American Journal of Epidemiology Advance Access originally published online on July 14, 2006
American Journal of Epidemiology 2006 164(4):398-399; doi:10.1093/aje/kwj227
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Letter to the Editor |
RE: "ASSOCIATION OF BODY MASS INDEX WITH SUICIDE MORTALITY: A PROSPECTIVE COHORT STUDY OF MORE THAN ONE MILLION MEN"
1 Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208
2 Division of Health and Family Studies, Institute for Families in Society, University of South Carolina, Columbia, SC 29208
(e-mail: bvw2{at}cdc.gov)
The increased prevalence of obesity and overweight has been vividly identified as "a massive tsunami headed toward the United States" (1
). The "war on fat" is growing contentious in this country, and worldwide as well. One might assume that the question of the effects of overweight and obesity on mental health would have been well answered by now. Unfortunately, this is not the case. A recent cohort study of more than one million Swedish men followed for three decades demonstrated a protective effect of increased body mass index (BMI; weight (kg)/height (m)2) against completed suicide (2). Fat may really be jolly for some of us (3, 4). There is additional evidence for this possibility from US national surveys.
Suicide attempters and suicide completers are similar, both clinically and demographically (5). Consistent with the findings of the Swedish study (2), I observed a significant inverse association between attempted suicide and BMI among 3,488 American men aged 17–39 years in the Third National Health and Nutrition Examination Survey (6), a cross-sectional survey of noninstitutionalized US civilians conducted from 1988 to 1994. I obtained this association after adjusting for potential confounders, including a diagnosis of major depressive disorder (table 1); the p value for trend was 0.04. After excluding women who were pregnant or breastfeeding at the time of the survey, I found that among women (n = 3,750), increased BMI was associated with a history of attempted suicide. However, the association was statistically significant neither for BMI categories nor for the trend test (p > 0.50).
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My observation is also consistent with a study of 40,086 African-American and White participants interviewed in the National Longitudinal Alcohol Epidemiologic Survey (7
), which was not cited by the Swedish investigators. This survey found that increased BMI was associated with suicide ideation among women but lower BMI was associated with suicide attempts and suicide ideation among men.
The seemingly protective effect of increased BMI against suicidal behavior among men has been observed in both a large cohort study (2) and national cross-sectional surveys (6, 7). However, because all of these studies were hypothesis-generating, further investigation is clearly needed. Additionally, the psychological benefits of increased BMI, if any, would be heavily outweighed by the increased risks of other diseases. I do not propose that my findings and those of other investigators be used to encourage increased BMI. Instead, as Magnusson et al. correctly pointed out, they provide "insights into the biology of depression and suicide that may result in a greater understanding of its etiology, treatment, and prevention" (2, p. 7).
ACKNOWLEDGMENTS
Conflict of interest: none declared.
References
- Analysis: obesity could shorten lifespan of young by two to five years. Obes Week 2005;4(March). (http://www.obesityweek.org/members/Vol4/News/031205.htm).
- Magnusson PK, Rasmussen F, Lawlor DA, et al. Association of body mass index with suicide mortality: a prospective cohort study of more than one million men. Am J Epidemiol 2006;163:1–8.
[Abstract/Free Full Text] - Jasienska G, Ziomkiewicz A, Gorkiewicz M, et al. Body mass, depressive symptoms and menopausal status: an examination of the "jolly fat" hypothesis. Women's Health Issues 2005;15:145–51.[CrossRef][Web of Science][Medline]
- Li ZB, Ho SY, Chan WM, et al. Obesity and depressive symptoms in Chinese elderly. Int J Geriatr Psychiatry 2004;19:68–74.[CrossRef][Web of Science][Medline]
- Mann JJ. Neurobiology of suicidal behaviour. Nat Rev Neurosci 2003;4:819–28.[Web of Science][Medline]
- National Center for Health Statistics. Third National Health and Nutrition Examination Survey (NHANES III) public-use data files. Hyattsville, MD: National Center for Health Statistics, 1997. (http://www.cdc.gov/nchs/products/elec_prods/subject/nhanes3.htm).
- Carpenter KM, Hasin DS, Allison DB, et al. 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;90:251–7.
[Abstract/Free Full Text]
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