Antisocial behavioral syndromes and body mass index among adults in the United States: results from the National Epidemiologic Survey on Alcohol and Related Conditions

OBJECTIVE: To describe associations of antisocial behavioral syndromes, including DSM-IV antisocial personality disorder (ASPD) and conduct disorder without progression to ASPD ("CD only"), and syndromal antisocial behavior in adulthood without CD before age 15 (AABS, not a codable DSM-IV disorder), with body mass index (BMI) status in the general US adult population. METHODS: This report is based on the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions (n = 43093; response rate, 81%). Respondents were classified according to whether they met criteria for ASPD, AABS, "CD only," or no antisocial syndrome, and on current BMI status based on self-reported height and weight. Associations of antisocial syndromes with BMI status were examined using multinomial logistic regression. RESULTS: Among men, antisociality was not associated with BMI. Among women, ASPD was significantly associated with overweight and extreme obesity; AABS was associated with obesity and extreme obesity; and "CD only" was significantly associated with overweight, obesity, and extreme obesity. CONCLUSIONS: Assessment of antisocial features appears warranted in overweight, obese, and extremely obese women, and assessment of BMI status appears indicated in antisocial women. Prevention and treatment guidelines for overweight and obesity may need revision to address comorbid antisociality, and interventions targeting antisociality may need to include attention to weight concerns.     

Excess body weight and risk of first-ever acute ischaemic non-embolic stroke in elderly subjects

In a population-based case–control study we assessed the association between obesity and acute ischaemic/non-embolic stroke. A total of 163 patients aged older than 70 years (88 men and 75 women) admitted due to a first-ever-in-a-lifetime acute ischaemic/non-embolic stroke and 166 volunteers (87 men and 79 women) without a history of cardiovascular disease were included. The association of stroke with body mass index (BMI) or waist circumference (WC) was determined by multivariate logistic regression modelling after adjusting for potential confounding factors. Overweight and obesity were more prevalent amongst stroke patients compared to controls. Subjects with a BMI ≥30 kg/m² had 2.5-times higher odds to suffer an acute ischaemic/non-embolic stroke compared to subjects within the lowest BMI category of 18.5–20.9 kg/m². Analysis of interaction showed that in the presence of overweight and/or obesity (classified as a BMI ≥25 kg/m² and/or a WC >102 cm in men and >88 cm in women) the inverse relationship between HDL cholesterol and ischaemic/non-embolic stroke was negated. Excess weight is associated with an increased risk of acute ischaemic/non-embolic stroke in elderly individuals independently of concurrent metabolic derangements. Moreover, in the presence of obesity, HDL cholesterol loses its protective effect against ischaemic stroke.     

Exposure to early life trauma is associated with adult obesity

Exposure to traumatic events during childhood is associated with an elevated risk of adult obesity. It has been hypothesized that the psychological sequelae from childhood trauma account for this risk, though no study has examined whether an increased risk of obesity is found in persons without psychological disorders. We examined exposure to early life stressors and body mass index (BMI) in 696 adults without significant medical or psychiatric history. Bivariate correlation showed that the total number of early life stressors (r=0.08), age (r=0.19), and sex (r=0.16) were significantly related to adult BMI. Given the relationship between sex and BMI, we examined the contribution of early life stressors to adult obesity separately for men and women. In men, hierarchical regression showed that exposure to early life stressors predicted adult obesity. Specifically, history of being bullied/rejected (Obese 31%, Normal weight, 9%) and emotional abuse (Obese, 17%; Normal weight, 2%) predicted adult obesity after controlling for the effects of age. In women, no relationship between early life stressors and adult obesity was found. These findings suggest that multiple processes mediate the relationship between early life stress and adult obesity and that their relative contributions may differ between men and women.     

Obesity, abdominal obesity and Alzheimer disease

BACKGROUND/AIMS: Obesity has a strong association with vascular and metabolic diseases, which have been linked with Alzheimer disease (AD). While recent studies have reported an association between mid-life obesity and dementia, the role of later-life obesity is less clear. This study investigated the relation between AD, obesity and abdominal obesity at later-life in a case-control study. METHODS: Participants were 50 consecutive patients with probable AD from memory disorders clinics in Launceston, Australia, and Bristol, England, and 75 cognitively normal controls. Height and weight [from which body mass index (BMI) was calculated] and hip and waist circumferences (from which waist-hip ratio was calculated) were measured. Participants were classified according to their BMI as: underweight (BMI <20.0 kg/m2); normal weight (BMI 20.0-24.9 kg/m2); overweight (BMI 25-29.9 kg/m2), or obese (BMI > or = 30 kg/m2). They were classified as abdominally obese if their waist-hip ratio was >0.9 (men) or >0.8 (women). RESULTS: AD was associated with obesity [OR 9.5, 95% CI 2.4-37.3, p = 0.001], underweight (OR 5.4, CI 0.9-33.7, p = 0.07) and abdominal obesity (OR 2.5, CI 1.1-5.7, p = 0.027) using logistic regression analyses adjusted for age, sex and location. The inclusion of metabolic risk factors in the model increased the ORs for obesity (OR 12.6, CI 2.8-56.5, p = 0.001) and underweight (OR 7.9, CI 1.0-66.3, p = 0.056). CONCLUSION: AD may be associated with obesity, underweight and abdominal obesity at later life. Larger prospective studies are required to investigate this further.     

Sex-specific, independent associations of insulin resistance with erythrocyte sedimentation rate in apparently healthy subjects

Insulin resistance and erythrocyte sedimentation rate (ESR, a non-specific marker of inflammation) are known risk factors for cardiovascular disease. Although obesity is associated with increased ESR, it is unclear whether insulin resistance is associated with ESR in humans. The relationship between insulin resistance and ESR was studied in a cross-sectional, health-area based study of 140 (89 men and 51 women) apparently healthy Caucasians subjects. ESR, additional inflammatory markers [soluble tumor necrosis alpha receptors 1 and 2 (sTNFR1 and sTNFR2); C-reactive protein (CRP)], and insulin sensitivity (SI, frequently sampled intravenous glucose tolerance test with minimal model analysis) were assessed in all subjects. An interaction with sex was documented in the relationship between ESR and both insulin resistance and obesity (p < 0.05), as log ESR correlated with log SI in men (r=-0.29, p=0.009), but not in women (r=-0.14, p=0.33), and correlated with body mass index (BMI) in women (r=0.49, p=<0.0001), but not in men (r=0.15, p=0.16). On multivariate analyses, these associations proved to be independent of known covariates, such as age, hematocrit, smoking and additional inflammatory markers in both men and women. In a replication study, variables independently associated with ESR were also insulin resistance (homeostasis model assessment) in men and obesity markers (either BMI or fat mass) in women. In conclusion, ESR is independently associated with either insulin resistance or obesity in a sex-specific manner. These findings contribute to explain the known relationship of this inflammatory marker with cardiovascular disease.     

Gender differences in association of plasma adiponectin with obesity reflect resultant insulin resistance in non-diabetic Japanese patients with schizophrenia

Adipose tissues poorly produce adiponectin in the population with increased body fat mass and diabetes mellitus. It was investigated whether hypoadiponectinemia is associated with obesity and insulin resistance in patients with chronically medicated schizophrenia. A cross-sectional study was designed for 73 non-diabetic Japanese patients with schizophrenia. The patients aged <70 years with body mass index (BMI) > or =18.5 were selected. Anthropometrics and blood parameters including fat-derived cytokines were measured, and then the BMI and homeostasis model assessment-insulin resistance (HOMA-IR) was calculated. The variables were compared between the non-obesity (BMI, 18.5-24.9) and obesity (> or = 25.0) groups, and between genders. Plasma adiponectin negatively correlated with BMI (r = -0.554, P < 0.0003) and HOMA-IR (r = -0.380, P = 0.007) in men, but not in women. The obesity group in men, as compared with the non-obesity group, showed significantly lower plasma adiponectin (P = 0.008) and higher HOMA-IR (P < 0.05), but not in women. Plasma leptin showed a significant positive correlation with BMI (r = 0.604, P < 0.0001 in men; r = 0.763, P < 0.0001 in women) and HOMA-IR (r = 0.618, P < 0.0001 in men; r = 0.679, P < 0.0001 in women). The mean plasma leptin in the obesity group was significantly higher than that in the non-obesity group (P < 0.01 in men; P < 0.01 in women). In contrast to plasma leptin, plasma adiponectin showed gender difference in relation to BMI and HOMA-IR.     

Obesity and depressive symptoms in Chinese elderly

OBJECTIVES: The main objective was to examine the association between obesity and depressive symptoms among Chinese elderly in Hong Kong. METHODS: Cross-sectional data on depressive symptoms and body mass index from 56 167 clients aged 65 or over who enrolled as members of Elderly Health Centres from July 1998 to December 2000 were analysed using multiple logistic regression with adjustment of potential confounders. RESULTS: Among 18 750 men and 37 417 women, the prevalence [95% confidence interval (CI)] of depressive symptoms (based on the Geriatric Depression Scale) was 4.9% (4.6-5.2%) and 7.9% (7.6-8.1%) respectively (p < 0.001). The prevalence of obesity (by World Health Organisation Asian standard: body mass index > or =25.0) in women was significantly higher than that of men (42.1% (41.6-42.7%) vs 36.6% (35.9-37.3%), p < 0.001). Obese men and women were about 20% less likely to suffer from depressive symptoms compared with those with normal weight after adjustment for confounders, with odds ratios (95% CI) of 0.82 (0.69-0.97) and 0.78 (0.71-0.86) respectively. Negative linear trends were observed between depressive symptoms and BMI categories in both sexes, and women showed a greater slope and stronger statistical significance than men. CONCLUSIONS: Both obese elderly men and women in Hong Kong were less likely to suffer from depressive symptoms than those of normal weight. The results support the 'jolly fat' hypothesis previously restricted to men, and extend the hypothesis to female elderly. Chinese traditional culture and positive values towards obesity may be protective against depressive symptoms.     

Relationship between obesity and depression in older Australian adults and examination of dietary patterns as influencing factors

This study aims to investigate the association between depression and obesity in older adults in Australia and the influencing effects of dietary patterns. The cross-sectional study design was used for the study. The study was conducted across nine community settings in Gold Coast, Queensland. The study cohort included 301 randomly selected men and women, aged 50–88 years. Depression was measured using the General Health Questionnaire. Body mass index (BMI) was assessed according to the Australian Bureau of Statistics criteria, and obesity was classified as a BMI of 30.0 kg/m². Dietary pattern was measured using a standardized Food Frequency Questionnaire. The associations between anxiety or depression and BMI and the dietary patterns were estimated using multinomial logistic regression models. In all participants, dietary patterns were associated with both depression and obesity. Diets had mediating effects on the association between depression and obesity. Participants who consumed more high-fat meat products and fewer fruits and vegetables had an increased chance of obesity. Participants who were depressed did not have an increased chance of obesity when dietary patterns were adjusted in the multinomial logistic regression model. The results of the study suggest that dietary patterns are related to both depression and obesity and are important mediators in the increasing probability of obesity. The results have implications to inform intervention programmes to target dietary-intake behaviour change so that depression and obesity can be prevented in older adults.     

Depressive symptoms during childhood and adult obesity: the Zurich Cohort Study

Depression and obesity have become major health problems with increasing prevalence. Given the limited effectiveness of treatment for weight problems, the identification of novel, potentially modifiable risk factors may provide insights on new preventive approaches to obesity. The purpose of this study was to test the hypothesis that depressive symptoms during childhood are associated with weight gain and obesity during young adulthood. Participants were from a prospective community-based cohort study of young adults (N=591) followed between ages 19 and 40 years. The sample was stratified to increase the probability of somatic and psychological syndromes. Information was derived from six subsequent semistructured diagnostic interviews conducted by professionals over 20 years. The outcome measures were body mass index (BMI) and obesity (BMI>30). Among women, depressive symptoms before age 17 years were associated with increased weight gain (4.8 vs 2.6% BMI increase per 10 years) representing greater risk for adult obesity (hazard ratio=11.52, P<0.05). Among men, only after controlling for confounders, depressive symptoms before age 17 years were associated with increased weight gain (6.6 vs 5.2% BMI increase per 10 years) in adulthood but not with occurrence of obesity. These associations between childhood depressive symptoms and adult body weight were adjusted for baseline body weight, a family history of weight problems, levels of physical activity, consumption of alcohol and nicotine, and demographic variables. As the magnitude of the associations was high, and depression during childhood is a prevalent and treatable condition, this finding may have important clinical implications for the prevention and treatment of obesity. Whether the results of this study are limited to populations with elevated levels of psychopathology remains to be tested.     

Gender specific temporal and cross-sectional associations between BMI-class and symptoms of depression in the elderly

ObjectiveThe aim of the study was the gender specific analysis of cross-sectional and longitudinal associations between body mass index class (BMI-class) and symptoms of depression in a representative sample of elderly German people.MethodsAt the baseline of the ESTHER study (2000–2002), 9953 participants completed a comprehensive questionnaire including items regarding weight, height, and depression history. After five years, 7808 participants again completed the questionnaire and the 15-item geriatric depression scale (GDS-15). BMI was classified into five classes: normal weight, 18.5≤BMI<25; overweight, 25≤BMI<30; obesity class I, 30≤BMI<35; obesity class II, 35≤BMI<40; obesity class III, BMI≥40.ResultsLogistic regression analysis for the cross-sectional data at five-year follow-up, adjusted for age, education, marital status, smoking, multimorbidity, physical activity, self-perceived cognitive impairment, and use of antidepressants, showed that the odds for depression were significantly elevated for women in obesity class II and significantly decreased for overweight men. The longitudinal analysis showed a similar pattern: Women in obesity classes II and III at baseline had significantly higher odds for being depressive five years later than women with normal weight at baseline (class II: OR=1.67; 95%CI=[1.06; 2.64]; class III: OR=2.93; 95%CI=[1.37; 6.26]; overweight men had lower odds than normal-weight men (OR=0.69; 95%CI=[0.51;0.92]).ConclusionThe relationship between obesity and symptoms of depression appears to be heterogeneous across BMI-classes. Women are more affected than men by obesity class II and III; overweight appears to be associated with reduced risk of depression in elderly men.     

Obesity in women in relation to mental illness,social factors and personality traits

The relationships between obesity and a number of psychosocial variables were studied in 800 women in the age-strata 38, 46, 50 and 54 years. The women were representative of the general population of women in the age-strata studied. Obesity was defined as the upper decile of a body weight index, defined according to Broca, in the various age-strata. High social class and high performance in school were negatively related to obesity. There was no significant relationship between social class in childhood and obesity at the investigation. Nor was there a significant relationship between number of psychosocial stressors and obesity. The shift towards higher social class during life characteristic of the study population was negatively associated with obesity. There were no significant relationships between obesity and present or previous mental illness (present disability degree, depth of depression, frequency of anxiety attacks, phobia grade, present use of psychotropic drugs, maximum disability degree during life, use of psychotropic drugs during life, contact with a psychiatrist) when due allowance was made for age and social class. There were, however, significant relationships between obesity and the personality traits extraversion (EPI) and sociability (CMPS) when allowance was made for age and social class.     

The relationship between body mass index and the diagnosis of carpal tunnel syndrome

Increased weignt and, more recently, body mass index (BMI), have been suggested as risk factors for carpal tunnel syndrome (CTS). In an effort to determine the relative risk (RR) of obesity in the development of CTS, 949 patients who had an evaluation of the right upper extremity that included motor and sensory conduction studies of the median and ulnar nerves were reviewed. Of these patients, 261 were diagnosed with a median mononeuropathy at the wrist. Those individuals who were classified as obese (BMI > 29) were 2.5 times more likely than slender individuals (BMI < 20) to be diagnosed with CTS. Forty-three percent of obese women and 32% of obese men had the diagnosis of CTS compared to 21% of slender women and 0% of slender men. © 1994 John Wiley & Sons, Inc.     

Associations between anxiety, depression, and the metabolic syndrome.

BACKGROUND: There is limited evidence as to whether the metabolic syndrome (MetS) is associated with depression or anxiety and, if so, whether this association is gender-specific. This study investigated in each gender whether the MetS is associated with anxiety or depression and whether these relationships are independent of age, obesity, smoking status, socioeconomic factors, and lifestyle. METHODS: Metabolic syndrome (American Heart Association/National Heart, Lung, and Blood Institute criteria), depression, and anxiety (Hospital Anxiety and Depression Scale) were assessed in 1598 subjects at risk of cardiovascular disease. RESULTS: In both men and women, the MetS was associated with an increased prevalence of depression but not anxiety. The number of components of the MetS increased with increasing levels of depression but not anxiety. This association between the MetS and depressive symptoms was independent of age, smoking status, socioeconomic factors, and lifestyle. The relationship was observed across body mass index categories and was independent of anxiety. CONCLUSIONS: The MetS is associated with depression and depressive symptoms but not anxiety irrespective of gender and overweight/obesity status in subjects at risk of cardiovascular disease. These findings suggest a potential importance of screening for depression in patients with the MetS.     

Body mass index and hospital discharge outcomes after ischemic stroke

BACKGROUND: Obesity is a risk factor for vascular disease and has been associated with poorer outcomes in hospitalized patients. OBJECTIVE: To evaluate the relationship between body mass index (BMI) (calculated as weight in kilograms divided by height in meters squared) and discharge outcomes among persons hospitalized for ischemic stroke. METHODS: The relationship between BMI and discharge outcomes was analyzed in 805 consecutive patients with ischemic stroke admitted to a university hospital stroke service. Patients were categorized into 4 BMI categories representing lean, overweight, and class I and class II obesity. Outcome measures analyzed included discharge functional activity, direct discharge to home, and length of hospital stay. The independent effect of BMI on outcome was evaluated with regression analysis, adjusting for other variables known to predict outcome after ischemic stroke. RESULTS: Four hundred fifty-one individuals (56.0%) met study criteria. Mean age was 65 years, and 28.0% were men. In multivariate analysis, the highest BMI category (compared with lowest BMI category) was associated with the least likelihood of being discharged directly home from the hospital stroke service (26% vs 45%, P = .04), and the upper 2 BMI categories (compared with lowest BMI category) were associated with a trend toward extended length of hospital stay (6.3 vs 5.2 days, P = .08). No significant differences in the functional activity outcome were noted across BMI categories. CONCLUSIONS: Elevated BMI is associated with a lower likelihood of being discharged home and a trend toward extended hospital stay among patients hospitalized for ischemic stroke. Body mass index at hospital admission had no relation to discharge functional activity after stroke.     

Bioelectric impedance is a better indicator of obesity in men with schizophrenia than body mass index

Body mass index (BMI) is commonly used as an indicator of obesity, although in both clinical and research settings the use of bioelectric impedance analysis (BIA) is commonplace. The purpose of this study was to examine the relationship between BMI, BIA and percentage body fat to determine whether either is a superior indicator of obesity in men with schizophrenia. The reference method of deuterium dilution was used to measure total body water and, subsequently, percentage body fat in 31 men with schizophrenia. Comparisons with the classification of body fat using BMI and BIA were made. The correlation between percentage body fat and BMI was 0.64 whereas the correlation between percentage body fat and BIA was 0.90. The sensitivity and specificity in distinguishing between obese and overweight participants was 0.55 and 0.80 for BMI and 0.86 and 0.75 for BIA. BIA proved to be a better indicator of obesity than BMI. BMI misclassified a large proportion of men with schizophrenia as overweight when they had excess adiposity of sufficient magnitude to be considered as obese. Because of the widespread use of BMI as an indicator of obesity among people with schizophrenia, the level of obesity among men with schizophrenia may be in excess of that previously indicated.     

Body mass index, waist circumference, waist-hip ratio and depressive symptoms in Chinese elderly: a population-based study

BACKGROUND: Studies that investigated the relationship between obesity and depressive symptoms in the elderly have generated conflicting findings, partly because of the use of body mass index (BMI) alone to measure obesity in the elderly. The use of BMI fails to account for varying proportions of muscle, fat and bone, and few studies have used other measures of central obesity, such as waist-hip ratio (WHR) and waist circumference (WC). OBJECTIVES: We examined whether individually BMI, WHR and WC were consistently associated with depressive symptoms in the elderly. METHODS: Analysis of cross-sectional data of 2604 community dwelling Chinese elderly aged 55 and above, including socio-emotional characteristics, self-rated health and functional status, anthropometric measurements and Geriatric Depression Scale (15 items, GDS-15). RESULTS: There was a negative trend in the prevalence of depressive symptoms (GDS > or =5) across increasing BMI categories: 16.9% in low BMI, 14.2% in normal weight, 12.1% in moderate to high BMI. The associations for moderate to high BMI (OR, 0.77; p = 0.04) relative to normal BMI, were statistically significant after controlling for confounding variables. However, no consistent trends in the prevalence of depressive symptoms and OR's were observed for increasing WHR and WC categories. CONCLUSION: Our results suggest that waist-hip and circumference measures of central obesity did not support an inverse relationship of obesity and depressive symptoms. An inverse relationship of BMI with depressive symptoms may indicate greater physiologic and functional reserve from greater muscle mass that protects against depressive symptoms.     

Leptin concentrations are increased in subjects treated with clozapine or conventional antipsychotics.

BACKGROUND: Overweight is a considerable clinical problem in patients treated with antipsychotic agents. Recent results suggest that insulin resistance with increased insulin levels is also associated with treatment with the atypical antipsychotic agent clozapine. Leptin is important for the control of body weight and has been proposed to be a link between obesity and the insulin resistance syndrome. This study examined if clozapine-treated subjects and subjects treated with conventional antipsychotics had increased leptin levels compared with the general population and whether there was a gender difference in this respect. METHOD: Clozapine-treated patients (N = 41), patients treated with conventional antipsychotic drugs (N = 62), and healthy subjects from the Northern Sweden Monitoring of Trends and Determinants in Cardiovascular Disease (MONICA) project (N = 189) were investigated with a cross-sectional study design. Weight, body mass index (BMI), and plasma leptin concentrations were measured, and all study subjects were investigated for the presence of diabetes mellitus. Drug treatment, health status, and smoking habits were registered. RESULTS: After adjustment for gender, BMI, smoking habits, age, and diabetes, hyperleptinemia was independently (p < .001) associated with clozapine treatment and with treatment with conventional antipsychotics (p < .005) within a multiple regression analysis. In separate multiple regression analyses, leptin levels were significantly associated with clozapine treatment in men (p = .002) and women (p =.023) and with conventional antipsychotic treatment in men (p = .027) but not in women. CONCLUSION: Treatment with clozapine as well as with conventional antipsychotics is associated with increased levels of circulating leptin. Hyperleptinemia can be an important link in the development of overweight and the insulin resistance syndrome in subjects receiving antipsychotic drugs, especially atypical agents like clozapine.     

Binge eating,body mass index,and gastrointestinal symptoms

Objective

Symptoms of both gastroesophageal reflux disease (GERD) and irritable bowel syndrome (IBS) are frequently reported by individuals who binge eat. Higher body mass index (BMI) has also been associated with these disorders and with binge eating (BE). However, it is unknown whether BE influences GERD/IBS and how BMI might affect these associations. Thus, we examined the potential associations among BE, GERD, IBS, and BMI.

Methods

Participants were from the Swedish Twin study of Adults: Genes and Environment (STAGE) and provided information on disordered eating behavior, BMI, gastrointestinal (GI) disorders, and commonly comorbid psychiatric and somatic illnesses. Key features of GERD and IBS were identified to create modified definitions of both disorders that were used as primary outcome variables. Logistic regression models were applied to determine the association between BE and each GERD/IBS both independently and in the context of BMI and other commonly comorbid psychiatric and somatic morbidities.

Results

Prevalence estimates for GERD and IBS were higher among women than men (all p-values < .001). Only the association between BE and IBS was significant in both men and women after adjustment for BMI and the psychiatric/somatic morbidities.

Conclusion

BE appears to be an important consideration in the presence of IBS symptoms in both men and women, even when considering the impact of BMI and other commonly comorbid conditions. This association underscores the importance of routine assessment of BE in patients presenting with IBS to effectively manage the concurrent presentation of these problems.     

Body mass index in adults with intellectual disability: distribution, associations and service implications: a population-based prevalence study

Background Previous studies of weight problems in adults with intellectual disability (ID) have generally been small or selective and given conflicting results. The objectives of our large‐scale study were to identify inequalities in weight problems between adults with ID and the general adult population, and to investigate factors associated with obesity and underweight within the ID population. Methods We undertook a population‐based prevalence study of 1119 adults with ID aged 20 and over on the Leicestershire Learning Disability Register who participated in a programme of universal health checks and home interviews with their carers. We performed a cross‐sectional analysis of the register data and compared the observed and expected prevalences of body mass index categories in the ID and general populations using indirect standardisation for age. We used logistic regression to evaluate the association of a range of probable demographic, physical, mental and skills attributes with obesity and underweight. Results In those aged 25 and over, the standardised morbidity ratio (SMR) for obesity was 0.80 (95% CI 0.64–1.00) in men and 1.48 (95% CI 1.23–1.77) in women. The SMR for underweight was 8.44 (95% CI 6.52–10.82) in men and 2.35 (95% CI 1.72–3.19) in women. Among those aged 20 and over, crude prevalences were 20.7% for obesity, 28.0% for overweight, 32.7% for normal weight and 18.6% for underweight. Obesity was associated with living independently/with family, ability to feed/drink unaided, being female, hypertension, Down syndrome and the absence of cerebral palsy. Underweight was associated with younger age, absence of Down syndrome and not taking medication. Conclusion Obesity in women and underweight in both men and women was more common in adults with ID than in the general population after controlling for differences in the age distributions between the two populations. The associated factors suggest opportunities for targeting high‐risk groups within the ID population for lifestyle and behaviour modification.     

Weight gain in adulthood in relation to socioeconomic factors,mental illness and personality traits: A prospective study of middle-aged women

The relationships between body weight change during a six-year follow-up period and a number of psychosocial variables were studied in a representative population sample of middle-aged women. Those women who had gained weight ? 5.0 kg were compared with the rest of the sample taking into account age, social class and initial level of obesity. Never-married women were over- represented among the women with weight gain ? 5.0 kg. Husband's social class (based on occupation) was inversely related with weight gain. Educational level, own social class and annual income were not significantly different between the two groups. There was a positive relation between mental illness (disability degree), depth of depression and weight gain. Use of psychotropic drugs, frequency of anxiety attacks and phobia grade were not related to weight gain, however. The personality trait order was positively related to weight gain, while there were no significant relationships between the other personality variables studied and weight gain. The study thus indicates that psychosocial factors might be of causal importance for the development of obesity in adult women. Further studies on the role of these factors for regulation of energy intake and expenditure seem to be justified.