Revisiting the link alexithymia-depression in individuals with obesity

Alexithymia is a psychological construct characterized by difficulty in recognizing and describing emotions. It has been linked to both obesity and depression. Our aim was to investigate the interplay between alexithymia and depressive symptoms in a sample of individuals with obesity. A sample of 275 adults with obesity (BMI ≥30 kg/m²) was randomly recruited from a nutrition clinic. Psychometric measures included Beck Depression Inventory (BDI) and Toronto Alexithymia Scale -20 (TAS-20). The relationship between alexithymia and depressive mood was further confirmed using the structured clinical interview in subjects with moderate-to-severe BDI scores. Binary logistic regression was used to assess the association between alexithymia and depression, stratified by obesity grade and gender. Linear regression was used to examine the predictive value of alexithymia for depression severity. 49.1% had moderate to severe depressive symptoms. Participants scoring definite alexithymia (TAS-20 ≥ 61) was 40.7%. Alexithymia and depressive mood showed a highly significant association (OR = 5.67, P < 0.001). This association kept constant across all grades of obesity and particularly marked among women (OR = 6.66, P < 0.001), but not observed in men (OR = 2.33, P=N·S). Regression analysis showed that alexithymia scores significantly predicted depression severity (BDI = -7.151 + 0.422 × (TAS-20), R² = 0.26, p < 0.001), with the prediction power for Grade I obesity being most obvious (R² = 0.41). In individuals with obesity, alexithymia is a strong and independent predictor for the severity of depression, especially among women and in the early stages of obesity. An integrative psychological intervention is needed for a better weight loss.