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Longitudinal Relationships Among Overweight, Life Satisfaction, and Aspirations in Young Women Kylie Ball,* David Crawford,* and Justin Kenardy†

Abstract BALL, KYLIE, DAVID CRAWFORD, AND JUSTIN KENARDY. Longitudinal relationships among overweight, life satisfaction, and aspirations in young women. Obes Res. 2004;12:1019 –1030. Objective: This study investigated associations of overweight status and changes in overweight status over time with life satisfaction and future aspirations among a community sample of young women. Research Methods and Procedures: A total of 7865 young women, initially 18 to 23 years of age, completed two surveys that were 4 years apart. These women provided data on their future life aspirations in the areas of further education, work/career, marital status, and children, as well as their satisfaction with achievements to date in a number of life domains. Women reported their height and weight and their sociodemographic characteristics, including current socioeconomic status (occupation). Results: Young women’s aspirations were cross-sectionally related to BMI category, such that obese women were less likely to aspire to further education, although this relationship seemed explained largely by current occupation. Even after adjusting for current occupation, young women who were obese were more dissatisfied with work/career/study, family relationships, partner relationships, and social activities. Weight status was also longitudinally associated with aspirations and life satisfaction. Women who were overweight or obese at both surveys were more likely than other

Received for review December 10, 2003. Accepted in final form April 26, 2004. The costs of publication of this article were defrayed, in part, by the payment of page charges. This article must, therefore, be hereby marked “advertisement” in accordance with 18 U.S.C. Section 1734 solely to indicate this fact. *School of Exercise and Nutrition Sciences, Deakin University, Melbourne, Victoria, Australia and †Centre of National Research on Disability and Rehabilitation Medicine, Mayne School of Medicine, University of Queensland, Herston, Queensland, Australia. Address correspondence to K. Ball, School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Highway, Burwood, 3125 Victoria, Australia. E-mail: [email protected] Copyright © 2004 NAASO

women to aspire to “other” types of employment (including self-employed and unpaid work in the home) as opposed to full-time employment. They were also less likely to be satisfied with study or partner relationships. Women who resolved their overweight/obesity status were more likely to aspire to being childless than other women. Discussion: These results suggest that being overweight/ obese may have a lasting effect on young women’s life satisfaction and their future life aspirations. Key words: life satisfaction, life aspirations, weight change, socioeconomic factors

Introduction Obesity is known to contribute to increased morbidity and/or mortality from a number of physical health conditions (1). However, obesity is also associated with social, economic, and psychological factors, and these relationships are less well understood. For example, there is substantial evidence (in developed countries) of an inverse relationship between body weight and socioeconomic status, such that obese persons, particularly women, are at significant socioeconomic disadvantage compared with their nonobese peers (2). This has often been attributed to the impact of socioeconomic status (SES)1 on subsequent development of obesity, a hypothesis that is theoretically plausible and consistent with empirical evidence (3,4). It is also possible that obesity may lead to lower SES. There is ample cross-sectional evidence (5) that overweight persons are subject to stigmatization, prejudice, and discrimination in relation to employment and promotion opportunities (6 – 8), education (9), income (10,11), health care (12), housing opportunities (13), friendships (14,15), and even financial support within families (16). There is also limited longitudinal evidence showing that obesity is an

1 Nonstandard abbreviations: SES, socioeconomic status; WHA, Women’s Health Australia; OR, odds ratio; CI, confidence interval.

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Overweight, Life Satisfaction, and Aspirations in Women, Ball, Crawford, and Kenardy

antecedent to social and economic disadvantage. In one study of a national sample (17), 10,039 participants 16 to 24 years of age in 1981 were examined that year and in 1988. It was found that during the course of 7 years, young overweight women married less often, had lower incomes (and higher risk of incomes below the poverty line), and completed fewer years of school. Similar but weaker trends were found among the men. A second longitudinal study of young adults (18) showed that obesity had a significant negative impact on wages among women, sometimes with lasting effects. Given the evidence of the social disability associated with obesity, these experiences might be expected to result in lower levels of life satisfaction and lower aspirations for future achievements in domains such as education, income, and marital status among obese persons. Few studies have investigated the relationship between aspirations and weight status. One study, in a population sample of almost 10,000 adolescents, investigated how past experiences and future aspirations regarding education, financial success, and occupational success varied by weight status (9). The prevalence of past negative social, educational, and psychological experiences was greatest among those who were obese, particularly for women. However, only one of the three aspirations assessed (educational aspirations) varied by weight status, with obese women being 40% more likely to expect not to finish college than those in a healthy weight range. Another study of over 30,000 teenagers found future job concerns did not differ markedly between those who were overweight and nonoverweight (19). There have been no studies that have investigated these issues in young adults, who may have had additional or different experiences of stigmatization than adolescents. In addition, there has been no research that has investigated how weight change over time is related to aspirations. A growing body of evidence attests to a poorer psychological profile associated with obesity in adults. Obese persons have been shown to be at greater risk for depression (20), anxiety (21), low self-esteem and poorer social relationships (22), and generally poorer mental health-related quality of life and psychosocial functioning (23–26). However, findings are inconsistent, with other studies showing no association between body weight and psychological health (27,28). While evidence suggests that obesity is negatively associated with a number of psychological outcomes, very few studies have examined satisfaction with current life aspects. This is of interest because it might be hypothesized that experiences of discrimination in employment, education, or personal relationships may impact satisfaction with achievements in these realms. However, to our knowledge, only one prospective study has investigated this, and the results did not provide clear support for this hypothesis (20). Further research is nec1020


essary to determine whether weight gain and obesity are associated with lower levels of life satisfaction over time. The aim of this study was to investigate associations of overweight and change in overweight status over time with life satisfaction and future aspirations in a community sample of young women. Young women were the focus of this study because they comprise a high-risk group for weight gain and obesity (29,30) and because it has been suggested that female obesity may be more discouraged and penalized than male obesity (11,31). It was hypothesized that overweight, and particularly obese, young women would report less life satisfaction and “lower” aspirations for education, occupation, marriage, and children compared with women who were not overweight. It was also hypothesized that the development of overweight over time would be associated with a lowering of life satisfaction and aspirations, and, conversely, the “resolution” of overweight would be associated with a rise in life satisfaction and aspirations.

Research Methods and Procedures Participants This study used data derived from the Australian Longitudinal Study on Women’s Health [now known as the Women’s Health Australia (WHA) project]. This is a nationwide longitudinal study of factors impacting on women’s health. WHA involves three age cohorts of women: young (18 to 23 years at Survey 1, in 1996), mid-aged (45 to 50 years at Survey 1), and older (70 to 75 years at Survey 1), selected from the Australian national health care database, which includes all women who are resident in Australia. Details of the recruitment methods and baseline surveys are described elsewhere (32,33). Women living in rural and remote areas of Australia were oversampled compared with those living in urban areas to counteract traditional bias toward urban samples. This paper focuses on 7865 participants from the young cohort of women (18 to 23 years of age at Survey 1). In 1996, a total of 14,779 young women (41% of those invited to participate) completed Survey 1, which assessed a broad range of women’s health issues. Comparison with the 1996 National Census showed that the sample was broadly representative of the female population in this age group, although tertiary-educated women were slightly overrepresented (32). Four years later, 9657 of these women (70% of the 13,826 Survey 1 respondents who had not subsequently withdrawn from the study, died, or been lost to follow-up) completed a follow-up survey (Survey 2). The present analyses focus only on those women who completed both Surveys 1 and 2. Comparison of women who did and did not respond to Survey 2 showed no consistent differences in terms of area or state of residence, education, occupation, marital status, or measures of self-rated physical or mental health. The present analyses excluded data from women


who did not provide both height and weight data at Survey 1 (n ⫽ 835) and from women who were pregnant (n ⫽ 694) or suffering from a chronic illness or condition that may have impacted on their weight (n ⫽ 263) at the time of either survey. Sociodemographic characteristics of the sample by weight and weight change status have been previously reported (24,34). Measures Survey 1 for the young cohort was administered in 1996 and consisted of 252 items, including questions about height and weight, life satisfaction, life aspirations, and sociodemographic characteristics. A similar survey with some additional questions was administered in 2000 (Survey 2). Details of the surveys are provided elsewhere (32,33). The survey items used in this study are presented below. Life Satisfaction. Women were asked in Survey 1 about their satisfaction with five aspects of their life: “In general, are you satisfied with what you have achieved in your life so far in the areas of work/career/study; family relationships; partner/closest personal relationship; friendships; social activities.” In Survey 2, the question on work/career/study was separated into three separate questions, but otherwise the same questions were repeated. Response options were very satisfied, satisfied, dissatisfied, and very dissatisfied. Aspirations. In both surveys, women were asked a series of questions about what they would like to be doing at age 35. These items were modified from Hakim (35) and included the question, “When you are 35, would you like to be in. . . ” with response options full-time paid employment, part-time paid employment, full-time unpaid work in the home, or other. (In Survey 2, other was replaced with self-employed/own business.) Women were also asked “When you are 35, would you like to have more educational qualifications than you have now?” (yes, no, not sure). Marital/relationship status aspirations were assessed with the questions, “When you are 35, would you like to be. . . ” [married, in a stable relationship but not married, single (not in a stable relationship), or other; in Survey 2, the other option was omitted]. Finally, women were asked “When you are 35, would you like to have. . . (no children, 1 or 2 children, ⬎2 children). Socioeconomic Status. For the purposes of this study, socioeconomic status was indicated by occupation, assessed in Survey 1, and categorized as Manager/Professional; Paraprofessional; Tradesperson, Clerk, Sales/Service; Machine/Manual; or No Job/Other. It was expected that a large proportion of women in this cohort would be studying and hence the question on main occupation stated “If you are a student, circle the occupation you are studying for.” Body Weight. Women were asked to report their height and weight, from which BMI was calculated as weight in kilograms divided by height in meters squared. Survey 2 BMI was calculated using Survey 1 height, which was not

expected to have changed in this young adult sample (36). BMI was categorized as underweight (BMI ⬍ 20 kg/m2), healthy weight (BMI ⫽ 20 to 25 kg/m2), overweight (BMI ⬎ 25 to 30 kg/m2), and obese (BMI ⬎ 30 kg/m2) (37). Overweight status was dichotomized as overweight (BMI ⬎ 25 kg/m2) or not, and change in overweight status between surveys was categorized as overweight at both Surveys 1 and 2 (referred to as S1 ⫹ S2), overweight at Survey 1 only (S1 only), overweight at Survey 2 only (S2 only), or not overweight at either survey (Neither). Statistical Analyses Analyses were conducted using the SPSS version 11.0 statistical software package (SPSS, Inc., Chicago, IL). ␹2 analyses were used to investigate differences in aspirations and life satisfaction among women in the four BMI categories (cross-sectional analysis) and across women in the four overweight status change categories (longitudinal analysis). To account for possible confounding of these relationships with current SES at Survey 1, multivariate regression models were subsequently used. The aspirations variables were treated as nonordered categorical response variables (e.g., married, unmarried stable relationship, single). Their associations with BMI category were analyzed in separate nominal regression models, adjusting for current occupation at Survey 1, using the NOMREG function in SPSS. The exception was education aspirations, where a logistic regression model was used because the response option was dichotomous. The satisfaction variables were treated as ordered responses (i.e., from very dissatisfied up to very satisfied), and their associations with BMI category were analyzed using separate ordinal regression models, adjusting for occupation, using the PLUM function in SPSS. The model fitted by PLUM in SPSS produces constant odds ratios (ORs) across cumulative categories of the dependent variable. The final set of analyses investigated longitudinal relationships between overweight status across the two surveys and Survey 2 aspirations and satisfaction. The analysis procedures followed those used for the cross-sectional relationships (i.e., ␹2 analyses and nominal/logistic regression for aspirations and ordinal regression for satisfaction variables). The additional component of the longitudinal analyses was the adjustment, where possible, for Survey 1 values of the dependent variables. (This was not possible where questions had changed between surveys.)

Results Cross-sectional associations of Survey 1 BMI category with aspirations and life satisfaction are presented in Table 1. Of the four aspirations assessed, only further education was found to be cross-sectionally associated with BMI category. Fewer overweight and obese women wanted to OBESITY RESEARCH Vol. 12 No. 6 June 2004

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Table 1. Associations between Survey 1 (Y1) BMI category and Survey 1 aspirations and satisfaction Survey 1 BMI category (%) Aspirations Employment Full-time paid employment Part-time paid employment and part-time work at home Full-time unpaid work in home Other Marital status Married Stable relationship not married Single Children 1 or 2 3 or more None Further Education Yes No

Underweight (n ⴝ 2029)

Healthy weight (n ⴝ 4102)

Overweight (n ⴝ 1215)

Obese (n ⴝ 519)

␹2, p

58.6

58.3

56.7

59.3

12.5, p ⫽ 0.19

32.3 4.2 4.9

34.2 3.7 3.8

33.8 5.3 4.3

31.5 4.9 4.3

89.1 9.7 1.1

89.2 9.8 1.0

88.6 10.4 1.0

86.2 12.8 1.0

5.2, p ⫽ 0.52

67.1 25.0 7.9

64.3 27.3 8.5

64.0 27.7 8.3

59.3 32.2 8.6

11.4, p ⫽ 0.08

74.6 25.4

75.5 24.5

71.5 28.5

68.8 31.2

14.4, p ⬍ 0.01

30.7 49.2 16.9 3.3

32.4 49.5 15.3 2.9

29.1 49.2 18.6 3.0

26.5 44.9 23.9 4.7

37.5, p ⬍ 0.01

38.4 50.2 10.1 1.3

41.5 50.2 7.3 1.0

39.5 49.1 10.0 1.3

36.8 52.9 7.8 2.5

32.55, p ⬍ 0.01

36.7 38.8 19.6 4.8

35.7 37.2 21.2 5.9

32.7 36.3 23.9 7.1

26.8 33.1 27.8 12.3

72.51, p ⬍ 0.01

34.7 50.8 13.2 1.3

36.3 51.6 10.6 1.4

35.8 52.4 10.3 1.5

35.6 52.5 10.3 1.6

11.86, p ⫽ 0.22

22.6 57.2 18.4 1.9

24.2 58.3 15.5 2.1

21.9 57.0 17.9 3.2

20.6 51.9 23.5 3.9

40.81, p ⬍ 0.01

Satisfaction Work/career/study Very satisfied Satisfied Dissatisfied Very dissatisfied Family relationships Very satisfied Satisfied Dissatisfied Very dissatisfied Partner/closest personal relationship Very satisfied Satisfied Dissatisfied Very dissatisfied Friendships Very satisfied Satisfied Dissatisfied Very dissatisfied Social activities Very satisfied Satisfied Dissatisfied Very dissatisfied 1022



Table 2. Adjusted* ORs and 95% CIs for associations between Survey 1 BMI category and Survey 1 satisfaction (ordinal regression) Satisfaction Work/career/study

Family relationships

Partner/closest personal relationship

Friendships

Social activities

BMI category

Adjusted OR

Adjusted 95% CI

Underweight Overweight Obese Healthy weight Underweight Overweight Obese Healthy weight Underweight Overweight Obese Healthy weight Underweight Overweight Obese Healthy weight Underweight Overweight Obese Healthy weight

0.89 0.92 0.79

0.81, 0.99 0.82, 1.05 0.66, 0.94

0.84 0.88 0.82

0.75, 0.93 0.78, 1.00 0.68, 0.98

1.09 0.83 0.55

0.98, 1.20 0.74, 0.94 0.46, 0.65

0.89 1.00 1.00

0.80, 0.98 0.88, 1.14 0.83, 1.19

0.89 0.86 0.69

0.80, 0.99 0.76, 0.98 0.58, 0.83

* Adjusted for occupation.

gain additional qualifications by age 35 compared with women who were underweight or in the healthy weight range. Several of the life satisfaction items differed significantly across BMI categories. Relatively fewer overweight and especially obese women reported being satisfied or very satisfied with work/career/study, partner/closest personal relationship, and social activities, and fewer obese women reported being very satisfied with family relationships compared with women in healthy weight or underweight BMI categories. Satisfaction with friendships did not differ by BMI category. Results of nominal regression models (or logistic regression for education aspirations) assessing cross-sectional associations between Survey 1 BMI category and aspirations showed that, after adjusting for current socioeconomic status (occupation), none of the aspirations were associated with BMI category (data not shown). Table 2 shows the ORs (adjusted for occupation) and 95% confidence intervals (CIs) for cross-sectional associations between Survey 1 BMI category and satisfaction, produced by ordinal regression models. These ORs indicate the odds of reporting the same or a higher level of satisfaction than the reference category (healthy weight women)—referred to here as being

“satisfied.” (Conversely, “less satisfied” is used to refer to a lower reported level on the satisfaction scale.) The adjusted ORs show that obese women were 0.79 times as likely and underweight women were 0.89 times as likely to be satisfied with work/career/study than healthy weight women. Obese (OR ⫽ 0.82), overweight (OR ⫽ 0.88), and underweight (OR ⫽ 0.84) women were all less likely to be satisfied with family relationships than healthy weight women. In terms of satisfaction with partner/closest personal relationship, obese (OR ⫽ 0.55) and overweight (OR ⫽ 0.83) women were less likely to be satisfied than healthy weight women. Compared with healthy weight women, only underweight (OR ⫽ 0.89) women were less likely to be satisfied with friendships. Finally, obese (OR ⫽ 0.69), overweight (OR ⫽ 0.86), and underweight (OR ⫽ 0.89) women were all less likely to be satisfied with social activities than women in the healthy weight range. Longitudinal associations between overweight status at Survey 1 and Survey 2 and aspirations and satisfaction at Survey 2 are reported in Table 3. Significant associations were found between overweight status over time and aspirations for employment, marital status, and children. Of those women who were not overweight at either survey OBESITY RESEARCH Vol. 12 No. 6 June 2004

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Table 3. Associations between Survey 1 (S1) and Survey 2 (S2) weight status and Survey 2 aspirations and satisfaction Weight status Surveys 1 and 2 (%)

Aspirations Employment Full-time paid employment Part-time paid employment Full-time unpaid work in home Self-employed/own business Marital status Married Stable relationship not married Single Children 1 or 2 3 or more None Further Education Yes No

Overweight S1 ⴙ S2 (n ⴝ 1440)

Overweight S2 only (n ⴝ 830)


Neither (n ⴝ 5226)

48.5 27.7 6.1 17.7

49.0 26.7 5.2 19.0

46.7 23.0 6.1 24.2

45.2 29.2 4.8 20.7

20.8, p ⫽ 0.013

86.6 12.7 0.7

86.0 13.0 1.0

82.2 17.4 0.4

88.9 10.5 0.6

19.2, p ⫽ 0.004

65.7 26.2 8.1

66.5 24.9 8.6

67.3 21.6 11.0

71.5 21.2 7.4

27.0, p ⬍ 0.001

60.3 39.7

59.7 40.3

62.8 37.2

61.6 38.4

1.9, p ⫽ 0.600

25.9 54.1 15.7 4.3

28.5 53.9 14.3 3.3

23.7 54.3 18.8 3.3

28.1 54.8 14.9 2.3

23.2, p ⫽ 0.006

22.1 47.0 25.4 5.5

23.9 48.6 23.4 4.1

23.3 46.9 24.1 5.7

23.7 50.0 22.3 4.1

14.6, p ⫽ 0.101

18.6 52.9 25.0 3.5

20.1 53.3 23.6 3.0

18.3 53.8 22.9 5.0

23.6 53.3 20.7 2.4

36.4, p ⬍ 0.001

41.7 50.5 6.4 1.3

47.0 45.1 7.0 0.9

40.8 49.8 7.8 1.6

45.5 46.1 7.4 1.0

14.2, p ⫽ 0.120

␹2, p

Satisfaction Work Very satisfied Satisfied Dissatisfied Very dissatisfied Career Very satisfied Satisfied Dissatisfied Very dissatisfied Study Very satisfied Satisfied Dissatisfied Very dissatisfied Family relationships Very satisfied Satisfied Dissatisfied Very dissatisfied

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Table 3. continued Weight status Surveys 1 and 2 (%)

Satisfaction Partner/closest personal relationship Very satisfied Satisfied Dissatisfied Very dissatisfied Friendships Very satisfied Satisfied Dissatisfied Very dissatisfied Social activities Very satisfied Satisfied Dissatisfied Very dissatisfied

Overweight S1 ⴙ S2 (n ⴝ 1440)



Neither (n ⴝ 5226)

39.6 30.9 20.5 9.0

50.3 29.0 15.9 4.8

42.0 31.0 19.2 7.8

46.2 31.2 17.8 4.8

60.8, p ⬍ 0.001

34.6 53.9 10.1 1.4

36.8 51.2 11.2 0.9

38.1 46.6 13.4 2.0

35.9 52.2 11.0 0.8

13.2, p ⫽ 0.152

20.5 58.5 18.8 2.2

22.5 56.6 19.5 1.3

21.5 58.3 19.0 1.2

22.0 59.5 17.1 1.4

11.2, p ⫽ 0.260

(Neither), a higher proportion (compared with other groups of women) reported aspiring to part-time work, to being married, and to having one or two children. Compared with other groups, more of the S1 only women wanted to be self-employed and have no children, and fewer wanted to be married. Significant associations were also found between overweight status over time and satisfaction with work, study, and partner/closest personal relationship. Compared with other women, of those women overweight at both surveys (S1 ⫹ S2) or S1 only, fewer were very satisfied with these three aspects of their lives. For S2 only women, the proportions reported as being very satisfied with these three aspects were similar to or higher than those of women who were not overweight at either survey. Table 4 shows adjusted ORs and 95% CIs for associations between overweight status at Surveys 1 and 2 and Survey 2 aspirations, from nominal (or logistic) regression models. The models controlled for effects of current occupation and for reported Survey 1 aspirations where possible (i.e., for aspirations for marital status, children, and education). Comparisons for these analyses are reported against the reference group of women who were not overweight at either survey time (Neither). Compared with the Neither group, S1 ⫹ S2 women were more likely to aspire to “other” forms of employment as opposed to full-time paid work. Weight status over time was not associated with Survey 2 marital aspirations in these adjusted models; similarly, there were no associations with Survey 2 education

␹2, p

aspirations. Weight status was associated with aspirations for children, with S1 only women twice as likely as the reference group to report at Survey 2 that they wanted no children. Compared with the reference group, S1 ⫹ S2 women were 21% more likely to report wanting three or more children. Table 5 shows adjusted ORs and 95% CIs for associations between overweight status at Surveys 1 and 2 and Survey 2 satisfaction, from ordinal regression models. Again, the models controlled for current occupation and for Survey 1 satisfaction values where possible (i.e., for satisfaction with family, partner, friendship, and social activities). The term “satisfied” was again used when referring to odds of reporting the same or higher level of satisfaction than the reference category of women not overweight at either survey. The models showed significant associations between weight status over time and satisfaction with study and with partner/closest personal relationship. The S1 ⫹ S2 group was less likely to be satisfied than the reference group with study (OR ⫽ 0.85) or partner/closest personal relationship (OR ⫽ 0.80).

Discussion Life aspirations and satisfaction seem to be related to weight in young Australian women. In most (but not all) instances, these relationships were characterized by greater BMI being associated with less satisfaction and aspirations OBESITY RESEARCH Vol. 12 No. 6 June 2004

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Table 4. Adjusted* ORs and 95% CIs for associations between weight status at Surveys 1 and 2 and Survey 2 aspirations (nominal or logistic regression) Aspirations Employment (full-time work ref cat) Part-time paid employment

Full-time unpaid work in home

Other

Marital (married ref cat) Single

Stable not married

Children (1 or 2 ref cat) No children

3 or more children

Further education Yes (further education)

Weight status Surveys 1 and 2

Adjusted OR

Adjusted 95% CI

S1 ⫹ S2 S2 only S1 only Neither (ref) S1 ⫹ S2 S2 only S1 only Neither S1 ⫹ S2 S2 only S1 only Neither

0.87 0.83 0.72

0.76, 1.01 0.69, 1.00 0.52, 1.01

1.12 0.91 1.17

0.86, 1.46 0.64, 1.30 0.67, 2.05

0.77 0.84 1.08

0.66, 0.91 0.68, 1.02 0.78, 1.50

S1 ⫹ S2 S2 only S1 only Neither S1 ⫹ S2 S2 only S1 only Neither

1.15 1.20 0.93

0.50, 2.63 0.44, 3.29 0.12, 7.00

1.06 1.06 1.22

0.87, 1.29 0.83, 1.34 0.82, 1.82

S1 ⫹ S2 S2 only S1 only Neither S1 ⫹ S2 S2 only S1 only Neither

1.02 1.01 2.01

0.78, 1.33 0.73, 1.40 1.23, 3.28

1.21 1.21 1.24

1.02, 1.43 0.98, 1.50 0.85, 1.81

S1 ⫹ S2 S2 only S1 only Neither

0.99 1.07 1.01

0.87, 1.14 0.91, 1.27 0.75, 1.36

* Adjusted for occupation and Survey 1 aspiration values where applicable (i.e., for marital status, children, education).

for work other than full-time, being unmarried, and having no children. Aspirations to further education were also less likely among obese women compared with other women. If such life aspirations translate into action, this difference may lead to a socioeconomic disadvantage among obese 1026


women. This study also found that obese women had a lower life satisfaction than other women in areas of work, close personal relationships, and social activities, but not in the area of friendships. One previous study (38) showed that obese women did not differ from nonobese women on


Table 5. Adjusted* ORs and 95% CIs for associations between weight status at Surveys 1 and 2 and Survey 2 satisfaction (ordinal regression) Satisfaction Work

Career

Study

Family relationships

Partner/closest personal relationship

Friendships

Social activities

Weight status Surveys 1 and 2 S1 ⫹ S2 S2 only S1 only Neither S1 ⫹ S2 S2 only S1 only Neither S1 ⫹ S2 S2 only S1 only Neither S1 ⫹ S2 S2 only S1 only Neither S1 ⫹ S2 S2 only S1 only Neither S1 ⫹ S2 S2 only S1 only Neither S1 ⫹ S2 S2 only S1 only Neither

Adjusted OR

Adjusted 95% CI

0.92 1.02 0.83

0.82, 1.03 0.88, 1.18 0.64, 1.06

0.92 1.00 0.97

0.82, 1.03 0.87, 1.15 0.76, 1.24

0.85 0.88 0.85

0.76, 0.95 0.76, 1.01 0.66, 1.01

0.94 1.09 0.98

0.83, 1.05 0.93, 1.26 0.75, 1.27

0.80 1.12 0.96

0.71, 0.89 0.97, 1.29 0.75, 1.24

0.96 0.97 1.04

0.84, 1.06 0.83, 1.12 0.80, 1.34

0.97 0.93 1.03

0.86, 1.09 0.80, 1.08 0.80, 1.34

* Adjusted for occupation and Survey 1 satisfaction values where applicable (i.e., for family, partner, friendships and social activities).

self-reported measures of social relationships or on friend/ co-worker reports of these measures. Our findings, at least in part, confirmed this. It may be that friends are more supportive and less discriminating of women who are obese than are partners or work colleagues. Also of interest was the finding that underweight women were less satisfied with work/career/study, family relationships, friendships, and social activities. Possibly, being underweight may be a consequence of poor physical or mental health, and this, in turn, is associated with problems in these realms of life. This contention is supported by findings of previous investigations that show associations of underweight with poorer physical and mental health among the young cohort of women in the WHA study (24).

There is evidence that lower life satisfaction is associated with poorer quality of life and mental health (39). Other data indicate that obesity is associated with poorer psychosocial health (23–26). The present findings suggest that this link may be mediated by lower life satisfaction. However, it is not clear that, in the context of overweight/obesity, poorer mental health leads to lowered satisfaction with life, or vice versa. While there is no evidence from this study to indicate the direction of relationships among life aspirations, life satisfaction, and mental health, it is apparent that overweight women do report problems in these areas. Given the escalating obesity epidemic worldwide and the fact that depression currently contributes to a substantial proportion of the burden of disease in countries such as Australia (40), OBESITY RESEARCH Vol. 12 No. 6 June 2004

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these findings may have important implications for the future psychological well-being of many women. When these relationships were examined for changes in weight status over time, the picture was less clear. In particular, women who were overweight or obese who then subsequently reduced their weight were distinct from other women, whether overweight or not, in terms of marital, reproductive, and employment aspirations. The significantly greater likelihood of aspiring to be childless was the most striking feature of women who had lost weight between the two sample time-points. Women who diet to lose weight are at risk of regaining that weight (41). Those women who have lost weight may either have had a previous experience of failed weight loss or are aware of the potential for weight regain and would want to avoid that outcome. Thus, a possible explanation for the lack of aspiration for children may be fear of weight regain, because pregnancy and childbirth represent life events during which women are at high risk of weight gain (34). While this explanation seems extreme, evidence suggests that many overweight people attach great importance to attaining an ideal weight, and many are hypothetically willing to pay a hefty price (including a job demotion or loss of income) to do so (42). An alternative explanation of these findings is that women who lost weight did so as a consequence of poor physical or mental health, and this poorer health affected their desire to have children. This hypothesis was tested in a subsidiary set of analyses (data not shown) and was partly supported by findings showing that women who were overweight at Survey 1 only had poorer mental health initially (as indicated by scores on the short form-36 mental health components scale) (43) at baseline than other women. This may partly explain the findings regarding aspirations to be childless among women who lost weight. In terms of life satisfaction, there were no differences between women who had become overweight over the course of the study and women who had never been overweight. In contrast, there were similarities in lack of satisfaction between women who were overweight throughout the study and women who had lost weight between the two study time-points. Two earlier longitudinal studies of obesity transitions produced findings consistent with this (17,18). In those studies, women initially overweight reported poor socioeconomic outcomes whether or not they subsequently reduced their weight. While our study did not examine socioeconomic outcomes directly, our findings suggest that a similar relationship exists for life satisfaction. While this finding is consistent with the notion that obesity has a lasting effect on life satisfaction, this should be interpreted cautiously, because long-term obesity in this study was associated with only two of seven domains of satisfaction. While there is little longitudinal data available on psychosocial consequences of weight change, in one prospec1028


tive investigation, Fine et al. (44) found that 4-year weight gain had little effect on mental health-related quality of life, a finding that is consistent with those of this study. In contrast, findings from another longitudinal study showed that weight gain did predict poorer psychological well-being in women (45). This is not consistent with our findings. It may be that there is a delayed impact on life satisfaction among women who gain weight, and if so, it may be necessary to follow these women further and note any changes in satisfaction. Alternatively, it is possible that the women who increased their weight may not have experienced any significant change in self-esteem or social stigma, because there is a gradual increase in weight with age across the whole population (29), and this phenomenon may be experienced as “normative.” Strengths of this study include the large, representative community sample and the longitudinal study methodology. However, the study was limited in that data were available from only two time-points; therefore, it was not possible to determine the temporal nature of changes in weight or the outcome variables occurrence. All measures, including height and weight, were self-reported. In addition, it was not possible to control for baseline levels of all variables, because several questions were modified slightly between surveys. Acknowledging these limitations, the findings nonetheless suggest that obesity is associated both cross-sectionally and longitudinally with future aspirations and lower levels of satisfaction in certain realms of life among young women. Social stigma associated with obesity in affluent societies is likely to explain some of the observed associations. That is, weight-based stigmatization may lead to lower life satisfaction, poorer psychological health, and, potentially, to poorer vocational/educational and marital aspirations. It remains for future studies to untangle these causal mechanisms and identify how best to promote healthy and positive life aspirations and satisfaction among all young women, regardless of their weight status.

Acknowledgments The WHA, which was conceived and developed by groups of interdisciplinary researchers at the universities of Newcastle and Queensland, is funded by the Commonwealth Department of Health and Ageing. We thank all participants for their valuable contribution to this project. Kylie Ball and David Crawford are both supported by National Health and Medical Research Council/National Heart Foundation Career Development Awards in Population Health. We thank Damien Jolley for advice on statistical analyses and interpretation. References 1. World Health Organization. Obesity: Prevention and Managing the Global Epidemic. Report of a WHO Consultation on Obesity. Geneva, Switzerland: World Health Organization; 1998.


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