Journal of Obesity & Weight Loss Category: Medical Type: Research Article
Weight, Mental Health, Income and Marital Satisfaction: Evidence from the National Longitudinal Survey of Youth
- Manouchehr Mokhtari1*, Elizabeth D Pollock1
- 1 School Of Public Health, University Of Maryland - College Park, 1142 SPH Building, College Park, MD 20742, United States
*Corresponding Author:Manouchehr Mokhtari
School Of Public Health, University Of Maryland - College Park, 1142 SPH Building, College Park, MD 20742, United States
Received Date: Sep 30, 2015 Accepted Date: Nov 14, 2015 Published Date: Nov 30, 2015
Using a nationally representative sample of US married female respondents from the , aged 37-45 in 2002, our study examines the degrees to which wives’ body weight is related to marital satisfaction as well as the possibility that depression symptoms and income mediate the relation between body weight and marital satisfaction.
While economic theory links income and satisfaction (utility), social norms provide a conceptual model for understanding the link between body weight and marital satisfaction. This model emphasizes the high reward for conformity to societal ideals, such as thinness, which are often widely internalized by members of a society [11-14]. Because the social norm is for women to be thin in American society, overweight women are stigmatized [11,12,15-17]. Because women commonly internalize society’s expectations, those who deviate from these standards can be expected to experience lower personal satisfaction and self-esteem, and even depression, because they have personally violated the norm [18,19]. Depression in turn negatively influences individual’s marital satisfaction [18,20,21]. In sum, social norms theory suggests that those who deviate from society’s expectations by having higher body weight will experience higher levels of depression and consequently lower levels of marital satisfaction .
BODY WEIGHT AND MARRIAGE
While focusing on marital dissolution or marital status, researchers often examine the impact of either body weight or physical health. This leaves a gap in research for the potential association between body weight and the quality of the marital relationship. The present study adds to the literature in an important way. This study examines the link between body weight and marital satisfaction while taking into account the effects of other factors (e.g., income) known to be related to marital satisfaction. Additionally, our study investigates the association between body weight and marital satisfaction using depression as a mediator and a potential pathway from body weight to marital satisfaction.
ECONOMICS AND SOCIODEMOGRAPHICS OF MARITAL SATISFACTION
Economics points to income as the main driver of marital satisfaction
Extant literature indicates that higher income individuals are less likely to be obese than lower income individuals [27-30]. Lower income individuals are less able to adhere to societal norms of being thin based on the notion that one’s ability to control time, food quality, physical activity level, and stress levels are differentially associated with income [31-33]. For example, an individual earning $35,000 has less time and money than an individual earning $60,000 to maintain a normal body weight and a happy relationship. Since income can influence both body weight and marital satisfaction differently depending on the level of income, we are hypothesizing that income will moderate the association between body weight and marital satisfaction.
Happily married people have fewer health complaints
Marital satisfaction has a “U” shaped relation to length of marriage
Race and ethnicity are linked to body weight
To date, few studies have examined the link between body weight and marital satisfaction while taking all of these additional variables into account. Informed by social norms theory, we hypothesized that body weight would be negatively correlated with marital satisfaction independent of length of marriage and number of children. Second, we hypothesized that depression would mediate the association between body weight and marital satisfaction. Third, we hypothesized that physical health, health status, income, and race and ethnicity would moderate the relationship between body weight and marital satisfaction independent of length of marriage and number of children.
Given that, the dependent variable, marital satisfaction, is a categorical variable, therefore, logistic regression models were fit. In particular, it is worth noting that the dependent variable (yi=marital satisfaction) in this study is an ordered indicator of levels of satisfaction (µj, where, j=0,1,2,3). Therefore, under the proportional odds assumption, an ordered logit model (yi*=Xi β+ε_i, where, μj-1<yi*≤μ_j) provides the proper setup for the reported regression analysis in this study . One must note that the odds ratios are linearly related to the predictors in the mode and that the parameters (β) are estimated by running the following regression, where, ln (.) is log of the odds:
For the reported statistical analysis in this paper, we used statistical software Stata  and , which allow for the proper use of weights when the sample has a complex design. The weight variable for 2002, which is included in the NLSY79, was used for the statistical analyses that are reported in Tables 1 and 2.
Body mass index
Physical health limitation
The CES-D and the health status items were included in a health module that was administered to respondents when they turned 40. Therefore, the respondents in this sample were asked their health status and CES-D questions between the years of 1998 and 2006.
Number of children
Length of marriage
Race and ethnicity
The dependent variable, marital satisfaction, is a categorical variable; therefore, logistic regression models were fit. We modeled the independent variables and marital satisfaction comparing extremely happy and fairly happy with the referent group extremely unhappy. We modeled four different associations of the variables used in this study. First, we examined the bivariate association of body weight category (normal weight, overweight and obese) and marital satisfaction. Since the directions and significance of the relationships shifted substantially (i.e., more than 10%), we examined how each control variable independently influenced the bivariate relationship (Table 2). Third, we examined whether depression symptoms mediated the relationship between body weight and marital satisfaction. Finally, in order to assess if physical health limitations, health status, income and race and ethnicity moderated the association between body weight and marital satisfaction, interaction terms were created and the interaction terms for each independent variable were added to the full model. We also conducted post hoc analyses to assess the independent relationships among body weight, income and marital satisfaction.
|Marital satisfactiona||2.85||1.32||1 - 3|
Body weight (BMI)b
Health statusfLength of marriageg
|Number of childrenh||1.91||1.27||0-10|
|Hispanic and Latino||0.06||0.23||0-1|
|Not Hispanic and Latino||0.94||0.23||0-1|
|American Indian or Alaska Native||0.04||0.20||0-1|
|Black or African American||0.08||0.28||0-1|
|Native Hawaiian or Pacific Islander||0.00||0.4||0-1|
aMarital satisfaction: 1=very unhappy, 2=fairly happy, 3=very happy; bBody in the table is the continuous measure of body mass index - in the analysis, BMI was divided into normal weight (BMI 18.5-25: 43.8% of the sample), overweight (BMI 25-30: 29.3%), and obese (BMI>30: 25%); cDepression symptoms (calculated by the CESD scale) was divided into three equal groups for the analysis (CESD=0, CESD=1-3, or CESD≥4); dPhysical health limitation: 0=No limitation, 1=With limitation; eIncome was divided into quartiles for the final analysis (<$33,200, 33,200-56,999, 57,000-89,999, and >90,000); fHealth status: 1=fair/poor health, 2=good health, 3=very good health, 4=excellent health; gLength of marriage was divided into three groups for analysis: 1=under 7 years, 2=7-14 years, 3=>14 years; *In addition, dummy variables for ethnicity were included in the final analysis (White=84%, Black=8.92%, Hispanic=7.01%).
At first the bivariate model of body mass index divided into weight status and marital satisfaction was run. Compared to normal weight individuals, overweight individuals are 23% less likely to be happy with their marriage (OR, 0.77 [0.62-0.96], p
The addition of depression symptoms (OR, 0.39 [0.30-0.50], p<0.001) to the bivariate model (overweight: OR, 0.76, [0.62-0.96], p
When health status is added into the bivariate model, it confounds the association between BMI and marital satisfaction, rendering no association between being overweight or obese and having lower marital satisfaction. Instead of BMI, health status predicted marital satisfaction (Table 2). Respondents who were in excellent health were 2.23 times more likely to be happy with their marriages than respondents in poor health (OR, 2.23 [1.58- 3.14], p<0.001). Respondents in very good health were 2.53 times more likely to be happy in their marriages than respondents in poor health (OR, 2.53 [1.82-3.51], p<0.001) and respondents in good health were 3 times more likely to be happy with their marriages than respondents in poor health (OR, 3.00 [2.10-4.29], p<0.001).
|(0.61, 0.95)||(0.63, 0.97)||(0.62, 0.95)||(0.63, 0.99)||(0.65, 1.01)||(0.72, 1.15)||(0.66, 1.02)||(0.73, 1.19)|
|(0.57, 0.91)||( 0.57, 0.91)||(0.55, 0.89)||(0.54, 0.88)||(0.60, 0.97)||(0.73, 1.20)||(0.65, 1.05)||(0.73, 1.24)|
|CESD under 8|
|(0.30, 0.51)||(0.45, 0.82)|
|No Physical Limit|
|(0.46, 0.83)||(0.83, 1.69)|
|(0.70, 1.31)||( 0.68, 1.38)|
|(1.28, 2.22)||(0.95, 1.77)|
|(1.21, 2.16)||(1.02, 1.99)|
|Married <7 years|
|(1.12, 1.81)||( 0.81, 1.38)|
|Over 14 years||3.70**||2.34**|
|(2.90, 4.72)||(1.77, 3.09)|
|(0.65, 1.01)||(0.48, 1.15)|
|(0.38, 0.75)||(0.53, 1.13)|
|(0.53, 1.32)||(0.70, 1.94)|
|(0.48, 3.14)||(0.61, 4.78)|
|(0.9, 3.88)||(0.11, 6.17)|
|(2.87, 5.00)||(2.43, 4.32)|
|(6.25, 11.14)||(4.97, 9.10)|
|(9.89, 18.36)||(7.59, 14.53)|
|(1.58, 3.14)||(0.89, 2.13)|
|Very Good Health||2.53*||1.25|
|(1.82, 3.51)||(0.84, 1.87)|
|(2.10, 4.29)||(0.99, 2.21)|
|Chi-square (df)||2.15 (3)||2.31 (3)||31.84 (5)||57.9 (4)||2.21 (4)||44.49 (5)||7.53 (5)||122.33 (17)|
Bold is reference group; **p<0.001, * p=0.05
The addition of income to the bivariate model also renders the association between BMI and marital satisfaction null. Income accounted for all of the association between BMI and marital satisfaction (overweight: OR, 0.91 [0.72-1.15], p<0.001; obese: OR, 0.93 [0.73-1.19], p<0.001). When compared to respondents who had an income under $33,200 those individuals with an income between $33,200 and $57,000 are 3.79 times more likely to be happy with their marriage (OR, 3.79 [2.87-5.00], p<0.001), whereas, individuals with an income between $57,000 and $90,000 are 8.34 times more likely to be happy with their marriage (OR, 8.34 [6.25-11.13], p<0.001). Individuals with an income over $90,000 are 13.47 times more likely to be happy with their marriage (OR, 13.47 [9.89-18.36], p<0.001) than individuals who earn less than $33,200. Income has a strong and consistent association with marital satisfaction - the higher the income; the happier individuals are with their marriages.
In the full model (Table 2), there is no association between BMI and marital satisfaction (overweight: OR, 0.93 [0.73-1.28], p>0.05; obese: OR, 0.95 [0.73-1.24], p>0.05) when controlling for depression symptoms, physical health limitations, number of children, length of marriage, race and ethnicity and income. There are independent associations between depression symptoms, being married for over 14 years, being in good health and all categories of income with marital satisfaction. Respondents who scored over eight on the CES-D scale were 38.6% less likely to be happy with their marriage (OR, 0.61 [0.45-0.82], p<0.001) than individuals reporting less than an eight on the CES-D scale. Respondents who were married for over 14 years were 2.34 times more likely to be happy than respondents who had been married for under 7 years (OR, 2.34 [1.77-3.09], p<0.001). Respondents who reported being in good health were almost 1.48 times more likely to be happy with their marriages (OR, 1.48 [0.99-2.20], p<0.05) than respondents who were in poor health. Respondents whose family income was between $33,200 and $56,999 were 3.25 times more likely to be happy with their marriage (OR 3.25 [2.43-4.32], p<0.001) and respondents whose family income was between $57,000 and $89,999 were 6.73 times more likely to be happy with their marriage (OR, 6.73 [4.97-9.10], p<0.001) and respondents who earned over $90,000 were 10.50 times more likely to be happy with their marriages (OR, 10.50 [7.59-14.53], p<0.001) compared to those respondents who earned less than $33,200.
To test the hypothesis that physical health, health status, income, and race and ethnicity would moderate the relationship between body weight and marital satisfaction, interaction terms were created for each level of each independent variable. For example, each level of physical health limitations (with a limitation, or without a limitation), health status (excellent health, very good health, good health and poor health), income (4th quartile, 3rd quartile, 2nd quartile, and 1stquartile), racial, and ethnic categories was multiplied by normal weight, overweight and obese. The interaction terms for each independent variable were then separately added into the full model to assess moderation -i.e., all of the interactions of health status were added into the full model, then removed, and then all of the interactions of income were added into the full model, and likewise for physical health limitation and race and ethnicity. There were no significant interactions (not shown). Our third hypothesis is not supported.
Additionally, in order to assess the independent relationships of body weight and marital satisfaction with income, post hoc models were run. We ran logistic regressions predicting income from body weight (overweight: OR, 0.65 [0.53-0.80], p<0.001; obese: OR, 0.53 [0.43-0.66], p<0.001), predicting marital satisfaction from income (OR, 2.33 [2.12-2.56], p<0.001) and predicting body weight from income (OR, 0.78 [0.72-0.85], p<0.001). Our post hoc analyses revealed that income is independently associated with both body weight and marital satisfaction. Overweight and obese individuals are 35% and 57%, respectively, less likely to have a higher income than normal weight individuals. Respondents with a higher income are 2.33 times more likely to be happy with their marriages than respondents who had a lower income. Finally, respondents with a high income were almost 22% less likely to have high body weight than respondents with a low income.
We found a negative relationship between body weight and marital satisfaction that was independent of physical health limitations, depressive symptoms, length of marriage, number of children and race and ethnicity. However, the addition of income rendered the association between body weight and marital satisfaction null suggesting that income, not body weight, is the most important factor in predicting marital satisfaction. It is noteworthy that factors that previous research has indicated as influencing marital satisfaction (i.e., depression symptoms, physical health limitations, length of marriage, number of children and race and ethnicity) did not weaken the association between body mass index and marital satisfaction.
Our additional hypothesis that depression would represent the internalization of societal norms for thinness and mediate the relationship between body weight and marital satisfaction was not supported. We hypothesized that high BMI would be negatively associated with marital satisfaction due to society’s high valuation of being “thin” or attaining a “normal” BMI. We hypothesized that individuals who were overweight would have more depression symptoms and therefore, lower marital satisfaction than their normal weight counterparts. Social norms theory suggested that not living up to society’s expectations by being overweight would engender feelings of depression that would weigh heavily on marital satisfaction. This was not supported. Instead we found that high depression symptoms were related to low marital satisfaction and that high body weight was not related to high depression symptoms.
We also found a complex association of body weight and marital satisfaction with income. Income was found to be independently associated with both body weight and marital satisfaction: the higher one’s body weight, the lower one’s income, and the lower one’s marital satisfaction. This could indicate that contrary to our expectations that high body weight would create feelings of sadness; high body weight is associated with lower income. Because social norms theory was not supported through our findings, some other explanation for the relations among body weight, income, and marital satisfaction is needed.
Our finding that income is the best predictor of marital satisfaction highlights the importance of income in our society. There is nothing inherent in relationships that require money in order to be happy; however, in this consumer-driven society money is positively associated with many positive health and lifestyle outcomes. The lower one’s income the less control one has in one’s time, food intake, physical activity level, and stress levels [31-33].
However, income affects marital satisfaction differently depending on income level. Although there is a consistent and powerful dose effect at each level, it is not necessary to have a very high income to see positive effects on marital satisfaction. Even respondents who reported an income over $34,000 reported happier marriages than those respondents reporting the lowest income level.
In addition to the main findings discussed above, this study revealed an interesting health paradox: those respondents do not link obesity with poor health. The link between overweight/obesity and poor health outcomes is well established [59,60]. In this study, the majority of respondents perceived themselves to be in good health or better, despite 60% of the sample being overweight or obese. This finding could also indicate a disparity in the knowledge of the negative health implications of obesity among the respondents.
Implications for practice
In addition, the associations of body weight and income and income and marital satisfaction suggest that assessment of both body weight and income could be important in clinical settings. Our results suggest that body weight and income should be considered and even directly addressed in therapy.
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Citation:Mokhtari M, Pollock ED (2015) Weight, Mental Health, Income and Marital Satisfaction: Evidence from the National Longitudinal Survey of Youth. J Obes Weight Loss 1: 001.
Copyright: © 2015 Manouchehr Mokhtari, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.