Are the fat more jolly?

Multiple mediation of the association between childhood emotional abuse and adult obesity by anxiety and bulimia - a sample from bariatric surgery candidates and healthy controls

Bulimia, which means a person has episodes of eating a very large amount of food (bingeing) during which the person feels a loss of control over their eating, is the most primitive reason for being overweight and obese. The extended literature has indicated that childhood emotional abuse has a close relationship with adverse mood states, bulimia, and obesity. To comprehensively understand the potential links among these factors, we evaluated a multiple mediation model in which anxiety/depression and bulimia were mediators between childhood emotional abuse and body mass index (BMI). A set of self-report questionnaires, including the Childhood Trauma Questionnaire (CTQ), Beck Anxiety Inventory, Beck Depression Inventory (BDI), and Eating Disorder Inventory (EDI), was sent out. Clinical data from 37 obese patients (age: 29.65 ± 5.35, body mass index (BMI): 37.59 ± 6.34) and 37 demographically well-matched healthy people with normal body weight (age: 31.35 ± 10.84, BMI: 22.16 ± 3.69) were included in the investigation. We first performed an independent t-test to compare all scales or subscale scores between the two groups. Then, we conducted Pearson correlation analysis to test every two variables' pairwise correlation. Finally, multiple mediation analysis was performed with BMI as the outcome variable, and childhood emotional abuse as the predictive variable. Pairs of anxiety, bulimia, and depression, bulimia were selected as the mediating variables in different multiple mediation models separately. The results show that the obese group reported higher childhood emotional abuse (t = 2.157, p = 0.034), worse mood state (anxiety: t = 5.466, p < 0.001; depression: t = 2.220, p = 0.030), and higher bulimia (t = 3.400, p = 0.001) than the healthy control group. Positive correlations were found in every pairwise combination of BMI, childhood emotional abuse, anxiety, and bulimia. Multiple mediation analyses indicate that childhood emotional abuse is positively linked to BMI (β = 1.312, 95% CI = 0.482-2.141). The model using anxiety and bulimia as the multiple mediating variables is attested to play roles in the relationship between childhood emotional abuse and obesity (indirect effect = 0.739, 95% CI = 0.261-1.608, 56.33% of the total effect). These findings confirm that childhood emotional abuse contributes to adulthood obesity through the multiple mediating effects of anxiety and bulimia. The present study adds another potential model to facilitate our understanding of the eating psychopathology of obesity.

Association between visceral adiposity and generalized anxiety disorder (GAD)

BACKGROUND AND OBJECTIVES

Due to an increased rate of inflammation in generalized anxiety disorder (GAD), insight into the mediating factors in the onset and recurrence of the inflammatory response can help to achieve novel treatments for alleviating the risk of GAD. In the current study, we aimed to evaluate the possible relationship between visceral adipose tissue (VAT) as an important intermediary in inflammation pathways and GAD in participants of the Employees' Health Cohort Study of Iran (EHCSIR).

METHOD

We analyzed the data from 3889 included participants aged > 18 years in the EHCSIR study, which were collected from 2017 to 2020. Lifetime and 12-month GAD were assessed using the Composite International Diagnostic Interview (CIDI-2.1) questionnaire. The adjusted prevalence ratio was computed to evaluate the association between GAD and visceral adiposity index (VAI), GAD and visceral fat area (VFA), GAD and body mass index (BMI) and ultimately GAD and waist circumference (WC) in males and females using STATA software.

RESULTS

Log-binomial analysis showed a higher prevalence ratio of 12-month GAD associated with VFA in women [PR: 1.42, CI: 1.07-1.87, P: 0.015]. The prevalence of lifetime GAD was higher in obese women (BM1 > 30) [PR: 2.35, CI: 1.07-5.13, P:0.03] than in women with normal BMI. Women with higher VAI were also significantly more likely to suffer lifetime GAD [PR: 1.25, CI: 1.05]. 1.48, P:0.01]. In males, the prevalence of lifetime diagnosed GAD per 1 standard deviation increase in VFA was 0.65 [CI: 0.46-0.91, P: 0.01].

CONCLUSION

Visceral adiposity as a positive agent was associated with GAD prevalence in women. The presence of GAD symptoms showed no relationship to VFA in men.

Maternal Mental Health Status Is Associated with Weight-Related Parenting Cognitions, Home Food Environment Characteristics, and Children's Behaviors

Women experience anxiety, depression, and stress at higher levels than men and have more parenting responsibilities, especially establishing health practices in the home. Given children's vulnerability, this study aimed to increase understanding of how mothers' mental health status relates to maternal weight-related cognitions, home food environments, and child health via a cross-sectional survey design. In a cluster analysis, using maternal anxiety, depression, and stress assessments, we placed the sample of 531 mothers of school-age children into four clusters: Cluster 1 had the best mental health status, Cluster 2 had high stress, Cluster 3 had anxiety and moderate stress, and Cluster 4 had anxiety, depression, and high stress. Our results indicate an overall downward trend in weight-related cognitions as mental health worsened. Similarly, as mental health declined, so did home food environment characteristics, such as the greater use of non-recommended child feeding practices, fewer family meals, and greater sugar-sweetened beverage supplies. As mothers' mental health status became poorer, children's general health and mental health quality of life declined, and sugar-sweetened beverage intake increased. Our findings suggest that maternal stress, anxiety, and depression are moderately to strongly linked with mothers' cognitions, home food environments, and children's health. Our results also suggest that mental health interventions for mothers should assess cognitions and home food environments and consider the extent to which these factors are affecting family health.

Prevalence of depression in patients with sarcopenia and correlation between the two diseases: systematic review and meta-analysis

BACKGROUND

Depression may be the most common cause of emotional distress later in life and can significantly reduce the quality of life in elderly individuals. Sarcopenia is a syndrome characterized by the continuous loss of skeletal muscle mass and decreased strength and function. In recent years, many studies have shown a correlation between sarcopenia and depression. The present study aimed to investigate the prevalence of depression among individuals with sarcopenia and to ascertain whether sarcopenia is independently associated with depression.

METHODS

We systematically searched the PubMed, Embase, and Google Scholar databases for papers on sarcopenia published up to 31 August 2021. We reviewed the literature on the number of individuals with sarcopenia, the number of individuals with both sarcopenia and depression, and the odds ratio (OR) of sarcopenia to depression. Statistical analyses were performed using Meta-DiSc 1.4 software and Stata version 12.0.

RESULTS

Nineteen articles met the inclusion criteria for review: nine reported both prevalence and ORs, four described prevalence only, and six detailed the ORs only. Regarding prevalence, there were 1476 cases of sarcopenia and 364 of depression in the selected studies; the mean age of the patients was 75.5 years, and the overall prevalence of depression was 0.28 [95% confidence interval (CI): 0.21-0.36]. Significant heterogeneity was noted (P < 0.001; I²  = 92.2%). In the case of ORs, there were 16 869 subjects with a mean age of 73 years; the overall adjusted OR between sarcopenia and depression was 1.57 (95% CI: 1.32-1.86). Significant heterogeneity was noted in the adjusted ORs (P < 0.001; I²  = 75.1%).

CONCLUSIONS

The prevalence of depression in patients with sarcopenia was high relatively, and there was a correlation between sarcopenia and depression.

"Jolly fat" or "sad fat": a systematic review and meta-analysis of the association between obesity and depression among community-dwelling older adults

OBJECTIVE

To review the evidence and explore the association between obesity and depression in community-dwelling older adults.

METHODS

We searched 6 electronic databases from inception to November 28, 2019. Observational studies investigating the association between obesity and depression among community-dwelling older adults aged 60 years or older were included. Two reviewers independently screened the studies, extracted the data and assessed the quality of the studies. The eligible studies were meta-analysed using the Comprehensive Meta-analysis Version 3.0.

RESULTS

Among the 16,059 studies identified from these databases, 19 studies meeting the inclusion criteria were included, of which 14 were meta-analysed. Meta-analyses showed that older adults who were overweight (pooled odds ratio: 0.847, 95% CI:0.789-0.908, p < 0.001) or obesity (pooled odds ratio: 0.795, 95% CI:0.658-0.960, p = 0.017) - assessed using the body mass index - were significantly less likely to be depressed than their counterparts with a normal weight. No significant association between obesity (as measured via waist circumference) and depression was detected (pooled odds ratio: 0.722, 95% CI:0.465-1.119, p = 0.145) in this group population. The subgroup analyses demonstrated that both female and male older adults with overweight/obesity were significantly less likely to have depression.

CONCLUSIONS

The "jolly fat" hypothesis is deemed to be applicable among community-dwelling older adults. Older adults might, therefore, be encouraged to increase their body weight above the normal level to be mentally healthy. Monitoring intentional weight loss among older adults should be reinforced for public health strategies.

The Prevalence of Depression and Anxiety and Their Lifestyle Determinants in a Large Sample of Iranian Adults: Results from a Population Based Cross-Sectional Study

Association of lifestyle-related factors and mental health has been less studied in Middle Eastern countries. This study aimed to examine the prevalence of two common mental health problems, i.e., depression and anxiety, and their lifestyle determinants in a large sample of Iranian population.

This study was conducted within the framework of SEPAHAN population based cross-sectional study (N=4763(. The General Practice Physical Activity Questionnaire (GPPAQ) was used to assess physical activity and the Iranian-validated version of Hospital Anxiety and Depression Scale (HADS) was applied to screen for anxiety and depression. Logistic regression was used as the main statistical method for data analysis by SPSS version 16.0. A P-value <0.05 was considered to be statistically significant.

The risk of anxiety and depression was 2.5 (OR=2.56,95% CI: 1.97-3.33) and 2.21(1.83-2.67) times higher in women than men, respectively. With every one-year increase in the age, the risk of anxiety decreased by 2% (OR=0.98,95% CI:0.97-0.99). Individuals with higher education had 56% lower risk of anxiety (OR=0.44,95% CI: 0.36-0.55) and 46% depression (OR=0.54,95% CI: 0.46-0.64) than the undergraduate group, and the risk of depression in the inactive (less than one hour of activity per week) group was 27% higher than the active group (OR=1.27,95% CI: 1.06-1.51). The risk of anxiety in the non-smoker group was 65% (OR=0.35,95% CI: 0.20-0.59) and depression was 64% lower than among smokers (OR=0.34,95% CI:0.22-0.53). In the ex-smoker group, the risk of anxiety was 60% (OR=0.40,95% CI:0.19-0.85) and depression was 59% lower than for the smoker group (OR=0.41,95% CI: 0.24-0.73).

This current study’s results demonstrated significant associations between unhealthy lifestyle factors and increased risk of anxiety and depression. Hence, special attention must be paid to preventive intervention programmes aiming to enhance healthy lifestyle among at-risk populations.

The moderator effect of age in the association between mood and adiposity in the elderly is specific for the subcutaneous adipose compartment: An MRI study

The positive association between obesity and depressive mood in young- and middle-age individuals is a phenomenon with major clinical implications in public health. Interestingly, the trend of this association in older individuals is not clear, given the conflicting results of multiple studies. Since aging is accompanied by changes in body fat distribution, we questioned whether age is a modulator of such association. This study explores the role of age in the association between mood and general (body mass index [BMI]) and abdominal adiposity (waist circumference [WC]) in older adults characterizing the different abdominal adipose tissue compartments (subcutaneous adipose tissue [SAT] and visceral adipose tissue [VAT]) with magnetic resonance imaging (MRI) techniques.

METHODS

One hundred twenty aged community-dwelling individuals (≥50 y of age) were assessed regarding depressive mood (Geriatric Depression Scale) and adiposity (BMI and WC). From these, 96 were assessed for SAT and VAT using MRI.

RESULTS

Using multiple linear regression models, depressive mood was positively associated with BMI, WC, and VAT. Age was a significant moderator of the association between depressive mood and BMI, WC, and SAT: positive in younger participants and null or negative in older participants. On the other hand, higher VAT was significantly associated with a more depressive mood, independently of age.

CONCLUSIONS

This study identifies age as a relevant moderator in the association between depressive mood and adiposity in the elderlies. Furthermore, the body fat compartment analysis revealed that the effect of age is specific for the SAT, suggesting its protective role in depressive mood.

Are Lipid Profile, Body Mass Index, Waist Circumference, and Blood Pressure of Depressed Elderly Patients Different from Healthy Subjects?

Background

Depression and obesity are among the increasingly publicized health problems, both being related to critical complications, and increasing the risk of substantial morbidity and mortality. An increasing number of documents indicate that obesity affects mental status, low serum cholesterol levels, and is related to depressive symptoms. The purpose of the present study was to evaluate the possible significant difference in lipid profile levels, body mass index (BMI), waist circumference (WC), and blood pressure (BP), between depressive and nondepressive older adults.

Methods

This was a case-control study where 107 patients, over 65-year-old, were enrolled in this study. Serum total cholesterol, high-density lipoprotein-cholesterol, low-density lipoprotein-cholesterol (LDL-C), triglycerides (TG), BP, and fasting blood sugar were measured. Data were analyzed using the statistical SPSS software version 22. Independent t-test was used to compare the results between the two groups and the Chi-square test was used to compare categorical variables. In addition, nonparametric Mann-Whitney test was used to evaluate the data.

Results

The depressive group showed significant lower BMI, WC, LDL-C, and TG (P < 0.001, P < 0.001, P < 0.016, and P < 0.014). Furthermore, the findings showed significantly higher systolic and diastolic BP in participants who had shown depressive symptoms (P < 0.035 and P < 0.024).

Conclusions

The findings suggest that a low BMI, serum LDL-C, and TG are related to depressive symptoms the Iranian elderly.

Obesity and anxiety symptoms: a systematic review and meta-analysis

BACKGROUND

Obesity and anxiety are the two most common health problems and increased body mass index can be lead to anxiety.

OBJECTIVE

The aim of this meta-analysis was to investigate the frequency of anxiety symptoms in people who are obese/overweight.

METHODS

For this purpose the authors systematically searched keywords in the databases PubMed, Scopus, PsycINFO and Google scholar through August 2018. After a comprehensive review, 25 studies were included into the meta-analysis.

RESULTS

Results of the meta-analysis showed that the frequency of anxiety in obesity had a pooled odds ratio (OR) of 1.30 and a 95% confidence interval (CI) of 1.20-1.41 and in overweight had an OR of 1.10 and CI of 1.00-1.21. Comparison between obesity/overweight and normal weight showed high frequency of anxiety in obesity/overweight with respect to subgroups (sex, obesity and anxiety assessment, adjusted/unadjusted, anxiety duration and age). Evaluation of 25 studies included in the meta-analysis showed publication bias.

CONCLUSION

Overall, findings indicate anxiety occurs more frequently in obese/overweight people compared with normal weight people.

Physical activity in depressed and non-depressed patients with obesity

PURPOSE

Obesity and depression have both been shown to be associated with reduced physical activity (PA). However, most studies have not applied objective measures to determine PA in patients. Moreover, to our knowledge, no studies are available comparing depressed and non-depressed patients with regard to PA.

METHODS

We investigated PA in 47 patients with both obesity and depression, 70 non-depressed patients with obesity, and 71 non-depressed and non-obese healthy control participants using the SenseWear™ Armband (SWA) with walked steps per day and metabolic equivalents (MET) as parameters for PA.

RESULTS

Depressed as well as non-depressed patients with obesity showed a significantly reduced PA as reflected by walked steps as well as reduced METs. Healthy controls walked a mean of 11,586 ± 3731 (SD) steps per day, whereas non-depressed patients with obesity accumulated 7283 ± 3547 and patients with both obesity and depression recorded only 6177 ± 3291 steps per day. However, the difference between depressed and non-depressed patients with obesity did not reach statistical significance either in terms of walked steps or with regard to METs.

CONCLUSIONS

Obesity seems to be associated with a substantial reduction of PA and energy expenditure, whereas the effect of an additional depressive disorder was comparably small. Even though depression did not have any statistically significant effect on steps and METs per day in this study with obese patients, it could be clinically relevant for an individual patient.

Low serum levels of High-Density Lipoprotein cholesterol (HDL-c) as an indicator for the development of severe postpartum depressive symptoms

Postpartum depression (PPD) is a psychiatric complication of childbirth affecting 10-20% of new mothers and has negative impact on both mother and infant. Serum lipid levels have been related to depressive disorders, but very limited literatures are available regarding the lipid levels in women with postpartum depression. The present study is aimed to examine the association of serum lipids with the development of postpartum depressive symptoms. This is a cross sectional study conducted at a tertiary care hospital in South India. Women who came for postpartum check-up at 6th week post-delivery were screened for PPD (September 2014-October 2015). Women with depressive symptoms were assessed using EPDS (Edinburgh Postnatal Depression Scale). The study involved 186 cases and 250 controls matched for age and BMI. Serum levels of lipid parameters were estimated through spectrophotometry and the atherogenic indices were calculated in all the subjects. Low serum levels of Total Cholesterol (TC) and High Density Lipoprotein cholesterol (HDL-c) were significantly low in PPD women with severe depressive symptoms. The study recorded a significant negative correlation between HDL-c and the EPDS score in PPD women (r = -0.140, p = 0.05). Interestingly, the study also observed a significant negative correlation between Body Mass Index (BMI) and EPDS scores in case group (r = -0.146, p = 0.047), whereas a positive correlation between the same in controls (r = 0.187, p = 0.004). Our study demonstrated that low levels of serum HDL-c is correlated with the development of severe depressive symptoms in postpartum women. Study highlights the role of lipids in the development of postpartum depressive symptoms.

Body weight misperception and psychological distress among young South Korean adults: the role of physical activity

Background

Emerging evidence suggests that body weight misperception may be associated with psychological distress among people in developed countries. Participating in physical activity (PA) may negate the association between weight misperception and psychological distress given the well-known benefits of PA on psychological health. This study examined the role of PA in associations between body weight misperception and psychological distress among young South Korean adults.

Methods

Data from individuals aged 20 to 39 years who participated in the Fifth Korean National Health and Nutrition Examination Surveys 2010–2012 (N = 6055) was included in the logistic regressions.

Results

The proportions of the respondents under- and over-perceiving their body weight were 66.9% and 0.8% among men and 16.3% and 15.6% among women respectively. A moderating effect of PA participation was observed on the relationship between body weight over-perception and depressed mood (Odds Ratio [OR] = 0.55; 95% Confidence Intervals [95% CI] = 0.34, 0.89). Among individuals who did not meet the recommended vigorous-intensity PA (≥ 20 min/session and ≥ 3 day/week), body weight over-perception was associated with depressed mood (OR = 1.71, 95% CI = 1.19, 2.46) compared to the accurate-perception group. However, no association was observed among those who met the recommended vigorous-intensity PA (OR = 1.52, 95% CI = 0.45, 5.22). Similar patterns were found among physically active versus inactive individuals (recommended walking not met: OR = 2.02, 95% CI = 1.29, 3.15; recommended walking met: OR = 1.28, 95% CI = 0.66, 2.49; muscular strengthening exercises for < 2 day/week: OR = 1.74, 95% CI = 1.21, 2.51; muscular strengthening exercises for ≥ 2 day/week: OR = 1.38, 95% CI = 0.37, 5.14). No relationship existed between body weight over-perception and depressed mood after adjusting for PA.

Conclusions

Participating in regular PA may buffer a potential negative impact of body weight over-perception on depressive mood.

Association between weight status and men's positive mental health: The influence of marital status

The purpose of this study was to (1) examine the association between weight status and men's positive mental health, defined as the presence of symptoms of emotional, psychological, and social well-being, and (2) evaluate the moderating effect of marital status. A total of 645 men aged between 19 and 71 years self-reported their height and weight and answered a questionnaire measuring their emotional, psychological, and social well-being. Analysis of variance revealed that mean levels of emotional, psychological, and social well-being did not significantly differ according to men's weight status. Moderation analyses indicated that, for men in a relationship (married or living common-law), there were no significant associations between overweight, obesity, and the three components of positive mental health. However, for single men, overweight was marginally associated with higher emotional well-being, while obesity was associated with lower psychological well-being and marginally associated with lower social well-being. Results of the present study suggest that health professionals and researchers should take the characteristics (such as marital status) of men with obesity and overweight into account when working with them. Mental health researchers may need to examine men in each weight category separately (e.g. obesity vs. overweight), since the association with positive mental health can differ from one category to another.

Relationship between body mass index and depressive symptoms: the "fat and jolly" hypothesis for the middle-aged and elderly in China

Background

Obesity has been identified as a worldwide epidemic. In China, the highest prevalence of obesity is observed in adults aged ≥45 years old. This study aimed to describe the association between BMI and depressive symptoms among a large representative sample of middle-aged and elderly in China.

Method

A longitudinal sample of the middle-aged and elderly (6,224 males and 6,883 females) who were interviewed in the 2011 China Health and Retirement Longitudinal Study was used. A multivariate logistic regression analysis was used to examine the effects of socio-demographic characteristics, lifestyle, activity status, health status, physical exercise and body weight on depressive symptoms.

Results

Approximately 6.94% of the males were underweight, 25.48% were overweight and 8.16% were obese. A higher prevalence of obesity was found among women, with 6.89% being underweight, 31.98% overweight and 14.28% obese. The underweight subjects were more likely to be depressed (odds ratio; OR = 1.30 and 1.19) compared with the normal weight people, respectively, whereas overweight and obese men and women were less likely to be depressed (overweight: OR = 0.76 and 0.80; obesity: OR = 0.64 and 0.65, respectively) than people of normal weight.

Conclusion

Our data are consistent with the “fat and jolly” hypothesis being valid in both middle-aged and elderly men and women.

The association between personality traits, cognitive reactivity and body mass index is dependent on depressive and/or anxiety status

OBJECTIVE

A range of biological, social and psychological factors, including depression and anxiety disorders, is thought to be associated with higher body mass index (BMI). Depression and anxiety disorders are associated with specific psychological vulnerabilities, like personality traits and cognitive reactivity, that may also be associated with BMI. The relationship between those psychological vulnerabilities and BMI is possibly different in people with and without depression and anxiety disorders. Therefore, we examined the relationship between personality traits, cognitive reactivity and severity of affective symptoms with BMI in people with and without depression and anxiety disorders.

METHODS

Data from 1249 patients with current major depressive and/or anxiety disorder and 631 healthy controls were sourced from the Netherlands Study of Depression and Anxiety. Linear and logistic regression analyses were used to determine the associations between personality traits (neuroticism, extraversion, conscientiousness), cognitive reactivity (hopelessness, aggression, rumination, anxiety sensitivity), depression and anxiety symptoms with BMI classes (normal: 18.5-24.9, overweight: 25-29.9, and obese: ≥30kg/m(2)) and continuous BMI. Due to significant statistical interaction, analyses were stratified for healthy individuals and depressed/anxious patients.

RESULTS

Personality traits were not consistently related to BMI. In patients, higher hopelessness and aggression reactivity and higher depression and anxiety symptoms were associated with higher BMI. In contrast, in healthy individuals lower scores on hopelessness, rumination, aggression reactivity and anxiety sensitivity were associated with higher BMI.

CONCLUSION

These results suggest that, particularly in people with psychopathology, cognitive reactivity may contribute to obesity.

The fatter are happier in Indonesia

PURPOSE

Although obesity and happiness are known to be negatively related in the developed world, little attention has been paid to this relationship in the developing world. We thus investigated the relationship in Indonesia and attempted to explain the underlying rationale.

METHODS

We considered about 12,000 respondents aged 15+ for each gender obtained from the Indonesian Family Life Survey 2007 by relating a measure of happiness to weight-related measures in ordered probit models.

RESULTS

The relationship between obesity and happiness was positive in Indonesia, and this relationship was robust. Our evidence suggests that the contrasting results for the two worlds result from affordability of obesity. That is, while even low socioeconomic status (SES) individuals in the developed world can afford to be obese, only high SES individuals in the developing world can do.

CONCLUSIONS

Our findings imply that obesity prevention in the developing world requires different measures than those used in the developed world.

Metabolic syndrome and central obesity in depression: A cross-sectional study

INTRODUCTION

The current epidemiological data and meta-analyses indicate a bidirectional association between depression and metabolic syndrome (MetS).

AIMS

To assess the prevalence of metabolic syndrome and obesity in drug naïve patients (in current episode) having Recurrent Major Depressive Disorder and Bipolar Depression.

METHOD

This was a single point cross sectional observational study that involved administration of diagnostic and assessment tools and blood investigations. Recruitment for the study was done from a period of September 2008 to august 2009.

RESULTS

The prevalence of MetS was significantly more in the depression group when compared to healthy controls. The Bipolar depression group had 24% prevalence and recurrent depression group had 26% prevalence as opposed to none in the control group. The prevalence of MetS did not differ significantly amongst the both depression groups. Presence of central obesity was significantly more in the recurrent depression (30%) and Bipolar depression (24%) as compared to controls (8%). There was no statistically significant difference between the two depression subgroups.

DISCUSSION

Our study adds to the mounting evidence that links the presence of depression and metabolic syndrome. As we had ensured a drug free period of at least 3 months, the findings in our study indicate that the metabolic syndrome observed in our study is independent of drug exposure.

CONCLUSIONS

This study demonstrated significantly more incidence of metabolic syndrome and central obesity in patients of depression than age and sex matched controls.

Does Low Body Mass Index Matter? Relationship between Body Mass Index and Subjective Well-Being among Long-Lived Women over 95 Years of Age

OBJECTIVES

To examine the relationship between body mass index (BMI) and subjective well-being (SWB) among long-lived women over 95 years of age and evaluate whether this relationship is mediated by functional ability.

DESIGN

Retrospective cohort study.

SETTING

Data from the Rugao longevity cohort, a population-based study in Rugao, China.

PARTICIPANTS

A sample of 342 long-lived women (mean age 97.4 ± 2.1, range 95-107) whose SWB and other covariates were available were included in this study.

MEASUREMENTS

BMI was calculated as weight in kilograms divided by height in meters-squared (kg/m(2)). SWB was measured by life satisfaction (LS), positive affect (PA), negative affect (NA) and affect balance (AB). Functional ability was assessed by the Katz Index of Activities of Daily Living (ADL).

RESULTS

According to BMI classification standards for China, the underweight group had lower levels of LS than the normal and overweight groups (28.62 vs. 30.51 and 31.57, respectively; p<.05). Correlation analysis showed that BMI was significantly related to LS (r = 0.166, p<.01). The strength of the BMI and LS association was diminished when ADL was included in the general linear regression models. Mediation analysis revealed that ADL mediated this relationship (effect size = 22.6%). We did not observe significant associations of BMI with other SWB components (PA, NA, and AB).

CONCLUSION

For long-lived women, low BMI, rather than elevated BMI, is an indicator of poor psychological well-being. The findings call for public health awareness about low body weight in long-lived women, especially in those with physical disabilities when focusing on quality of life.

Changes in Body Mass Index and the Trajectory of Depressive Symptoms Among Rural Men and Women

PURPOSE

This study examined the association between body mass index (BMI) changes over time and the risk of elevated depressive symptoms in a cohort of Midwestern rural adults.

METHODS

The longitudinal study used data from a telephone survey in 2005 including 1,475 men and women enrolled in the Walk the Ozarks to Wellness Project from 12 rural communities in Missouri, Arkansas, and Tennessee. Multilevel random intercept mixed models were used to estimate adjusted odds ratios (aOR) and 95% confidence intervals (CI) for the association between BMI calculated from self-reported height and body weight and elevated depressive symptoms, adjusting for sociodemographic, behavioral, and medical variables.

FINDINGS

Elevated depressive symptoms were common in this rural population (17%-19%) and the mean BMI was 28 kg/m² . For each unit increase in BMI over time, representing an average increase of about 5.8 pounds from baseline weight, there was a 6% increased odds of elevated depressive symptoms (aOR: 1.06, 95% CI: 1.02-1.12).

CONCLUSIONS

Our findings hold important public health implications given the increasing rates of overweight and obesity over the past couple of decades, particularly among rural adults.

Quality of life as a mediator in the association between body mass index and negative emotionality in overweight and obese non-clinical sample

PURPOSE

The present study investigates the differences in physical health-related quality of life (HRQoL) among overweight and obese people, as well as the correlates of HRQoL in this population and the association between BMI, depression, anxiety, and potential mediating effects of HRQoL.

METHODS

The research was conducted on a sample of overweight and obese adults who visited their primary care physician. A total of 143 women and 130 men were enrolled in the study, 43% of the subjects were overweight, and 57% of the subjects were obese. The subjects ranged in age between 21 and 60 years. Depression and anxiety were assessed using the Hospital Anxiety and Depression Scale, and HRQoL was evaluated using the Medical Outcome Study Short-Form 36.

RESULTS

The analysis of variance results showed that women in comparison to men have lower physical HRQoL (e.g. worst physical functioning, more bodily pain), and that severely obese patients have lower physical HRQoL in comparison to overweight ones. The regression analysis results indicated that some of the aspects of physical HRQoL (e.g. physical functioning, role limitations) mediate the relationship between BMI and depression only in women. The higher level of body mass decreased the physical HRQoL, which became a potential risk factor for the development of depressive symptoms.

CONCLUSIONS

The results from the present study show that a different pattern of functioning exists between men and women. It is important to identify the factors that can effectively motivate and stimulate obese people to change their lifestyle and to consider the differences in psychological functioning between women and men.

Depression, obesity, and metabolic syndrome: prevalence and risks of comorbidity in a population-based representative sample of Mexican Americans

INTRODUCTION

We examined the prevalence of depression, obesity, and metabolic syndrome and associations between them in a population-based representative cohort of Mexican Americans living on the United States-Mexico border.

METHOD

The sample in this cross-sectional analysis consisted of 1,768 Mexican American adults (≥ 18 years of age) assessed between the years 2004 and 2010, with whom we tested our central hypothesis of a significant relationship between obesity and depression. Depression was measured using the Center for Epidemiologic Studies-Depression scale (CES-D) with a cutoff score of ≥ 16 for depression and a cutoff score of ≥ 27 for severe depression. We categorized body mass index (BMI) values as obese (≥ 30kg/m(2)) and later subdivided the obese subjects into obese (30-39 kg/m(2)[inclusive]) and morbidly obese (≥ 40 kg/m(2)). Metabolic syndrome was defined using the American Heart Association definition requiring at least 3 of the following: increased waist circumference, elevated triglycerides, reduced high-density lipoprotein (HDL) cholesterol, elevated blood pressure, and elevated fasting glucose. Weighted data were analyzed to establish prevalence of depression, obesity, and metabolic syndrome. Univariate and multivariable weighted regression models were used to test potential associations between these disorders.

RESULTS

Using weighted prevalence, we observed high rates of depression (30%), obesity (52%), and metabolic syndrome (45%). Univariate models revealed female gender (P = .0004), low education (P = .003), low HDL level (P = .009), and increased waist circumference (P = .03) were associated with depression. Female gender (P = .01), low education (P = .003), and morbid obesity (P = .002) were risk factors for severe depression and remained significant in multivariable models.

CONCLUSIONS

In this large cohort of Mexican Americans, obesity, female gender, and low education were identified risk factors for depression. These indicators may serve as targets for early detection, prevention, and intervention in this population.

Evaluation of Nutritional Status of Patients with Depression

Aims and Objectives. Our goal was to determine nutritional status, body composition, and biochemical parameters of patients diagnosed with depression based on DSM-IV-TR criteria. Methods. A total of 59 individuals, aged 18–60 years admitted to Mental Health Centre of Kayseri Education and Research Hospital, were included in the study. The participants were randomly assigned to two groups; depression group (n = 29) and control group (n = 30). Anthropometric measurements, some biochemical parameters, demographic data, and 24-hour dietary recall were evaluated. Results. 65.5% of depression and 60.0% of control group were female. Intake of vitamins A, thiamine, riboflavin, B6, folate, C, Na, K, Mg, Ca, P, Fe, Zn, and fibre (p < 0.05) were lower in depression group. Median levels of body weight, waist circumference, hip circumference, waist-to-hip ratio (p < 0.05) were significantly higher in depression group. Fasting blood glucose levels, serum vitamins B12, and folic acid (p < 0.05) in depression group were lower than controls. Serum insulin and HOMA levels of two groups were similar. Conclusion. Some vitamin B consumption and serum vitamin B12 and folic acid levels were low while signs of abdominal obesity were high among patients with depression. Future research exploring nutritional status of individuals with depression is warranted.

Invited commentary: Fitness and fatness-causes of depression or of misclassification?

Parsing the relative contributions of fitness and fatness to various disease states has long interested investigators, despite their almost certainly intertwined causal relationships. In this issue of the Journal, Becofsky et al. ( examined these constructs in relation to depressive symptoms assessed using the Center for Epidemiologic Studies Depression Scale, a widely used and well-validated instrument that ascertains several domains related to depression. The authors found stronger and more consistent associations of elevated depressive symptoms with objectively measured fitness than with any measure of fatness. These analyses highlight a serious concern in analyses of risk factors for complex clinical constructs--the likelihood of differential misclassification with respect to the risk factors of interest in scales with multiple, wide-ranging domains. In this interesting example, the multi-item Center for Epidemiologic Studies Depression Scale, which validly captures the multiple domains of depression, contains measures of psychomotor retardation that could easily reflect fitness itself. Because an instrument's validity is uncertain if selected items are removed and gold-standard measures of complex clinical constructs are rarely truly gold, options to remedy this problem in most epidemiologic studies are few. Nonetheless, their analysis illustrates the particular caution needed when examining exposures that plausibly relate to misclassification in multidimensional outcomes of interest.

Is there a role for leptin in the reduction of depression symptoms during weight loss therapy in obese adolescent girls and boys?

Several studies have sought to clarify the association between adolescent obesity and psychological distress. Recently, a biological link between leptin resistance and depression has been proposed. The aim of the present study was to examine changes in leptin concentrations as a potential predictor of reduced depression symptoms in obese adolescents during long-term interdisciplinary weight loss therapy. Seventy-five obese adolescents (age: 16.28±2.37 years; BMI: 35.65±4.64 kg/m2) engaged in a long-term interdisciplinary therapy for weight loss. They were evaluated at baseline and after 1 year of treatment for body composition, serum analyses and depression symptomatology. After therapy, body mass BMI, fat mass (% and kg), waist circumference, visceral, subcutaneous and visceral/subcutaneous fat and depression symptoms decreased and lean mass (%) increased significantly. There was an improvement in inflammatory profiles with a significant reduction in leptin and increase in adiponectin. Regression analyses showed that decreased leptin predicted amelioration in depression symptoms independent of age, gender and changes in visceral fat, body mass, fat mass (%) and leptin/adiponectin ratio. These associations appear stronger in girls than boys. The attenuation of hyperleptinemia appears to play an important role in the association between weight loss and depression, particularly in obese girls.

Waist-to-hip ratio, dyslipidemia, glycemic levels, blood pressure and depressive symptoms among diabetic and non-diabetic Chinese women: a cross-sectional study

OBJECTIVES

To explore the relationship between depressive symptoms and waist-to-hip ratio, dyslipidemia, glycemic levels or blood pressure among diabetic and non-diabetic Chinese women.

METHODS

11,908 women aged ≥40 years were enrolled in this cross-sectional study, including 2,511 with type 2 diabetes and 9,397 without. Depressive symptoms (defined as having mild-to-severe depressive symptoms) were assessed by the Patient Health Questionnaire-9 (PHQ-9) diagnostic algorithm. The prevalence and the odds ratios (ORs) with 95% confidence intervals (CIs) for having depressive symptoms were estimated using logistic regression analysis.

RESULTS

The age-adjusted prevalence of depressive symptoms was significantly higher in non-diabetic subjects with waist-to-hip ratio (WHR) ≥0.9 (8.6%, age-adjusted OR 1.51 [95% CI 1.17, 1.95]), total cholesterol (TC)>6.22 mmol/L (8.8%, 1.58 [1.16, 2.15]), and Hemoglobin A1c (HbA1c) ≥6.00 mmol/L (7.7%, 1.69 [1.34, 2.14]), while it was significantly lower in non-diabetic subjects with diastolic blood pressure (DBP) between 80 to 89 mmHg (6.2%, 0.78 [0.64, 0.95]). These relationships remained significant even after controlling for multiple factors (WHR ≥0.9: multivariable-adjusted OR 1.39 [95% CI 1.07, 1.80]; TC>6.22 mmol/L: 1.56 [1.14, 2.12]; HbA1c ≥6.00 mmol/L: 1.64 [1.30, 2.08]; DBP 80-89 mmHg: 0.78 [0.64, 0.95]). However, no significant trend between depressive symptoms and WHC, TC, HbA1c, DBP was observed in diabetic women, and no significant trend relationship between depressive symptoms and BMI, WC, TG, or SBP was observed in both non-diabetic and diabetic women. Moreover, the prevalence of depressive symptoms was significantly higher in previously-diagnosed diabetes, compared with non-diabetic subjects, while no significant differences were observed between newly-diagnosed diabetes and non-diabetic subjects.

CONCLUSION

The present study showed a relationship between WHR, TC, HbA1c, DBP and depressive symptoms among non-diabetic women, while no significant relationship between them was observed among diabetic women, even after controlling for multiple confounding factors.

Body mass index and depressive symptoms in primary care settings: examining the moderating roles of smoking status, alcohol consumption and vigorous exercise

WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT

Depressive symptoms and obesity are highly prevalent in primary care settings. Depressive symptoms and obesity are positively related; as body weight increases, individuals are more likely to display depressive symptoms.

WHAT THIS STUDY ADDS

This study examines the moderating roles of health behaviours (alcohol use, smoking status and vigorous exercise) on the relationship between body mass index and depressive symptoms. Exercise attenuates the relationship between depressive symptoms and obesity. Primary care patients often report multiple health risk behaviours and symptoms, including obesity and depressive symptomatology. This study examined the relationship between body mass index (BMI) and depressive symptomatology among primary care patients and tested its moderation by health behaviours. Primary care patients (n = 497) completed self-report questionnaires. Using three multilevel models, we tested the moderation of health behaviours on the BMI-depressive symptoms relationship. After controlling for relevant covariates, BMI was positively related to depressive symptoms. Smokers reported more depressive symptoms (P < 0.01), whereas vigorous exercisers reported fewer (P < 0.001). Alcohol consumption was not related to depressive symptoms (P > 0.05). Only vigorous exercise significantly moderated the BMI-depression relationship (P < 0.05). BMI is positively related to depressive symptoms among patients who do not participate in vigorous activity, suggesting that vigorous activity reduces the risk for depressive symptoms among patients with higher BMI.

Does obesity predict bipolarity in major depressive patients?

BACKGROUND

Differential association of obesity in bipolar and unipolar Major Depressive Episode (MDE) has not been systematically studied. We explore the relationships between obesity and history of manic and hypomanic symptoms in a large national clinical sample of MDE patients.

METHOD

The sample comprised 571 consecutive patients with a DSM-IV diagnosis of MDE enrolled in a 7 months period. The study involved 30 psychiatric facilities for outpatients, distributed throughout Italy. Diagnosis was formulated by psychiatrists with extensive clinical experience in the diagnosis and treatment of mood disorders. In all patients height (meters) and weight (kilograms) were systematically measured at the moment of the clinical evaluation. The severity of depressive and anxious symptomatology was self-evaluated by the means of Zung's questionnaires for depression and anxiety. For the evaluation of lifetime manic or hypomanic features, Hypomania Check List-32 was also administered. Obese and Non-Obese subgroups were identified on the basis of a >30 BMI cut off point.

RESULTS

BMI ≤30 was observed in 86 (15.1%) of our MDE patients. The Obese and Non-Obese subgroups did not report differences as regards to age and gender distribution. Obese patients reported a lower number of years of education in comparison with Non-Obese patients. As regards to marital status, Obese patients were more frequently married in comparison with the Non-Obese patients. Obese patients were more frequently belonging to the bipolar group than Non-Obese patients. Obese subjects also reported more frequently than Non-Obese an HCL total score >14. The effect of educational level, marital status and bipolar-unipolar distinction on the probability of Obese group membership was analyzed by stepwise logistic regression. Bipolar subtype resulted to be the strongest predictor of Obesity.

LIMITATIONS

Pharmacological treatments and co-morbidity with other psychiatric disorders are not explored and accounted for in our analyses.

CONCLUSIONS

Obesity in our national sample of patients with MDE is associated with bipolar subtype and (hypo)manic symptoms. These findings suggest the possibility that the presence of obesity in patients with MDE might be related to bipolarity. A common impulsive-addictive diathesis is proposed as mediating mechanism. Further longitudinal studies in clinical and non-clinical populations are necessary to better define the burden and the role of the association between obesity and bipolarity.

Heaviness, health and happiness: a cross-sectional study of 163066 UK Biobank participants

BACKGROUND

Obesity is known to increase the risk of many diseases and reduce overall quality of life. This study examines the relationship with self-reported health (SRH) and happiness.

METHODS

We conducted a cross-sectional study of the 163 066 UK Biobank participants who completed the happiness rating. The association between adiposity and SRH and happiness was examined using logistic regression. SRH was defined as good (excellent, good), or poor (fair, poor). Self-reported happiness was defined as happy (extremely, very, moderately) or unhappy (moderately, very, extremely).

RESULTS

Poor health was reported by 44 457 (27.3%) participants. The adjusted ORs for poor health were 3.86, 2.92, 2.60 and 6.41 for the highest, compared with lowest, deciles of Body Mass Index, waist circumference, waist to hip ratio and body fat percent, respectively. The associations were stronger in men (p<0.001). Overall, 7511 (4.6%) participants felt unhappy, and only class III obese participants were more likely to feel unhappy (adjusted OR 1.33, 95% CI 1.15 to 1.53, p<0.001) but the associations differed by sex (p<0.001). Among women, there was a significant association between unhappiness and all levels of obesity. By contrast, only class III obese men had significantly increased risk and overweight and class I obese men were less likely to be unhappy.

CONCLUSIONS

Obesity impacts adversely on happiness as well as health, but the association with unhappiness disappeared after adjustment for self-reported health, indicating this may be mediated by health. Compared with obese men, obese women are less likely to report poor health, but more likely to feel unhappy.

Are children and adolescents with psychiatric illness at risk for increased future body weight? A systematic review

The aim of this paper was to review the longitudinal relationship between early-onset depression and disruptive behaviour and adult body weight. A systematic review of prospective longitudinal studies was conducted of articles in which (1) initial assessment occurred during childhood or adolescence (<18 y); and (2) the primary outcome reported as body mass index (BMI), overweight (BMI>25-<30 kg/m(2)), obesity (BMI ≥ 30 kg/m(2)), or depression; and (3) validated assessment measures for assessment of depressive symptoms or disruptive behaviour problems were employed. A total number of 16 articles were identified for review. Obese adolescent females are more likely to develop depressive illness in adulthood than their non-obese peers. Conversely, depressed adolescent females, and possibly males, are more likely to become overweight adults than non-depressed adolescents. There are insufficient data addressing future depression risk among overweight, non-obese, adolescents to evaluate the potentially interactive nature of this relationship. Studies to date are consistent in reporting that children with behaviour problems are at increased risk of future overweight, though whether this risk is conferred by conduct symptoms, ADHD symptoms, or both, is less clear. Care providers of children with disruptive behaviour problems and depressed adolescents should monitor weight gain. Among obese adolescent females, mood should be followed.

Bidirectional association between weight change and depression in mid-aged women: a population-based longitudinal study

BACKGROUND

There is some evidence for a bidirectional association between obesity and depression. However, studies examining weight change and depression are scarce and report inconsistent findings.

OBJECTIVE

The objective was to investigate the relationship between average annual percentage weight change and depression in mid-aged women.

DESIGN

This was a prospective cohort study.

SUBJECTS

A total of 8246 women aged 45-50 years at baseline participating in the Australian Longitudinal Study on Women's Health were surveyed every 3 years over a 12-year period. Information on body mass index and depression was collected at each survey. We used regression models to investigate the effect of weight change predicting depression and vice versa, by calculating odds ratios (ORs) with 95% confidence intervals (CIs).

RESULTS

Weight gain was associated with an increased risk of prevalence (OR 1.39, 95% CI 1.25-1.56) and incidence (OR 1.30, 95% CI 1.14-1.49) of depression. However, in time-lagged analyses, where weight change between the two preceding surveys was used to predict incidence of depression at the current survey, no statistically significant associations with depression were found. Compared with women without depression, women with prevalent and incident depression had an increased risk of weight gain (OR 1.29, 95% CI 1.19-1.40 and OR 1.20, 95% CI 1.05-1.38, respectively). When incidence of depression was lagged with respect to weight change between the two subsequent surveys, depression remained associated with an increased risk (OR 1.19, 95% CI 1.00-1.41) of gaining weight.

CONCLUSION

These findings suggest that depression may cause weight gain over the next 3 years, but that weight change (loss or gain) may not lead to depression. Further research at shorter intervals, perhaps 6 monthly or yearly is needed to ascertain whether weight change is an independent predictor of depression in the shorter term.

The impact of obesity on quality of life

An important association exists between obesity and mental illness that impacts all aspects of an individual's quality of life. This association can begin early in the developmental trajectory and we do not yet completely understand all the mechanisms linking obesity and mental illness. What we e do know is that physical health factors that often occur secondary to obesity, combined with societal attitudes toward those that are obese coupled with iatrogenic treatment factors linked to psychiatric pharmacotherapy and a number of biologic mediators result in an important and increasing common comorbidity. Recognizing this association is essential for the proper management of both conditions. The following review addresses this issue and provides clinical pearls to help deal with this issue.

Obesity and depressive symptoms in the elderly: a survey in the rural area of Chizhou, Anhui province

OBJECTIVE

The aim of the present study is to examine the relationship between obesity and depressive symptoms and to test the "Jolly Fat" hypothesis among older Chinese.

METHODS

A total of 736 rural Chinese aged 60 years and older participated in this cross-sectional study. Body mass index (BMI = kg/m(2) ) was calculated from the subjects' measured weight (kg) and height (meter). Depressive symptoms were assessed using the 30-item Geriatric Depression Scale (GDS-30), with a cut-off point of 11.

RESULTS

Among 736 total participants, the prevalence of depressive symptoms was 24.1% in men and 27.9% in women. A trend about depressive symptoms decreased with increasing BMI was found in men (χ(2) trend = 5.74, df = 1, p = 0.01). A weak inverse linear trend between obesity and depressive symptoms was observed among subjects. In men, obese group was less likely to suffer from depressive symptoms compared with normal weight group before or after adjustment for confounders, with odds ratios of 0.32 (95% confidence interval (CI): 0.12-0.85) and 0.28 (95% CI: 0.09-0.85), respectively. However, the association between BMI and depressive symptoms in women showed no significant differences.

CONCLUSIONS

Our results supported the "Jolly Fat" hypothesis only in rural older Chinese men, but not in women. Gender differences existed in the relationship between obesity and depressive symptoms.

Binge eating as a determinant of emotional state in overweight and obese males with cardiovascular disease

OBJECTIVES

The present study investigates the association between depression, anxiety and binge eating at baseline with weight-change after an approximately 1-year period in a clinical sample of obese adult males with cardiovascular disease.

METHODS

At the time of the first measurement, the sample consisted of 69 overweight and obese men (age range between 36 and 74); 34 patients attended a follow-up measurement 6-17 months after the first measurement, and completed selected psychological instruments.

RESULTS

After the follow-up period, only 28.7% patients' lost weight, 29.9% patients' had the same weight, and finally 41.4% patients' gained weight. When comparing the first and the second assessments, the level of anxiety and depression is relatively stable. Men, who, at the time of the second assessment, gained weight, and were binge eating at baseline, were more depressed and anxious in comparison with the other two groups of patients.

CONCLUSIONS

It is necessary to focus primarily on binge eating symptoms as a part of weight reduction treatment as well as to treat anxiety and depression in CVD patients. Binge eating is an eating disorder per se, and therefore it is important to treat it before the person starts weight reduction procedures as part of the risk prevention treatment for CVD patients.

An interval of the obesity QTL Nob3.38 within a QTL hotspot on chromosome 1 modulates behavioral phenotypes

A region on mouse distal chromosome 1 (Chr. 1) that is highly enriched in quantitative trait loci (QTLs) controlling neural and behavioral phenotypes overlaps with the peak region of a major obesity QTL (Nob3.38), which we identified in an intercross of New Zealand Obese (NZO) mice with C57BL/6J (B6). By positional cloning we recently identified a microdeletion within this locus causing the disruption of Ifi202b that protects from adiposity by suppressing expression of 11β-Hsd1. Here we show that the Nob3.38 segment also corresponds with the QTL rich region (Qrr1) on Chr. 1 and associates with increased voluntary running wheel activity, Rota-rod performance, decreased grip strength, and anxiety-related traits. The characterization of a subcongenic line carrying 14.2 Mbp of Nob3.38 with a polymorphic region of 4.4 Mbp indicates that the microdeletion and/or other polymorphisms in its proximity alter body weight, voluntary activity, and exploration. Since 27 out of 32 QTL were identified in crosses with B6, we hypothesized that the microdeletion and or adjacent SNPs are unique for B6 mice and responsible for some of the complex Qrr1-mediated effects. Indeed, a phylogenic study of 28 mouse strains revealed a NZO-like genotype for 22 and a B6-like genotype for NZW/LacJ and 4 other C57BL strains. Thus, we suggest that a Nob3.38 interval (173.0-177.4 Mbp) does not only modify adiposity but also neurobehavioral traits by a haplotype segregating with C57BL strains.

Longitudinal Relationships Among Overweight, Life Satisfaction, and Aspirations in Young Women

OBJECTIVE

This study investigated associations of overweight status and changes in overweight status over time with life satisfaction and future aspirations among a community sample of young women.

RESEARCH METHODS AND PROCEDURES

A total of 7865 young women, initially 18 to 23 years of age, completed two surveys that were 4 years apart. These women provided data on their future life aspirations in the areas of further education, work/career, marital status, and children, as well as their satisfaction with achievements to date in a number of life domains. Women reported their height and weight and their sociodemographic characteristics, including current socioeconomic status (occupation).

RESULTS

Young women's aspirations were cross-sectionally related to BMI category, such that obese women were less likely to aspire to further education, although this relationship seemed explained largely by current occupation. Even after adjusting for current occupation, young women who were obese were more dissatisfied with work/career/study, family relationships, partner relationships, and social activities. Weight status was also longitudinally associated with aspirations and life satisfaction. Women who were overweight or obese at both surveys were more likely than other women to aspire to "other" types of employment (including self-employed and unpaid work in the home) as opposed to full-time employment. They were also less likely to be satisfied with study or partner relationships. Women who resolved their overweight/obesity status were more likely to aspire to being childless than other women.

DISCUSSION

These results suggest that being overweight/obese may have a lasting effect on young women's life satisfaction and their future life aspirations.

Comparison of physical and psychological status in younger and older overweight-obese women

BACKGROUND AND AIM

Obesity prevalence is noticeably growing, even in the elderly. Most of the studies concerning the impact of obesity in the elderly evaluated physical co-morbidities, whilst very few data are available on psychological co-morbidities in people ≥ 60 years of age. The present study aimed to compare anthropometrical measures, physical co-morbidities and psychosocial factors correlated with overweight and obesity in younger and elderly people.

METHODS AND RESULTS

In 456 women in the age range of 18-59 years and 128 women in the age range of 60-80 years with body mass index (BMI) ≥ 25/kg m², body weight, height and waist and hip circumferences were measured. The presence of co-morbidities such as osteoarthritis, hypertension, type 2 diabetes and hypercholesterolaemia was assessed. The Obesity Related Well Being 97 Questionnaire (ORWELL 97), Body Uneasiness Test (BUT), Symptom Check List 90 (SCL 90) and Binge Eating Scale (BES) tests were used to evaluate psychometric variables. BMI was not significantly different between younger overweight-obese subjects and older overweight-obese subjects, whereas waist circumference and waist-to-hip ratio (WHR) were significantly higher in the elderly. Osteoarthritis, hypertension and hypercholesterolaemia were significantly more frequent in the elderly. Older overweight-obese subjects had better scores in most of the psychometric questionnaires.

CONCLUSIONS

Our results show that older overweight-obese subjects have generally more physical co-morbidities but a better psychological status than younger adults, despite similar BMI. These data may contribute to a better understanding of obesity consequences in the elderly and may help clinicians to differentiate obesity treatments in relation to patients' age.

Obesity, psychiatric status, and psychiatric medications

This article has shown that obesity is related to several psychiatric disorders, the most thoroughly researched of which is depression. In both community and clinical populations, the observed relationship is more consistent in women than in men, and is stronger in more severely obese individuals. The presence of BED also is associated with elevated risk of additional psychopathology. Longitudinal research provides evidence to support a pathway from obesity to depression, as well as one from depression to obesity. Weight loss, particularly with nonpharmacologic methods, appears to have favorable group-level effects on mood, but may be associated with adverse outcomes for some individuals. Persons who require antipsychotic medications are at risk for weight gain and metabolic abnormalities, and their management should be informed by consensus guidelines.

Temporal relationships between overweight and obesity and DSM-IV substance use, mood, and anxiety disorders: results from a prospective study, the National Epidemiologic Survey on Alcohol and Related Conditions

OBJECTIVE

To present nationally representative findings on the prospective relationships between overweight and obesity and DSM-IV substance use, mood, and anxiety disorders.

METHOD

A nationally representative sample of 34,653 US adults was interviewed in Wave 1 (2001-2002) and Wave 2 (2004-2005) of the National Epidemiologic Survey on Alcohol and Related Conditions. The target population was the civilian population residing in households and group quarters, with gathered data adjusted to be representative of the civilian population of the United States on the basis of the 2000 Decennial Census. The main outcome measures were the incidence of DSM-IV substance use, mood, and anxiety disorders and changes in body mass index status during the 3-year follow-up period.

RESULTS

Regression analyses that controlled for a wide array of covariates showed that overweight and obese women were at increased risk (P < .05) for incident major depressive disorder during the follow-up period (adjusted OR [AOR] = 1.3 [95% CI, 1.02-1.56] and AOR = 1.2 [95% CI, 1.02-1.51], respectively). Overweight men and obese men were at decreased risk (P < .05) of incident drug abuse and alcohol dependence (AOR = 0.7 [95% CI, 0.44-0.96] and AOR = 0.7 [95% CI, 0.52-0.97]), respectively. Obese women had a decreased risk (P < .05) of incident alcohol abuse and drug dependence (AOR = 0.6 [95% CI, 0.45-0.88] and AOR = 0.4 [95% CI, 0.21-0.91], respectively). Men with drug dependence and women with specific phobia had a decreased risk (P < .05) of becoming overweight or obese during the follow-up period (AOR = 0.4 [95% CI, 0.19-0.99] and AOR = 0.8 [95% CI, 0.66-0.95], respectively).

CONCLUSIONS

Increased risk of major depressive disorder among overweight and obese women could be attributed to stigma and greater body dissatisfaction among women in Western cultures. Overweight and obesity may serve as protective factors against developing incident substance use disorders, possibly due to shared neural functions in the brain underlying addictions to numerous substances. Results are discussed in terms of their clinical implications, including the need to update treatment guidelines for the management of overweight, obesity, and major depressive disorder.

Association between Body Mass Index and depression: the "fat and jolly" hypothesis for adolescents girls

BACKGROUND

Results concerning the association between Body Mass Index (BMI) and depression in adolescence are conflicting, some describing a linear association (increase in BMI with level of depression), some a U-shaped association (both underweight and obesity are associated with high levels of depression), and they mostly concern small samples. The purpose of this study was to describe the association between BMI and depression in a large representative sample of French adolescents.

METHODS

The association between BMI and depression, measured on the Adolescent Depression Rating Scale (ADRS), was tested in a French national representative sample of 39542 adolescents aged 17. Self-report data is derived from the 2008 ESCAPAD study, an epidemiological study based on a questionnaire focused on health and drug consumption. We used spline function analysis to describe the association between BMI and depression.

RESULTS

The association between BMI and depression is significant (p < 0.001) and non-linear for both genders, with no effect of parental working and marital status. For boys, there is U-shaped association. For girls the shape of the association is complex and shows inverted convexity for high levels of BMI. The spline shows higher scores for depression among overweight girls than among obese girls.

CONCLUSION

There is evidence for a gender difference in the association between BMI and depression in adolescents, supporting the need to study boys and girls separately. Overweight adolescent girls are more likely to be depressed than obese adolescent girls, giving support for "fat and jolly" hypothesis not only among older women but also among adolescent girls.

Does weight gain during pregnancy influence postpartum depression?

The goal of this study was to determine if weight gain during pregnancy has an effect on postpartum depression (PPD). Data were collected in a web survey from 238 women who had recently given birth. The data were analyzed for the total sample and also by body weight category before pregnancy. Findings revealed that weight gain was inversely associated with PPD for the obese women in our sample. For these women, the less weight they gained, the more likely they were to experience PPD. History of depression, partner support, and age were also predictors of PPD.

Impaired CNS leptin action is implicated in depression associated with obesity

Recent epidemiological studies indicate that obesity increases the incidence of depression. We examined the implication of leptin for obesity-associated depression. Leptin induced antidepressive behavior in normal mice in a forced swimming test (FST), and leptin-overexpressing transgenic mice with hyperleptinemia exhibited more antidepressive behavior in the FST than nontransgenic mice. In contrast, leptin-deficient ob/ob mice showed more severe depressive behavior in the FST than normal mice, and leptin administration substantially ameliorated this depressive behavior. Diet-induced obese (DIO) mice fed a high-fat diet showed more depressive behavior in the FST and in a sucrose preference test compared with mice fed a control diet (CD). In DIO mice, leptin induced neither antidepressive action nor increment of the number of c-Fos immunoreactive cells in the hippocampus. Diet substitution from high-fat diet to CD in DIO mice ameliorated the depressive behavior and restored leptin-induced antidepressive action. Brain-derived neurotrophic factor concentrations in the hippocampus were significantly lower in DIO mice than in CD mice. Leptin administration significantly increased hippocampal brain-derived neurotrophic factor concentrations in CD mice but not in DIO mice. The antidepressant activity of leptin in CD mice was significantly attenuated by treatment with K252a. These findings demonstrated that leptin induces an antidepressive state, and DIO mice, which exhibit severe depressive behavior, did not respond to leptin in both the FST and the biochemical changes in the hippocampus. Thus, depression associated with obesity is due, at least in part, to impaired leptin activity in the hippocampus.

Evidence for prospective associations among depression and obesity in population-based studies

Obesity may lead to depression or be one of its consequences. We reviewed population-based studies in order to, first, identify the most commonly used research methods, and, second, to evaluate the strength of evidence for prospective associations among obesity and depression. We examined 25 studies, of which 10 tested 'obesity-to-depression' pathways, and 15 tested 'depression-to-obesity' pathways. Descriptive statistics summarized the frequency with which various measurements, designs and data analytic strategies were used. We tallied the number of studies that reported any vs. no statistically significant associations, and report on effect sizes, identified moderating variables within reports, and sought common findings across studies. Results indicated considerable methodological heterogeneity in the literature. Depression was assessed by clinical interview in 44% of studies, weight and height were directly measured in 32%, and only 12% used both. In total, 80% of the studies reported significant obesity-to-depression associations, with odds ratios generally in the range of 1.0 to 2.0, while only 53% of the studies reported significant depression-to-obesity associations. Sex was a common moderating variable. Thus, there was good evidence that obesity is prospectively associated with increased depression, with less consistent evidence that depression leads to obesity. Recommendations for future research regarding study samples, measurement and data analysis are provided.

Health status and lifestyle factors as predictors of depression in middle-aged and elderly Japanese adults: a seven-year follow-up of the Komo-Ise cohort study

BACKGROUND

Depression is a common mental disorder. Several studies suggest that lifestyle and health status are associated with depression. However, only a few large-scale longitudinal studies have been conducted on this topic.

METHODS

The subjects were middle-aged and elderly Japanese adults between the ages of 40 and 69 years. A total of 9,650 respondents completed questionnaires for the baseline survey and participated in the second wave of the survey, which was conducted 7 years later. We excluded those who complained of depressive symptoms in the baseline survey and analyzed data for the remaining 9,201 individuals. In the second-wave survey, the DSM-12D was used to determine depression. We examined the risks associated with health status and lifestyle factors in the baseline survey using a logistic regression model.

RESULTS

An age-adjusted analysis showed an increased risk of depression in those who had poor perceived health and chronic diseases in both sexes. In men, those who were physically inactive also had an increased risk of depression. In women, the analysis also showed an increased risk of depression those with a BMI of 25 or more, in those sleeping 9 hours a day or more and who were current smokers. A multivariate analysis showed that increased risks of depression still existed in men who had chronic diseases and who were physically inactive, and in women who had poor perceived health and who had a BMI of 25 or more.

CONCLUSIONS

These results suggest that lifestyle and health status are risk factors for depression. Having a chronic disease and physical inactivity were distinctive risk factors for depression in men. On the other hand, poor perceived health and a BMI of 25 or more were distinctive risk factors for depression in women. Preventive measures for depression must therefore take gender into account.

Does the association between depressive symptomatology and physical activity depend on body image perception? A survey of students from seven universities in the UK

This cross-sectional study assessed the association between depression and PA in university students of both genders and the role of body image perception as a potential effect modifier. Undergraduate students (N = 3706) from seven universities in the UK completed a self-administered questionnaire that assessed sociodemographic information; a range of health, health behaviour and health awareness related factors; the modified version of Beck’s Depression Inventory (M-BDI); educational achievement, and different levels of physical activity (PA), such as moderate PA (at least 5 days per week moderate exercise of at least 30 minutes), and vigorous PA (at least 3 days per week vigorous exercise of at least 20 minutes). Only 12.4% of the sample achieved the international recommended level for moderate PA, and 33.1% achieved the recommendations for vigorous PA. Both moderate and vigorous PA were inversely related to the M-BDI score. Physically active students, regardless of the type of PA, were significantly more likely to perceive their health as good, to have higher health awareness, to perform strengthening exercises, and to be males. The stratified analyses indicated that the association between depression and PA differed by body image. In students perceiving their body image as ‘just right’, moderate (>4th percentile) and high (>5th percentile) M-BDI scores were inversely related to vigorous PA. However, in students who perceived their body image as ‘overweight’, the inverse association was only significant in those with high M-BDI scores. We conclude that the positive effect of PA on depression could be down modulated by the negative impact of a ‘distorted’ body image on depression. The practical implications of these findings are that PA programmes targeting persons with depressive symptoms should include effective components to enhance body image perception.