Association Between Weight Control Failure and Suicidal Ideation in Overweight and Obese Adults

A Cross-sectional Study

Yeong Jun Ju; Kyu-Tae Han; Tae-Hoon Lee; Woorim Kim; Jeong Hun Park; Eun-Cheol Park


BMC Public Health. 2016;16(259) 

In This Article


South Korea currently has many public health issues. Among OECD members, Korea has ranked first in suicide rate for 11 years. The mortality rate from suicide increased rapidly from 22.6 % in 2003 to 28.5 % in 2013, making suicide the fourth leading cause of death in Korea.[27] In addition, the prevalence of obesity has continued to increase over the last 10 years, resulting in lifestyle changes. Obesity has become a serious national problem and is no longer a concern only in Western countries.[28,29] Considering that these issues remain a concern and that obesity is an important factor affecting mental health, it is necessary to design effective strategies to prevent and manage suicidal ideation among the overweight and obese populations.

We found that weight control failure was significantly associated with suicidal ideation among obese females, whereas this association was not significant in obese males or overweight populations after multivariable adjustment. This finding can be explained by weight stigma. Weight stigma has been described as negative weight-related attitudes and beliefs. Obese individuals are often highly stigmatized,[30] and obese females experience weight stigma more than do obese males.[31,32] Weight stigma experiences were significantly related to depressive symptoms, decreased self-esteem and suicidality.[33,34] Obese females in particular may be more vulnerable to the societal standards of beauty and obesity stigma compared with males, thereby degrading mental health. Hence, weight control failure among obese females may affect experience with weight stigma, thereby deteriorating psychological wellbeing, and in particular, suicidal ideation.

Our findings suggests that efforts to reduce the high suicide rate should target obese females. Considering that the prevalence of obesity is high among middle-aged women and that the age-specific obesity rate in Korean females has recently increased sharply, obese females are an important target group for intervention.[35] Despite its issues remain a concern, programs to resolve issues are rare. From our findings, therefore, we suggest that suicide prevention programs need to focus on supporting obese females, such as encouraging physical activity, and supporting enrollment in weight control programs. In Korea, most weight control programs for obesity are focused on children. Despite positive outcomes, the few programs focusing on obese females experienced limitations such as barriers in the recruitment and retention of participants.[36] Therefore, policy makers should develop strategies for participants' continuous participation using effectiveness tools, such as telephone counseling and mobile phone SMS messages.[37] Such support can improve not only the mental but also the physical health of obese females.

In addition, our subgroup analysis indicated that menopause, household composition, or low income potentially affect the association between weight control failure and suicidal ideation, even though the modifying effect was not significant. The overall trends seen among our findings have serious implications for the management of suicidal ideation. Several studies offer potential explanations. Regarding menopause, females may experience weight gain during the peri-menopausal to post-menopausal period, and this weight gain may exacerbate the changes in health risk factors that appear during menopause.[20,38] For that reasons, obese females may experience the weight gain. Thus, policy makers should consider health policy providing hormone injections for women experiencing menopause. Regarding household composition, previous studies reported that family members and support networks including parents, spouses, and friends can increase the effectiveness of weight control in obese populations. Such support networks would be most effective in eradicating negative attitudes and bias regarding weight.[39,40] Therefore, policy makers should consider programs utilizing family and a support network, it could help weight control in obese populations.

Meanwhile, we found a gradient in suicidal ideation by socio-demographic factors such as education, income, and employment status in both males and females. More disadvantage males and females were more likely to report suicidal ideation, in particular obese females. Few studies offer potential explanations by focusing relationship between socioeconomic gradient and obesity. Which relationship was well established through previous studies.[41,42] For example, because higher socioeconomic groups tend to have a healthier diet, higher educational attainment, income and occupational status were associated with lower risk of obesity. In addition, studies suggests that the relation between socio-economic inequality and obesity is stronger among females than among males.[43,44] On the other hands, obese females are socially and economically disadvantaged.[45] They are less likely to practice the healthy dieting thereby increasing the weight. Therefore, weight gain and unhealthy dietary practices due to socio and economic disadvantage in women may lead to more weight control failure and weight stigma, thereby exacerbating the mental health. Meanwhile, few studies has shown an inverse results between socioeconomic status and obesity.[46,47] These studies found that high education attainment or high income was related to prevalence of obesity in females. Based our results and previous studies, the relationship between social gradient and suicidal ideation among obese population are not currently, because studies on those relationship is less well established. Therefore, further studies on those findings are needed.

This study has several strengths compared with previous studies. First, the study used a large representative sample, and data were collected from a nationally representative population. Second, to our knowledge, our study is the first to report on the relationship between weight control failure and suicidal ideation among obese populations. Previous studies focused only on the relationship between weight-based stigmatization or obesity and mental health in adolescents. Finally, our study focused on the cause of suicidal ideation among overweight and obese populations.

However, there were also several limitations. First, the present study was unable to identify a causal relationship between weight control failure and suicidal ideation, because the study design was cross sectional, and information was obtained via self-report. Second, our subgroup analysis findings are limited with regard to the interpretation of the results, because the modifying effect was not significant, although the findings showed significant differences in each group. Therefore, other studies are needed to confirm our findings. Third, we did not investigate the reasons behind weight control failure and change in weight. Furthermore, we did not consider various factors related to weight change, such as food intake volume, exercise frequency and exercise intensity. Fourth, we could not accurately measure suicidal ideation, because the question pertaining to suicidal ideation required only a "yes" or "no" answer. In addition, we could not accurately assess weight control failure, because the answers were subjective. Therefore, self-reporting of the respondents could have led to an underestimation of the actual relationship between weight control failure and suicidal ideation.

Despite the limitations, this is the first study to investigate the association between weight control failure and suicidal ideation among obese and overweight Koreans. Considering that the high prevalence of suicide and the increasing prevalence of obesity in Korea, our findings are important for health policy makers to identify solutions for controlling suicide problem.