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As if the many physical health concerns associated with the obesity epidemic weren’t worrisome enough, new research shines a light on an alarming mental health connection: Teenagers who are overweight are at higher risk of attempting suicide. Even teens who merely believe themselves overweight — but actually are not — are more predisposed to suicidal behavior, the researchers found.

The study, which appears online in the Journal of Adolescent Health, looked at more than 14,000 high school students to determine the relationship between a high body mass index (BMI) and suicide attempts, as well as the relationship between perceived overweight and suicide attempts, and found higher risk in both cases.

Contrary to what the researchers had originally expected, the association was as strong for boys as for girls, said lead study author Monica Swahn, PhD.

“This is a major concern since more and more children and youth are becoming overweight and obese,” said Swahn, associate professor in the Institute of Public Health at Georgia State University.

“The mental health issues and distress that some youth who are overweight may experience … appears to be a growing, but largely unaddressed, issue,” Swahn told Daily News Central. “We tend to overlook the need for mental healthcare and prevention and underestimate the scope and range of services needed.”

Reality vs. Perception

For the study, participants answered a survey question:”How do you describe your weight?” They could choose among five responses: very underweight, slightly underweight, about the right weight, slightly overweight or very overweight, Swahn said.

“In our analyses, we looked at those who said they were either slightly or very overweight to determine their potential increased risk for suicide attempts. Our study shows that those who felt that they were overweight were about 40 percent more likely to also report suicide attempt.”

Hatim Omar, MD, chief of the Division of Adolescent Medicine at the University of Kentucky, said his own experience has led him to believe that perceived obesity does increase both depression and suicide risk. “Teens are vulnerable because of their development,” he said, “and any actual or perceived changes in their lives, including weight issues, can potentially increase the risk of depression or suicide.”

Understanding these associations can help in the development of appropriate strategies for suicide prevention, according to the researchers.

“We cannot only focus prevention strategies on those who are overweight and who are concerned about their weight, but we also need to include youth who feel that they are overweight even though they may not be,” Swahn said.

Societal Pressures

“Youth feel very pressured to fit in and to fit certain limited ideals of beauty,” she added.

“Unfortunately, as a society, we are very focused on beauty and in particular weight,” she noted. “Weight gain and weight loss are pervasive issues that many of us struggle with. So, of course, these issues are linked to our well-being and our mental health.

The sad aspect of our findings is that it is not only those who actually are overweight that are at increased risk for suicide attempt, but also that those who perceive themselves as overweight, even if they’re not actually overweight, are at increased risk for suicide attempts.

This finding appears to reflect the very strong influence of social constructs related to body image and body ideals. It is also important to point out that in our study, the link between perceived overweight and suicide attempts was important for both boys and girls.”

Omar noted that “this study adds another wake-up call to providers, parents, teachers and society about the need for screening for depression and suicide risk in all teens, with special attention to teens with perceived or actual obesity.”

Signs of Depression

Swahn pointed to several common symptoms of depression that parents and caretakers can look for: persistent sad or irritable mood;loss of interest in activities once enjoyed;psychomotor agitation or retardation;feelings of worthlessness or inappropriate guilt; recurrent thoughts of death or suicide;difficulty concentrating;difficulty sleeping or oversleeping;loss of energy;significant change in appetite or body weight.

“If five or more of these symptoms are present for more than two weeks, it is very likely that the person can be diagnosed as depressed,” Swahn said.

What should be the role of parents, teachers, healthcare professionals and others in providing appropriate feedback to teens regarding weight and body image? Is there a conflict between nurturing health and fitness on the one hand, and self-esteem on the other?

“It is very important that we find a balance between supporting healthy eating and exercise to achieve well-being and pushing too hard for quick fixes, weight loss and unrealistic body ideals,” Swahn said. “All of us, as parents, caring adults, teachers and healthcare professionals, can have active roles in promoting healthy youth development that support healthy eating and frequent exercise.

External Influences

“However, it is important to recognize the many external influences that manipulate our eating,” she continued. “I just read Dr. [David] Kessler’s new book, The End of Overeating, which is a fascinating account of how the food industry, together with the advertising industry, have made it nearly impossible for some people to control their food intake.

Food has been manipulated, packaged and sold in a way to increase the proportions of sugar, salt and fat, which lead most of us wanting more and on a downward spiral to weight gain. Given this heavy influence, particularly among our children who are growing up with all these messages, it is clear that we need to serve as advocates for our children as well.”

The study authors recommend and encourage future research to examine issues pertaining to perceived and actual weight and their role in suicidal behavior.

“There is growing empirical evidence that there is a strong link between these,” said Swahn, “and that concerns about weight can contribute to distress and suicidal behavior. Ideally, future research should disentangle these associations … and also examine the factors that may alleviate the risk among those who perceive themselves to be overweight.”

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Tags: body shape, lead study author, suicide attempts, weight gain, suicidal behavior

Poor Sleep Linked to Higher BMI


A “good night’s sleep” may be more important than we think. In addition to allowing us to feel rested, energetic and clear-thinking, studies have shown that there are connections between sleep and heart health. There also has been research demonstrating that sleep may affect body weight.

The latest to shed light on the sleep-weight connection is a study presented Sunday at the American Thoracic Society’s 105th International Conference in San Diego, which indicates that body mass index, or BMI, is linked to length and quality of sleep in a surprisingly consistent fashion.

Researchers at Walter Reed Army Medical Center analyzed the sleep, activity and energy expenditures of 14 nurses who had volunteered for a heart-health program, part of the Integrative Cardiac Health Project.

The program included nutritional counseling, exercise training, stress management and sleep improvement.

The subjects were categorized either as “short sleepers” or “long sleepers.” The short sleepers tended to have a higher BMI, averaging 28.3, compared with the long sleepers, whose average BMI was 24.5, according to lead investigator Arn Eliasson, MD.

The short sleepers also had greater difficulty falling asleep and staying asleep, he reported.

In spite of sleeping less, the overweight individuals in the study were more active than the normal weight participants by about 25 percent, and they burned almost 1,000 more , the study found.

Dr. Eliasson suggested that stress could disrupt the length and quality of sleep, as well as increase eating and other behaviors contributing to weight gain

Also, getting less sleep appears to cause a reduction in leptin, a hormone that triggers the feeling of fullness, perhaps causing short sleepers to eat more.

Leptin’s Role

That raises the possibility of using leptin supplements to curb overeating.

“It is conceivable that leptin may become an agent that can be administered to help with weight management, but we are not there yet,” Dr. Eliasson told Daily News Central. “Science is still sorting out the role that leptin plays in weight management and its variation with sleep.”

He compared leptin to melatonin, in terms of the current level of scientific understanding of their roles.

“Melatonin pulses at predictable times that coincide with sleepy times of the day,” noted Dr. Eliasson. “However, melatonin administration is not a reliable soporific agent. So what gives? Rozerem (ramelteon, a melatonin receptor agonist) has made it to market to help with sleep but it is less reliable for regulating sleep and inducing sleep than other agents like the new benzodiazepine receptor agonists. We know even less about leptin at this time.”

Given the low likelihood that any magic pill will soon hit the market to make up for the effects of short sleep on body weight, one solution might be to get the proper amount of sleep. However, it can be tricky to figure out how much sleep you actually need for optimal functioning.

Calculating Sleep Needs

“Sleep needs vary greatly by individual, and there is no single good test to measure what an individual’s sleep need is,” Dr. Eliasson said.

On average, adults need regular episodes of about 8 hours 15 minutes per 24-hour period — but that’s a statistical average. The range is much broader: 4 hours to 10 hours, depending on the individual. Children require about 9 hours, and teens may need a little more. By adulthood, adults generally need about 8 hours per night, according to Dr. Eliasson.

Contrary to common belief, aging in itself doesn’t reduce the amount of sleep required, he noted. Other things may conspire to interfere with a regular schedule of night-time sleeping though, such as medical conditions, orthopedic issues, medications, mental health and living circumstances — whether one has to get up at the same time each morning to go to work or is retired, for example.

The result is that older people often break up their sleep into shorter episodes at night combined with daytime napping.

If you want to pinpoint the ideal amount of sleep for you, Dr. Eliasson suggests a six-month experiment: Attempt to get very regular amounts of a certain length of sleep for a few weeks, and keep a diary recording how you feel during that period. For example, get 7 hours of sleep per night for three to four weeks, noting what time you go to bed and get up, when you nap, and how you feel.

Keep those regular sleep hours on week days, weekends and holidays. Then, expand your sleep time to 7 hours 20 minutes per night for three to four weeks recording similar variables. Then, expand to 7 hours 40 minutes per night for three to four weeks, and so on. Over six months, you will be able to zero in on the amount of sleep needed to feel rested and be functioning in peak form.

“This sort of experiment takes a lot of dedication and time, and not many people are willing or able to make this happen,” Dr. Eliasson observed.

Primitive Biology

James Gangwisch, a post-doctoral fellow in psychiatric epidemiology at Columbia University, led an earlier study that found a relationship between sleep and obesity. He hypothesized that sleeping less might trigger our bodies to store more fat because we’re still functioning biologically like primitive humans.

Early humans may have slept less during the long days of summer when food was plentiful, Gangwisch suggested, and their bodies may have then stored extra fat in anticipation of the winter, when food would be scarce. Perhaps the bodies of short sleepers now function as though it’s perpetually summer, and they’re always storing as much fat as possible.

“The theory involving storing fat in the summer during periods of short sleep appeals to common sense and is a tidy way to explain why short sleep may favor weight gain,” Dr. Eliasson commented. “It would be lovely to have some measurable hormones or transmitters that would put names and faces on the characters of this unfolding story. Give science another five to 10 years!”

Future Research

Dr. Eliasson intends to continue researching this subject through the Integrative Cardiac Health Project at Walter Reed Army Medical Center.

There are currently plans in the works to evaluate the impact of stress reduction on sleep. Researchers will employ mechanisms such as exercise, meditation, acupuncture and acupressure to reduce stress and assess the effect on sleep induction, sleep duration, and energy expenditure. They hope to make their findings known in the next year or two.

Work in this field goes far beyond helping people achieve the pleasant aftermath of “a good night’s sleep.”

A body of research over the past decade has established that sleep has “a huge impact” on heart health, Dr. Eliasson pointed out.

“The association applies to both sleep quantity and sleep quality,” he said. “Not getting enough sleep makes people vulnerable to heart attacks and stroke — perhaps mediated through impact of insufficient sleep on glucose metabolism, cholesterol levels, and stress hormones. Likewise, poor quality sleep as demonstrated by the paradigm of sleep apnea increases risks for and stroke as well.

“The statistics are staggering,” Dr. Eliasson continued, “in that more than mild sleep apnea — moderate and severe sleep apnea — is associated with a three- to four-fold increased chance for developing and a five- to six-fold increased chance for stroke.

“Our hard-charging, on-the-go, 24/7 lifestyle carries measurable risks,” Dr. Eliasson concluded. 

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Tags: heart health program, army medical center, lead investigator, Walter Reed Army Medical Center, consistent fashion

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