Elsevier

Psychiatry Research

Volume 178, Issue 2, 30 July 2010, Pages 230-235
Psychiatry Research

Depression and obesity: A meta-analysis of community-based studies

https://doi.org/10.1016/j.psychres.2009.04.015Get rights and content

Abstract

To examine the nature of the association between depression and obesity and to determine possible underlying (demographic) factors, we conducted a meta-analysis of cross-sectional studies in the general population. We searched in major bibliographical databases (PubMed, Embase and PsycInfo) for studies examining the association between obesity and depression in the adult, general population. Seventeen studies were included with a total of 204,507 participants. We calculated an overall pooled mean effect size and conducted subgroup analyses on gender, age, continent of residence, year of publication and several differences in measurement methods. After removing two outliers, the overall association for depression and obesity was very significant. Subgroup analyses showed a trend indicating a possible significant difference between males and females. We found a significant positive association for females and a smaller non-significant association for males. The results of other subgroup analyses showed no significant differences. According to the findings of this study, there is a significant positive association between depression and obesity in the general population, which appeared to be more marked among women. Further research should focus on underlying factors and examine causal pathways between depression and obesity.

Introduction

In recent decades, a considerable number of population-based studies have examined the association between depression and obesity. According to the World Health Organization (WHO), depression is among the leading causes of disability (WHO, 2006), affecting about 121 million people globally at each moment in time. Obesity is an increasing major public health concern. In 2002, the prevalence in the US adult population was 32.2%, having doubled since 1980 (Ogden et al., 2006). Both depression and obesity are causing huge burden of disease and enormous economic costs, worldwide (Allison et al., 1999, Druss et al., 2000, WHO, 2006).

The high prevalence of both might be an indication of an association between depression and obesity (Stunkard et al., 2003). This could be expected from a psychiatric point of view, since increased food intake and decreased physical activity, are Diagnostic and Statistical Manual of Mental Disorders, fourth edition, (DSM-IV) symptoms of depression, and these symptoms are also responsible for weight gain. Furthermore, negative body image and stigmatisation of obese individuals could lead to low self esteem and psychological distress (Ross, 1994). However, this hypothesis has not yet been ascertained in community samples (Stunkard et al., 2003).

Current community studies show mixed results. Some researchers find a positive association (John et al., 2005, Baumeister and Härter, 2007, Ohayon, 2007), some a negative association (Crisp and McGuiness, 1975, Crisp et al., 1980, Palinkas et al., 1996) and there are studies that found no association at all (Kress et al., 2006, Ohayon and Hong, 2006). Hence, it seems clear that not all obese individuals in the general population suffer from mood disorders; accordingly, there could be specific factors protecting some individuals. Sociodemographic variables may be potential moderators and mediators in the association between depression and obesity and might explain the conflicting results (Friedman and Brownell, 1995).

Some researchers have investigated demographic variables as moderators that influence the association between depression and obesity. For instance, a few studies have examined gender as a possible moderator. The results are conflicting, with some studies indicating a significant association between depression and obesity in females but not in males (Istvan et al., 1992, Carpenter et al., 2000, Onyike et al., 2003, McIntyre et al., 2006, Scott et al., 2007), while other studies found no gender discrepancy (Haukkala and Uutela, 2000, Herva et al., 2006). This could possibly be explained by differences in study design. For example some used self-report questionnaires (Haukkala and Uutela, 2000, Herva et al., 2006), while others used DSM-IV criteria to establish a diagnosis (Carpenter et al., 2000, Onyike et al., 2003, McIntyre et al., 2006, Scott et al., 2007). Furthermore, there is evidence that socioeconomic status (SES) influences the association. A stronger association was found among those with higher SES (Moore et al., 1962, Ross, 1994, Scott et al., 2007), but there are studies reporting these findings only for females and not for males (Carpenter et al., 2000). In addition, there are incongruent results for age as a moderating factor, with some showing no age differential effects (Scott et al., 2007), others showing a lack of association in the oldest age group, and one longitudinal study showing an obesity–depression association that rose with increasing age (Hasler et al., 2005). So far, no differences have been found in the association between different ethnic groups (Franko et al., 2005).

Because the results of the studies in this area do not point in the same directions, a meta-analysis may be helpful in clarifying the association between depression and obesity. Until now, only one meta-analysis has been conducted. In this meta-analysis, published in 1995, no association was found between depression and obesity. The authors suggested that there should be more research to investigate the nature of the association between depression and obesity and variables influencing the association (Friedman and Brownell, 1995).

In order to clarify the nature of the association between depression and obesity, and discover which demographic variables (gender, age, diagnostic criteria, and area of residence) and measurement issues have an effect on the association, we conducted a meta-analysis of studies that have been published on this subject.

Section snippets

Literature search

We conducted a systematic literature search. First, we conducted systematic searches in major bibliographical databases (Pubmed, PsycInfo and Embase; the end date of the search was 20 September 2007). In these databases we combined keywords and text words referring to obesity (obesity, BMI, body mass index and overweight) and depression (depressi⁎, depressed, depressive and depression). We used no language restrictions. We studied all 5771 abstracts (1909 Pubmed, 679 Embase and 3183 PsycInfo).

Included studies

A total of 17 studies met the inclusion criteria (Stewart and Brook, 1983, Istvan et al., 1992, Ross, 1994, Palinkas et al., 1996, Carpenter et al., 2000, Haukkala and Uutela, 2000, Roberts et al., 2002, Onyike et al., 2003, John et al., 2005, Ohayon and Hong, 2006, Ohayon, 2007, Hach et al., 2006, Johnston et al., 2004, Herva et al., 2006, McIntyre et al., 2006, Simon et al., 2006, Scott et al., 2007) and selected characteristics of these studies are presented in Table 1. In these 17 studies a

Discussion

In the meta-analysis of 17 community-based studies with a total of 204,507 participants, we found a significant association between depression and obesity (OR = 1.26; 95% CI; 1.17–1.36, P  0.001) in a moderately heterogeneous group (I2 = 46.18). All the potential moderators (age, continent of residence, year of publication and differences in measurement methods) did not influence this association, with the exception of gender. The association between depression and obesity was more clearly present

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