A systematic review of variables associated with the relationship between obesity and depression

Obesity, Overweightness, and Depressive Symptomology Among American Indian Youth

OBJECTIVES

Despite evidence that American Indian adolescents are at a heightened risk of obesity/overweightness and experiencing depression, relative to other groups, there exists a dearth of studies that have examined the association between objective and perceptual measures of obesity and overweightness and depression with this understudied group. Our study represents one of the first studies to examine this association among American Indian youth.

METHODS

Using a subsample of American Indian youth from waves I and II of the National Longitudinal Study of Adolescent Health (a survey of schools and students in the USA, with wave I collected in 1994 and wave II collected in 1995), we explore this association. We examine three measures of weight: obesity, body mass index, and weight perception. We also consider gender-specific models and a subsample of non-Hispanic whites, in order to assess race differences in the obesity and overweightness-depression relationship.

RESULTS

Our findings reveal that neither of our objective measures of weight, obesity, nor body mass index are significant predictors of depressive symptoms for either American Indian or white youth. However, we find evidence that the subjective measure of weight perception is a significant predictor of depressive symptoms for white females, but not for American Indian females.

CONCLUSIONS

Our results contribute to past findings that measures of obesity/overweightness weight may be more important to white female's mental health than females from other racial groups, although additional research is warranted.

Cytometric analysis of adipose tissue reveals increments of adipocyte progenitor cells after weight loss induced by bariatric surgery

Obesity-related comorbidities are, in large part, originated from the dysfunction of adipose tissue. Most of them revert after the normalization of body mass. Adipose tissue is essentially occupied by adipocytes. However, different populations of immunological cells and adipocyte precursor cells (AdPCs) are the main cellular components of tissue. During obesity, body fat depots acquire a low-level chronic inflammation and adipocytes increase in number and volume. Conversely, weight loss improves the inflammatory phenotype of adipose tissue immune cells and reduces the volume of adipocytes. Nevertheless, very little is known about the evolution of the human AdPCs reservoir. We have developed a flow cytometry-based methodology to simultaneously quantify the main cell populations of adipose tissue. Starting from this technical approach, we have studied human adipose tissue samples (visceral and subcutaneous) obtained at two different physiological situations: at morbid obesity and after bariatric surgery-induced weight loss. We report a considerable increase of the AdPCs reservoir after losing weight and several changes in the immune cells populations of adipose tissue (mast cells increase, neutrophils decrease and macrophages switch phenotype). No changes were observed for T-lymphocytes, which are discussed in the context of recent findings.

Weight change among normal weight, overweight and obese employees and subsequent diagnosis-specific sickness absence: A register-linked follow-up study

Aims: Obesity and weight change are associated with sickness absence; however, less is known about the diagnoses for sickness absence. We examined the association between stable and changing weight by body mass index groups with sickness absence due to any, musculoskeletal and mental diagnoses among midlife female and male employees. Methods: The Finnish Helsinki Health Study phase 1 survey took place in 2000–2002 (response rate 67%) and phase 2 in 2007 (response rate 83%). Based on self-reported body mass index, we calculated the weight change between phases 1 and 2 (body mass index change ⩾5%). The data were linked with registers of the Social Insurance Institution of Finland, including information on diagnoses (ICD-10) for sickness absence >9 days. We used a negative binom ial model to examine the association with sickness absence among 3140 women and 755 men during the follow-up (2007–2013). Results are presented as rate ratios. Covariates were age, sociodemographic factors, workload, health behaviors and prior sickness absence. Results: Weight-gain (rate ratio range=1.27–2.29), overweight (rate ratio range=1.77–2.02) and obesity (rate ratio range=2.16–2.29) among women were associated with a higher rate of sickness absence due to musculoskeletal diseases, compared to weight-maintaining normal-weight women. Similarly, obesity among men was associated with sickness absence due to musculoskeletal diseases (rate ratio range=1.55–3.45). Obesity among women (rate ratio range=1.54–1.72) and weight gain among overweight men (rate ratio=3.67; confidence interval=1.72–7.87) were associated with sickness absence due to mental disorders. Conclusions: Obesity and weight gain were associated with a higher rate of sickness absence, especially due to musculoskeletal diseases among women. Preventing obesity and weight gain likely helps prevent sickness absence.

Why some obese people become depressed whilst others do not: exploring links between cognitive reactivity, depression and obesity

Obesity and depression are two major public health concerns, particularly when they co-occur. To date, mechanisms underlying this association have not been established and it is unclear why some obese people become depressed whilst others do not. However, considering the strong association between depression and cognitive reactivity (CR), the present study explores possible associations between obesity, depression and CR in light of the scarce and conflicting nature of past literature. 254 participants were included for measures of depression, CR and obesity. Multivariate analyses of covariance examined the effects of depression and obesity as well as interaction effects of depression x obesity controlling for age and gender. Directions of effects were analysed by means of regression analyses and group contrasts. Linear analyses revealed (1) a significant effect of obesity on the rumination (RUM) and control/perfectionism subscales of CR, (2) a significant effect of depression on CR and all of its subscales, and (3) a significant interaction effect between obesity x depression on RUM. Results may support the 'Jolly Fat Hypothesis' and the existence of a psychologically protected subgroup of obese patients characterised by a lower ruminative thinking style and fewer depressive symptoms. Thus, incorporating anti-rumination therapy into treatment for obese individuals may be beneficial to prevent the development of comorbid depression.

Factors Affecting Body Image Discordance Amongst Korean Adults Aged 19-39 Years

Objectives

This study was designed to investigate factors affecting the discordance between body image and body mass index amongst Korean adults aged 19–39 years.

Methods

Data (N = 59,361) from the 2014 Korean Community Health Survey was analyzed using descriptive analysis, chi-square test, and logistic regression analysis.

Results

To examine the factors affecting body image discordance as observed in 43.1% of participants, the group was subdivided into underestimation and overestimation. There were 36.0% of participants that were body image discordant underestimators and 7.1% were overestimators. Multivariate logistic regression analysis showed that the underestimators tended to be men, graduated from high school, married, current/ex-smokers, ex-drinkers, had between 5 to 9 hours sleep (inclusive), had fair to good self-rated health, and demonstrated healthy weight control behavior, relative to the reference group. In comparison, overestimators tended to be in the 19–29 year group and had signs of depression. The OR of individuals who were men, married, and had healthy weight control behavior was significantly lower in the overestimators group.

Conclusion

These findings show that tailored interventions to promote accurate body awareness should be based on the type of body image discordance. In addition, it is necessary to develop and implement a program of body image improvement that considers the factors affecting body weight discordance.

Impact of New-Onset Postoperative Depression on Readmission Outcomes After Surgical Coronary Revascularization

BACKGROUND

Depression affects between 10% and 40% of cardiac surgery patients and is associated with significantly worse outcomes. The incidence and impact of new-onset depression beyond acute follow-up remain ill-defined. The present study aimed to evaluate the incidence, risk factors, and prognostic implication of depression on 90-d readmission rates after coronary artery bypass grafting (CABG) surgery.

METHODS

A retrospective cohort study was performed identifying adult patients without prior depression who underwent CABG surgery using the 2010-2014 National Readmissions Database. CABG patients who were readmitted more than 2 wk but within 90 d of discharge were categorized based on the presence of new-onset depression. Association between the development of new-onset depression and rehospitalization were morbidity, mortality, costs, and length of stay (LOS) and were examined using multivariable regression.

RESULTS

During the study period, 1,001,945 patients underwent CABG. Of these, 11.7% of patients were readmitted after 14 d but within 90 d of discharge with 5.1% of these patients having a diagnosis of new-onset depression. Postoperative new-onset depression was not associated with increased readmission morbidity, costs, or LOS. Mortality in new-onset depression readmissions was 1.2%, compared with 2.3% in all readmitted patients (P = 0.014). Depression was associated with lower odds of mortality (OR = 0.56, P = 0.02).

CONCLUSIONS

New-onset depression following CABG discharge was not associated with increased odds of mortality, morbidity, costs, or increased LOS on readmission. Rather, new-onset depression is associated with decreased odds of readmission mortality. Overall, CABG readmissions are decreasing, whereas the rate of new-onset depression is slightly increasing. Implementation of routine depression screening tools in postoperative CABG care may aid in early detection and management of depression to enhance postoperative recovery and quality of life.

Facilitators and barriers to modifying dietary and hygiene behaviours as adjuvant treatment in patients with depression in primary care: a qualitative study

BACKGROUND

Major depression is a highly prevalent condition. Its pathogenesis is related to a wide variety of biological and psychosocial factors and among these is factors related to lifestyle. Lifestyle-based interventions seem to be appropriate strategies as coadjutant treatment. The objective of this study is to explore and identify expectations and experiences of both patients and healthcare professionals that can point to the main barriers and facilitators with regard to the promotion of healthy dietary and hygiene behaviours in patients suffering from major depression.

METHODS

A qualitative design was used to collect information from a wide range of purposefully and theoretically guided samples of depressed patients and health professionals from Primary Care (PC). Both in-depth interviews and discussion groups were used. A standardized protocol was designed to guide the interviews and groups, including the preparation of a topic list to be addressed, with previously tested, open suggestions that could be of interest. A thematic analysis was performed from grounded theory in order to explore, develop and define until saturation the emergent categories of analysis derived from the individual interview and group data.

RESULTS

Both patients as well as PC professionals noted a series of central aspects with respect to the implementation of a programme for the acquisition of healthy dietary and hygiene habits for depressive patients, which may be organized around 'personal', 'programmatic', and 'transversal' aspects. As for the personal aspects, categories regarding 'patient history', and 'disposition' were found; the programmatic aspects included categories such as 'presentation and monitoring', and modification of 'cognitive' and 'behavioural' habits; whereas the transversal aspects comprised the possibilities of 'social support' and defining categories of 'objectives'.

CONCLUSION

The implementation of intervention programmes that combine dietary and hygiene-related factors in patients with depression is complex, given the nature of the disorder itself, and its symptoms such as apathy and feelings of guilt or incompetence. Key issues exist for the success of the intervention, such as the simplicity of guidelines, tailoring through motivational interviewing, prolonged and intense monitoring throughout the different stages of the disorder, and the provision of adequate feedback and social support. PC could be an appropriate level in which to implement these interventions.

Optimisation of follow-up after metabolic surgery

Bariatric surgery has many benefits beyond weight loss, including improved control of glycaemia, blood pressure, and dyslipidaemia; hence, such surgery has been rebranded as metabolic surgery. The operations are, unfortunately, also associated with major surgical and medical complications. The medical complications include gastro-oesophageal reflux disease, malnutrition, and metabolic complications deriving from vitamin and mineral malabsorption. The benefits of surgery can be optimised by implementing specific protocols before and after surgery. In this Review, we discuss the assessment of the risk of major cardiac complications and severe obstructive sleep apnoea before surgery, and the provision of adequate lifelong postsurgery nutritional, vitamin, and mineral supplementation to reduce complications. Additionally, we examine the best antidiabetic medications to reduce the risk of hypoglycaemia after gastric bypass and sleeve gastrectomy, and the strategies to improve weight loss or reduce weight regain. Although optimising clinical pathways is possible to maximise metabolic benefits and reduce the risks of complications and micronutrient deficiencies, evolution of these strategies can further improve the risk-to-benefit ratio of metabolic surgery.

Mediation of the bidirectional relations between obesity and depression among women

Past research established that obesity increases risk for development of depression, and depression increases risk for development of obesity. The current study tested physical impairment (difficulty with instrumental activities of daily living), social dysfunction (low social support and high social strain), and emotional eating (using food to cope with stress) as mediators of the bidirectional, longitudinal relations between depression and obesity. A national sample of mid-life adults in the United States (N = 7108) was assessed at three time points over 18 years. Depression predicted increases in obesity, and obesity predicted increases in depression, for women but not for men. Among women, path analyses revealed that physical impairment, social dysfunction, and emotional eating mediated development of obesity from depression, and that physical impairment and emotional eating mediated development of depression from obesity. These results suggest that prevention or treatment of obesity-linked depression and depression-linked obesity in women may need to address multiple connections between these disorders.

Association between obesity and depressive symptoms in Mexican population

PURPOSE

Obesity and depression are among the leading causes of disability in Mexico, but their association has not been explored yet. The aim of the current study was to investigate the association between obesity and depression in Mexican population.

METHODS

We used data from the health and nutrition survey (ENSANUT 2012), which is representative of the Mexican population. Obesity was determined using the body mass index (BMI) and abdominal obesity by measuring waist circumference. Depressive symptoms were reported using the Center for Epidemiological Studies Depression Scale Short-Form (CES-D-SF, scale 0-21). Regression analyses were performed between obesity and depression, adjusting for gender, age, living with a partner, education, and diabetes history.

RESULTS

Obese women had 1.28 (95% CI 1.07-1.53) times the odds of having depression in comparison with normal-weight women, whereas no association was found for men (OR 0.94; 95% CI 0.74-1.19). A significant association between BMI and depressive symptoms score (β = 0.05, 95% CI 0.02-0.07) was present in women, but no association was found for men (β = - 0.02, 95% CI - 0.05 to 0.00). There was a statistically significant association between waist circumference and depression scores again for women (β = 0.03, 95% CI 0.01-0.04) but not for men (β = 0.00, 95% CI - 0.01 to 0.01). No associations were found between abdominal obesity and depression for both genders. No association was found between different obesity severity levels and depression for both genders.

CONCLUSION

Obesity was associated with depression in Mexican women, whereas no association was found between obesity and depression in men.

Variation of genes encoding KAT1, AADAT and IDO1 as a potential risk of depression development

Numerous data suggests that the disorders of tryptophan catabolites (TRYCATs) pathway, including a decreased level of tryptophan or evaluated concentration of harmful TRYCATs -kynurenine, quinolinic acid, 3-hydroxyanthranilic acid, 3-hydroxytryptophan - may cause the occurrence of DD symptoms. In this work, we assessed the relationship between single-nucleotide polymorphisms (SNPs) of KAT1, KAT2 and IDO1 gene encoding, and the risk of depression development. Our study was performed on the DNA isolated from peripheral blood of 281 depressed patients and 236 controls. We genotyped, by using TaqMan probes, four polymorphisms: c.*456G > A of KAT1 (rs10988134), c.975-7T > C of AADAT (rs1480544), c.-1849C > A (rs3824259) and c.-1493G > C(rs10089084)of IDO1. We found that only the A/A genotype of c.*456G > A - KAT1 (rs10988134) increased the risk of depression occurrence. Interestingly, when we stratified the study group according to gender, this relationship was present only in male population. However, a gene-gene analysis revealed a link between the T/T-C/C genotype of c.975-7T > C - AADAT (rs1480544)or c.-1493G > C - IDO1 (rs10089084) and C/C-C/A genotype of c.975-7T > C - AADAT (rs1480544)and c. -1849C > A - IDO1 (rs3824259) and the disease. Moreover, we found, that the c.975-7T > C - AADAT and c. *456G > A KAT1 (rs10988134) polymorphisms may modulate the effectiveness of selective serotonin reuptake inhibitors therapy. Concluding, our results confirm the hypothesis formulated in our recently published article that the SNPs of genes involved in TRYCATs pathway may modulate the risk of depression. This provides some further evidence that the pathway plays the crucial role in development of the disease.

Decreased level of irisin, a skeletal muscle cell-derived myokine, is associated with post-stroke depression in the ischemic stroke population

Background

Depression is a frequent mood disorder in stroke patient. Our aim was to determine irisin levels in serum and investigate their associations with post-stroke depression (PSD) in a 6-month follow-up study in Chinese patients with first-ever acute ischemic stroke (AIS).

Methods

The subjects were first-ever AIS patients who were hospitalized at three stroke centers during the period from January 2015 to December 2016. Neurological and neuropsychological evaluations were conducted at the 6-month follow-up. Serum irisin concentrations were measured by enzyme-linked immunosorbent assay (ELISA).

Results

During the study period, 1205 patients were included in the analysis. There were 370 patients (30.7%) classified as depression. The depression distribution across the irisin quartiles ranged between 49.8% (first quartile) and 9.9% (fourth quartile). In the patients with depression, serum irisin levels were lower compared with those in patients without depression (P < 0.001). In a multivariate model using the first (Q1) quartile of irisin vs. Q2–4 together with the clinical variables, the marker displayed predictive information and increased risk of PSD by 75% (odds ratio [OR] for Q1, 1.75 [95% confidence interval [CI], 1.15–2.65]). In addition, a model containing known risk factors plus irisin compared with a model containing known risk factors without irisin showed a greater discriminatory ability; the area under the curve (AUC) increased from 0.77 to 0.81 (95% CI, 0.76–0.86).

Conclusions

The data suggested that reduced serum levels of irisin were powerful biological markers of risk of developing PSD even after adjustment by variables. Further studies are necessary to confirm this association, which may open the way to the proposal of new therapeutic options.

Trial registration

ChiCTR-OPC-17013501. Retrospectively registered 23 September 2017

Fat mass and obesity-associated (FTO) rs9939609 polymorphism modifies the relationship between body mass index and affective symptoms through the life course: a prospective birth cohort study

Although bi-directional relationships between high body mass index (BMI) and affective symptoms have been found, no study has investigated the relationships across the life course. There has also been little exploration of whether the fat mass and obesity-associated (FTO) rs9939609 single-nucleotide polymorphism (SNP) is associated with affective symptoms and/or modifies the relationship between BMI and affective symptoms. In the MRC National Survey of Health and Development (NSHD), 4556 participants had at least one measure of BMI and affective symptoms between ages 11 and 60-64 years. A structural equation modelling framework was used with the BMI trajectory fitted as latent variables representing BMI at 11, and adolescent (11-20 years), early adulthood (20-36 years) and midlife (36-53 years) change in BMI. Higher levels of adolescent emotional problems were associated with greater increases in adult BMI and greater increases in early adulthood BMI were associated with higher subsequent levels of affective symptoms in women. The rs9939609 risk variant (A allele) from 2469 participants with DNA genotyping at age 53 years showed mostly protective effect modification of these relationship. Increases in adolescent and early adulthood BMI were generally not associated with, or were associated with lower levels, of affective symptoms in the FTO risk homozygote (AA) group, but positive associations were seen in the TT group. These results suggest bi-directional relationships between higher BMI and affective symptoms across the life course in women, and that the relationship could be ameliorated by rs9939609 risk variant.

[Referral behavior of general physicians for patients with obesity]

The prevalence of obesity and overweight is constantly rising. Thus, obesity is increasingly considered as one of the most important healthcare problems in Germany. Surgical interventions have been proven to be the only treatment option to achieve sustained weight loss along with a reduction of obesity-related comorbidities in the vast majority of morbidly obese patients. With respect to the small numbers of weight loss surgeries conducted in Germany, several reasons are currently discussed. General practitioners play a very important role in gatekeeping when it comes to decisions about treatment. Research has shown that knowledge and stigma play a role when treatment pathways for patients with obesity are defined. Interventions are required to make treatment decisions by physicians or patients independent of social pressure due to stigma or gaps in expertise.

A Review of Childhood Behavioral Problems and Disorders in the Development of Obesity: Attention Deficit/Hyperactivity Disorder, Autism Spectrum Disorder, and Beyond

PURPOSE OF REVIEW

Given the high rates of pediatric and adult obesity, it is imperative to identify early risk factors that might contribute to excess weight gain. This review aims to investigate the relationship between childhood behavioral problems with the development and persistence of obesity. Specifically, this review highlights the association of obesity with (1) neurocognitive constructs, such as executive functioning and inhibition/impulsivity, and (2) disorders commonly diagnosed in childhood, including attention deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD).

RECENT FINDINGS

Consistent evidence supports a relationship between childhood behavioral problems, executive functioning, inhibition/impulsivity, ADHD, and ASD with obesity across the lifespan. Longitudinal studies suggest behavior problems, neurocognitive functioning deficits, and ADHD symptoms in childhood predict weight gain over time. Identifying risk factors in childhood that promote obesity may help develop targeted intervention and prevention programs. Additional research should elucidate mechanisms that account for these relationships.

Age at menarche and adult body mass index: a Mendelian randomization study

BACKGROUND

Pubertal timing has psychological and physical sequelae. While observational studies have demonstrated an association between age at menarche and adult body mass index (BMI), confounding makes it difficult to infer causality.

METHODS

The Mendelian randomization (MR) technique is not limited by traditional confounding and was used to investigate the presence of a causal effect of age at menarche on adult BMI. MR uses genetic variants as instruments under the assumption that they act on BMI only through age at menarche (no pleiotropy). Using a two-sample MR approach, heterogeneity between the MR estimates from individual instruments was used as a proxy for pleiotropy, with sensitivity analyses performed if detected. Genetic instruments and estimates of their association with age at menarche were obtained from a genome-wide association meta-analysis on 182,416 women. The genetic effects on adult BMI were estimated using data on 80,465 women from the UK Biobank. The presence of a causal effect of age at menarche on adult BMI was further investigated using data on 70,692 women from the GIANT Consortium.

RESULTS

There was evidence of pleiotropy among instruments. Using the UK Biobank data, after removing instruments associated with childhood BMI that were likely exerting pleiotropy, fixed-effect meta-analysis across instruments demonstrated that a 1 year increase in age at menarche reduces adult BMI by 0.38 kg/m² (95% CI 0.25-0.51 kg/m²). However, evidence of pleiotropy remained. MR-Egger regression did not suggest directional bias, and similar estimates to the fixed-effect meta-analysis were obtained in sensitivity analyses when using a random-effect model, multivariable MR, MR-Egger regression, a weighted median estimator and a weighted mode-based estimator. The direction and significance of the causal effect were replicated using GIANT Consortium data.

CONCLUSION

MR provides evidence to support the hypothesis that earlier age at menarche causes higher adult BMI. Complex hormonal and psychological factors may be responsible.

Psychosocial Predictors of Change in Depressive Symptoms Following Gastric Banding Surgery

OBJECTIVE

The aim of this study is to identify psychosocial variables associated with the relationship between weight loss and change in depressive symptoms following gastric banding surgery.

METHODS

Ninety-nine adults completed self-report questionnaires assessing depressive symptoms and other psychosocial variables (self-esteem, body image dissatisfaction, perceived physical health, and perceived weight-based stigmatisation) prior to gastric-band surgery and monthly for 6-month post-surgery.

RESULTS

Weight, depressive symptoms, and other psychosocial variables improved significantly 1-month post-surgery and remained lower to 6 months. Weight loss from baseline to 1- and 6-months post-surgery significantly correlated with change in depressive symptoms. Body image dissatisfaction and self-esteem accounted for some of the variance in change in depressive symptoms from baseline to 1-month and baseline to 6-months post-surgery.

CONCLUSIONS

Depressive symptoms improved significantly and rapidly after bariatric surgery, and body image dissatisfaction and self-esteem predicted change in depressive symptoms. Interventions targeting body image and self-esteem may improve depressive symptoms for those undergoing weight loss interventions.

IDO chronic immune activation and tryptophan metabolic pathway: A potential pathophysiological link between depression and obesity

Obesity and depression are among the most pressing health problems in the contemporary world. Obesity and depression share a bidirectional relationship, whereby each condition increases the risk of the other. By inference, shared pathways may underpin the comorbidity between obesity and depression. Activation of cell-mediated immunity (CMI) is a key factor in the pathophysiology of depression. CMI cytokines, including IFN-γ, TNFα and IL-1β, induce the catabolism of tryptophan (TRY) by stimulating indoleamine 2,3-dioxygenase (IDO) resulting in the synthesis of kynurenine (KYN) and other tryptophan catabolites (TRYCATs). In the CNS, TRYCATs have been related to oxidative damage, inflammation, mitochondrial dysfunction, cytotoxicity, excitotoxicity, neurotoxicity and lowered neuroplasticity. The pathophysiology of obesity is also associated with a state of aberrant inflammation that activates aryl hydrocarbon receptor (AHR), a pathway involved in the detection of intracellular or environmental changes as well as with increases in the production of TRYCATs, being KYN an agonists of AHR. Both AHR and TRYCATS are involved in obesity and related metabolic disorders. These changes in the TRYCAT pathway may contribute to the onset of neuropsychiatric symptoms in obesity. This paper reviews the role of immune activation, IDO stimulation and increased TRYCAT production in the pathophysiology of depression and obesity. Here we suggest that increased synthesis of detrimental TRYCATs is implicated in comorbid obesity and depression and is a new drug target to treat both diseases.

Fasting Plasma Glucose, Self-Appraised Diet Quality and Depressive Symptoms: A US-Representative Cross-Sectional Study

Depression and type 2 diabetes (T2D) contribute significantly to global burden of disease and often co-occur. Underpinning type 2 diabetes is poor glycaemic control and glucose is also an obligatory substrate for brain metabolism, with potential implications for cognition, motivation and mood. This research aimed to examine the relationships between fasting plasma glucose and depressive symptoms in a large, population representative sample of US adults, controlling for other demographic and lifestyle behavioural risk factors. Using the 2013–2014 National Health and Nutrition Examination Survey (NHANES) data, this study first investigated the relationship between fasting plasma glucose and mental disorders at a population-level, accounting for demographic, health behavioural and weight-related factors known to co-occur with both type 2 diabetes and mental disorders. Depressive symptoms were derived from the 9-item Patient Health Questionnaire. Fasting plasma glucose was obtained through medical examination and demographic (age, household income, sex) and health characteristics (perceived diet quality, daily time sedentary) were self-reported. Body mass index was calculated from objectively measured height and weight. In the univariate model, higher fasting plasma glucose was associated with greater depressive symptoms among females (b = 0.24, 95% CI = 0.05, 0.43, p < 0.05), but not males. In the final fully adjusted model, the relationship between fasting plasma glucose and depressive symptoms was non-significant for both males and females. Of all independent variables, self-appraised diet quality was strongly and significantly associated with depressive symptoms and this remained significant when individuals with diabetes were excluded. Although diet quality was self-reported based on individuals’ perceptions, these findings are consistent with a role for poor diet in the relationship between fasting plasma glucose and depressive symptoms.

Profiles of sociodemographic, behavioral, clinical and psychosocial characteristics among primary care patients with comorbid obesity and depression

The objective of this study is to characterize profiles of obese depressed participants using baseline data collected from October 2014 through December 2016 for an ongoing randomized controlled trial (n = 409) in Bay Area, California, USA. Four comorbidity severity categories were defined by interaction of the binary levels of body mass index (BMI) and depression Symptom Checklist 20 (SCL20) scores. Sociodemographic, behavioral, clinical and psychosocial characteristics were measured. Mean (SD) age was 51 (12.1) years, BMI 36.7 (6.4) kg/m2, and SCL20 1.5 (0.5). Participants in the 4 comorbidity severity categories had similar sociodemographic characteristics, but differed significantly in the other characteristics. Two statistically significant canonical dimensions were identified. Participants with BMI ≥ 35 and SCL20 ≥ 1.5 differed significantly from those with BMI < 35 and SCL20 < 1.5 on dimension 1, which primarily featured high physical health (e.g., central obesity, high blood pressure and impaired sleep) and mental health comorbidities (e.g., post-traumatic stress and anxiety), poor health-related quality of life (in general and problems specifically with obesity, anxiety, depression, and usual daily activities), and an avoidance problem-solving style. Participants with BMI < 35 and SCL20 ≥ 1.5 differed significantly from those with BMI ≥ 35 and SCL20 < 1.5 on dimension 2, which primarily included fewer Hispanics, less central obesity, and more leisure-time physical activity, but greater anxiety and post-traumatic stress and poorer obesity- or mental health-related quality of life. In conclusion, patients with comorbid obesity and depression of varying severity have different profiles of behavioral, clinical and psychosocial characteristics. This insight may inform analysis of treatment heterogeneity and development of targeted intervention strategies. Trial registration:ClinicalTrials.gov #NCT02246413.

Examining the association between depression and obesity during a weight management programme

The prevalence of depression in those with obesity is reported to be as high as double that in individuals of normal weight. There is potentially a bi-directional relationship between obesity and depression. Some research has suggested that depression results in weight gain and obesity, and other studies have suggested that those with obesity are more likely to develop depression at a later stage. The aim of this study was to investigate the association of depression symptoms with weight change over a 12-month study. Seventy participants undertook a 3-month lifestyle (diet and exercise) weight loss intervention, and were followed up as part of a 12-month study. Participants completed the Beck Depression Inventory-II (BDI-II) and had their body weight measured throughout the study. Baseline body mass index (BMI) of participants (mean ± standard deviation [SD]) was 31.1 ± 3.9 kg m^-2 , body weight was 89.4 ± 16.1 kg, and age was 45.4 ± 11.1 years; 63% of the cohort were female. The mean weight change from baseline to 3 months was -5.2% (±SD 4.3%), and from baseline to 12 months was -4.2% (±SD 6.1%). There was a significant decrease in BDI-II scores over the 12-month study, and a 1-unit decrease in BDI-II score was associated with a further decrease in body weight of -0.4%. The current study indicated that weight loss was associated with improvements in mood for non-clinically depressed individuals with obesity, and these improvements persisted during a period of 3-12 months of follow-up.

The association between depressive symptoms and insulin resistance, inflammation and adiposity in men and women

INTRODUCTION

Depression has been shown to be associated with elevated leptin levels, low-grade inflammation and insulin resistance. These derangements are often measured in mixed gender cohorts despite the different body compositions and hormonal environments of men and women and gender-specific prevalence and responses to depression.

METHODS

A cross-sectional analysis was carried out on a cohort of 639 participants from the ADDITION-Leicester dataset to assess differences in markers of diabetes risk, cardiovascular risk and inflammation in depressed and non-depressed individuals. Depressive symptoms were determined using the WHO (Five) well-being index. Multivariate linear and logistic regression analyses were adjusted for age, sex, ethnicity, body mass index, smoking, social deprivation and activity levels for continuous and binary variables respectively. Further analysis included stratifying the data by gender as well as assessing the interaction between depression and gender by including an interaction term in the model.

RESULTS

Women with depressive symptoms had a 5.3% larger waist circumference (p = 0.003), 28.7% higher HOMA IR levels (p = 0.026), 6.6% higher log-leptin levels (p = 0.01) and 22.37% higher TNF-α levels (p = 0.015) compared with women without. Conversely, depressive symptoms in men were associated with 7.8% lower body fat % (p = 0.015) but 48.7% higher CRP levels (p = 0.031) compared to men without. However, interaction analysis failed to show a significant difference between men and women.

CONCLUSIONS

Depressive symptoms are associated with metabolic derangements. Whilst women tended to show elevations in biomarkers related to an increased risk of type 2 diabetes (HOMA IR, leptin and TNF-α), men showed a marked increase in the cardiovascular disease risk biomarker CRP. However, perhaps due to the cohort size, interaction analysis did not show a significant gender difference.

Socioeconomic Context as a Moderator in the Relationship between Body Mass Index and Depression in Europe

BACKGROUND

Obesity and depression are two major health issues in contemporary societies. This study aims to address two fundamental questions: (1) what is the impact of macro-level adverse socioeconomic circumstances on depression? and (2) how do macro-level variations in the socioeconomic context affect the relationship between body mass index (BMI) and depression?

METHODS

Data from the 7th round of the European Social Survey were used, collected from a sample size of 37,623 participants and aggregated around a total of 20 countries. A random intercept multilevel model was constructed to study the variations in the relationship between depression and BMI. The contextual effect of risk of poverty, unemployment rate, and gross domestic product per capita were studied at the country level.

RESULTS

First, both unemployment and poverty risk were found to be positively associated with depressive disorders. Second, the results show that a higher risk of poverty at the macro level may increase the effect of BMI on depression in European countries.

CONCLUSION

The present study provides new evidence suggesting that the obesity-depression relationship will be, on average, stronger in countries with poor socioeconomic conditions. Therefore, adverse socioeconomic contextual conditions may increase depression associated with obesity.

"Metabolically Healthy" Obesity and Hyperuricemia Increase Risk for Hypertension and Diabetes: 5-year Japanese Cohort Study

OBJECTIVE

Whether obesity without metabolic syndrome (i.e., "metabolically healthy" obesity) confers similar or less metabolic risk remains controversial.

METHODS

A retrospective 5-year cohort study of 9,721 Japanese subjects (48.5 ± 10.5 years, 4,160 men) was conducted in 2004 and reevaluated 5 years later. Subjects were excluded if they were hypertensive or diabetic or were receiving medications for dyslipidemia and/or gout or hyperuricemia in 2004. Study subjects were categorized according to baseline BMI  ≥ 25 kg/m² (overweight/obesity) and < 25 kg/m² (lean/normal weight) and also whether they had metabolic syndrome. The cumulative incidence of hypertension and diabetes over 5 years between groups was assessed. A second analysis evaluated whether baseline hyperuricemia provided additional risk.

RESULTS

Subjects with overweight/obesity but without metabolic syndrome carried increased cumulative incidence of hypertension (14.6% vs. 7.2%, P < 0.001) and diabetes (2.6% vs. 1.1%, P = 0.004) over 5 years compared to lean/normal subjects without metabolic syndrome. Overweight/obesity conferred an increased risk for diabetes even in individuals with normal fasting blood glucose. Hyperuricemia became an independent risk factor for developing hypertension over 5 years in lean/normal subjects without metabolic syndrome. A 1 mg/dL increase in serum uric acid carried increased risk for hypertension (19%) and diabetes (27%).

CONCLUSIONS

Metabolically healthy obesity and hyperuricemia confer increased risk for hypertension and diabetes.

Obesity and socioeconomic disadvantage in midlife female public sector employees: a cohort study

BACKGROUND

The two-way relationship between obesity and socioeconomic disadvantage is well established but previous studies on social and economic consequences of obesity have primarily focused on relatively young study populations. We examined whether obesity is associated with socioeconomic disadvantage through the 10-12-year follow-up, and how obesity-related socioeconomic inequalities develop during midlife among women.

METHODS

Baseline data were derived from the female population of the Helsinki Health Study cohort, comprising 40-60 -year-old employees of the City of Helsinki, Finland in 2000-2002 (n = 6913, response rate 69%). The follow-up surveys were carried out in 2007 (n = 5810) and 2012 (n = 5400). Socioeconomic disadvantage was measured by five dichotomous measures. Repeated logistic regression analyses utilising generalized estimating equations (GEE) were used to test the association between baseline self-reported obesity and the likelihood of socioeconomic disadvantage through all phases. The effect of time on the development of inequalities was examined by time interaction terms in random effect logistic regression models.

RESULTS

After adjustment for educational level, baseline obesity was associated with repeated poverty (OR = 1.23; 95% CI; 1.05-1.44), frequent economic difficulties (OR = 1.74; 95% CI; 1.52-1.99), low household net income (OR = 1.23; 95% CI; 1.07-1.41), low household wealth (OR = 1.90; 95% CI; 1.59-2.26) and low personal income (OR = 1.22; 95% CI; 1.03-1.44). The differences in poverty rate and low personal income between the participants with obesity and participants with normal weight widened during the follow-up. Living without a partner and early exit from paid employment explained the widening of inequalities.

CONCLUSIONS

Weight status inequalities in socioeconomic disadvantage persisted or widened during the late adulthood.

Primary Cardiovascular Disease Risk Factors Predicted by Poor Working Conditions in the GAZEL Cohort

The mechanisms by which work environment might influence cardiovascular disease (CVD) risk are still a matter of debate. In particular, the involvement of the main behavioral and clinical risk factors and their relationships with working conditions are not always clear, despite an abundant body of literature. Most studies have investigated the impact of a limited number of characteristics of the work environment on the occurrence of 1 or a few risk factors. In contrast, in this study we used a global approach in which 30 objective and subjective indicators of working conditions were tested as predictors of 9 modifiable CVD risk factors in a well-characterized cohort of 20,625 middle-aged French workers who were followed from the 1990s until they retired or until December 31, 2013. The incidence of 3 CVD risk factors (obesity, sleep complaints, and depression) was predicted by a large number of indicators of working conditions in both age- and sex-adjusted and multivariate-adjusted Cox regression models, whatever the significance threshold retained. These results suggest the existence of close relationships between a poor work environment and a higher risk of developing obesity, sleep complaints, or depression. These risk factors may contribute to increased CVD risk not only when workers are exposed to poor working conditions but also after retirement, as predictors of the appearance of other risk factors.

Which biopsychosocial variables contribute to more weight gain in depressed persons?

Depression appears to be associated with weight gain. Little is known about whether this association is independent of, or partly due to, several biopsychosocial variables. This study aims to investigate which biopsychosocial variables contribute to weight gain over a 4-year period in persons with major depressive disorder (MDD) or high depressive symptoms. Data from 1658 adults who participated in the Netherlands Study of Depression and Anxiety were used. Baseline depression was measured with a DSM-IV based psychiatric interview and with a depressive symptom measure. Four year weight gain was classified as stable weight (within 5% gain or loss) versus weight gain (>5% gain). Twenty-one baseline psychological, lifestyle and biological variables and antidepressant use were considered as potential contributing variables. In sociodemographic adjusted models, MDD and depressive symptoms were associated with subsequent weight gain. None of the biopsychosocial variables or antidepressants was associated with weight gain, thus did not contribute to the observed increased weight gain risk in depression, except for alcohol intake and TCA use. Future research should explore other potential factors that may be responsible for the increased risk for subsequent weight gain in depression, e.g. unhealthy dietary patterns or eating styles, or underlying intrinsic factors such as genetics.

Sex Differences in Obesity and Mental Health

PURPOSE OF REVIEW

The purposes of this study were to examine the relationships between obesity and a wide range of mental health issues and to identify where sex differences exist and may vary across disorders.

RECENT FINDINGS

Research on sex differences in the relationship between obesity and psychiatric disorders is more abundant in some areas, such as depression and eating disorders, than others, such as anxiety, trauma, and substance use. However, for most of the disorders, their relationships with obesity and sex are complex and are usually moderated by additional variables. Thus, studies that find stronger relationships for women between depression and obesity cross-sectionally do not tell the whole story, as longitudinal studies suggest that this relationship may also be present among men, particularly when confounders are considered. For those with eating disorders, men and women with obesity are fairly equally affected, and weight and shape concerns may play a role in maintaining these behaviors for both sexes. Weight stigma, though, seems to have worse consequences for women than men with obesity. Sex differences exist in relation to the associations between mental health and obesity. However, these differences vary by disorder, with disorder-specific moderators playing a role, such as age for depressive disorders, comorbid depression for anxiety disorders, and weight and shape concerns for eating disorders. More work is needed to understand if sex differences play a role in the relationship between obesity and anxiety, trauma, and substance use disorders.

Depression and Chronic Liver Diseases: Are There Shared Underlying Mechanisms?

The occurrence of depression is higher in patients with chronic liver disease (CLD) than that in the general population. The mechanism described in previous studies mainly focused on inflammation and stress, which not only exists in CLD, but also emerges in common chronic diseases, leaving the specific mechanism unknown. This review was to summarize the prevalence and risk factors of depression in CLD including chronic hepatitis B, chronic hepatitis, alcoholic liver disease, and non-alcoholic fatty liver disease, and to point out the possible underlying mechanism of this potential link. Clarifying the origins of this common comorbidity (depression and CLD) may provide more information to understand both diseases.

Circulating C19 steroids and progesterone metabolites in women with acute depression and anxiety disorders

Depression and anxiety disorders are highly prevalent in women. Although several studies have reported altered circulating steroids accompanying various mental disturbances, knowledge about alterations in the peripheral steroid pattern in such pathologies is incomplete. Therefore, we attempted to add to this knowledge using the simultaneous quantification of circulating steroids by gas chromatography mass spectrometry (GC-MS) in groups of premenopausal women in the follicular phase of the menstrual cycle (22 women with depression, 17 with anxiety disorders, 17 healthy controls). In addition to age-adjusted analysis of covariance (ANCOVA) followed by multiple comparisons, we developed models to successfully discriminate these groups from each other on the basis of steroid levels. Women with depression showed a reduced sulfoconjugation of steroids as well as lower levels of 7α-, 7β- and 16α-hydroxy-metabolites of C19 Δ5 steroids. Women with depression have significantly lower circulating levels of 5α/β-reduced pregnane steroids (with exception of free isopregnanolone) than women with anxiety or controls. Finally, our data indicate higher levels of estrogens in women with anxiety disorders when compared to women with depression.

Weight, gender, and depressive symptoms in South Korea

Objectives

Obesity consistently predicts depression risk, but the underlying mechanisms are poorly understood. Body concerns are proposed as key. South Korean society is characterized by extremely high levels of explicit weight stigma, possibly the highest globally. Using cross‐sectional Korean 2014 National Health Examination Survey (KNHANES) data, we test this proposition in a nationally representative sample of South Korean adults (N = 5,632).

Methods

Depressive symptoms (outcome variable), was based on the PHQ‐9. Weight status (predictor variable), was based on direct measures of height and weight converted to BMI. Weight concern was self‐reported. Mediation analyses tested how weight concern mediated the influence of weight status on depressive symptoms for women and men.

Results

Current weight status influenced depressive symptoms in Korean adults, but not always directly. Concerns of being “fat” mediated that relationship. The effect increased significantly as BMI increased within “normal” and overweight/obese categories for women, and in overweight/obese categories for men. Even though women classified as underweight were significantly more depressed than those in other weight categories, there was no similar mediation effect related to weight concerns.

Conclusion

For South Koreans, the stress of adhering to social norms and avoiding stigma related to body weight seems to explain the relationship between higher body weight and more depressive symptoms. Women are more vulnerable overall, but men are not immune. This study demonstrates that body concerns help explain why weight predicts depression, and more broadly supports the proposition that widespread weight‐related stigma is a potentially major, if unrecognized, driver of population‐level health disparities.

Perceived weight discrimination mediates the prospective relation between obesity and depressive symptoms in U.S. and U.K. adults

OBJECTIVE

Obesity has been shown to increase risk of depression. Persons with obesity experience discrimination because of their body weight. Across 3 studies, we tested for the first time whether experiencing (perceived) weight-based discrimination explains why obesity is prospectively associated with increases in depressive symptoms.

METHOD

Data from 3 studies, including the English Longitudinal Study of Ageing (2008/2009-2012/2013), the Health and Retirement Study (2006/2008-2010/2012), and Midlife in the United States (1995/1996-2004/2005), were used to examine associations between obesity, perceived weight discrimination, and depressive symptoms among 20,286 U.S. and U.K. adults.

RESULTS

Across all 3 studies, Class II and III obesity were reliably associated with increases in depressive symptoms from baseline to follow-up. Perceived weight-based discrimination predicted increases in depressive symptoms over time and mediated the prospective association between obesity and depressive symptoms in all 3 studies. Persons with Class II and III obesity were more likely to report experiencing weight-based discrimination, and this explained approximately 31% of the obesity-related increase in depressive symptoms on average across the 3 studies.

CONCLUSION

In U.S. and U.K. samples, the prospective association between obesity (defined using body mass index) and increases in depressive symptoms in adulthood may in part be explained by perceived weight discrimination. (PsycINFO Database Record

Mental distress in treatment seeking young adults (18-25 years) with severe obesity compared with population controls of different body mass index levels: cohort study

Young adults (18-25) with severe obesity constitute a challenging patient group, and there is limited evidence about their mental health status compared to population controls. Mental distress in treatment seeking young adults with severe obesity (n = 121, mean body mass index [BMI] = 39.8 kg m^-2 ) was compared with matched (1:3 for age, gender and socioeconomic status) population controls of normal weight (n = 363, mean BMI = 22.4 kg m^-2 ), as well as unmatched population controls with class I obesity (n = 105, mean BMI = 32.1 kg m^-2 ) or severe obesity (n = 41, mean BMI = 39.7 kg m^-2 ). Mental distress was measured by the General Health Questionnaire-12 (GHQ-12), and we quantified physician-diagnosed depression, present anxiety and suicide attempts. Poisson regression and linear regression analysis were used for analysing differences in mental distress between groups. Treatment seekers experienced more mental distress than normal weight controls as measured by continuous (adjusted mean: 3.9 vs. 2.2 points, P <0.001) and categorical (cut-off for mental distress ≥3 points, RR: 1.76, P <0.001) GHQ-12 scores, depression (RR: 2.18, P < 0.001), anxiety (RR: 1.97, P < 0.001) and suicide attempts (RR: 2.04; P = 0.034). Treatment seekers also experienced more mental distress as measured by continuous GHQ-12 than controls with class I obesity (adjusted mean: 2.3 points) or severe obesity (adjusted mean: 2.1; both, P < 0.001). Young adult treatment seekers with severe obesity constitute a risk group for mental distress compared to population controls of different BMI levels.

Body mass index moderates the relationship between C-reactive protein and depressive symptoms: evidence from the China Health and Retirement Longitudinal Study

The present study aimed to investigate the role of abnormal body mass index (BMI, kg/m²) in the depression-CRP (C-reactive protein) relationship in a healthy middle-aged and elderly Chinese population. Analytical samples were drawn from the China Health and Retirement Longitudinal Study (CHARLS), and participants were categorized by different BMI levels. Depressive subtypes were evaluated both at baseline and follow-up using the Center for Epidemiology Studies Depression scale. Hs-CRP and other variables were measured at baseline. Multiple linear regression analyses were used to evaluate the cross-sectional and longitudinal relationship between depression and baseline hs-CRP. Depression was significantly negatively associated with BMI (ρ = −0.077, p < 0.0001), with underweight associated with worse depressive symptoms than other BMI groups. Both cross-sectional and longitudinal associations between serum hs-CRP and depressive subtypes were significantly positive in the underweight group (p < 0.05). However, in the other BMI groups (from normal weight to obesity), the CRP-depression relationship was no longer significant (p > 0.05). The significant relationship between CRP and depression in the underweight group suggested that not only obesity but also a low BMI could explain a substantial portion of the inflammation-depression link.

Depression, its comorbidities and treatment, and childhood body mass index trajectories

OBJECTIVE

No prior studies have evaluated depression diagnoses and cumulative antidepressant use in relation to longitudinal body mass index (BMI) trajectories in a population-representative sample.

METHODS

Electronic health record data from 105,163 children ages 8 to 18 years with 314,648 BMI values were used. Depression diagnoses were evaluated as ever versus never, cumulative number of encounters with diagnoses, and total duration of diagnoses. Antidepressants were evaluated as months of use. Associations were evaluated with diagnoses alone, antidepressants alone, and then together, adjusting for covariates.

RESULTS

A total of 6,172 (5.9%) and 10,628 (10.1%) children had a diagnosis of depression or received antidepressant treatment, respectively. At all ages, children receiving Medical Assistance (30.9%) were more likely to be treated with antidepressants. Depression diagnosis and antidepressant use were each independently and positively associated with BMI trajectories; associations were stronger with longer durations of diagnosis and treatment. Among children who received 12 or more months of antidepressants (vs. none), the mean (95% CI) weight gain at 18 years associated with antidepressant use (all classes) was 2.10 (1.76-2.45) kg.

CONCLUSIONS

Depression and antidepressant use were both independently associated with increasing BMIs over time, suggesting an important unintended consequence of healthcare to the obesity epidemic.

Association of pre-pregnancy body mass index, gestational weight gain with cesarean section in term deliveries of China

China has one of the highest rates of cesarean sections in the world. However, limited epidemiological studies have evaluated the risk factors for cesarean section among Chinese women. Thus, the aim of this cohort study was to investigate the associations between pre-pregnancy BMI, gestational weight gain (GWG) and the risk of cesarean section in China. A total of 57,891 women with singleton, live-born, term pregnancies were included in this analysis. We found that women who were overweight or obese before pregnancy had an elevated risk of cesarean section. Women with a total GWG above the Institute of Medicine (IOM) recommendations had an adjusted OR for cesarean section of 1.45 (95% CI, 1.40-1.51) compared with women who had GWG within the IOM recommendations. Women with excessive BMI gain during pregnancy also had an increased risk of cesarean section. When stratified by maternal pre-pregnancy BMI, there was a significant association between excessive GWG and increased odds of cesarean section across all pre-pregnancy BMI categories. These results suggest that weight control efforts before and during pregnancy may help to reduce the rate of cesarean sections.

Socio-economic status influences the relationship between obesity and antenatal depression: Data from a prospective cohort study

BACKGROUND

Obesity has been associated with increased risk of antenatal depression, but little is known about this relationship. This study tested whether socio-economic status (SES) influences the relationship between obesity and antenatal depression.

METHODS

Data were taken from the Screening for Pregnancy Endpoints (SCOPE) cohort. BMI was calculated from measured height and weight at 15±1 weeks' gestation. Underweight women were excluded. SES was indicated by self-reported household income (dichotomised around the median: low SES ≤£45,000; high SES >£45,000). Antenatal depression was defined as scoring ≥13 on the Edinburgh Postnatal Depression Scale at both 15±1 and 20±1 weeks' gestation, to identify persistently elevated symptoms of depression.

RESULTS

Five thousand five hundred and twenty two women were included in these analyses and 5.5% had persistently elevated antenatal depression symptoms. There was a significant interaction between SES and BMI on the risk of antenatal depression (p=0.042). Among high SES women, obese women had approximately double the odds of antenatal depression than normal weight controls (AOR 2.11, 95%CI 1.16-3.83, p=0.014, adjusted for confounders). Among low SES women there was no association between obesity and antenatal depression. The interaction effect was robust to alternative indicators of SES in sensitivity analyses.

LIMITATIONS

1) Antenatal depression was assessed with a self-reported screening measure; and 2) potential mediators such as stigma and poor body-image could not be examined.

CONCLUSIONS

Obesity was only associated with increased risk of antenatal depression among high SES women in this sample. Healthcare professionals should be aware that antenatal depression is more common among low SES women, regardless of BMI category.

Body image mediates the depressive effects of weight gain in new mothers, particularly for women already obese: evidence from the Norwegian Mother and Child Cohort Study

Background

Multiple studies show that obesity and depression tend to cluster in women. An “appearance concern” pathway has been proposed as one basic explanation of why higher weights might lead to depression. The transition to motherhood is a life phase in which women’s body image, weight, and depressive risk are in flux, with average weight increasing overall during this period. Examination of how these factors interact from pre- to post-pregnancy provides a means to test how body image plays a key role, as proposed, in causally shaping women’s depressive risk.

Methods

Tracking 39,915 pregnant women in the Norwegian Mother and Child (MoBA) Cohort Study forward 36 months after their deliveries, we test the moderating and mediating effects of body image concerns on the emergence of new mothers’ depressive symptoms by using a binary logistic regression model with a discrete-time event history approach and mediation analysis with bootstrapping.

Results

For women with high pre-pregnancy body mass index (BMI), weight gain heightens their depressive symptoms over time. Body image concerns mediate the association between weight gain and the development of depressive symptoms regardless of weight status. However, the mediation effect is more evident for women with higher pre-pregnancy BMI. Conversely, better body image is highly protective against the transition to mild or more severe depressive symptoms among new mothers, but only for women who were not classified as obese prior to their pregnancies.

Conclusions

These findings support a role for body image concerns in the etiology of depressive symptoms during the transition to motherhood. The findings suggest body image interventions before or during pregnancy could help reduce risks of depression in the early postpartum period and well beyond.

Decreased Escitalopram Concentrations Post-Roux-en-Y Gastric Bypass Surgery

BACKGROUND

There is a high coincidence between obesity and psychiatric disorders including depression. Depressive disorders are commonly treated with antidepressants, including the selective serotonin reuptake inhibitor Lexapro (escitalopram). Although candidates for elective Roux-en-Y gastric bypass (RYGB) surgery may be treated with escitalopram, drug dosing strategies are typically not adjusted postoperatively. Therefore, studies are needed to better characterize escitalopram drug concentrations in a postsurgical setting.

METHODS

Turbulent flow-liquid chromatographic-tandem mass spectrometric methods were used to quantify escitalopram concentrations in serum in study participants approved for RYGB. Blood was collected from study subjects 2 weeks before surgery, and 2 and 6 weeks postoperatively, to assess the impact of RYGB on systemic drug concentrations.

RESULTS

Twelve samples from 4 study participants were collected and analyzed for serum escitalopram concentrations. Two weeks post-RYGB, although there were minimal changes in each participant's body mass index (<5%), drug concentrations were 33% (4%-71%) decreased as compared with presurgical serum concentrations. There were further decreases in drug concentrations 6 weeks postsurgery. All clinical laboratory values were within normal reference intervals.

CONCLUSIONS

RYGB significantly alters the gastrointestinal tract and impacts escitalopram drug concentrations, even shortly after surgery.

Characteristics of patients potentially eligible for pharmacotherapy for weight loss in primary care practice in the United States

Objective

To describe the characteristics of real‐world patients potentially eligible for adjunctive pharmacotherapy for weight loss.

Methods

Patients from the GE Centricity electronic medical record database were selected if they had body mass index (BMI) ≥30 or ≥27 to <30 kg m⁻² with ≥1 obesity‐associated comorbidity (hypertension, dyslipidemia, or type 2 diabetes) from 2002–2011; were aged ≥18 years and had ≥12 months of continuous enrollment before and after the date of first eligible BMI recorded (index date). Descriptive statistics and logistic regression were used for analysis.

Results

Of the 1,835,541 patients with overweight or obesity included, comorbidities were common (hypertension [55.4%], dyslipidemia [36.1%] and type 2 diabetes [13.4%]). The percentage of patients who received pharmacotherapy for weight loss was 0.7% within 12 months after the index date. Patients who received pharmacotherapy had higher BMI (median, 33.6 vs. 31.3 kg m⁻²), were younger (median, 42 vs. 52 years), primarily women (84.3 vs. 58.2%), commercially insured (70.1 vs. 50.4%) and had more frequent use of antidepressants (30.8 vs. 14.1%) and non‐steroidal anti‐inflammatory drugs (21.7 vs. 12.0%) than those who did not at baseline (all P values < 0.0001).

Conclusions

Few eligible patients received pharmacotherapy for weight loss. Patients who received pharmacotherapy tended to be heavier, younger, female, commercially insured, and used more antidepressants and non‐steroidal anti‐inflammatory drugs.

The Association Between Obesity and Hostility: The Mediating Role of Plasma Lipids

OBJECTIVE

Recent research indicates an association between obesity and psychopathology status, the nature of which remains unclear. We evaluated the mediating role of biochemical disturbances in this association among a treatment-seeking sample of obese individuals.

METHOD

The study enrolled 143 consecutive overweight and obese individuals (mean age 35±9 y) and 143 normal-weight controls (mean age 34±9 y), matched by age and sex. We measured psychopathology features using the Symptom Checklist 90-Revised (SCL-90-R), a standardized self-evaluation rating scale, and biochemical parameters (plasma cholesterol, triglyceride, and fasting glucose levels) of all participants. Nonlinear regression models were used to estimate the associations among obesity, psychopathology, and biochemical factors.

RESULTS

Obesity was associated positively and significantly (P<0.05) with all of the SCL-90-R subscales, with the exception of anxiety and phobic anxiety, as well as with levels of plasma glucose, cholesterol (P<0.01), and triglycerides (P<0.001). Tests for mediation showed that obesity was significantly associated, for the mediators of plasma cholesterol [parameter estimate=-0.033, P<0.05] and triglycerides (parameter estimate=-0.059, P<0.05), only with hostility (parameter estimate=-0.024, P<0.05 and parameter estimate=-0.041, P<0.05, respectively).

CONCLUSIONS

Our data suggest that biological substrates that are critically related to obesity, such as dyslipidemia, may mediate, at least in part, the association between obesity and hostility.