www.kjfp.or.kr 311 INTRODUCTION
In modern society, relatively young women with leptosomatic phy- siques are considered to be ideal and tend to have advantages. On the other hand, obese and overweight women tend to be discriminated against and face social disadvantages. What is worse, women who are of
normal weight are also facing social discrimination and disadvantages.
Therefore some women, even those who are of normal weight and not obese or overweight, long to have leptosomatic physiques considered to be ideal in modern society and attempt to do so by reducing their weight.1,2) In fact, obesity is related to not only physical problems but also psychological problems.3,4) Moreover, social prejudice against obese peo-
Received September 6, 2017 Revised October 11, 2017 Accepted October 19, 2017
Corresponding author Jiyeong Heo Tel: +82-51-610-9060, Fax: +82-55-758-2241 E-mail: [email protected]
ORCID: https://orcid.org/0000-0001-6681-6182
Copyright © 2019 The Korean Academy of Family Medicine
This is an open-access article distributed under the terms of the Creative Commons At- tribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Brief
Communication
https://doi.org/10.21215/kjfp.2019.9.3.311 eISSN 2233-9116
Korean J Fam Pract. 2019;9(3):311-314
Korean Journal of Family Practice
KJFP
한국 20-40세 여성에서 식이조절과 자살사고의 연관성:
국민건강영양조사 2010년 자료 이용
허지영*, 권세륜, 심수정
좋은강안병원 가정의학과
The Relationship between Reduced Meals for Controlling Weight and Suicidal Ideations in Korean Women Aged 20-40 Years: The 2010-2012 Korean National Health and Nutrition Examination Survey
Jiyeong Heo*, Seryun Kwon, Sujung Shim
Department of Family Medicine, Good Gang-An Hospital, Busan, Korea
Background: Attempting unhealthy weight control can be related to psychological problems such as suicidal ideations, depression, and eating disorders. Therefore, we analyzed the relationship between reduced meals for controlling weight and suicidal ideations in Korean women aged 20–
40 years.
Methods: The Korean National Health and Nutrition Examination Survey is a cohort survey investigating the health behavior, chronic disease prevalence, and food and nutrition intake status of the Korean population. Ours is a cross-sectional study of 1,761 Korean women aged 20–40 years who were especially interested in weight control and who participated in the 2010–2012 Korean National Health and Nutrition Examination. We measured the percentages of smoking, drinking, educational standards, personal income, stress perception, depression, suicidal ideations, and obesity among the subjects. The participants’ age and body mass index were measured as weighted means and standard errors. The relationship between reduced meals for controlling weight and suicidal ideations in Korean women aged 20–40 years was examined by logistic regression analysis.
Results: Of the 1,761 participants who took the survey, 642 participants experienced suicidal ideations. After making all adjustments, the odds ratio of suicidal ideations with reduced meals was 1.237 (0.588–2.602).
Conclusion: The finding of this study revealed that there was no relationship between reduced meals for controlling weight and suicidal ideations.
Keywords: Suicidal Ideations; Reduced Meal; Weight-Control Methods; Mental Health
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312 Korean J Fam Pract. 2019;9(3):311-314
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ple has a negative influence on those problems.5) Although the majority of people mainly choose healthy weight control methods, such as regular exercise and having a balanced diet, some others who have an extraordi- nary obsession with what modern society considers to be an ideal body type tend to choose methods of critically excessive and unhealthy weight control. Even some people with normal weight, body mass index, and lipid profile select extremely unhealthy weight control methods such as fasting, skipping meals, going on monotrophic diets, engaging in inten- sive and excessive exercise, or taking diuretics, purgative medications, and herbal medications that have not been verified. Such critically exces- sive unhealthy weight control methods lead to psychological problems such as depression, suicidal ideations and so on.6,7) In particular, the rela- tionship between unhealthy weight control methods and psychological diseases including suicidal ideations was revealed in the study by Kittler, Menard, and Phillips (2007), which was conducted in the United States.6,7) Rapidly losing weight can also cause amenorrhea. One of the reasons for this is that dramatic changes in eating habits can lead to an increase in the level of leptin in blood.8) Psychological problems such as severe stress and depression can also change people’s eating habits the other way around.9,10) Women who have an unhealthy obsession with ac- quiring leptosomatic physiques have been linked to suicidal ideations and attempts.1) Thus, this study was conducted to determine the relation- ship between reduced meals for controlling weight and suicidal ideations in Korean women aged 20–40 years.
METHODS
1. Subjects
The Korean National Health and Nutrition Examination Survey is a cohort survey that investigates the health behavior, chronic disease prev- alence, and food and nutrition intake status of the Korean population.
The survey receives institutional review board approval from the Korea Centers for Disease Control and Prevention. This study analyzed data from the 2010–2012 Korean National Health and Nutrition Examination Survey (KNHANES). A stratified multistage clustered probability design was used to select a representative sample. Although a total of 25,534 par- ticipants responded to the health interview survey, the participants for this study were limited to Korean women aged 20–40 years, especially those who were interested in weight control, and the final sample for the present study comprised 1,761 individuals.
2. Study methods
Data on weight control methods, suicidal ideations, stress, and depres- sion were collected through a self-reported questionnaire survey. Prior to this survey, all subjects completed an informed consent form. The weight control methods used were assessed by the question: “During the last one year, have you chosen to have reduced meals without skipping meals to lose weight?” Possible answers to the question were “yes” or “no.” Suicidal ideations were assessed by the question: “During the last one year, have you ever had thoughts of committing suicide?” Possible answers to the question were “yes” or “no.” Stress was assessed by the question: “During the last one year, have you ever had stress lasting more than two weeks?”
Possible answers to the question were “yes” or “no.” Depression was as- sessed by the question: “Have you ever been diagnosed with depression by a doctor?” Possible answers to the question were “yes” or “no.” Body mass index was calculated using the formula: body weight (kg)/height2 (m2). Body weight and height were measured to the nearest 0.1 kg and 0.1 cm, respectively. Obesity was defined as a body mass index of more than 25.0 (kg/m2) in this study.
3. Statistical analysis
For analysis, we used the KNHANES stratification variables and sam- pling weights. We measured the percentages of smoking, drinking, edu- cational standards, personal income, stress perception, depression, sui- cidal ideations, and obesity among the subjects. The mean age and mean body mass index of participants were presented as weighted means and standard errors. A two-tailed test, which is appropriate for testing the dif- ferences in the means of a sample to examine the relationship between independent variables and dependent variables, was conducted. The odds ratio of suicidal ideations was calculated using logistic regression analysis and participants’ age, body mass index, drinking, smoking, in- come, education, stress, and depression data were adjusted. Data were analyzed using IBM SPSS Statistics 20.0 (IBM Co., Armonk, NY, USA).
A P-value <0.05 was considered to be statistically significant.
RESULTS
1. General characteristics of the study subjects according to non-reduced meals and reduced meals
The average ages of participants in the non-reduced meal and the re- duced meal groups were approximately 32.0 and 31.5 years old, respec-
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허지영 외. 한국 20–40세 여성에서 식이조절과 자살사고의 연관성
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tively (P>0.05). The average body mass index of both those in the non-re- duced meal and the reduced meal groups was approximately 23.3 (kg/
m2) (P>0.05). Smoking, drinking, stress, suicidal ideations, and obesity were not statically significant (P>0.05). The percentages of 20–30-year- olds in the non-reduced meal and the reduced meal groups were approxi- mately 45.2% and 49.1%, respectively (P<0.001), while those of 31–40-year-olds in the non-reduced meal and the reduced meal groups were approximately 54.8% and 50.9%, respectively (P<0.001). Education, income, and depression were statically significant (P<0.05). These results are shown in Table 1.
2. The relationship of suicidal ideations according to non-reduced meals and reduced meals
The adjusted relationship of suicidal ideations according to reduced meals is shown in Table 2. After making adjustments for age, body mass index, smoking, drinking, income, education, stress, and depression, the odds ratio with suicidal ideations for reduced meals was 1.237 (0.588–
2.602). There was no relationship between suicidal ideations and reduced meals.
DISCUSSION
This cross-sectional study examines the relationship of suicidal ide- ations among Korean women aged 20–40 years and their intake of non- reduced meals or reduced meals using the 2010–2012 KNHANES. In this study, no relationship was found between suicidal ideations and re- duced meals for controlling weight in the US-based study by Kittler, Me- nard, and Phillips (2007), a relationship between critically excessive methods of unhealthy weight control and psychological problems in- cluding depression and suicidal ideations was found.6,7) Reduced meals for controlling weight generally lead to increased blood cortisol levels.
Subjects who choose to consume reduced meals to control their weight tend to have a higher risk of suicidal ideations. Therefore, social support and education are needed to publicize sound and healthy methods of weight control to prevent individuals from experimenting with critically excessive unhealthy methods that will lead to negative outcomes.
This study has several limitations. First, it followed a cross-sectional design, making it difficult to determine a causal relationship. Second, there is a possibility of recall bias. Third, the accuracy of results may be limited, because the size of reduced meals and the total quantity of an ad- equate meal was not quantified. Finally, because the sample comprised relatively young Korean women who were especially interested in weight control and getting rid of excess fat, the generalizability of the study’s findings may be limited. In the future, we will use an expanded sample size to acquire a better understanding of the relationship between re- duced meals for controlling weight and suicidal ideations in Korean women.
Table 2. Logistic regression between non-reduced and reduced meal groups
Variables Odds ratio (95% confidence interval)
Model 1 1.188 (0.862–1.639)
Model 2 1.184 (0.858–1.633)
Model 3 1.156 (0.832–1.605)
Model 4 1.104 (0.796–1.530)
Model 5 1.237 (0.588–2.602)
Model 1 was adjusted for age. Model 2 was additionally adjusted for body mass index in addition to Model 1. Model 3 was additionally adjusted for smoking and drinking in addition to Model 2. Model 4 was additionally adjusted for in- come and education in addition to Model 3. Model 5 was additionally adjusted for stress and depression in addition to Model 4.
Table 1. General characteristics of the study subjects Variables Non reduced
meals (n=512)
Reduced meals (n=1,249) P-value
Age (y) 32.0±0.3 31.5±0.2 >0.05
20–30 45.2 (2.7) 49.1 (1.8) <0.001
31–40 54.8 (2.7) 50.9 (1.8) <0.001
Body mass index (kg/m2) 23.3±0.2 23.3±0.1 >0.05
Smoking (yes) 11.2 (1.8) 9.4 (1.1) >0.05
Drinking (yes) 56.4 (2.6) 54.8 (1.8) >0.05
Education <0.05
≤Elementary school graduate
1.2 (0.6) 0.3 (0.2)
Middle school graduate 2.9 (0.9) 1.9 (0.5) High school graduate 56.6 (2.5) 42.2 (1.8) ≥College graduate 39.2 (2.5) 55.0 (1.9)
Income <0.05
Low 30.6 (2.5) 25.3 (1.5)
Low-middle 25.0 (2.1) 25.2 (1.4)
Middle-high 27.1 (2.5) 23.9 (1.3)
High 16.6 (1.8) 24.4 (1.5)
Stress 39.4 (2.6) 37.8 (1.6) >0.05
Depression 31.2 (5.7) 23.1 (3.5) <0.05
Suicidal ideations 19.3 (2.1) 17.2 (1.3) >0.05
Obesity 26.8 (2.5) 25.3 (1.6) >0.05
Values are presented as mean±standard error or as % (standard error).
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CONFLICT OF INTEREST
No potential conflict of interest relevant to this article was reported.
ORCID
Jiyeong Heo, http://orcid.org/0000-0001-6681-6182 Seryun Kwon, http://orcid.org/0000-0002-9801-1044 Sujung Shim, http://orcid.org/0000-0002-9587-6886
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