Unzufriedenheit mit dem eigenen Gewicht nach Reduktionsdiät bei Frauen und Männern:

Body weight dissatisfaction by socioeconomic status among obese, preobese and normal weight women and men: results of the cross-sectional KORA Augsburg S4 population survey

Background

Body weight dissatisfaction is an important factor in preventing weight gain and promoting weight loss or maintenance. This study focuses on differences in the rates of body weight dissatisfaction among obese, preobese and normal weight women and men by socioeconomic status within a general adult population in Germany.

Methods

Data were analyzed from 4186 adults aged 25 to 74 who participated in a cross-sectional, representative population-based health survey (KORA S4, 1999–2001, Augsburg region/Germany). Body mass was measured anthropometrically and indexed following international standards. Among the 2123 women participating in the survey, 40.3% had a normal weight, 34.9% were preobese, and 24.8% were obese (compared to 25.9%, 51.4% and 22.6% among men, respectively). Body weight dissatisfaction, educational level, household income and occupational status were assessed by computer-aided personal interviewing. An index for socioeconomic status was calculated and categorized into quintiles. Multiple logistic regressions were performed to test for differences in the odds of body weight dissatisfaction across socioeconomic strata in normal weight, preobese and obese groups. Body mass index, age, family status, place of residence and health behaviors were adjusted for.

Results

Overall, being dissatisfied with one’s body weight was more prevalent in women (48.3%) than in men (33.2%). In the normal weight group, no significant differences in the odds of being dissatisfied were found across socioeconomic groups among women or men. Among preobese men, compared to the lowest socioeconomic stratum, increased odds of being dissatisfied with one’s body weight were associated with the highest socioeconomic index group (OR = 2.3, 95% CI: 1.4–3.8), middle and high educational level (OR = 1.6, 95% CI: 1.1–2.3, and OR = 1.9, 95% CI: 1.3–3.7), high income (OR = 1.8, 95% CI: 1.2–2.7), and middle and high occupational status (both OR = 1.8, 95% CI: 1.2–2.6). Among preobese women, the odds of being dissatisfied were only significantly elevated in those with a middle educational level (OR = 1.6, 95% CI: 1.1–2.3). Among obese men, elevated odds were found in the highest socioeconomic index group (OR = 3.7, 95% CI: 1.8–7.5) and in those with a high educational level (OR = 2.3, 95% CI: 1.3–4.1), high income (OR = 2.6, 95% CI: 1.4–4.7), and middle and high occupational status (both OR = 2.2, 95% CI: 1.3–3.6). The odds of dissatisfaction among obese women were not associated with socioeconomic status as a whole, but were associated with a high educational level, albeit with a comparatively large confidence interval (OR = 3.6, 95% CI: 1.0–12.8).

Conclusions

In Germany, body weight dissatisfaction is more prevalent among obese and preobese men in high socioeconomic status groups, a pattern not found in women. The exception to this is a greater prevalence of dissatisfaction among obese and preobese women with a high educational level (albeit inconsistently). Moreover, there is a social gradient in body weight dissatisfaction, especially in obese men, which may partly explain why obesity is more prevalent in men with low socioeconomic status. It also suggests that they are a target group for obesity care in which body weight satisfaction is an important topic.

Obesity and health-related quality of life: does social support moderate existing associations?

OBJECTIVES

Obesity has been shown to be negatively related to physical health-related quality of life (HQOL) much more strongly than mental HQOL. This is remarkable given findings on obesity-related social stigmata and associations with depression. Considering obesity as a stressor, this study tests for a moderating role of social support for obesity/HQOL associations among women and men.

DESIGN

Data come from N=2,732 participants aged 35-74 years in a 2004-2005 general population survey in the Augsburg region, Germany.

METHODS

Body weight and height were assessed by anthropometric measurements (classified by body mass index using WHO standards), social support by the Social Support Questionnaire 14-item Short-Form (F-SozU-K14) and HQOL by the 12-item Short-Form Health Survey (SF-12). In multiple regression and general linear models, age, education, family status, health insurance, and place of residence were adjusted for.

RESULTS

Among both genders, obesity was associated with reduced physical but not mental HQOL. Among men reporting strong social support, physical HQOL was impaired neither in the moderately nor the severely obese group (compared with normal weight), while it was given less social support. Among women, poor physical HQOL was associated with obesity regardless of social support.

CONCLUSIONS

In this adult population sample, no association was found for obesity with mental HQOL. In contrast, a negative association with physical HQOL exists for all subgroups except men with strong social support, indicating that social support buffers obesity-related impairments in physical HQOL in men but not in women. This suggests that obese women and men with strong social support represent distinct populations, with possible implications for obesity care.

Public health is an interdiscipline, and about wholes and parts: indeed, critical health psychology needs to join forces

Hepworth's assessment of critical health psychology's capacity to contribute to public health promotion (this issue) is commented on and supplemented by selected issues relevant to Hepworth's timely call for interdisciplinary research and action in this context. Drawing on eco-epidemiology, multilevel research strategies are suggested that comprehensively account for individual/psychological and population/sociological factors. It is delineated how health promotion policies may be backed by psychologically informed policy analysis. Regarding health, it is argued to keep scrutinizing ill-health and to resist simplistic notions of quality of life or wellness but also to enhance these by incorporating concepts from positive psychology. Finally, it is considered whether trans disciplinarity may be in aid of fully realizing the potentials of blending the merits of health psychology and public health.

Use of medical doctors, physical therapists, and alternative practitioners by obese adults: does body weight dissatisfaction mediate extant associations?

OBJECTIVE

The objective of this study was to assess the association of obesity with the utilization of general practitioners (GP), medical specialists (MS), physical therapists (PT), and alternative practitioners (AP), and to elucidate whether body weight dissatisfaction mediates extant associations.

METHODS

In an adult population survey (KORA Survey S4 1999/2001) in Augsburg, Germany, anthropometric body mass [body mass index (BMI), kg/m(2)], utilization, physical comorbidities, functional limitations due to body weight, and body weight dissatisfaction were assessed and analyzed via multiple logistic regressions.

RESULTS

Obese adults (BMI>or=30) had around double odds of AP, GP, and PT utilization. Regarding AP and, to a lesser extent, PT, body weight dissatisfaction both had direct effects and mediated excess utilization. Most notably, the odds for AP use were about twofold in those who were dissatisfied, and the association of obesity and AP use diminished when adjustment for dissatisfaction was performed. Among overweight participants (25<or=BMI<30), only PT use was elevated and tended to be mediated by dissatisfaction as well.

CONCLUSION

Body weight dissatisfaction mediates obesity-attributable utilization of nonmedical health care providers, especially AP. Possibly, dissatisfaction leads to demands for psychosocial care that is expected to be offered by complementary and allied health professions. For health services utilization research, results call for a scrutiny of body weight dissatisfaction-a known barrier to adopting long-term healthy lifestyles. For practice, results indicate that AP and PT may have special opportunities to encourage the use of preventive services by obese adults.