Association between anxiety symptoms, obesity, and the perception of obesity in South Korea

Obesity is linked not only to physical health problems but also to mental health issues. Besides biological obesity, which is measured by criteria such as body mass index (BMI), there may be a link between perceived obesity and psychiatric symptoms. The way individuals perceive their body image is not just a mental concept; it can have physical, emotional, and psychological effects. Self-perception is a strong predictor of anxiety. This suggests that how one views their body plays a crucial role in influencing psychological distress. Therefore, this study aimed to investigate the relationship between perceived obesity and anxiety using a large sample of Koreans. This study used data from the Korea National Health and Nutrition Examination Survey spanning 6 years (2019-2021, 2022-2024) and involving 16,228 participants. We examined the relationship between the Generalized Anxiety Disorder-7 scale (GAD-7) and subjective body image perception. The data analysis employed a complex sampling design that accounted for weights. In the basic characteristics of the study participants, continuous variables were reported as weighted means along with their standard errors (SE). In contrast, categorical variables were expressed as sample sizes and weighted percentages. Univariate regression was used to estimate correlations among subjective obesity recognition, BMI, and GAD-7 scores. We calculated adjusted odds ratios (ORs) and 95% confidence intervals (CIs) using hierarchical logistic regression. Model 1 included sex, age, education level, household income quartile, occupation, and marital status. Model 2, adjusted for the factors in Model 1, included stress awareness. Model 3 further adjusted for the factors in Model 2 and added subjective health perception. Statistical significance was established at the p<0.05 level. The difference in GAD-7 scores between obese (2.2±0.0) and normal-weight (2.1±0.1) subjects was not statistically significant (p = 0.151). Correlation analyses showed that GAD-7 scores were associated with subjective recognition of obesity (OR, CI, p value: 1.251, 1.129-1.385, <0.001), but not with actual obesity (p=0.540). In the model 3 results of logistic regression, the OR (CI, p value) of subjective obese recognition for anxiety symptoms in total subjects, subjects with normal weight, subjects with obesity, in order, as follows: 1.081 (0.972-1.202, 0.150), 1.199(1.042-1.379, 0.011), 0.938 (0.703-1.252, 0.664)

The findings revealed that while actual obesity perception was not a risk factor for anxiety among individuals with obesity, cognitive distortions about obesity were indeed a risk factor for anxiety in subjects with a normal BMI. The recent increase in the use of anti-obesity medications may be attributed not only to the desire for weight loss and a healthier lifestyle, but also to a distorted perception of body shape, even among those of normal weight. The findings of this study could provide a hypothesis to explain this social phenomenon.

		Model 1		Model 2		Model 3
		Odd ratio (95% Confidential interval)	p value	Odd ratio (95% Confidential interval)	p value	Odd ratio (95% Confidential interval)	p value
Subjective body type recognition	No (Reference)	1		1		1
	Yes	1.289(1.134-1.464)	<0.001	1.289(1.134-1.464)	0.002	1.289(1.134-1.464)	0.040
Obesivity	No (Reference)	1		1		1
	Yes	0.918(0.809-1.041)	0.181	0.944(0.829-1.075)	0.384	0.901(0.789-1.030)	0.127

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