Obesity, Depression Often Coexist In Middle-Aged Women

What is the reason? Depression and obesity likely fuel one another, said lead author Gregory Simon, M.D. “When people gain weight, they’re more likely to become depressed, and when they get depressed, they have more trouble losing weight,” said Simon, a psychiatrist and researcher at Group Health Cooperative in Seattle.

In the study, published in the January/February issue of General Hospital Psychiatry, researchers interviewed 4,641 female health-plan enrollees, ages 40 to 65, by phone. The women responded to items on height, weight, exercise levels, dietary habits and body image. They also completed the Patient Health Questionnaire, a measure of depression symptoms.

Women with clinical depression were more than twice as likely to be obese, defined as having a body-mass index (BMI) of 30 or more; likewise, obese women were more than twice as likely to be depressed.

Moreover, women with BMIs at or above 30 exercised the least, had the poorest body image and ingested 20 percent more calories than those with lower BMIs. The depression-obesity association held even when the researchers controlled for marital status, education, tobacco use and antidepressant use.

The association was stronger in this study than in previous, comparable ones — possibly because the sample was predominantly white and middle-class, Simon said: “There is some evidence that being overweight is less stigmatized for men, for lower-income people and for women in nonwhite ethnic groups.”

The stigma of being overweight could hurt self-esteem, and thus, efforts to lose weight, Simon said. “It’s not that these women are clueless,” he said. “It’s that they’re hopeless.”

The takeaway for obese women is to focus on rebuilding their spirit, which can help with losing pounds, he said.

Health care providers should glean a similar message from the study results, said Richard Rubin, Ph.D., a Johns Hopkins University psychologist. “Providers need to monitor for depression and treat it in overweight individuals, especially given the dramatically increased risk of diabetes among those who are overweight,” said Rubin, former president for health care and education of the American Diabetes Association.

General Hospital Psychiatry is a peer-reviewed research journal published bimonthly by Elsevier Science. For information about the journal, contact Wayne Katon, M.D., at (206) 543-7177.

Simon GE, et al. Association between obesity and depression in middle-aged women. Gen Hosp Psychiatry 30(1), 2008.