This document is a proposal for a study examining the relationship between body mass index (BMI) and mental health status. It hypothesizes that people with higher BMI, classified as overweight or obese, may have higher levels of depression, anxiety, and stress than those with average weight. The study aims to investigate this association among students at the International Islamic University Malaysia. It will measure BMI and mental health status using the Depression Anxiety Stress Scale-21. The proposal provides background on related previous research and operational definitions of key terms to be used in the study.

1. (The relationship of Body Mass Index and
Mental Health Status)
A proposal submitted in fulfilment of the requirements for
the Bachelor of Human Sciences in Psychology
Nuramal Hayati bt Mohd Amron (1126844)
Supervisor: Dr. Syarifah Azizah bt Wan Ahmadul Badwi
Department of Psychology
Kulliyyah of Islamic Revealed Knowledge and
Human Sciences
Semester 2, 2014/2015

2. Introduction
Nowadays in the developed countries, obesity can be represent as a major public health
problem (Doll, Petersen & Steward-Brown, 2000). Obesity can leads to variety of chronic
diseases such as diabetes, hypertension and heart disease (Doll et al., 2000; Maguen, Madden,
Cohen, Bertenthal, & Neylan, 2013). To indicate one body weight status, individual should
measure it by calculating their Body Mass Index (BMI) (Lee & Yen, 2014).
Obesity also can be associated with mental health disturbance (Lee et al., 2014; Doll et
al., 2000; Mumford, Liu, Hair & Yu, 2013). Previous research reported that the example of
psychological status which is significant with unhealthy weight are depression (Mumford, 2013;
Lee et al., 2014; Mukamal, Kawachi, Miller & Rimm, 2007) as well as anxiety (Lee et al., 2014;
Mumford et al., 2013; Mukamal et al., 2007; Zhao, Ford, Dhingra, Li1, Strine & Mokdad, 2009)
and stress (Lee et al., 2014; Mumford et al., 2013; Zhao et al., 2009). Young people who are in
the state of obesity tend to suffer psychologically compared to average weight people (Lee et al.,
2014). To short, higher BMI people lead to worse psychological status. However, there was
stated from previous research that shown oppositely. According to Carpenter, Hasin, Allison, &
Faith (2000), people with lower BMI tend to have worse psychological well-being and mostly
they are among men.
Statement of Problem/ Hypothesis
This topic is important to be reviewed because there are arising cases of morbidity and
suffer from chronic illnesses are people who are in the state of obesity. In an additional analysis,
people who are obese and not in the ideal state of BMI trajectory, suffers the highest in statistical
analysis stated of depression, anxiety and stress. Therefore, this research is an awareness for
people to stay healthy and in the state of best BMI to be in a positive well-being.
This research addressing the questions of; how does BMI can be related to mental health
status? Does it a bidirectional relationship? This research is needed because there is still lack of
non-clinical research which includes university students as its sample. The relationship of BMI
and mental health status among Asian people also not being well examined in the previous
research.
The aim of this research is to investigate the association between BMI and mental health
status which includes depress, anxiety and stress among IIUM students. Therefore, it is
reasonable to hypothesize that people whose BMI is in the state of overweight and obese may
have higher level of depress, anxiety and stress rather than those who are in the average body
weight. However, to confirm this hypothesis further research is needed. From this research, what

3. can be learnt is the importance of maintaining a good state of BMI in order to sustain a positive
mental and physical well-being. The indicator that lead to mental health status such as depress,
anxiety and stress may be obesity and overweight. Therefore, researcher will make a public
awareness which relates to weight management to sustain fitness among people especially
students.
Literature Review
It is reported that people who are obesity tend to suicide. The higher potential risk of
people who are getting suicide is from man who are obese (Mukamal et al., 2007). This is proved
that body weight linked with the emotional welfare. There was a study in German by Becker et al
(2001), stated that they found the connotation between mental disorder and body weight. The
study assumed that overall, the highest mental disorders are women who are obese. The subject
who were suffers anxiety disorder also frequently from women who were obese rather than not
obese. Therefore, these phenomena shows us that Body Mass Index (BMI) or body weight does
give a link and relation upon mental health status among public. Other than mental health status,
body weight also have association with physical health such as chronic diseases.
A study conducted by Mumford et al (2013), which examined between concurrent
trajectories of BMI and mental health patterns in emerging adulthood. It showed that individuals
with unhealthy weight related to mental health which can turn to depression to an individual.
Nevertheless, this study was conducted among adulthood people which show further research in
teenagers specifically student should be examined in the future.
There was a study conducted among student of University Malaysia Sarawak which
related on Gender Differences in Body Mass Index Body Weight, Perception and Weight Loss
Strategies (Kuan et al, 2011). Generally, females were more concerned about body weight than
males. They diet more frequently, had self-induced vomiting, and used laxatives and exercise as
their weight-loss strategies. Even though this study could give some pictures in term of the
subjects, yet it was not emphasized on mental health status thus make this present study need to
be conducted. Plus, this study also has been conducted long time ago so there might be some
changes in student behavior as time goes by.
In term of children, there is also reported a lot of children having emotional issues such
as depression, stress, anxiety and PTSD when it is relates to physical body. The level of well-
being among obese/overweight children are decrease compared to children who are in the state
of normal weight. What is more astonishing, the level of depress among children who are in the
state of severely obese is same to children who are having cancer (Lee & Yen, 2014).

4. Operational Definitions
Body Mass Index (BMI) or body weight. BMI is a formula to measure the ideal body
mass by calculating weight in kilograms divided by height in meters squared. The Depression
scale assesses dysphoria, hopelessness, devaluation of life, self-deprecation, lack of
interest/involvement, anhedonia, and inertia. The Anxiety scale assesses autonomic arousal,
skeletal muscle effects, situational anxiety, and subjective experience of anxious affect. The
Stress scale is sensitive to levels of chronic non-specific arousal. It assesses difficulty relaxing,
nervous arousal, and being easily upset/agitated, irritable/over-reactive and impatient. Mental
health status will be measured by using DASS Inventory Scale.
Method
Participant
The participants of this research was enrolled from local student of International Islamic
University Malaysia specifically undergraduate students. There is 100 students which are 50 in
the state of normal weight and 50 in the state of overweight/obese. The participant will be
recruited by using convenience sampling design. Participants must be in the range of age from 20
to 26 years old. The participants also must be a single people which means not getting married
yet.
Instruments
Body Mass Index (BMI)
Body weight and height data will be collected by using self-report. Then, the BMI will be
calculated by using calculator (weight [kg]/ height x height [m]). According to World Health
Organization (WHO), the WHO Expert Consultation classified BMI cut-off points for body
weight classification for Malaysian adult population in seven classes which are “underweight”,
“normal weight”, “overweight”, “pre-obese”, “obese class I”, “obese class II” and “obese class
III”. It can be seen as in the table 1 below.

5. Body weight
classification
BMI cut-off points
definition (kg/m2)
Comorbidities risk BMI cut-off points
for public health
action
Underweight <18.5 <18.5
Normal weight 18.5 to 24.9 Low 18.5 to 24.9
Overweight 25.0 25.0
Pre-obese 25.0 to 29.9 Moderate 25.0 to 29.9
Obese class I 30.0 to 34.9 High 30.0 to 34.9
Obese class II 35.0 to 39.9 Very High 35.0 to 39.9
Obese class III 40.0 40.0
Table 1
Depression Anxiety Stress Scale 21 (DASS 21)
DASS 21 is a brief version the scale of DASS 42 which measure depression, anxiety and stress
emotional states over the past week. DASS 21 contain 21 items which used four-point evaluation
scale (0: Did not apply to me at all, 1: Applied to me to some degree, or some of the time, 2:
Applied to me to a considerable degree, or a good part of time, 3: Applied to me very much, or
most of the time) to assess the level of mental health status which focus more on depression,
anxiety and stress. In order to obtain the scores of the depression, anxiety and stress scale, the
relevant of seven items should be sum up. The higher the scores, the severe the emotional status.
The samples of the items are ‘I felt that I had nothing to look forward to’ (depression) ‘I was
aware of dryness of my mouth’ (anxiety) and ‘I found it difficult to relax’ (stress) (Meredith,
Strong & Feeney, 2007).
Procedure
The study will be divided into two parts: data collection part and data analysis part. Before the
data collection period, researcher should determine the potential risk upon this research either it
is no risk research, minimal risk research or full review risk research. Before collecting the data,
participants will be informed consents the purpose of the research, expected duration and
procedures. Participants also will be informed that they have rights to decline to participate and
to withdraw from the research once it has started. After that, the researcher will collect the BMI
data by taking self-report from the participants itself and distributing DASS 21 to the participants
afterwards. After done collecting data, participants will be debriefed. During this stage, the
research questions will be addressed and any misconception will be discussed. Participants also
will be briefed that their details and information are private and confidential. It will not be
exposed and disclosed to the public as it will against the ethics of research. After data collection
finished, the researchers will analyse the data by using Statistical Package for Social Science
(SPSS).

6. References
Becker, E. S., Margraf, J., Turke, V., Soder, U., & Neumer, S. (2010). Obesity and
Mental Illness in a Representative Sample of Young Women. International Journal of
Obesity, 25, 1, S5–S9.
Lee, J. I., & Yen, C. F. (2014). Associations between Body Weight and Depression,
Social Phobia, Insomnia, and Self-Esteem among Taiwanese Adolescents. Kaohsiung
Journal of Medical Sciences, 30, 625-630.
Mukamal, K. J., Kawachi, I., Miller, M., & Rimm, E. B. (2007). Body Mass Index and
Risk of Suicide among Men. Arch Intern Med, 167, 468-475.
Maguen, S., Madden, E., Cohen, B., Bertenthal, D., & Neylan, T. (2013). The Relationship
between Body Mass Index and Mental Health among Iraq and Afghanistan Veterans.
J Gen Intern Med, 28, S563–70.
Mumford, E. A., Liu, W., Hair, E. C., & Yu, T. C. (2013). Concurrent Trajectories of BMI and
Mental Health Patterns in Emerging Adulthood. Journal of Social Science and Medicine.
Kuan, P. X., Ho, H. L., Suhaili, M. S., Siti, A. A., & Gudum, H. R. (2011). Gender Differences
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Meredith. P. J., Strong. J., & Feeney, J. A. (2007). Evidence of a relationship between adult
attachment and appraisals of chronic pain. Pain Res Manage, 10 (4), 191-200.
Doll, H. A., Sophie E. K. Petersen, S. E. K., & Stewart-Brown., S. L. (2000). Obesity and
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Zhao, G., Ford, E. S., Dhingra, S., Li, C., Strine, T. W., & Mokdad, A. H. (2009). Depression
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Carpenter, K. M., Hasin, D. S., Allison, D. B., Faith, M. S. (2000). Relationships between
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