82.9 ± 12.25
Height (cm) 157.8 ± 5.3 156.6 ± 9.3
Body Mass Index (BMI) 36.65 ± 7.1 33.77 ± 5.77
Waist circumference (cm) 109.9 ± 14.05 110.7 ± 13.37
Hip circumference (cm) 121.7 ± 13.8 118.7 ± 12.5
Fat% 43.3 ± 4.5 39.17 ± 9.6
Fat free mass (kg) 51.09 ± 7.1 49.16 ± 6.95
Table 3.
The association between obesity, depressive and eating disorders
OR (95% CI) P. value
disorders Major depression 0.83 (0.35 - 1.93) 0.657
Dysthymic disorder 0.27 (0.083 - 0.9) 0.026
disorders Bulimia nervosa 0.56 (0.47 - 0.68) 0.219
Disorders not
otherwise specified 0.26 (0.052 - 1.27) 0.075
We found that older obese women were less likely to suffer
from dysthymic disorder than their middle-aged compartments.
The inverse association between dysthymic disorder and
obesity among elderly Iranian women support the “Jolly Fat’’
hypothesis (Crisp & McGuiness, 1976). Our results were fairly
in consistent with the previously reported findings in two Asian
populations. Elderly Japanese women with chronic medical
conditions were less likely to suffer from depressive symptoms
(Kuriyama et al., 2006). An inverse relationship was also re-
ported in elderly Chinese women compared to normal weight
(Li et al., 2004).
However, in contrast to the studies in elderly Asians, in eld-
erly Caucasians obesity was reported to be positively related to
depressive symptoms (Carpenter, Hasin, Allison, & Faith,
2000). Li et al. hypothesized that this difference might be due
to the fact that being a little fat in Asian cultures is not regarded
unhealthy, rather showed the wealth of an individual ( Li et al.,
2004). Therefore, obesity might increase self steam in older
adults. On the other hand, in western societies the stigma at-
tached to being obese might cause people to suffer lower self
esteem and to have more negative self-images, perhaps result-
ing in higher levels of depression.
This inverse relationship in women might also have biologi-
cal origin, as in Postmenopausal statues, elderly women with
higher levels of adipose tissue have higher levels of estrogen,
which might protect against the depressive symptoms (Kim et
al., 2010). Our study was limited to women. Also, the cross-
sectional of the study made us unable to assess whether obesity
is a cause or consequence of depressive symptoms. Neverthe-
less, this study has several advantages. We compare the depres-
sive disorders including dysthymic disorder between middle-
aged and older adults and using random sampling.
In conclusion, we found an inverse relationship between
dysthymic disorder and obesity in Iranian elderly women, in
consistent with the “Jolly Fat” hypothesis. Public health work-
ing against obesity should be cautioned about the potential side
effect of depressive symptoms in the elderly women. Prospec-
tive studies in middle-aged women are warranted for better
understanding of this inverse relationship.
Association, A. P. (2000). Diagnostic and statistical manual of mental
disorders: DSM-IV-TR®. Arlington, VA: American Psychiatric
Li, Z. B., Ho, S. Y., Chan, W. M., Ho, K. S., Li, M. P., Leung, G. M., et
al. (2004). Obesity and depressive symptoms in Chinese elderly. In-
ternational Journal of Ge r i at r ic Psychiatry, 19, 68-74.
Blaine, B. (2008). Does depression cause obesity? A meta-analysis of
longitudinal studies of depression and weight control. Journal of
Health Psychology, 13, 1190-1197.
Carpenter, K. M., Hasin, D. S., Allison, D. B., & Faith, M. S. (2000).
Relationships between obesity and DSM-IV major depressive disor-
der, suicide ideation, and suicide attempts: Results from a general
population study. American Journal of Public Health, 90, 251-257.
Chan, R. S., & Woo, J. (2010). Prevention of overweight and obesity:
How effective is the current public health approach. International
Journal of Environmental R esearch and Public Health, 7, 765-783.
Crisp, A. H., & McGuiness, B. (1976). Jolly fat: Relation between
obesity and psychoneurosis in general population. British Medical
Journal, 1, 7.
De Wit, L., Luppino, F., Van Straten, A., Penninx, B., Zitman, F., &
Cuijpers, P. (2010). Depression and obesity: A meta-analysis of
community-based studies. Psychiatry Research, 178, 230-235.
Herrmann, S. D., Heumann, K. J., Der Ananian, C. A., & Ainsworth, B.
E. (2013) Validity and reliability of the global physical activity ques-
tionnaire (GPAQ). Measurement in Physical Education and Exercise
Science, 17, 221-235.
Kim, E., Song, J. H., Hwang, J.-Y., Ahn, K., Kim, J., Koh, Y. H., et al.
(2010). Obesity and depressive symptoms in elderly Koreans: Evi-
dence for the “Jolly Fat” hypothesis from the Ansan Geriatric (AGE)
Study. Archives of Gerontology and Geriatrics, 51, 231-234.
Kuriyama, S., Koizumi, Y., Matsuda-Ohmori, K., Seki, T., Shimazu, T.,
Hozawa, A., et al. (2006). Obesity and depressive symptoms in eld-
erly Japanese: The Tsurugaya Project. Journal of Psychosomatic Re-
search, 60, 229-235.
LaCoursiere, D. (2011). 2. Psychological aspects of obesity in women.
In D. Conway (Ed.), Pregnancy in the obese woman: Clinical man-
agement (pp. 15-32). Hoboken, NJ: Wiley-Blackwell.
Puhl, R. M., Brownell, K., Schwartz, M., & Rudd, L. (2005). Coping
with weight stigma. In K. D. Brownell (Ed.), Weight bias: Nature,
consequences, and remedies (pp. 275-284). New York: Guilford Press.
Puhl, R. M., Moss-Racusin, C. A., Schwartz, M. B., & Brownell, K. D.
(2008). Weight stigmatization and bias reduction: Perspectives of
overweight and obese adults. Health Education Research, 23, 347-
Sartorius, N. (2010). Cross-cultural research on depression. Psychopa-
thology, 19, 6-11.
Spitzer, R. L., Levy, D. A., Miller, W. R., Rollnick, S., Sheafor, B. W.,
Charles, R., et al. (2012). Diagnostic and statistical manual of mental
disorders (4th ed.). Washington, DC: American Psychiatric Associa-
tion. (2000) Text revision (DSM-IV-TR)