Epidemiology
The image in the mirror or the number on the scale, which counts? When it comes to depression, it’s a weighted issue.
From mutations of coronavirus to massive shifts in technology and geopolitics, the world is changing rapidly. So, too, is the epidemiological relationship between depression and obesity.
Arsh Kaur Mallhi, a fourth-year doctoral student in the Jiann-Ping Hsu College of Public Health (JPHCOPH) at Georgia Southern University, recently published on this topic in the Journal of Psychiatric Research. Co-authors include Georgia Southern epidemiology professors Jian Zhang, M.D., and Kelly Sullivan, Ph.D.
The study updates research conducted by Zhang 10 years ago, in which Georgia Southern students reported that what women saw in the mirror, not the number on the scale, influenced their mood. A woman who had a healthy weight but was wrongly self-perceived as being overweight was most likely to feel depressed.
Further, the concern with self-body image, although mostly misperceived, was highly prevalent among women, causing major distress or problems in social life, work, school or other areas of functioning.
Zhang believed it was time to reevaluate how the intertwined relationship between leading chronic conditions had evolved, and tasked Mallhi with research on the psychiatric impact of obesity.
New analyses conducted by the team found that among white women, actual body weight is becoming a stronger predictor of depression while self-perceived obesity is becoming less influential.
This switching pattern shows that white women have gradually paid more attention to the number on the scale. Excessive body weight, reliably detected by a scale, may contribute to depression, which can be a strong predictor of various chronic conditions, such as diabetes, cardiovascular diseases and even cancers.
“The switch makes the efforts in promoting bodyweight-related physical and mental health more harmonious,” said Mallhi. “Unlike what was reported previously, excessive body weight is associated with both physical and mental health. The increasing popularity of the body-positivity movement might be the driver behind the diminishing association between perceived body image and depression in white women.”
Mallhi’s study found no association between body weight and depression among Black and Hispanic women, neither self-perceived nor measured by the scale.
“We should look at this from a dichotomous perspective,” said Zhang. “No relationship suggests low social pressure to maintain body weight and a low risk of psychological and emotional strains. However, low pressure to maintain a healthy body weight may also be translated into no motivation or no action to achieve a healthy weight, presenting an immense challenge to obesity-prevention efforts.”
Sullivan noted that they aren’t surprised that the relationship between body weight and depression has evolved in sex-race-specific trajectories as society becomes more diversified culturally.
“One-size-for-all public health intervention rarely exists,” she said. “A unified intervention approach may be counterproductive between segments of the population. The public health approach must be consistently fine-tuned to adapt to our rapidly evolving world. Culturally competent interventions should be explored.”
The Georgia Southern team examined data from 27,387 men and women who participated in the Centers for Disease Control and Prevention’s annual National Health and Nutrition Examination Survey from 2005 to 2018. Depression was ascertained using the Patient Health Questionnaire, a commonly used tool to assist primary care clinicians in screening for depression. Participants were also asked whether they considered themselves to be underweight, overweight or about the right weight before nurses measured their body weight and height to calculate their body mass index.
The COVID-19 pandemic exacerbated both weight gains and anxiety, making addressing obesity and depression more urgent, said JPHCOPH Dean Stuart Tedders, Ph.D.
“COVID presents opportunities to address health emergencies with a newfound urgency,” Tedders said. “The JPHCOPH strives to provide opportunities to maximize each student’s potential, and more and more of our students are publishing their work in top journals to advance public health research and inform public health policy. I am very proud of what our students are achieving. Arsh’s study is just one example of the many ways in which our students are impacting the public’s health through their education and beyond.”
‘Rising star’ graduate: Sylvia Ofori’s journey from Ghana to Georgia Southern to Harvard
On her first flight from Ghana to the United States, Sylvia Ofori arrived in Atlanta, Georgia, at 1 a.m. By 4 o’clock the next afternoon, Ofori was in her first American classroom in Georgia Southern University’s Jiann-Ping Hsu College of Public Health on the Statesboro Campus.
Jet-lagged and attempting to absorb a foreign campus and classroom procedures, Ofori was out of sorts when her professor, Isaac Chun-Hai Fung, Ph.D., encouraged her to apply for a student research position following class introductions.
Within days, she’d interviewed and earned the spot, supported by funding from the Centers for Disease Control and Prevention. In their first meeting, Fung challenged Ofori to publish 10 papers by the end of her public health doctoral program.
“I wasn’t familiar with publications, but he threw that challenge at me from the beginning,” Ofori remembered. “Wow. His plan was for me to start working on dissertation-related projects immediately.”
Ofori’s first project was a scoping review on the use of digital technology to improve and monitor handwashing in children. Following a presentation of her review at the University’s 2019 Research Symposium, her work was published in an academic journal, and many more followed as co-author with Fung and another mentor, Kamalich Muniz-Rodriguez, DrPH.
By the end of her doctoral training, Sylvia had published 11 papers with Fung, and three more manuscripts will be submitted.
Today, Ofori will earn a DrPH in public health with a concentration in epidemiology as she crosses the stage in one of two Savannah commencement ceremonies. In June, she’ll begin as a Postdoctoral Fellow in the Department of Epidemiology at Harvard University to continue global public health research she began at Georgia Southern.
Ofori also heads to Boston with a 2022 Georgia Southern Averitt Award for Excellence in Graduate Research and experience working on the University’s COVID-response team within the office of the dean of students. She was also a student mentor and worked part time for Ionis Pharmaceuticals, a California-based company that researches rare diseases.
“She is a rising star in her field,” said Fung of Ofori.
As the daughter of a nurse, Ofori grew up amid attention to public welfare. Later, she earned an undergraduate degree in pharmacy from Kwame Nkrumah University of Science and Technology and a Master of Public Health from the Ensign College of Public Health of Ghana.
Following, she served as a community pharmacist in one of the busiest areas of Ghana. It was there that Ofori was exposed to especially vulnerable populations, which inspired her to pursue public health at the highest level.
Ofori’s dissertation centered around COVID-19 practices in Ghana, employing mathematical models to understand transmission dynamics, and to compare the impact or effectiveness of interventions implemented against the disease.
As a Harvard Fellow, she’ll lead mentored research projects on modeling infectious diseases and train public health professionals in Africa on how to use the models in their daily work. For the latter part, she will travel to Rwanda to teach the basic concepts of epidemiology, and develop curriculum for training programs.
“My career goal is to implement training programs for low-and middle-income countries,” said Ofori. “So having that experience would prepare me for that. “
Another intent is to inform policy in Ghana, and she looks forward to presenting her research findings at multiple conferences this fall in her home country.
“Showing evidence like this would kind of be a wake-up call to the government and many people to push vaccines to the country,” said Ofori. “That is the most impactful.”
The chance to create a paradigm shift in health care is incredibly meaningful to Ofori.
“It’s rewarding doing something that could actually lead to change, or that people or health care professionals will use your work and your recommendations to make changes to whatever they are working with,” she noted. “I’m pretty honored to do something like that.”
Today, as a researcher trained at Georgia Southern, Ofori feels prepared for her next steps.
“I feel fulfilled through the training and mentorship, and the networking opportunities I’ve had,” she said. “I feel like that built me into a researcher and will prepare me for whatever challenges that I face in the future. And through my experience here, I know people to connect with when I have challenges, and I know how to identify resources to make me a better researcher.”
Fung’s investment in her as a student and a professional can’t be understated.
“It’s been an amazing experience,” said Ofori. “I didn’t think we would get this far in terms of the number of projects we worked on. I’m really grateful that he took that chance on me that first day.
“There were projects that he asked me to do and I felt like, ‘I can’t do this. I don’t think I’m prepared for this.’ But he would let me know the resources I can use. Pushing me to reach my potential has been a really rewarding experience. I’m so grateful to him for the four years that I have been at Georgia Southern.”