Obesity–depression associations in the population

https://doi.org/10.1016/S0022-3999(02)00308-2Get rights and content

Abstract

This article summarizes data on the relationship between obesity and depression in the population. Both obesity and depression are increasingly prevalent and associated with numerous health complications including hypertension, coronary heart disease, and increased mortality. There does not appear to be a simple or single association between these disorders. Meta-analytic studies suggest no statistically significant relationship, although pooling all subjects may mask important variables that moderate or mediate potential covariations. Sociodemographic, psychosocial, and genetic factors may render certain obese individuals more prone to depression or vice versa. Physiological and behavioral variables that link obesity and depression have received limited study. There are likely multiple obesity–depression covariations in the population, rather than a single pattern of association. There is a need for longitudinal and mechanistic studies to understand casual pathways and greater collaboration between depression and obesity specialists.

Introduction

Obesity and depression are increasingly prevalent and associated with various health complications. Obesity is associated with hypertension, dyslipidemia, diabetes mellitus, coronary heart disease, stroke, as well as increased all-cause mortality [1]. Depression is associated with increased risk of coronary heart disease, myocardial infarction, heart failure in patients with systolic hypertension, low bone mineral density, and increased mortality [2], [3], [4], [5], [6], [7]. Over 60% of the adult US population is overweight or obese [1], and depression is one of the most common psychiatric disorders among patients seeking outpatient care [8]. These disorders incur substantial costs to society [9], [10] and the individual [11], [12].

Obesity and depression research, by and large, have evolved as two independent disciplines. With respect to common etiological models, there have been few developments since early psychodynamic models [13]. With respect to clinical innovations, the two fields rarely overlap. During the past 50 years, it has largely been assumed that relative body weight (RBW: weight adjusted for height) is unrelated to depression in the population. This may be true. However, the relationship may be more complicated than originally believed [14].

This article reviews data on the associations between RBW and depression in the population and summarizes potential moderators and mediators of these covariations. We conclude that there may be multiple covariations and that greater insights will be achieved through increased collaboration between obesity and depression specialists.

Section snippets

Cross-sectional studies

An extensive literature spanning several decades has addressed the relationships among obesity, general psychopathology, and depression in particular [13]. This literature includes community- and clinic-based studies. Results from this literature, on balance, do not suggest a strong or simple relationships among these variables. Most community studies find no significant association [14], [15], some studies reported significantly less anxiety and depression among obese individuals [16], [17],

Identifying moderators and mediators of potential RBW–depression covariations

The mechanisms underlying RBW–depression covariation are largely unknown. However, potential moderators and mediators have been identified in the literature and suggest important avenues for research and clinical intervention. Potential moderators and mediators are summarized in Table 1 and reviewed below. Moderators are defined as variables upon which obesity–depression covariation is conditional. Thus, one may observe an association in one level of a moderator variable but not another (e.g.,

Sociodemographic factors

Demographic variables such as socioeconomic status (SES), income, education, gender, and ethnicity may moderate RBW–depression covariation [14]. The classic “Midtown Manhattan Study” provided perhaps the earliest evidence. In a community study of 1660 New York City residents, the association between obesity and depression significantly varied as a function of gender and SES in persons 20–39 years old (see Fig. 1). Among men, the difference in the percentage of depressed between obese and normal

Negative verbal commentary

History of negative verbal commentary (i.e., weight teasing) is associated with significantly greater depression among obese individuals [50]. In a 3-year prospective study of adolescents, teasing history mediated the relationship between obesity status and subsequent levels of depression [51]. In this model, baseline obesity status elicited teasing, which in turn elicited increased depression 3 years later through increased appearance dissatisfaction (Fig. 5). In a sample of 115 obese females

Conclusions

Fig. 6 pictorially summarizes four generic research models or strategies that have been used to address questions concerning obesity–depression associations. The “bivariate model” tests simple associations between body fat and depression measures, without examining putative moderators and mediators. This strategy has been the most common approach in the literature and, arguably, will yield few new insights by itself at this time. “Moderation models” test whether the relationship between obesity

Acknowledgements

This work was supported in part by NIH Grant No. K08MH01530.

References (72)

  • JC Lovejoy et al.

    Abdominal fat distribution and metabolic risk factors: effects of race

    Metabolism

    (1996)
  • Clinical guidelines for the identification, evaluation, and treatment of overweight and obesity in adults: the evidence report

    (1998)
  • R Schulz et al.

    Association between depression and mortality in older adults: the Cardiovascular Health Study

    Arch Intern Med

    (2000)
  • RJ Anderson et al.

    The prevalence of comorbid depression in adults with diabetes: a meta-analysis

    Diabetes Care

    (2001)
  • T Pohjasvaara et al.

    Depression is an independent predictor of poor long-term functional outcome post-stroke

    Eur J Neurol

    (2001)
  • J Robbins et al.

    The association of bone mineral density and depression in an older population

    J Am Geriatr Soc

    (2001)
  • J Abramson et al.

    Depression and risk of heart failure among older persons with isolated systolic hypertension

    Arch Intern Med

    (2001)
  • R Kimerling et al.

    Depression and outpatient medical utilization: a naturalistic 10-year follow-up

    Ann Behav Med

    (1999)
  • DB Allison et al.

    The direct health care costs of obesity in the United States

    Am J Public Health

    (1999)
  • BG Druss et al.

    Health and disability costs of depressive illness in a major US corporation

    Am J Psychiatry

    (2000)
  • MS Faith et al.

    Emotional eating and obesity

  • KB Wells et al.

    The functioning and well-being of depressed patients: results from the medical outcomes study

    JAMA, J Am Med Assoc

    (1989)
  • MS Faith et al.

    Assessment of psychological status among obese persons

  • MA Friedman et al.

    Psychological correlates of obesity: moving to the next research generation

    Psychol Bull

    (1995)
  • AH Crisp et al.

    Jolly fat: relation between obesity and psychoneurosis in general population

    Br Med J

    (1976)
  • AL Stewart et al.

    Effects of being overweight

    Am J Public Health

    (1983)
  • RR Wing et al.

    Waist to hip ratio in middle-aged women: associations with behavioral and psychosocial factors and with changes in cardiovascular risk factors

    Arterioscler Thromb

    (1991)
  • J Istvan et al.

    Body weight and psychological distress in NHANES I

    Int J Obes Relat Metab Disord

    (1992)
  • M Sullivan et al.

    Swedish obese subjects (SOS)—an intervention study of obesity. Baseline evaluation of health and psychosocial functioning in the first 1743 subjects examined

    Int J Obes

    (1993)
  • FX Pi-Sunyer

    The effect of central fat distribution on cardiovascular disease

  • RC Prather et al.

    Psychopathology associated with bulimia, binge eating, and obesity

    Int J Eating Disord

    (1988)
  • ML Fitzgibbon et al.

    Obese people who seek treatment have different characteristics than those who do not seek treatment

    Health Psychol

    (1993)
  • NE Sherwood et al.

    Binge status as a predictor of weight loss treatment outcome

    Int J Psychiatry

    (1999)
  • MJ Seegers et al.

    Psychological and bioclinical CHD risk factors: quantitative differences between obese, normal and thin subjects

    J Psychosom Res

    (1974)
  • AL Stewart et al.

    Effects of being overweight

    Am J Public Health

    (1983)
  • TA Wadden et al.

    Dissatisfaction with weight and figure in obese girls: discontent but not depression

    Int J Obes

    (1989)
  • Cited by (0)

    View full text