The Impact of Obesity on Suicidality among Female Patients Suffering from Bipolar Affective Disorder: The Indirect Role of Body Dissatisfaction

IntroductionObesity is becoming a growing public health challenge and a preventive and therapeutic priority among the adult population, with a significant increase in prevalence recorded over the past two decades [1-3]. Obesity not only constitutes a serious health threat, it is also comorbid with other medical conditions, including psychiatric disorders [4-11]. One of the most frequent methods for establishing obesity is the measurement of the BMI (Body Mass Index), expressed as mass in kilograms over height in meters squared [12-13]. Obesity is a frequent condition among persons suffering from Bipolar Affective Disorder (BAD) and is associated with significant impairments in quality of life as a result of increased body weight [14-16]. It is significantly correlated with disorder outcome among patients suffering from BAD [17]. Obese persons, in comparison with those of average body weight, experience a greater number of depressive and manic episodes during their lifetime, and their clinical presentations have a higher intensity of symptoms and more frequent depressive residues [18-22].Obesity is associated with several significant psychological and social factors such as poorer quality of life, deficient social functionality, greater sense of dissatisfaction, lowered self-esteem, and poorer overall bodily health [23-26]. Current cultural norms encourage the ideal of a slim body build. Contemporary Western cultures deem obese persons to be responsible for their state, and they promote an attitude of personal responsibility for many aspects of life including the control of body weight and appearance. As a result of these cultural assumptions, obese people are often described as "lazy, ugly and stupid." Obese persons therefore, often experience discrimination and are stigmatized in their professional and private lives. Taking into consideration these negative attributions, it is logical that obese persons face an increased risk of developing various disorders, including severe, mental disorders and suicidal behaviors [20-27].Suicidal behavior is defined as encompassing a broad semantic spectrum: from suicidal ideation, verbalization, planning, intent and self-harming to attempted suicides and their execution, i.e., committing suicide. Suicidal behavior is an etiologically complex phenomenon predicated on biological, environmental, developmental and learned factors [28-31]. With BAD, there is a high rate of suicidal risk of approximately 15 percent. Suicidal behaviors are the third leading general cause of mortality, and the third leading cause of mortality in the 15- to 24-year-old age group [21,24,32-35].In similar studies of large, nationally representative sample groups (over 40,000 people), Carpenter et al. found a gender-dependent correlation between obesity and depression. Among a group of obese women, 37% had experienced a severe depressive episode, 20% had experienced suicidal ideation, and 23% had attempted suicide in the past year. Among women of average body mass, no correlation with either depression or suicidality was found [7].Women are preoccupied with their body mass and figure. They aspire to an ideal body, and they evaluate themselves based upon how they look, i.e., their outer appearance [36-39]. The perception itself of real bodily appearance is affected by the "ideal" appearance of a body and social stereotypes [37,40,41]. The body is seen as a reflection of the self. The body image is both a way in which people experience themselves but, equally importantly, a way in which they believe that others see them. Body image changes constantly over the lifetime depending upon objective and subjective influences (growth, trauma, pain, operations). The cultural environment and its common definitions of what is desirable and attractive play a significant role in the devel- opment of body image. A person's body image includes their perception of cultural standards, an evaluation of the measure in which they are consistent with standards, and a perception of the importance of membership in a cultural group and of one's place within it [40-42]. …