Acta Medica Iranica 2012. 50(3):177-184.

BMI Correlation with Psychiatric Problems Among 10-18 Years Iranian Students
Marjan Zakeri, Mojtaba Sedaghat, Mohammad Esmaeil Motlagh, Reza Tayari Ashtiani, Glayol Ardalan


Obesity and its related emotional and physical consequences are a worldwide problem. Obese individuals are usually stigmatized. This study is proposed to assess the correlation between body mass index, gender and age with psychiatric symptoms among Iranian students. A number of 9172 students aged 10-18 years (53.5% girls and 46.5% boys) from all provinces of Iran participated in this study. Data was collected using the global school based health survey questionnaire of the World Health Organization (GSHS-WHO). Overall, prevalence of predictors of having emotional problems, depression and anxiety were 27.8%, 29.7% and 11.5% respectively. Girls had significantly higher prevalence of predictors of psychiatric symptoms. Overall obesity was a protective factor against emotional problems OR (CI95%):0.79(0.65-0.98), but it was attributable to obese boys OR (CI95%):0.72(0.55-0.95). Depression and anxiety symptoms were higher in intermediate school girls and high school girls and boys. More attention should be paid to girls' psychological problems. Besides, obesity had an indirect relation with predictors of having psychiatric problems in Iranian boys and it might be due to: (1) parents' beliefs about heaviness as a predictor of healthiness, (2) boys' lower vulnerability to psychological consequences of obesity and (3) lower pressure from parents on their obese sons to lose weight.


Child; Body mass index; Depression; Anxiety; Emotion; Iran

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Syed EU, Hussein SA, Haidry SE. Prevalence of emotional and behavioural problems among primary school children in Karachi, Pakistan: multi informant survey. Indian J Pediatr 2009;76(6):623-7.

Maughan B, Collishaw S, Meltzer H, Goodman R. Recent trends in UK child and adolescent mental health. Soc Psychiatry Psychiatr Epidemiol 2008;43(4):305-10.

Tick NT, van der Ende J, Verhulst FC. Twenty-year trends in emotional and behavioral problems in Dutch children in a changing society. Acta Psychiatr Scand 2007;116(6):473-82.

Office of Surveillance, Epidemiology, and Laboratory Services. Behavioral Risk Factor Surveillance System. Prevalence and Trends Data. Overweight and Obesity (BMI). [Internet] 2009 May 15 [cited 2012 Feb 15]; Available from: cat=OB&yr=2009&qkey=4409&state=All

Freedman DS, Khan LK, Serdula MK, Galuska DA, Dietz WH. Trends and correlates of class 3 obesity in the United States from 1990 through 2000. JAMA 2002;288(14):1758-61.

Ogden CL, Carroll MD, Curtin LR, McDowell MA, Tabak CJ, Flegal KM. Prevalence of overweight and obesity in the United States, 1999-2004. JAMA 2006;295(13):1549-55.

Lee IM, Manson JE, Hennekens CH, Paffenbarger RS Jr. Body weight and mortality. A 27-year follow-up of middle-aged men. JAMA 1993;270(23):2823-8.

Hajian-Tilaki KO, Sajjadi P, Razavi A. Prevalence of overweight and obesity and associated risk factors in urban primary-school children in Babol, Islamic Republic of Iran. East Mediterr Health J 2011;17(2):109-14.

Montazerifar F, Karajibani M, Rakhshani F, Hashemi M. Prevalence of underweight, overweight and obesity among high-school girls in Sistan va Baluchistan. East Mediterr Health J 2009;15(5):1293-300.

Anderson SE, Cohen P, Naumova EN, Must A. Association of depression and anxiety disorders with weight change in a prospective community-based study of children followed up into adulthood. Arch Pediatr Adolesc Med 2006;160(3):285-91.

Dixon JB, Dixon ME, O'Brien PE. Depression in association with severe obesity: changes with weight loss. Arch Intern Med 2003;163(17):2058-65.

Simon GE, Von Korff M, Saunders K, Miglioretti DL, Crane PK, van Belle G, Kessler RC. Association between obesity and psychiatric disorders in the US adult population. Arch Gen Psychiatry 2006;63(7):824-30.

Baumeister H, Härter M. Mental disorders in patients with obesity in comparison with healthy probands. Int J Obes (Lond) 2007;31(7):1155-64.

Bjerkeset O, Romundstad P, Evans J, Gunnell D. Association of adult body mass index and height with anxiety, depression, and suicide in the general population: the HUNT study. Am J Epidemiol 2008;167(2):193-202.

Carpenter KM, Hasin DS, Allison DB, Faith MS. Relationships between obesity and DSM-IV major depressive disorder, suicide ideation, and suicide attempts: results from a general population study. Am J Public Health 2000;90(2):251-7.

Sotoudeh G, Mirdamadi SR, Siassi F, Khosravi S, Chamari M. Relationships of overweight and obesity with hormonal and metabolic parameters in hirsute women. Acta Med Iran 2003;41(1):37-44.

Pabst SR, Negriff S, Dorn LD, Susman EJ, Huang B. Depression and anxiety in adolescent females: the impact of sleep preference and body mass index. J Adolesc Health 2009;44(6):554-60.

Peralta RL. Thinking sociologically about sources of obesity in the United States. Gender Issues 2003;21(3):5-16.

Eisenberg ME, Neumark-Sztainer D, Story M. Associations of weight-based teasing and emotional wellbeing among adolescents. Arch Pediatr Adolesc Med 2003;157(8):733-8.

Spiotta RT, Luma GB. Evaluating obesity and cardiovascular risk factors in children and adolescents. Am Fam Physician 2008;78(9):1052-8.

Malhotra A, Hillman D. Obesity and the lung: 3. Obesity, respiration and intensive care. Thorax 2008;63(10):925-31.

Moayeri H, Rabbani A, Keihanidoust ZT, Bidad K, Anari S. Overweight adolescents: a group at risk for metabolic syndrome (Tehran adolescent obesity study). Arch Iran Med 2008;11(1):10-5.

Pang W, Sun Z, Zheng L, Li J, Zhang X, Liu S, Xu C, Li J, Hu D, Sun Y. Body mass index and the prevalence of prehypertension and hypertension in a Chinese rural population. Intern Med 2008;47(10):893-7.

Herva A, Laitinen J, Miettunen J, Veijola J, Karvonen JT, Läksy K, Joukamaa M. Obesity and depression: results from the longitudinal Northern Finland 1966 Birth Cohort Study. Int J Obes (Lond) 2006;30(3):520-7.

Tang J, Yu Y, Du Y, Ma Y, Zhu H, Liu Z. Association between actual weight status, perceived weight and depressive, anxious symptoms in Chinese adolescents: a cross-sectional study. BMC Public Health 2010;10:594.

Warraich HJ, Javed F, Faraz-Ul-Haq M, Khawaja FB, Saleem S. Prevalence of obesity in school-going children of Karachi. PLoS One 2009;4(3):e4816.

Shields M, Tremblay MS. Canadian childhood obesity estimates based on WHO, IOTF and CDC cut-points. Int J Pediatr Obes 2010;5(3):265-73.

Orsi CM, Hale DE, Lynch JL. Pediatric obesity epidemiology. Curr Opin Endocrinol Diabetes Obes 2011;18(1):14-22.

Aziz S, Umm-e-Rubab, Noorulain W, Majid R, Hosain K, Siddiqui IA, Manzoor S. Dietary pattern, height, weight centile and BMI of affluent school children and adolescents from three major cities of Pakistan. J Coll Physicians Surg Pak 2010;20(1):10-6.

Zhai F, Wang H, Du S, He Y, Wang Z, Ge K, Popkin BM. Lifespan nutrition and changing socio-economic conditions in China. Asia Pac J Clin Nutr 2007;16 Suppl 1:374-82.

French SA, Story M, Neumark-Sztainer D, Fulkerson JA, Hannan P. Fast food restaurant use among adolescents: associations with nutrient intake, food choices and behavioral and psychosocial variables. Int J Obes Relat Metab Disord 2001;25(12):1823-33.

Nielsen SJ, Siega-Riz AM, Popkin BM. Trends in energy intake in U.S. between 1977 and 1996: similar shifts seen across age groups. Obes Res 2002;10(5):370-8.

Nielsen SJ, Siega-Riz AM, Popkin BM. Trends in food locations and sources among adolescents and young adults. Prev Med 2002;35(2):107-13.

Haines PS, Hama MY, Guilkey DK, Popkin BM. Weekend eating in the United States is linked with greater energy, fat, and alcohol intake. Obes Res 2003;11(8):945-9.

Jeffery RW, Utter J. The changing environment and population obesity in the United States. Obes Res 2003;11 Suppl:12S-22S.

Nielsen SJ, Popkin BM. Patterns and trends in food portion sizes, 1977-1998. JAMA 2003;289(4):450-3.

Young LR, Nestle M. The contribution of expanding portion sizes to the US obesity epidemic. Am J Public Health 2002;92(2):246-9.

Bowman SA, Gortmaker SL, Ebbeling CB, Pereira MA, Ludwig DS. Effects of fast-food consumption on energy intake and diet quality among children in a national household survey. Pediatrics 2004;113(1 Pt 1):112-8.

McCrory MA, Fuss PJ, Hays NP, Vinken AG, Greenberg AS, Roberts SB. Overeating in America: association between restaurant food consumption and body fatness in healthy adult men and women ages 19 to 80. Obes Res 1999;7(6):564-71.

French SA, Harnack L, Jeffery RW. Fast food restaurant use among women in the Pound of Prevention study: dietary, behavioral and demographic correlates. Int J Obes Relat Metab Disord 2000;24(10):1353-9.

Ma Y, Bertone ER, Stanek EJ 3rd, Reed GW, Hebert JR, Cohen NL, Merriam PA, Ockene IS. Association between eating patterns and obesity in a free-living US adult population. Am J Epidemiol 2003;158(1):85-92.

Nicklas TA, Yang SJ, Baranowski T, Zakeri I, Berenson G. Eating patterns and obesity in children. The Bogalusa Heart Study. Am J Prev Med 2003;25(1):9-16.

Thompson OM, Ballew C, Resnicow K, Must A, Bandini LG, Cyr H, Dietz WH. Food purchased away from home as a predictor of change in BMI z-score among girls. Int J Obes Relat Metab Disord 2004;28(2):282-9.

Maddah M. Childhood obesity and early prevention of cardiovascular disease: Iranian families act too late. Int J Cardiol 2008;126(2):292-4.

Jain A, Sherman SN, Chamberlin LA, Carter Y, Powers SW, Whitaker RC. Why don't low-income mothers worry about their preschoolers being overweight? Pediatrics 2001;107(5):1138-46.

Maddah M, Solhpour A. Obesity in relation to gender, educational levels and living area in adult population in Rasht, northern Iran. Int J Cardiol 2010;145(2):310-1.

KarasaliIhoğlu S, Oner N, Ekuklu G, Vatansever U, Pala O. Body mass index percentiles among adolescent girls living in Edirne, Turkey. Pediatr Int 2003;45(4):452-7.

Flynn MA. Fear of fatness and adolescent girls: implications for obesity prevention. Proc Nutr Soc 1997;56(1B):305-17.

Richardson LP, Davis R, Poulton R, McCauley E, Moffitt TE, Caspi A, Connell F. A longitudinal evaluation of adolescent depression and adult obesity. Arch Pediatr Adolesc Med 2003;157(8):739-45.

Pine DS, Goldstein RB, Wolk S, Weissman MM. The association between childhood depression and adulthood body mass index. Pediatrics 2001;107(5):1049-56.

Crisp AH, McGuiness B. Jolly fat: relation between obesity and psychoneurosis in general population. Br Med J 1976;1(6000):7-9.

Anderson SE, Cohen P, Naumova EN, Jacques PF, Must A. Adolescent obesity and risk for subsequent major depressive disorder and anxiety disorder: prospective evidence. Psychosom Med 2007;69(8):740-7.

Erickson SJ, Robinson TN, Haydel KF, Killen JD. Are overweight children unhappy?: Body mass index, depressive symptoms, and overweight concerns in elementary school children. Arch Pediatr Adolesc Med 2000;154(9):931-5.

Neumark-Sztainer D, Story M, French SA, Resnick MD. Psychosocial correlates of health compromising behaviors among adolescents. Health Educ Res 1997;12(1):37-52.

Moreno FA, McGahuey CA, Freeman MP, Delgado PL. Sex differences in depressive response during monoamine depletions in remitted depressive subjects. J Clin Psychiatry 2006;67(10):1618-23.

Nishizawa S, Benkelfat C, Young SN, Leyton M, Mzengeza S, de Montigny C, Blier P, Diksic M. Differences between males and females in rates of serotonin synthesis in human brain. Proc Natl Acad Sci U S A 1997;94(10):5308-13.

Deecher D, Andree TH, Sloan D, Schechter LE. Frommenarche to menopause: exploring the underlying biology of depression in women experiencing hormonal changes. Psychoneuroendocrinology 2008;33(1):3-17.


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