Applied Research in Quality of Life

, Volume 9, Issue 2, pp 295–308 | Cite as

Mental Health and Obesity: A Meta-Analysis

  • Alejandro Magallares
  • Jose Luis Pais-Ribeiro


The relationship between obesity and psychological distress is not clear because research conducted so far is not conclusive, with some studies finding that obese people report less mental health than normal-weight individuals, whilst others find that obesity may work as a protective factor that prevents people with weight problems from developing mental health issues. In this meta-analysis we review research that compares the mental health (measured with SF-36) of class I obese people (Body Mass Index between 30 and 34.99) with normal weight people (Body Mass Index between 18 and 24.99) in non-clinical adult populations. The meta-analysis conducted assumed a random-effects model and a weighted mean effect size was calculated (d), together with its statistical significance and confidence interval. Results reveal that obese women report less mental health than normal weight females (d = −.26) but that obese men show more mental health than normal weight individuals (d = .62). The results give support to the so-called “Jolly Fat” hypothesis.


Obesity Mental health SF-36 “Jolly Fat” hypothesis 



  1. Anzures, J., & Higgins, J. (2010). Graphical displays for meta-analysis: an overview with suggestions for practice. Research Synthesis Methods, 1, 66–80. doi: 10.1002/jrsm.6.CrossRefGoogle Scholar
  2. Astbury, J. (2001). Gender disparities in mental health. World Health Organisation Round Tables.Google Scholar
  3. Atlantis, E., Goldney, R., Eckert, K., & Taylor, A. (2012). Trends in health-related quality of life and health service use associated with body mass index and comorbid major depression in South Australia, 1998–2008. Quality of Life Research, 21, 1695–1704. doi: 10.1007/s11136-011-0101-7.CrossRefGoogle Scholar
  4. *Bentley, T., Palta, M., Paulsen, A., Cherepanov, D., Dunham, N., Feeny, D., et al. (2011). Race and gender associations between obesity and nine health-related quality-of-life measures. Quality of Life Research, 20, 665–674. doi: 10.1007/s11136-011-9878-7.CrossRefGoogle Scholar
  5. Borenstein, M., Hedges, L., Higgins, J., & Rothstein. (2010). A basic introduction to fixed-effect and random-effects models for meta-analysis. Research Synthesis Methods, 1, 97–111. doi: 10.1002/jrsm.12.CrossRefGoogle Scholar
  6. *Burns, C., Tijhuis, M., & Seidell, J. (2001). The relationship between quality of life and perceived body weight and dieting history in Dutch men and women. International Journal of Obesity, 25, 1386–1392.CrossRefGoogle Scholar
  7. Callegari, A., Michelini, I., Sguazzin, C., Catona, A., & Klersy, C. (2005). Efficacy of the SF-36 questionnaire in identifying obese patients with psychological discomfort. Obesity Surgery, 15, 254–260. doi: 10.1381/0960892053268255.CrossRefGoogle Scholar
  8. Cameron, A., Magliano, D., Dunstan, D., Zimmet, P., Hesketh, K., & Shaw, J. (2012). A bi-directional relationship between obesity and health-related quality of life: evidence from the longitudinal AusDiab study. International Journal of Obesity 36, 295–303. doi: 10.1038/ijo.2011.103.Google Scholar
  9. Carr, D., & Friedman, M. A. (2005). Is obesity stigmatizing? Body weight, perceived discrimination, and psychological well-being in the United States. Journal of Health and Social Behavior, 46, 244–259.CrossRefGoogle Scholar
  10. Cohen, J. (1992). A power primer. Psychological Bulletin, 112, 155–159.CrossRefGoogle Scholar
  11. Cooper, H. (2010). Research synthesis and meta-analysis: A step by step approach. Thousand Oaks: Sage.Google Scholar
  12. Cooper, H., Hedges, L. V., & Valentine, J. C. (Eds.). (2009). The handbook of research synthesis and meta-analysis (2nd ed.). New York: Russell Sage.Google Scholar
  13. Costa-Font, J., & Gil, J. (2006). Revisiting the ‘Fat and Jolly’ hypothesis: socio-environmental determinants of obesity and depression in Spain. Socio-Economic Review, 4, 513–542. doi: 10.1093/ser/mwl018.CrossRefGoogle Scholar
  14. Crisp, A. H., & McGuiness, B. (1976). Jolly fat: relation between obesity and psychoneurosis in general population. British Medicine Journal, 1, 7–9.CrossRefGoogle Scholar
  15. Crisp, A. H., Queenan, M., Sittampaln, Y., & Harris, G. (1980). ‘Jolly fat’ revisited. Journal of Psychosomatic Research, 24, 233–241.CrossRefGoogle Scholar
  16. de Wit, L., Luppino, F., van Straten, A., Penninx, B., Zitman, F., & Cuijpers, P. (2010). Depression and obesity: a meta-analysis of community-based studies. Psychiatry Research, 178, 230–235. doi: 10.1016/j.psychres.2009.04.015.CrossRefGoogle Scholar
  17. Doll, H., Petersen, S., & Stewart-Brown, S. (2000). Obesity and physical and emotional well-being: associations between body mass index, chronic illness, and the physical and mental components of the SF-36 questionnaire. Obesity Research, 8, 160–170. doi: 10.1038/oby.2000.17.CrossRefGoogle Scholar
  18. Dorner, T. E., & Rieder, A. (2010). Obesity paradox or reverse epidemiology: is high body weight a protective factor for various chronic conditions. Deutsche Medizinische Wochenschrift, 135, 413–418.CrossRefGoogle Scholar
  19. Faith, M., Butryn, M., Wadden, T., Fabricatore, A., Nguyen, A., & Heymsfield, S. (2011). Evidence for prospective associations among depression and obesity in population-based studies. Obesity Reviews, 12, 438–453. doi: 10.1111/j.1467-789X.2010.00843.x.CrossRefGoogle Scholar
  20. Ferguson, C. (2009). An effect size primer: a guide for clinicians and researchers. Professional Psychology: Research & Practice, 40, 532–538. doi: 10.1037/a0015808.CrossRefGoogle Scholar
  21. *Franco, O., Wong, Y., Kandala, N., Ferrie, J., Dorn, J., Kivimaki, M., et al. (2012). Cross-cultural comparison of correlates of quality of life and health status: the Whitehall II Study (UK) and the Western New York Health Study (US). European Journal of Epidemiology, 27, 255–265. doi: 10.1007/s10654-012-9664-z CrossRefGoogle Scholar
  22. Friedman, M., & Brownell, K. (1995). Psychological correlates of obesity: moving to the next research generation. Psychological Bulletin, 117, 3–20.CrossRefGoogle Scholar
  23. Garner, R., Feeny, D., Thompson, A., Bernier, J., McFarland, B., Huguet, N., et al. (2012a). Bodyweight, gender, and quality of life: a population-based longitudinal study. Quality of Life Research, 21, 813–825. doi: 10.1007/s11136-011-9989-1.CrossRefGoogle Scholar
  24. Garner, R., Feeny, D., Thompson, A., Bernier, J., McFarland, B., … Blanchard, C. (2012b). Bodyweight, gender, and quality of life: a population-based longitudinal study. Quality ofLife Research, 21, 813–825. doi: 10.1007/s11136-011-9989-1
  25. Han, C., Jo, S. A., Seo, J. A., Kim, B. G., Kim, N. H., Jo, I., et al. (2009). Adiposity parameters and cognitive function in the elderly: application of “Jolly Fat” hypothesis to cognition. Archives of Gerontology and Geriatrics, 49, 133–138.CrossRefGoogle Scholar
  26. Hamer, M., Batty, G., & Kivimaki, M. (2012). Risk of future depression in people who are obese but metabolically healthy: the English longitudinal study of ageing. Molecular Psychiatry, 17, 940–945. doi: 10.1038/mp.2012.30.CrossRefGoogle Scholar
  27. Haslam, D. W., & James, W. P. (2005). Obesity. Lancet, 366, 1197–1209. doi: 10.1016/S0140-6736(05)67483-1.CrossRefGoogle Scholar
  28. Hedges, L. V., & Vevea, J. L. (1998). Fixed and random-effects models in meta-analysis. Psychological Methods, 3, 486–504.CrossRefGoogle Scholar
  29. Higgins, J., Thompson, S., Deeks, J., & Altman, D. (2003). Measuring inconsistency in meta-analyses. British Medicine Journal, 327, 557–560. doi: 10.1136/bmj.327.7414.557.CrossRefGoogle Scholar
  30. *Hopman, W., Berger, C., Lawrence, J., Barr, S., Gao, Y., Prior, J., et al. (2007). The association between body mass index and health-related quality of life: data from CaMos, a stratified population study. Quality of Life Research, 16, 1595–1603. doi: 10.1007/s11136-007-9273-6 CrossRefGoogle Scholar
  31. International Association for the Study of Obesity. (2012). Global prevalence of adult population. London: IASO.Google Scholar
  32. Jansen, A., Havermans, R., Nederkoorn, C., & Roefs, A. (2008). Jolly fat or sad fat?: subtyping non-eating disordered overweight and obesity along an affect dimension. Appetite, 51, 635–640. doi: 10.1016/j.appet.2008.05.055.CrossRefGoogle Scholar
  33. Jia, H., & Lubetkin, E. I. (2007). The impact of obesity on health-related quality-of-life in the general adult US population. Journal of Public Health, 27, 156–64. doi: 10.1093/pubmed/fdi025.CrossRefGoogle Scholar
  34. Johnson, B., Kremer, P., Swinburn, B., & de Silva-Sanigorski, A. (2012). Multilevel analysis of the Be Active Eat Well intervention: environmental and behavioural influences on reductions in child obesity risk. International Journal of Obesity, 36, 901–907. doi: 10.1038/ijo.2012.23.CrossRefGoogle Scholar
  35. Juarez, L., Soto, E., & Pritchard, M. (2012). Drive for muscularity and drive for thinness: the impact of pro-anorexia websites. Eating Disorders, 20, 99–112. doi: 10.1080/10640266.2012.653944.CrossRefGoogle Scholar
  36. Kim, E., Song, J. H., Hwang, J., Ahn, K., Kim, J., Koh, Y. H., et al. (2010). Obesity and depressive symptoms in elderly Koreans: evidence for the “Jolly Fat” hypothesis from the Ansan Geriatric (AGE) Study. Archives of Gerontology and Geriatrics, 51, 231–234. doi: 10.1016/j.archger.2009.10.014.CrossRefGoogle Scholar
  37. King, D. (2011). The future challenge of obesity. Lancet, 378, 743–744. doi: 10.1016/S0140-6736(11)61261-0.CrossRefGoogle Scholar
  38. Kivimaki, M., Jokela, M., & Batty, G. D. (2011). Does obesity really protect against psychological distress? Examining the ‘fat-jolly’ versus ‘fat-sad’ hypotheses using Mendelian randomization. Journal Of Internal Medicine, 269, 519–20. doi: 10.1111/j.1365-2796.2011.02357.x.CrossRefGoogle Scholar
  39. Knoesen, N., Mancuso, S., Thomas, S., Komesaroff, P., Lewis, S., & Castle, D. (2012). Relationship between severity of obesity and mental health: an Australian community survey. Asia-Pacific Psychiatry, 4, 67–75. doi: 10.1111/j.1758-5872.2011.00164.x.CrossRefGoogle Scholar
  40. Kolotkin, R. L., Crosby, R. D., Kosloski, K. D., & Williams, G. R. (2001). Development of a brief measure to assess quality of life in obesity. Obesity Research, 9, 102–111. doi: 10.1038/oby.2001.13.CrossRefGoogle Scholar
  41. Kolotkin, R. L., Meter, K., & Williams, G. R. (2001). Quality of life and obesity. Obesity Review, 2, 219–229.CrossRefGoogle Scholar
  42. Kolotkin, R. L., & Crosby, R. D. (2002). Psychometric evaluation of the Impact Of Weight On Quality Of Life-Lite Questionnaire (IWQOL-Lite) in a community sample. Quality of Life Research, 1, 157–171. doi: 10.1023/A:1015081805439.CrossRefGoogle Scholar
  43. Kuo, S., Lin, K., Chen, C., Chuang, Y., & Chen, W. (2011). Depression trajectories and obesity among the elderly in Taiwan. Psychological Medicine, 41, 1665–1676. doi: 10.1017/S0033291710002473.CrossRefGoogle Scholar
  44. *Larsson, U., Karlsson, J., & Sullivan, M. (2002). Impact of overweight and obesity on health-related quality of life—a Swedish population study. International Journal of Obesity and Related Metabolic Disorders, 26, 417–424.CrossRefGoogle Scholar
  45. Lerdal, A., Andenæs, R., Bjørnsborg, E., Bonsaksen, T., Borge, L., & Fagermoen, M. (2011). Personal factors associated with health-related quality of life in persons with morbid obesity on treatment waiting lists in Norway. Quality of Life Research, 20, 1187–1196. doi: 10.1007/s11136-011-9865-z.
  46. Lipsey, M., & Wilson, D. (2001). Practical meta-analysis. Thousand Oaks: Sage.Google Scholar
  47. Miller, C. T., & Downey, K. T. (1999). A meta-analysis of heavyweight and self-esteem. Personality and Social Psychology Review, 3, 68–84.CrossRefGoogle Scholar
  48. Murnen, S. (2011). Gender and body images. In T. Cash & L. Smolak (Eds.), Body image: A handbook of science, practice, and prevention (pp. 173–179). New York: Guilford Press. doi: 10.1016/B978-0-12-384925-0.00019-5.Google Scholar
  49. Myers, A., & Rothblum, E. (2010). Coping with prejudice and discrimination based on weight. In J. L. Chin (Ed.), The psychology of prejudice and discrimination: A revised and condensed edition (pp. 187–197). Santa Barbara: Praeger.Google Scholar
  50. Palinkas, L. A., Wingard, D. L., & Barrett-Connor, E. (1996). Depressive symptoms in overweight and obese older adults: a test of the “jolly fat” hypothesis. Journal of Psychosomatic Research, 40, 59–66. doi: 10.1016/0022-3999(95)00542-0.CrossRefGoogle Scholar
  51. Patel, V. (2005). Gender in mental health research. Italy: World Health Organisation.Google Scholar
  52. Puhl, R., & Heuer, C. (2009). The stigma of obesity: a review and update. Obesity, 17, 941–964. doi: 10.1038/oby.2008.636.CrossRefGoogle Scholar
  53. Puhl, R., Heuer, C., & Brownell, K. (2010). Stigma and social consequences of obesity. In P. Kopelman, I. Caterson, & W. Dietz (Eds.), Clinical obesity in adults and children (pp. 25–40). New York: Wiley-Blackwell.Google Scholar
  54. *Renzaho, A., Wooden, M., & Houng, B. (2010). Associations between body mass index and health-related quality of life among Australian adults. Quality of Life Research, 19, 515–520. doi: 10.1007/s11136-010-9610-z CrossRefGoogle Scholar
  55. Revah-Levy, A., Speranza, M., Barry, C., Hassler, C., Gasquet, I., … & Falissard, B. (2011). Association between Body Mass Index and depression: the “fat and jolly” hypothesis for adolescents girls. BMC Public Health, 16, 1–7. doi: 10.1186/1471-2458-11-649
  56. RevMan: The Cochrane Collaboration’s Review Manager (Vers. 5.1) (2011). The Cochrane Collaboration.Google Scholar
  57. Roberts, R., Strawbridge, W., Deleger, S., & Kaplan, G. (2002). Are the fat more jolly? Annals Of Behavioral Medicine, 24, 169–80.CrossRefGoogle Scholar
  58. Rothstein, H. R., Sutton, A. J., & Borenstein, M. (Eds.). (2005). Publication bias in metaanalysis: Prevention, assessment, and adjustments. Chichester: Wiley.Google Scholar
  59. Sánchez-Meca, J., & Marin-Martinez, F. (1998). Weighting by inverse variance or by sample size in meta-analysis: a simulation study. Educational and Psychological Measurement, 58, 211–220. doi: 10.1177/0013164498058002005.CrossRefGoogle Scholar
  60. Sánchez-Meca, J., & Botella, J. (2010). Revisiones sistemáticas y meta-análisis: herramientas para la práctica profesional [Systematycal review and meta-analysis: profesional practice tools]. Papeles del Psicólogo, 31, 7–17.Google Scholar
  61. *Santos, R., & Pereira, J. (2008). O peso da obesidade: avaliação da qualidade de vida relacionada com a saúde em utentes de farmácias [Obesity weight: quality of life assesment related to health in pharmacy clients]. Qualidade de vida, 26, 25–37.Google Scholar
  62. *Saraç, F., Parýldar, S., Duman, E., Saygýlý, F., Tüzün, M., & Yýlmaz, C. (2007). Quality of life for obese women and men in Turkey. Preventing Chronic Disease, 4, 1–7.Google Scholar
  63. Song, F., Parekh, S., Hooper, L., Loke, Y. K., Ryder, J., Sutton, A. J., et al. (2010). Dissemination and publication of research findings: an updated review of related biases. Health Technology Assessment, 14, 188–193. doi: 10.3310/hta14080.Google Scholar
  64. *Surtees, P., Wainwright, N., & Khaw, K. (2004). Obesity, confidant support and functional health: cross-sectional evidence from the EPIC-Norfolk cohort. International Journal of Obesity, 28, 748–758.CrossRefGoogle Scholar
  65. *Tsai, W., Yang, C., Lin, S., & Fang, F. (2004). Impact of obesity on medical problems and quality of life in Taiwan. American Journal of Epidemiology, 160, 557–565. doi: 10.1093/aje/kwh251.CrossRefGoogle Scholar
  66. Thompson, J. K., Heinberg, L. J., Altabe, M. N., & Tantleff-Dunn, S. (1999). Exacting beauty: theory, assessment and treatment of body image disturbance. Washington: American Psychological Association. doi: 10.1037/10312-000.
  67. van der Windt, D., Dunn, K., Spies-Dorgelo, M., Mallen, C., Blankenstein, A., & Stalman, W. (2008). Impact of physical symptoms on perceived health in the community. Journal of Psychosomatic Research, 64, 265–274. doi: 10.1016/j.jpsychores.2007.10.003.CrossRefGoogle Scholar
  68. *Vasiljevic, N., Ralevic, S., Marinkovic, J., Kocev, N., Maksimovic, M., … & Tomic, J. (2008). The assessment of health-related quality of life in relation to the body mass index value in the urban population of Belgrade. Health and Quality of Life Outcomes, 6, 1–10. doi: 10.1186/1477-7525-6-106
  69. Wadden, T. A., & Stunkard, A. J. (1987). Psychopathology and obesity. Annual New York Academic Sciences, 499, 55–65.CrossRefGoogle Scholar
  70. *Wang, R., Wu, M., Ma, X., Zhao, Y., Yan, X., … & He, J. (2011). Body mass index and health-related quality of life in adults: a population based study in five cities of China. European Journal of Public Health, 1–6. doi: 10.1093/eurpub/ckr080
  71. Ware, J. E., Kosinski, M., & Dewey, J. E. (2000). How to score version two of the SF-36® health survey. Lincoln: QualityMetric Incorporated.Google Scholar
  72. Ware, J. E., & Sherbourne, C. D. (1992). The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Medical Care, 30, 473–483.CrossRefGoogle Scholar
  73. Ware, J. E., Snow, K. K., Kosinski, M., & Gandek, B. (1993). SF-36 health survey: Manual and interpretation guide. Boston: The Health Institute, New England Medical Center.Google Scholar
  74. Wee, C., Davis, R., & Hamel, M. (2008). Comparing the SF-12 and SF-36 health status questionnaires in patients with and without obesity. Health and Quality of Life Outcomes, 6, 1–7. doi: 10.1186/1477-7525-6-11.CrossRefGoogle Scholar
  75. World Health Organization (1995). Physical status: The use and interpretation of anthropometry. WHO Technical Report Series no. 854. Geneva: WHO.Google Scholar
  76. World Health Organization (2000). Obesity: Preventing and managing the global epidemic. WHO Technical Report Series 894. Geneva: WHO.Google Scholar
  77. World Health Organisation. (2001). World Health Report 2001: Mental Health: New Understanding, New Hope. Geneva: WHO.Google Scholar
  78. Yamazaki, S., Fukuhara, S., & Green, J. (2005). Usefulness of five-item and three-item Mental Health Inventories to screen for depressive symptoms in the general population of Japan. Health and Quality of Life Outcomes, 3, 48. doi: 10.1186/1477-7525-3-48.CrossRefGoogle Scholar
  79. Yu, N., Chen, C., Liu, C., Chau, Y., Chang, C., & Chang, G. (2011). Association of body mass index and depressive symptoms in a Chinese community population: results from the Health Promotion Knowledge, Attitudes, and Performance Survey in Taiwan. Medical Journal, 34, 620–627.Google Scholar
  80. Zhao, G., Ford, E., Li, C., Tsai, J., Dhingra, S., & Balluz, L. (2011). Waist circumference, abdominal obesity, and depression among overweight and obese U.S.adults: National Health and Nutrition Examination Survey 2005–2006. BMC Psychiatry, 11, 130. doi: 10.1186/1471-244X-11-130.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media Dordrecht and The International Society for Quality-of-Life Studies (ISQOLS) 2013

Authors and Affiliations

  • Alejandro Magallares
    • 1
    • 3
  • Jose Luis Pais-Ribeiro
    • 2
  1. 1.School of Psychology, Social Psychology DepartmentUniversidad Nacional de Educacion a Distancia (UNED)MadridSpain
  2. 2.School of PsychologyUniversidade de PortoPortoPortugal
  3. 3.Departamento de Psicología Social y de las OrganizacionesFacultad de Psicología UNEDMadridSpain

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