Date Published: February 05, 2017
Publisher: John Wiley and Sons Inc.
Author(s): Alexandra A. Brewis, Seung Yong Han, Cindi L. SturtzSreetharan.
Obesity consistently predicts depression risk, but the underlying mechanisms are poorly understood. Body concerns are proposed as key. South Korean society is characterized by extremely high levels of explicit weight stigma, possibly the highest globally. Using cross‐sectional Korean 2014 National Health Examination Survey (KNHANES) data, we test this proposition in a nationally representative sample of South Korean adults (N = 5,632).
Depressive symptoms (outcome variable), was based on the PHQ‐9. Weight status (predictor variable), was based on direct measures of height and weight converted to BMI. Weight concern was self‐reported. Mediation analyses tested how weight concern mediated the influence of weight status on depressive symptoms for women and men.
Current weight status influenced depressive symptoms in Korean adults, but not always directly. Concerns of being “fat” mediated that relationship. The effect increased significantly as BMI increased within “normal” and overweight/obese categories for women, and in overweight/obese categories for men. Even though women classified as underweight were significantly more depressed than those in other weight categories, there was no similar mediation effect related to weight concerns.
For South Koreans, the stress of adhering to social norms and avoiding stigma related to body weight seems to explain the relationship between higher body weight and more depressive symptoms. Women are more vulnerable overall, but men are not immune. This study demonstrates that body concerns help explain why weight predicts depression, and more broadly supports the proposition that widespread weight‐related stigma is a potentially major, if unrecognized, driver of population‐level health disparities.
Social stigma is proposed as a major unrecognized driver of population‐level health disparities, one vastly understudied as a key aspect of human health and biology (Hatzenbuehler, Phelan, & Link, 2013). A growing set of literature is considering how feeling “too fat,” exacerbated under social conditions of high weight stigma, might result in an array of negative health outcomes like weight gain and depression—with women especially at risk (see Major, Tomiyama, & Hunger, 2017 for a recent review). This theorized relationship is based almost entirely on analysis of data drawn from the US, Western Europe, and Australia, especially undergraduate college student samples. With the rise of overweight/obesity as a common aspect of contemporary human biology, and the concurrent rise of anti‐obesity public health efforts, weight stigma is globalizing (e.g., Brewis, Wutich, Falletta‐Cowden, & Rodriguez‐Soto, 2011; Marini, et al., 2013). Yet, we do not know if weight stigma might also exert significant influence on stress‐related health outcomes outside of the Anglosphere (cf. Hackman, Maupin, & Brewis, 2016; Maupin and Brewis, 2014), and if the risk is similarly feminized.
Alongside low national levels of obesity, South Korean beauty standards are stringent and normative ideals focus on the need for slim physical body presentation. Using a large nationally representative sample of adults, we found that body size predicts level of depressive symptoms. This analysis of nationally representative data from South Korea demonstrates that current weight status (BMI) influences depressive symptoms, but not necessarily directly. Specifically, concern about being “obese” (비만) is a significant mediator among both men and women who are classified by their BMI as overweight/obese, and among women classified as “normal,” so that greater concern led to a stronger relationship between BMI and depressive effects. Women are much more vulnerable to “fat” concerns overall, and this accordingly heightens their depressive risk relative to men as they go up in weight across both normal and overweight/obese weight categories.