Obesity in French Inmates: Gender Differences and Relationship with Mood, Eating Behavior and Physical Activity

CONTEXT: Inmates, notably women, are at greater risk for obesity and metabolic complications than the general population according to several studies from high income countries. Data regarding French correctional institutions are lacking so far. To fill this gap, we have assessed in a sample from a French prison (33 females and 18 males) the gender-specific effect of incarceration on weight and body mass index (BMI) and examined their current metabolic status. Furthermore, to reveal the possible determinants of increased obesity, we analyzed emotional vulnerability, eating behavior and physical activity using self-reported questionnaires. RESULTS: In this sample, obesity (BMI≥30 kg/m2) was already frequent in women (18.2%) but rather scarce for men (11%) at prison entry. Incarceration worsened the rate of obesity in both genders (21.2% and 16.7% respectively). At the time of study, abdominal obesity estimated through waist circumference was particularly prevalent in women (69.7%) versus men (27.8%) and metabolic syndrome was detected in 33% of female against none in male inmates. Abdominal obesity was associated with female sex (p<0.03), low physical activity (p<0.05) and eating disorder (p = 0.07) in univariate analyses. Low physical activity remained significant as an explanatory factor of higher abdominal obesity in multivariate analysis. A marked difference between genders was found for practice of physical activity with a higher proportion of women compared to men being inactive (37.9% vs. 11.8%) and fewer women being very active (17.2% vs. 41.2%). CONCLUSION: This study revealed that a significant proportion of women of this correctional institution combined established obesity, a metabolic syndrome and very little practice of physical activity which put them at high risk of cardiovascular disease. Thus, obesity should be better surveyed and treated in prison, especially for female inmates. Increased physical activity, adapted to obese women, would be the first mean to decrease obesity and gender differences

Gender differentials in the presentation of symptoms, assessment, diagnosis and treatment of mentally ill prisoners

Critical criminologists have written extensively about the gendered nature of the criminal justice system and of its deleterious consequences. This chapter will continue in that same tradition and examine the extent to which gender plays a key role in the presentation of symptoms, assessment, diagnosis and treatment of mentally ill prisoners. The importance of such an exercise is clear. The 'Standard Minimum Rules for the Treatment of Prisoners' that was adopted by the First United Nations Congress on the Prevention of Crime and the Treatment of Offenders in 1955 made it very clear via Rule 62 that [t]he medical services of the institution shall seek to detect and shall treat any… mental illnesses or defects which may hamper a prisoner's rehabilitation'. Thus, the ensuing analysis here will explore how the gender of a prisoner influences the way in which a mentally ill inmate presents their symptoms (and seeks medical assistance); as well as, how they are thereafter assessed, diagnosed and treated by prison health services. By doing so, it is hoped that penal administrators and correctional health professionals in India will be made more aware of, or sensitive to, these variances, and that the subsequent assessment, diagnosis and treatment of such prisoners will be more gender-responsive so as to maximize the prospect of successful rehabilitation