Reply to the Letter to the Editor “Sex-stratified results should be evaluated alongside sex-adjusted results for further discussion of significant associations with sex”: Further discussion on significant associations related to sex

Dear Dr. Yuji Aoki,

Thank you for your insightful comments regarding our study. We appreciate the opportunity to address the points raised concerning the evaluation of sex-stratified results alongside sex-adjusted results to better understand the significant associations reported. Below, we present our analyses and interpretations in response to your questions.

 1. Response to Question on Sex-Stratified Results

To evaluate the sex-specific associations more comprehensively, we conducted sex-stratified logistic regression analyses on the working-age population data. The following significant associations were observed:

 

Results for Women:

Living with family (compared to living alone):

Crude odds: 0.29 (95% CI: 0.12-0.70), p = 0.006

Adjusted odds: 0.25 (95% CI: 0.10-0.66), p = 0.005

Alcohol consumption (none, compared to ≥1 time per week):

Crude odds: 2.97 (95% CI: 1.29-6.82), p = 0.011

Adjusted odds: 3.13 (95% CI: 1.29-7.57), p = 0.012

 

Results for Men:

Eating alone (compared to eating with family):

Crude odds: 2.50 (95% CI: 1.20-5.18), p = 0.014

Adjusted odds: 2.28 (95% CI: 1.03-5.03), p = 0.041

 

Eating speed (fast, compared to slow):

Crude odds: 2.14 (95% CI: 1.03-4.46), p = 0.042

Adjusted odds: 2.82 (95% CI: 1.26-6.32), p = 0.012

 

The analyses included age as an adjustment factor. No other significant associations were identified in the sex-stratified analyses.

 2. Discussion on Sex-Specific Associations

 A. Stress Management and Obesity in Women:

Women who reported inadequate stress management exhibited a significantly higher risk of obesity (adjusted odds: 2.20, p = 0.008). This finding supports previous research suggesting that stress may lead to unhealthy eating behaviors or emotional eating, particularly in women. Stress management interventions, such as counseling or mindfulness practices, could play a crucial role in reducing obesity risk among women.

 B. Alcohol Consumption and Obesity in Women:

Non-drinking women had a significantly higher risk of obesity compared to those who consumed alcohol at least once per week (adjusted odds: 3.13, p = 0.012). This counterintuitive finding may reflect that moderate alcohol consumption contributes to appetite regulation or stress reduction, while abstinence might lead to alternative, less healthy coping mechanisms, such as overeating. Further research is necessary to clarify these dynamics and establish appropriate guidelines.

 C. Eating Habits and Obesity in Men:

For men, eating speed was strongly associated with obesity risk (adjusted odds: 3.61, p < 0.001). Rapid eating may prevent the timely onset of satiety signals, leading to excessive calorie intake. Public health campaigns encouraging mindful eating and slower eating habits may prove effective for reducing obesity prevalence in men.

 D. Social Factors and Obesity in Men:

Men who ate alone were at significantly higher risk of obesity (adjusted odds: 2.28, p = 0.041). This association highlights the importance of social eating as a potential protective factor against obesity, possibly due to improved meal quality and portion control when eating with others.

 3. Implications for Future Research and Public Health Policies

Our findings emphasize the need for sex-specific approaches to obesity prevention and management. Tailored interventions, focusing on stress management for women and promoting healthier eating habits for men, could yield more effective outcomes. Additionally, further studies incorporating other lifestyle factors, such as physical activity and sleep patterns, would enhance our understanding of these associations.

We hope this response clarifies our findings and addresses your concerns. We appreciate your valuable feedback, which has contributed to a deeper exploration of these important relationships.

 

January 13, 2025