With Obesity, Social Isolation and Loneliness Are Tied to Early Death
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Interventions to help with loneliness and social isolation may put people with obesity at a lower risk for health complications, according to a new study published January 22 in JAMA Network Open.
Social and psychological factors are often ignored in favor of dietary and lifestyle factors when it comes to improving health in people with obesity, says the lead study author, Lu Qi, MD, PhD, a professor of epidemiology and the director of Tulane University Obesity Research Center in New Orleans. “Our findings suggest that improving loneliness and social isolation may benefit health in people with obesity,” he says.
What’s the Difference Between Social Isolation and Loneliness?
Social isolation and loneliness are more than just bad feelings, fleeting emotions, or temporary situations: They are distinct factors that are linked, separately, with health outcomes and mortality (death).
Social isolation measures the scarcity of contact with others and related health resources, while loneliness reflects a sense of detachment potentially linked to emotional states like depression.
Both are associated with numerous illnesses, including a higher risk of anxiety, depression, heart disease, dementia, and stroke, as well as all-cause mortality and cancer mortality, according to a meta-analysis published in the June 2023 Nature Human Behavior.
Study Subjects Who Reported Feeling Less Lonely and Socially Isolated Were Less Likely to Die
To explore whether improving social isolation and loneliness in people with obesity could lower their risk of dying early, researchers used data from nearly 400,000 people (without cancer or heart disease when data collection began) from the UK Biobank, a large-scale biomedical database and research resource.
Participants were followed between March 2006 and November 2021, with an average follow-up of almost 13 years, according to the study. Data was collected on risk factors that could cause death for any reason, along with cancer- and heart-disease-related deaths.
Researchers measured the degree of isolation with questions about how many people the subjects lived with, how often they saw family or friends, and how often they visited the gym, social clubs, religious gatherings, or adult education classes. Questions to measure loneliness included, “Do you often feel lonely?” and “How often are you able to confide in someone close to you?”
Investigators then analyzed data to determine the cause of death for the subjects who died during the study period and then correlated it to their level of social isolation and loneliness.
Over that time, all causes of death for people classified as obese were 36 percent lower in people who felt less lonely and socially isolated.
Social isolation was found to be a greater risk factor for all causes of mortality, including cancer, cardiovascular disease, depression, anxiety, and lifestyle risk factors — which included alcohol use, exercise habits, and diet.
“Importantly, our results indicated that control of social isolation and loneliness might attenuate the obesity-related excess risk of all-cause mortality,” the authors wrote.
Social Isolation and Loneliness Could Contribute to Inflammation and Unhealthy Behaviors
Although the study wasn’t designed to look at why loneliness and social isolation could take a toll on health, Dr. Qi points to previous studies indicating that loneliness and isolation may affect biological function and metabolism factors, such as inflammation.
“Loneliness and social isolation could also affect behaviors, including more drinking and smoking and less exercise, which lead to changes that subsequently impact health in humans,” he says.
People With Obesity Face Additional Social Barriers
People with obesity face social barriers and biases that people without obesity don’t experience, says Fatima Cody Stanford, MD, MPH, an associate professor of medicine at Harvard Medical School and an obesity medicine expert at Massachusetts General Hospital in Boston. Dr. Stanford was not involved in the study.
“Unfortunately, persons with obesity are unfairly judged based on their appearance. This does not bode well for their social environment and engagements because people assume they are lazy, undisciplined, or careless because of their appearance,” says Dr. Stanford.
Anti-fat bias may hamper the ability of a person with obesity to make social connections, says Stanford. A person with obesity may withdraw from situations where they may have to eat in front of others, for instance, or engage in physical activities in a group, because they may be self-conscious about how others perceive them in these situations, Stanford says.
“But others [without obesity] can go into these situations without being judged,” Stanford points out.
Loneliness and Social Isolation Impact the Health of People Without Obesity, Too
The study findings are supported by previous research conducted in the general populations, which also found links between social isolation and loneliness and early death, wrote the authors.
This includes a study from Finland that showed social isolation was related to a 26 percent increased risk of all-cause mortality in the general population when separately adjusting for income, education, genetics, depressive symptoms, cognitive performance, and health-related behaviors.
Another study, which used data from the Swedish Panel Study of Living Conditions of the Oldest Old (SWEOLD), indicated that social isolation and loneliness were associated with an increased all-cause mortality risk.
Expert Tips on How to Deal With Isolation and Loneliness
In a worldwide Gallup poll that included more than 140 countries, nearly 1 in 4 adults reported being “very” or “fairly” lonely. In May of last year, the former U.S. Surgeon General Vivek Murthy, MD, announced an advisory to address what he called “the epidemic of loneliness and isolation” affecting the country.
Top tips from the advisory for alleviating loneliness and isolation include:
- Invest time in nurturing your relationships. Take time each day to reach out and connect with a friend or family member.
- Minimize distraction during conversation. An example: When you’re having a meal or important conversation, don’t check your phone.
- Be responsive, supportive, and practice gratitude. There’s evidence that practicing gratitude can help with feelings of loneliness.
- Seek help when you are struggling. Reach out to a friend, family member, counselor, or healthcare provider or call the 988 crisis line.
For her patients with obesity, Stanford recommends seeking out people who recognize that “you are more than your size.”
“You are human, and you deserve respect at all times,” she says.
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