The study, which appears online in the Journal of Adolescent Health, looked at more than 14,000 high school students to determine the relationship between a high body mass index (BMI) and suicide attempts, as well as the relationship between perceived overweight and suicide attempts, and found higher risk in both cases.

Contrary to what the researchers had originally expected, the association was as strong for boys as for girls, said lead study author Monica Swahn, PhD.

"This is a major concern since more and more children and youth are becoming overweight and obese," said Swahn, associate professor in the Institute of Public Health at Georgia State University.

"The mental health issues and distress that some youth who are overweight may experience ... appears to be a growing, but largely unaddressed, issue," Swahn told Daily News Central. "We tend to overlook the need for mental healthcare and prevention and underestimate the scope and range of services needed."

Reality vs. Perception

For the study, participants answered a survey question:"How do you describe your weight?" They could choose among five responses: very underweight, slightly underweight, about the right weight, slightly overweight or very overweight, Swahn said. "In our analyses, we looked at those who said they were either slightly or very overweight to determine their potential increased risk for suicide attempts. Our study shows that those who felt that they were overweight were about 40 percent more likely to also report suicide attempt."

Hatim Omar, MD, chief of the Division of Adolescent Medicine at the University of Kentucky, said his own experience has led him to believe that perceived obesity does increase both depression and suicide risk. "Teens are vulnerable because of their development," he said, "and any actual or perceived changes in their lives, including weight issues, can potentially increase the risk of depression or suicide."

Understanding these associations can help in the development of appropriate strategies for suicide prevention, according to the researchers.

"We cannot only focus prevention strategies on those who are overweight and who are concerned about their weight, but we also need to include youth who feel that they are overweight even though they may not be," Swahn said.

Societal Pressures

"Youth feel very pressured to fit in and to fit certain limited ideals of beauty," she added.

"Unfortunately, as a society, we are very focused on beauty and in particular weight," she noted. "Weight gain and weight loss are pervasive issues that many of us struggle with. So, of course, these issues are linked to our well-being and our mental health. The sad aspect of our findings is that it is not only those who actually are overweight that are at increased risk for suicide attempt, but also that those who perceive themselves as overweight, even if they're not actually overweight, are at increased risk for suicide attempts. This finding appears to reflect the very strong influence of social constructs related to body image and body ideals. It is also important to point out that in our study, the link between perceived overweight and suicide attempts was important for both boys and girls."

Omar noted that "this study adds another wake-up call to providers, parents, teachers and society about the need for screening for depression and suicide risk in all teens, with special attention to teens with perceived or actual obesity."

Signs of Depression

Swahn pointed to several common symptoms of depression that parents and caretakers can look for:

"If five or more of these symptoms are present for more than two weeks, it is very likely that the person can be diagnosed as depressed," Swahn said.

What should be the role of parents, teachers, healthcare professionals and others in providing appropriate feedback to teens regarding weight and body image? Is there a conflict between nurturing health and fitness on the one hand, and self-esteem on the other?

"It is very important that we find a balance between supporting healthy eating and exercise to achieve well-being and pushing too hard for quick fixes, weight loss and unrealistic body ideals," Swahn said. "All of us, as parents, caring adults, teachers and healthcare professionals, can have active roles in promoting healthy youth development that support healthy eating and frequent exercise.

External Influences

"However, it is important to recognize the many external influences that manipulate our eating," she continued. "I just read Dr. [David] Kessler's new book, The End of Overeating, which is a fascinating account of how the food industry, together with the advertising industry, have made it nearly impossible for some people to control their food intake. Food has been manipulated, packaged and sold in a way to increase the proportions of sugar, salt and fat, which lead most of us wanting more and on a downward spiral to weight gain. Given this heavy influence, particularly among our children who are growing up with all these messages, it is clear that we need to serve as advocates for our children as well."

The study authors recommend and encourage future research to examine issues pertaining to perceived and actual weight and their role in suicidal behavior.

"There is growing empirical evidence that there is a strong link between these," said Swahn, "and that concerns about weight can contribute to distress and suicidal behavior. Ideally, future research should disentangle these associations ... and also examine the factors that may alleviate the risk among those who perceive themselves to be overweight."