Psychosocial factors and obesity in 17 high-, middle- and low-income countries: the Prospective Urban Rural Epidemiologic study

Abstract

Background/Objectives:Psychosocial stress has been proposed to contribute to obesity, particularly abdominal, or central obesity, through chronic activation of the neuroendocrine systems. However, these putative relationships are complex and dependent on country and cultural context. We investigated the association between psychosocial factors and general and abdominal obesity in the Prospective Urban Rural Epidemiologic study.Subjects/Methods:This observational, cross-sectional study enrolled 151 966 individuals aged 35–70 years from 628 urban and rural communities in 17 high-, middle- and low-income countries. Data were collected for 125 290 individuals regarding education, anthropometrics, hypertension/diabetes, tobacco/alcohol use, diet and psychosocial factors (self-perceived stress and depression).Results:After standardization for age, sex, country income and urban/rural location, the proportion with obesity (body mass index ⩾30 kg m−2) increased from 15.7% in 40 831 individuals with no stress to 20.5% in 7720 individuals with permanent stress, with corresponding proportions for ethnicity- and sex-specific central obesity of 48.6% and 53.5%, respectively (P<0.0001 for both). Associations between stress and hypertension/diabetes tended to be inverse. Estimating the total effect of permanent stress with age, sex, physical activity, education and region as confounders, no relationship between stress and obesity persisted (adjusted prevalence ratio (PR) for obesity 1.04 (95% confidence interval: 0.99–1.10)). There was no relationship between ethnicity- and sex-specific central obesity (adjusted PR 1.00 (0.97–1.02)). Stratification by region yielded inconsistent associations. Depression was weakly but independently linked to obesity (PR 1.08 (1.04–1.12)), and very marginally to abdominal obesity (PR 1.01 (1.00–1.03)).Conclusions:Although individuals with permanent stress tended to be slightly more obese, there was no overall independent effect and no evidence that abdominal obesity or its consequences (hypertension, diabetes) increased with higher levels of stress or depression. This study does not support a causal link between psychosocial factors and abdominal obesity.

Investigation Of Obesity-Related Mortality Rates In Delaware

“…This allowed us to evaluate, analyze, and report any mortality-related trends (and/or impacts) that could be correlated to various parameters, including diseases linked to obesity (Dietz, 2015; Yang & Colditz, 2015; Malik et al, 2013; Thornton & Beilfuss, 2016; Stokes & Preston, 2016; Wadden et al, 2002; Wang et al, 2011, Prince et al, 2015; Ware et al, 2016; Arnold et al, 2015; Rosengren et al, 2015; Taber et al, 2012; Shi et al, 2015; Finkelstein et al, 2004; Chang et al, 2010, 2014; Gupta, 2014; Masters et al, 2013; Kitahara et al, 2014; Finch & Crimmins, 2016; Flegal et al, 2004; Delaware Vital Statistics Data, 2015; U.S. Census Bureau, American FactFinder, 2015; CDC, 2015), socioeconomic factors (based on county residence, income, education) (Dietz, 2015; Yang & Colditz, 2015; Malik et al, 2013; Thornton & Beilfuss, 2016; Whaples, 2016; Stokes & Preston, 2016; Wadden et al, 2002; Wang et al, 2011; Arnold et al, 2015; Rosengren et al, 2015; Wang & Beydoun, 2007; Dinwiddie et al, 2016; Taber et al, 2012; Bower et al, 2015; Shi et al, 2015; Levi et al, 2014; Friede et al, 1993; Alemayehu & Berger, 2016; Raghupathi & Raghupathi, 2014; D’Souza, Walls, et al, 2015; Moss, 2015; Finkelstein et al, 2004; Chang et al, 2010, 2014; Gupta, 2014; Masters et al, 2013; Kitahara et al, 2014; Finch & Crimmins, 2016; Flegal et al, 2004; Delaware Vital Statistics Data, 2015; U.S. Census Bureau, American FactFinder, 2015; CDC, 2015), age (Dietz, 2015; Yang & Colditz, 2015; Malik et al, 2013; Thornton & Beilfuss, 2016; Whaples, 2016; Stokes & Preston, 2016; Wadden et al, 2002; Wang et al, 2011; Prince et al, 2015; …”

Associations between psychological stress and smoking, drinking, obesity, and high blood pressure in an upper middle‐income country in the African region

“…In this context, cortisol is a most‐studied hormone related to psychological stress, possibly because it can be reliably measured in various biologic media and because of its numerous effects on behaviors, metabolism, and immune activity (Nater, Skoluda, & Strahler, ). Psychological stress can also induce unhealthy conditions, for example, tobacco use (Castaneda et al, ; Rosengren et al, ; Rosengren et al, ), alcohol use (Rosengren et al, ; Stringhini, Viswanathan, Gedeon, Paccaud, & Bovet, ), obesity (Brunner, Chandola, & Marmot, ; Rosengren et al, ), type 2 diabetes mellitus (Castaneda et al, ; Rosengren et al, ), or high blood pressure (Gasperin, Netuveli, Dias‐da‐Costa, & Pattussi, ; Gilbert‐Ouimet, Trudel, Brisson, Milot, & Vezina, ; Steptoe, Brydon, & Kunz‐Ebrecht, ; Steptoe & Kivimaki, ). Of note, most studies on psychological stress and CVD are cross‐sectional and the direction of the associations cannot be defined (e.g., psychological stress can cause a person to drink, but drinking can also be a cause of psychological stress).…”

“…Psychological stress is typically associated with sex, age, and socioeconomic status (SES), which underlies the importance to adjust analyses between psychological stress and CVRFs for these sociodemographic variables. For example, low SES often predicts smoking, drinking, obesity, and type 2 diabetes (Brunner et al, 1997;Castaneda et al, 2016;Rosengren et al, 2015;Steptoe & Kivimaki, 2013;Stringhini et al, 2013), with some differences according to sex.…”

Effect of co-occurrence of overweight/obesity and psychosocial stress dimensions on risk factors for cardiovascular disease among construction workers

“…4 There is increasing evidence that psychosocial stress may contribute to overweight/obesity, particularly abdominal or central obesity, through chronic activation of the neuroendocrine system. 2 In particular, the risk of obesity may increase in highdemand, low-control work environments and for lateshift work, night duty, and those who work long hours. 5,6 In addition, high social support at work has been shown to be associated with overweight.…”

“…There is also an increased expectation for self-actualization, reliance on interpersonal coordination in the execution of work tasks, and increasing job insecurity. 2,3 Research has traced psychosocial stress to physical conditions, organizational structure, interpersonal conflict, nature of work, and personal characteristics, including overweight and obesity. 4 There is increasing evidence that psychosocial stress may contribute to overweight/obesity, particularly abdominal or central obesity, through chronic activation of the neuroendocrine system.…”