Are Overweight, Obesity, and Extreme Obesity Associated With Psychopathology? Results From the National Epidemiologic Survey on Alcohol and Related Conditions.

Objective: This study examined associations of overweight, obesity, and extreme obesity with sociodemographic characteristics and specific DSM-IV Axis I and II disorders among men and women.

Method: Face-to-face interviews were conducted in a large national survey of the adult U.S. population conducted from 2001 to 2002.

Results: In general, black men; black, Hispanic, and Native American women; women who were not married/cohabiting; and those residing in the South and Midwest and in rural areas were at greatest risk of overweight, obesity, and extreme obesity. Women with obesity and extreme obesity were more likely to have atypical major depressive episodes in their bipolar illness. Panic disorder was associated (odds ratio [OR] = 1.5) with overweight among men, and specific phobia was associated with overweight (OR = 1.2) and obesity (OR = 1.3) among women. Antisocial personality disorder was also associated with overweight (OR = 1.5) and extreme obesity (OR = 1.9) among women, and avoidant personality disorder was associated (OR = 1.7) with extreme obesity among women.

Conclusion: Obesity among women appears to be related to episodes of major depression with atypical features occurring in established bipolar I disorder. Due to symptom overlap, panic disorder among overweight men may signal the presence of an undiagnosed illness such as cardiovascular disease or diabetes mellitus, type 2. More frequent exposure/vulnerability to stress may predispose overweight/obese women to specific phobia. Treatment guidelines for psychiatric disorders need to address the management of comorbid overweight and obesity, and treatment guidelines for obesity need to address the management of comorbid psychopathology.