Relationships among Body Mass Index, Body Image, and Depression in Korean Adults: Korea National Health and Nutrition Examination Survey 2014 and 2016

BACKGROUND: This study extends the findings of our previous examination of the relationship between obesity and depression in Korean adults. Here, we further investigate the relationships among body image perception, weight control method, and depression based on data from the Korea National Health and Nutrition Examination Survey in 2014 and 2016. METHODS: In total, we analyzed 11,782 participants. We classified them into four groups according to body mass index (BMI): underweight (BMI <18.5 kg/m(2)), normal-to-overweight (BMI 18.5–24.9 kg/m(2)), obesity stage I (BMI 25.0–29.9 kg/m(2)), and obesity stage II (BMI >30.0 kg/m(2)). Current depression was defined as a score of at least 10 on the nine-item Patient Health Questionnaire. We performed chi-square tests and multivariate logistic regression analyses to examine the relationships among BMI, body image perception, method of weight control, and depression. RESULTS: Depression was diagnosed in 6.5% of the study participants. The underweight group had the highest odds ratio (OR) for depression (OR, 1.94; 95% confidence interval [CI], 1.42–2.65). Further, participants in the extremely lean subgroup within the underweight group had an even higher OR for depression (OR, 3.06; 95% CI, 2.28–4.10). Regarding weight management methods, the rate of depression was higher for fasting and for skipping or reducing a meal than for exercise. CONCLUSION: Biased BMI and body image perception are associated with increased incidence of depression. In addition, specific weight control methods, such as fasting, skipping a meal, and reducing food consumption, are also associated with increased incidence of depression.