Hypertension, dyslipidemia and weight perception
Hypertension could result of (or from) hyperinsulinemia induced by obesity and/or T2DM and other factors. Systolic pressure were different between patients aged ≤40 years old (higher) and 41–60 years old (lower); and ≥61 years old (higher) (0.026). Literature evaluates differently the ideal level of systolic blood pressure, considering age. [
39,
40]. Higher diastolic pressure was in aged ≤40 years old. Hypertension, prevalent in ≤40 years old, possibly was initial effect of lesser sensibility of insulin and inadequate eating habits; in patients aged ≥61 years old, probably was result of a longer history of obesity and worse management of insulin prescribed.
A < D was present in hypertension without use of anti-hypertensive, in patients with ≤40 years old; while use of anti-hypertensive was linked with A > D or A = D. It means that anti-hypertensive did not influence weight perceptions in A = D. Some factor associated to hypertension can be linked with A > D.
Patients who were not making use of anti-hypertensive drugs and perceived their weight A < D were statistically significant (see Table
1). Patients using anti-hypertensive presented 3.6 more chances of A > D than A < D or 3.5 more chances to perceive A = D than A < D. It was not studied how frequently and correctly anti-hypertensive drug were used by them or how accessible for patients it was. In A = D the use of anti-hypertensive did not affect weight perception. Then A > D could be more affected by anti-hypertensive probably due to wrong way to use it, even though correct prescription and orientation.
In patients who perceived A > D: 46% were not previously submitted to diet to lose weight (p = 0.0091), which is in agreement with literature. It was observed in male gender in multiple correspondence analysis test. The lack of diet could have contributed to less results, suggesting worse posture toward own health. If irregular access of antihypertensives, or uncorrected use by patients, the hypertension could not be controlled.
Non-treated hypertension suggests that alexithymia could be secondary to hypertension, explaining partially the misperception in this age interval (≤40). Depression and use of anti-hypertensive among A = D did not seem to interfere in weight perceiving. It might express levels of pro-inflammatory state. Depression itself can represent psychological elaboration of the own health state. The dimension of weight misperception in male who presented alexithymia, severe or moderate depression, and/or anxiety, was relevant in A > D, despite also present in female. Age and level of BMI (higher) seems linked with them.
A = D presented higher LDL (133 mg/dl), A > D higher total cholesterol (205 mg/dl) and hypertriglycerides (323 mg/dl). Neuro-inflammation could be linked with A > D.
Psychological aspects and types of weight perception
Higher levels of depression were prevalent in patients who perceived A = D and A > D. Minimal levels of depression were prevalent in patients A < D (p = 0.049). Depression in both cases (A = D and A > D) can result of pro-inflammatory state of those patients, stressor events in their lives, or their awareness regarding their poor health. Since BMI I (minimal levels), but clearly ≥ BMI II, pro-inflammatory signs seems producing effects as depression.
35% of A < D accepted their physical appearance, contrarily of A = D (66%) and A > D (69%) (p = 0.0018). A < D seems genuinely a perception alteration, probably not as a result of a self-censure. 50% of A < D felt offended by social aggression about their weight; A = D (20%) and A > D (34%) (p = 0.007). The elevated percentage of patients who feeling target of social aggression in A < D, compared with the acceptation of their own appearance, could signalize denying (psychological mechanism): the censure remained “outside”, but denied by themselves. 69% of A < D was unsatisfied with themselves due to their disease (48% of A = D; 42% of A > D) (p = 0.027). As they were predominately BMI I and youngest, being portable of a disease could seem to them less acceptable. 74% of A < D felt unsatisfied with themselves because their obesity; A = D (51%) and A > D (54%) (p = 0.068). Despite A < D expressing highly unsatisfied with these items they were less affected by depression. The lesser was their dissatisfaction, in patients who presented A = D or A > D, the greater was their depression: as A = D could be psychological elaboration, but A > D probably linked with culpability, or damage in weight perception due to neuro-inflammation. Higher BMI and age, likely lesser the faith to achieve better results due to aging. Crescent the BMI, higher could be the conformism and lower the feeling to be able to fight against of obesity’s growing. A > D could be affected by emotional eating. They felt dissatisfaction with their obesity, more than A = D whose obesity seems recent than in A > D. BMI III if earlier linked with emotional eating, could after be intensified by cited brain damage.
A > D associated with BMI III, seems higher affected by pro-inflammatory effects. A > D linked with depression, BMI III and use of anti-hypertensive could be associated to irregular behavior regarding health, mainly males, who did not make diet, physical activity and treatments. If BMI III patients were greater emotionally immature their adherence to health habits could be compromised.
A = D was associated with BMI II and presented depression-related. This depression could be less associated with culpability, considering the accurate weight perception evolved. It can be related to a psychological elaboration process regarding their awareness of BMI, difficulties related to treatment, diet, aging and others aspects. It seems related to their health state and effect of their pro-inflammatory process which could reinforce levels of depression. Other sources of stress were not studied to explain prevalence of depression in BMI II. However, among female, climacteric and menopause can be linked with. They also used anti-hypertensive medication. It did not interfere in their weight perception. These patients could have regular attitude regarding the anti-hypertensive medication, following correctly instructions.
Patients who perceived A > D exhibited 3.6 more chances to present moderate or severe depression than A < D. A = D demonstrated 3.8 more chances to present moderate or severe depression than A < D. It is possible that in A = D, middle-age with their hormonal alterations, mainly amongst female, and initial stage of treatment’s against obesity due to recent acquisition of obesity, elevated the chances of depression-related to pro-inflammation. Gain of weight in middle-age could be culturally tolerated due to expectations about aging.
The higher the BMI, A > D was the prevalent type of perception. The lesser the BMI, A < D was the type; intermediate BMI, A = D. Despite A > D could be a type of perception reflecting structural brain alterations, it seems that pro-inflammation and depression-related were strongest associated to A > D such as bias in perceiving weight, reinforcing it as vicious circle. A < D, if not enough affected by pro-inflammation, presented a minimal depression. Since middle-age, and among BMI II and BMI III patients, depression was present in similar level.
Probable alexithymic patients were prevalent among A < D as a frontier (34%). It was present among in A > D (29%) and A = D (17%). Probable alexithymia and minimal levels of depression could be, beside non controlled hypertension, symptom of initial damages caused by obesity. The higher was the obesity expressed by BMI, the lesser was the presence of probable alexithymia. The distribution of probable alexithymia was opposite to the way to perceive weight: A < D (34%) and A > D (29%).
A < D, due to interval of age, could result of more rigorous expectations to deal with obesity and weight control, suggesting intern demand induced by external cues. A > D likely express, despite probable irregular use of anti-hypertensive and failed access to this medication, unstable attitude regarding treatment. A > D showed lesser patients earlier evolved in diet, during life, than A < D and A = D (p = 0.0091). It suggests worse attitude regarding eating, health and weight, lesser motivation or more negligence with health-items.
Patients who perceived their weight as A < D prevalently showed lower level of depression and less alexithymia (50%) compared with A > D and A = D (see Table
1). In A > D, alexithymia seems secondarily associated with depression.
Alexithymia, associated to BMI III and depression, seems susceptible to influences of brain alterations (amygdala, cingular gyrus and linked areas) already present. Imprecise perception of patients regarding items in general, including obesity, and different reaction in dealing with visual food stimulation can be linked with. Cognitive damages due to aging, low level of formal education and lack of information to behave correctly toward health, could still be associated.
Congruently the “pure” alexithymic (did not linked with depression or anxiety or both) was prevalent between A < D weight perception (43%). The Alexithymia associated with depression and/or anxiety was prevalent in those who perceived the weight A > D (22%). (see Table
1). The disapproval of their own appearance was present in those who perceived their weight as A > D (p = 0.0018) (a feature in male subjects). There was 2.5 more chances of alexithymia in A > D than A < D. Alexithymia was specially related to A > D, but A > D was strongly related to depression, mainly among BMI III. Their misperception is accompanied by lesser comprehension of their own feelings; part of them disapproved their appearance. If they did not be able to control factors as weight, it can signalize less adherence to treatments, which was indicated by males.
In A < D, the influence of depression was minimal, and the influence of alexithymia was lower than among other types of weight perception, if aged ≤40 years old. BMI I was prevalent between A < D. A < D was associated to hypertension, not treated by anti-hypertensive (p = 0.037). Alexithymia, if present amongst them, seems to be “pure” alexithymia (not associated with depression and anxiety). Whether there was less expressive effects of pro-inflammation, in A < D pro-inflammation, eventually neuro-inflammation, seems more relevant for alexithymia than depression.
Being ≤40 years old patients seems more relevant, beside civil state in lower level, reflecting developmental and cultural period of influence, with specific exigencies as: being “attractive” to achieve a partner, to obtain a stable profession and an occupational performance. If married the partner perception of weight can influencing self-image. Amongst non-married more stress, more lack of confidence in themselves and less skills to establish significant attachment could be evolved.
In A = D the differences in presence of obesity during infancy, adolescence and adulthood were more distinct: 6, 11 and 31% respectively. The differences of obesity at each period of development was less distinguishable in A > D (11, 18 and 25%), and in A < D (13, 15 and 27%). In A = D the presence of obesity since adulthood is higher than in other period of life-course. In A > D and A < D it was not greatly the difference between them in each period. A = D indicated less presence of obesity during infancy, while A > D and A < D were similar at this point.
In summary, 3 types of weight perception present distinguishable differences: A > D, A = D and A < D. A < D seems related to better self-control (BMI I) despite presence of obesity during infancy and adolescence. A > D seems reflecting lesser self controlled patients, with lesser diet during infancy and adolescence: possibly lack of model to better control their eating habits or lack of limits on food intake along life. A = D presented as main features: 3.8 more chances of depression than A < D (unhealthy state, beginning of treatment, probable elaboration of their disease and psychological state) and 4.3 more chances of alexithymia than A < D (62% of 41–60 year-old patients; many presented higher cholesterol, mainly LDL and hypertriglycerides; probably hormonal changes in female patients). A = D with alexithymia seems partially linked with higher cholesterol, indicating neuroinflammation due to hypertriglycerides. In middle age cognitive damages can initiate due to many factors: alexithymia could be expression of their unhealthy state. It did not induce patients to body image alteration.
The features of the patients who perceived A < D were: 89% did not use anti-hypertensive; 90% presented minimal depression; 50% were alexithymic and 34% presented probable alexithymia. Hypertension can influence alexithymia on A < D. The prevalence of probable alexithymia (38%) was in patients who did not use anti-hypertensive medication (uncontrolled hypertension). It can be observed prevalence (86%) of alexithymia among patients with controlled hypertension who used anti-hypertensive medication (p = 0.069). This difference, not statically significant, indicated an aspect in A > D: possible structural alteration.
A < D can be resultant of patients with greater aware regarding their actual health state: 74% declared to be unsatisfied with their weight (p = 0.068); 69% with their disease (p = 0.027). Youngest the patients, greater was their dissatisfaction with weight and disease.
A > D presented 3.6 more chances of moderate or severe depression (higher among males as already cited). Their depression here seems not accompanied by sentiments of fault, except in male who did not accept their appearance. Alexithymia, higher levels of depression (moderate or severe), higher levels of BMI (BMI III) seem importantly linked with A > D as a type of weight misperception.
Females, who declared had been anteriorly made diet as treatment to lose weight were exactly those who perceived their weight A > D (45%, p = 0.0091). Opposite attitude compared on male A > D.
Comparing on the patients who declared had been overweight during infancy one observed that A > D (33%) were different of those who perceived A = D (18%) (p = 0.073) and since adulthood (p = 0.009) period in which A = D was higher (90%) than A > D (73%), and A < D (86%). Even though not expressively, it can be observed that A = D and A < D were, in that case, more similar than A > D.
Higher was depression and alexithymia, crescent was the BMI. A > D seems expressing earlier beginning of obesity in life-course without diet, which explains more pro-inflammatory effects in psychological aspects and less diet during life. A < D express anterior starting of overweight than A = D, but both made treatments against obesity “earlier” (p = 0.0091).
If alexithymia is structural it partially explains less adherence to weight control and other items related to treatment. If associated to depression, it can be caused by pro-inflammation due to higher BMI (III) and their consequences. If it is an effect that did not contribute to the best comprehension of their won feelings and perception of weight, it can promote less adherence to diet and other treatments. If not structural, alexithymia seems an effect lack of model in general, beside lack of model to eating-control. It could also occur regarding feelings interpretation.