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Background: The extent to which physical activity and psychological factors may affect the risk of diabetes mellitus among lean individuals remains unclear. Purpose: This study aimed to investigate the associations of total physical activity (TPA) and psychological factors with lean type 2 diabetes mellitus (T2DM) risk. Research Design: A prospective cohort study. Study Sample: The study population included 1,945 Korean adults who maintained a body mass index <23 kg/m 2 . Data Collection and Analysis: Baseline data on TPA and psychological factors were collected and T2DM incidence was assessed for 10 years. For analysis, a multivariable Cox proportional hazards regression model was used. Results: TPA was inversely associated with T2DM risk and this association was more pronounced in participants who were depressed or distressed; the top TPA quartile exhibited significant reductions in T2DM risk of 66% (95% confidence interval [CI]: 0.15, 0.78) and 65% (95% CI: 0.14, 0.88) among participants who reported depressed mood and those who perceived high distress, respectively, compared with the bottom TPA quartile. Conclusions: The current study demonstrated the preventive effects of physical activity on T2DM in lean adults through its interaction with psychological factors., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

This study was conducted to identify risk factors that influence the probability and severity of unhealthy weight control behaviors (UWCBs) and to consider gender difference. Data were obtained from a national survey. The study population was composed of 66,068 adolescents in grades 7-12 at 400 middle schools. The effect of the independent variables on UWCBs was analyzed using zero inflated negative binominal regression. Higher body mass index group, overweight perception, appearance stress, and depressive mood were found to be risk factors of UWCBs' probability in both genders. For boys, older age, underweight, accurate or under-perception of weight, and depressive mood influenced severity of UWCBs. For girls, older age, appearance stress, and depressive mood influenced severity of UWCBs. The new findings mean to consider the range of UWCBs experienced, which can offer more sensitive and predictable information. Further interventions should be developed to consider gender specific risk factors.

For many years, body dissatisfaction was considered a western phenomenon, and was studied mostly in Caucasian women. Recent studies, however, suggest that these issues are also present in men and in other ethnic groups. This research investigated the differential effects of various sociocultural pressures transmitted from the media, one's parents, and one's peers on the drives for thinness and muscularity, and body dissatisfaction among 1125 Korean college students (56% male) using structural equation modeling. The results indicate that, after controlling for body mass index and exercise, media pressures exerted the largest effects on participants' body ideals and, in turn, body dissatisfaction across both genders ( β = 0.44, and 0.30, p < 0.05, for females and males, respectively). This study's results also indicate that there are considerable gender differences in this relationship. Specifically, the results show that parental and media pressure had significant indirect relationships with body dissatisfaction via the drive for thinness among females, while peer and media pressures had significant indirect relationships with body dissatisfaction via the drive for muscularity among males. As body dissatisfaction is known to significantly affect an individual's mental and physical health, future research needs to identify relevant influential factors in this area, as well as the paths they have leading to increased body dissatisfaction.

The current study explores the moderation of the relationship between obesity and labor market outcomes by direct employment efforts such as job hunting and job training of young adults. The study used data provided by the Korean Education and Employment Panel, a longitudinal data survey comprising middle and high school students from 2004 to 2015. Two dependent variables were assessed in this study: employment status and wage. The individual-level fixed effects were controlled. Despite having more direct employment efforts of either or both experience in job hunting and job training, compared to normal-weight counterparts, underweight men and overweight and obese women were reported to have a disadvantage in both dependent variables. Underweight men with job training experience were 12.02% less likely to be employed, while overweight and obese men had 6.80 times higher monthly wages when job training experience was accompanied compared to no such experience. For overweight and obese women, compared to that of their normal-weight counterparts, employment probability decreased by 4.78% per week-increase in job hunting, by 2.81% if any experience in job hunting. For underweight women, compared to that of their normal-weight counterparts, employment probability increased by 4.56 times per week-increase in job hunting and by 5.59 times if experience in job hunting, and by 6.96% if experience in job training. The results indicate that employment efforts do not fully moderate the presence of obesity penalty for labor market outcomes on those early in their careers.

Purpose: Although distortion of weight perceptions has been known as a risk factor for adolescent depression, little has been known about the relationship between weight misperception patterns and depressive symptoms. This study explored the relationship between distortion of weight misperception patterns and depressive symptoms in Korean adolescents., Methods: The subjects of this study were 109,373 middle school students who participated in the Korea Youth Risk Behavior Web-based Survey (KYRBWS) from 2011 to 2013. By comparing the difference between Body Mass Index (BMI) and subjective perceptions of body weight, misperceptions of weight were classified into two categories: misperception of underweight and misperception of overweight., Results: When confounding variables were adjusted, the results of the logistic regression analysis revealed that male students who perceived themselves as underweight despite their normal weight were 110% more likely to have depressive symptoms (OR = 1.10, 95% CI: 1.03-1.18) than male students with accurate weight perceptions. On the contrary, for female students, misperceptions of underweight had no significant relationship with depression symptoms. Regarding misperceptions of overweight, female students who perceived themselves as overweight despite their normal weight were 107% (OR = 1.07, 95% CI: 1.02-1.11) more likely to have depressive symptoms than female students with accurate weight perceptions. Moreover, female students who perceived themselves as overweight when they were underweight were 137% (OR = 1.37, 95% CI: 1.18-1.58) more likely to have depressive symptoms., Conclusion: Male students who underestimate their body weight and female students who overestimate their body weight were at a greater risk of depression emotions than students with accurate weight perceptions.

Objective personality tests, such as the Minnesota Multiphasic Personality Inventory (MMPI), might be more sensitive to reflect subclinical personality and be more state-dependent in an individual's lifetime, so they are good scales to predict the psychological distress regarding certain states. The aim of this study was to identify the specific pattern between body mass index (BMI) and psychological distress using the objective personality test. For this study, we investigated BMI and the Korean Military Multiphasic Personality Inventory (MPI). A retrospective cross-sectional study was conducted with 19-yr-old examinees who were admitted to the Military Manpower Administration in Korea from February 2007 to January 2010. Of 1,088,107 examinees, we enrolled 771,408 subjects who were psychologically apparent healthy possible-military-service groups. Afterwards, we reviewed and analyzed directly measured BMI and MPI results. In terms of the validity scales, the faking-good subscale showed an inverted U-shaped association, and faking-bad and infrequency subscales showed a U-shaped association with BMI groups. In terms of the neurosis scales, all clinical subscales (anxiety, depression, somatization, and personality disorder) also showed a U-shaped association with BMI groups. For the psychopath scales, the schizophrenia subscale showed a U-shaped association, and the paranoia subscale showed a near-positive correlation with BMI. In conclusion, a specific U-shaped pattern was observed between BMI and the MPI in 19-yr-old men in Korea. Underweight and obesity are related to psychological distress, so supportive advice and education are needed to them.

Objective: This study assessed the association between subjective body image or objective body mass index (BMI) and the risk of daily smoking in Korean adolescents, with a purpose of identifying the most suitable models., Materials and Methods: Using the 2013 9th Korea Youth Risk Behavior Web-based Survey data for 72,435 students, odds ratios were calculated for daily smoking in the past month, according to the subjective body image and calculated BMI using a respective multiple logistic regression model. The combined effect of these two factors was also analyzed by pairing a BMI category with a subjective body image category, using odds ratios for the same event within each sex group., Results: Among the surveyed students, 7.2% of boys and 1.8% of girls were classified as daily smokers. Students who perceived themselves as being very obese tended to be at lower risk of daily smoking (OR=0.61 in boys with 95% CI=0.47 to 0.79; OR=0.66 in women with 95% CI=0.47 to 0.93). In addition, boys within the obese or overweight BMI category showed a lower risk of daily smoking (OR=0.86, 95% CI: 0.77-0.96). Lean BMI was significantly associated with higher odds ratios for daily smoking only in female students (OR=1.24, 95% CI: 1.02-1.52). When pairing these two objective and subjective factors, results suggested that subjective body image has a greater effect on daily smoking than BMI in both boys and girls., Conclusions: In both male and female students, subjective body image had a greater effect on daily smoking than body mass index. A model using the combination of BMI and subjective body image was the best fit in girls, in contrast to the model using subjective body image only best suitable in boys, for the prediction of daily smoking. These results including several factors associated with daily smoking in Korean students, provide useful data for the development and implementation of smoking intervention and cessation programs for adolescents.

Background: Understanding body weight status dissatisfaction may be important for understanding weight control behaviours and mental health., Aims: To investigate the relationships between body weight status misperceptions in nulliparous normal-weight young women and weight control-related behaviours and mental health., Subjects and Methods: Body weight perceptions, weight control methods, depressive mood and psychological distress were measured in 717 nulliparous normal-weight women, aged 18-40 years, who participated in the 2007-2009 Korean National Health and Nutrition Examination Surveys (KNHANES-IV)., Results: Among 717 participants, 24 subjects (4.1 ± 1.0%) misperceived themselves to be underweight and 295 subjects (39.2 ± 2.2%) misperceived themselves to be overweight. Those with overweight misperceptions were more likely to fail to maintain their targeted body weights, despite weight control efforts (p < 0.001). Weight control behaviours such as taking diet pills were more common among women with overweight misperception (p < 0.001). Compared to the accurate body weight perception group, age-adjusted ORs for depressive mood and psychological distress were 1.82 (1.06-3.13) and 1.65 (1.10-2.47) in the overweight misperception group., Conclusions: Body weight status misperception may be important for understanding weight control-related behaviours and psychiatric illness among nulliparous normal-weight young women.

Background: Overweight and obesity is a serious problem worldwide related to cardiovascular and other diseases. Personality traits are associated with the abnormal body mass indices (BMIs) indicative of overweight and obesity. However, the links between personality traits and BMI have been little studied in Korea., Methods: We evaluated the association between personality traits and BMI in men and women using the rural Ansung and urban Ansan cohort from the Korean Genome Epidemiology Study, and the Kangbuk Samsung Hospital Cohort Study datasets. A shorter version of the original Revised Neuroticism-Extroversion-Openness Personality Inventory (NEO-PI-R) was used to measure the five-factor model of personality (neuroticism, extraversion, openness to experience, agreeableness, and conscientiousness)., Results: Data from a total of 1,495 men (mean age 60.0 ± 9.8 years; mean BMI 24.3 ± 3.0 kg/m2) and 2,547 women (mean age 47.0 ± 15.5 years; mean BMI 22.8 ± 3.4 kg/m2) were included in the analysis. Compared with the normal weight groups, overweight and obese men scored higher on openness to experience and lower on conscientiousness. Overweight and obese women scored lower on neuroticism and openness to experience and higher on agreeableness. Extraversion was positively associated with BMI in men (β=0.032, P<0.05). BMI and waist circumference were significantly increased in individuals who were less dutiful. In women, neuroticism was inversely associated with BMI (β=-0.026, P<0.05). Openness to experience was negatively, and agreeableness was positively, associated with BMI (openness to experience: β=-0.072, agreeableness β=0.068) and waist circumference (openness to experience: β=-0.202, agreeableness: β=0.227) (P<0.05)., Conclusion: Personality traits were associated with underweight, overweight, and obesity in men and women. Increased understanding of the underlying factors contributing to this association will aid in the prevention and treatment of abnormal BMI.

Attentional bias toward idealized bodies (men: muscular; women: thin) may cause upward comparisons and increase body dissatisfaction (BD). We investigated attentional biases of 39 men and 41 women with high and low BD toward muscular male bodies and thin female bodies. An eye-tracker measured gaze durations and fixation frequencies while exposing participants to images of thin, normal, muscular, and fat bodies of the same gender. Results revealed longer and more frequent attention toward muscular bodies in high BD men, and toward thin bodies in high BD women. High BD men and women also rated muscular and thin bodies as more attractive than those with low BD. Although men attended to muscular and women attended to thin bodies, both showed an attentional bias toward body types they rated as more attractive. These findings could provide indirect evidence in explaining the relationship between BD and the social comparison theory with attentional bias., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

The objective of this study was to assess the relationship between weight-related attitudes and suicidal behavior after consideration of depressive mood in Korean adolescents. The study population consisted of a nationally representative sample of 74,698 adolescents (n = 39,466 boys, 35,232 girls) in middle and high school who completed the Korea Youth Risk Behavior Web-based Survey (KYRBWS) in 2007. Logistic regression models were used to examine the relationships between measures of weight-related and self-reported suicidal behavior, controlling for demographics, depressive mood, stress perception, level of school achievement, and substance use. Suicide attempts were surveyed among those reported to have suicidal ideation (n = 7,579 boys, 10,204 girls). Significantly more girls than boys reported suicidal ideation (29 vs. 19%) and suicide attempts (7.7 vs. 4.5%). Factors significantly associated with suicidal ideation were overestimation of weight (vs. correct estimation) and behaviors to lose or gain weight (vs. no weight control) among boys and overestimation of weight and attempting to lose weight among girls. In contrast, the odds of suicide attempts were significantly higher among boys who tried to lose, gain, or maintain their weight (vs. no weight control) and girls who underestimated their weight (vs. correct estimation) and tried to lose weight (vs. no weight control). Boys and girls classified as overweight or at risk for overweight were significantly less likely to report suicide attempts compared to those classified as underweight. Weight-related attitudes, such as incorrect weight perception and weight control behaviors, seem to be useful indicators for identifying Korean adolescents who are at risk for suicidal behaviors.