Social Determinants, and Psychiatric and Cardiometabolic Comorbidities of Disordered Weight Control Behaviors and Body Weight Misperception

Abstract

This dissertation examined risk factors for disordered weight control behaviors (DWCB, i.e., fasting, skipping meals, one-food diet, self-induced vomiting, inappropriate laxatives/diuretics/diet pills use for weight control) at multiple levels including individual, school, and geographic area, and associations of DWCB and weight status estimation pattern (WSEP) with depressive symptoms (DepS) and metabolic syndrome (MetS). We used the Korea Youth Risk Behavior Web-based Survey in Paper 1, and the Korea National Health and Nutrition Examination Survey in Papers 2 and 3. Weight perception and control behaviors were measured by self-reported questionnaire, and DepS was measured by the Patient Health Questionnaire-9 Korean version. MetS was defined using the revised National Cholesterol Education Program’s Adult Treatment Panel III Guidelines. In Paper 1, through a four-level multilevel modeling approach, we found significant between-school and between-classroom variations in DWCB. Household and school environmental factors including vocational school (versus general), co-educational school (versus single-sex), higher/lower household income (versus med-level), and lower parental education were positively associated with DWCB, above and beyond individual characteristics, suggesting that social contextual factors, as well as individual-level factors, should be considered when developing effective prevention strategies. In Papers 2 and 3, we found that weight status overestimation (WSOE), compared with accurate estimation (WSAE), was positively associated with DepS among normal weight women, whereas underestimation (WSUE), compared with WSAE, was inversely associated with DepS among obese women. Conversely, WSOE, compared with WSAE, was positively associated with MetS among normal weight men, whereas WSUE, compared with WSAE, was inversely associated with MetS among obese men. Overall DWCB as well as fasting and skipping meals were positively associated with DepS only among women, whereas one-food diet and unprescribed diet pills use were positively associated with DepS only among men. Overall DWCB and skipping meals were inversely associated with MetS and low high-density lipoprotein cholesterol only among women. While our findings suggest potentially differential roles of WSEP and DWCB in predicting the risk of depression and MetS across gender, weight status, and specific DWCB, further studies are needed to better understand the influences of weight perception and control behaviors on cardiometabolic and mental health.