Indian Journal of Health and Well-being © 2017 Indian Association of Health, Research and Welfare

2017, 8(12), 1472-1475 ISSN-p-2229-5356,e-2321-3698

http://www.iahrw.com/index.php/home/journal_detail/19#list UGC Journal No 42787 and NAAS Ratings 4.13

Obesity and depression: Are they related?

Neelam Rathee
Department of Psychology, Govt. College for Girls, Sector -11, Chandigarh

Obesity is a common disorder that is becoming even more common. Prevalence of depression among present
population is also increasing. For years, it was assumed that any relationship of depression to obesity in the general
population was largely coincidental. Research in the recent past, however, has uncovered a large number of
mediating variables that relate depression and obesity. Depression influences obesity under some circumstances
and obesity influences depression under others. The present study is an attempt to gain some insight into the
complex relationship of obesity and depression using Body Mass Index (BMI) for obesity factor and depression
score obtained by Beck Depression Inventory (BDI). Findings revealed significant positive correlation between the
level of obesity and depression of normal, overweight and obese subjects. The test of significance of difference (t-
test) revealed significant difference between the means of depression of the three groups.

Keywords: body mass index, depression, obesity

Adolescent obesity and depression are increasingly prevalent and are
currently recognized as major public health concerns worldwide. In
India too, the number of overweight people has increased
significantly over the last ten years. Even by conservative estimates,
five per cent of the total population in the country is believed to be
overweight. Obesity is a condition characterized by excessive
accumulation of fat in the body (Wolper et al., 1994). Overweight has
been defined in terms of body mass index (BMI). This is the figure
obtained by dividing body weight by the square of height in meters.
(BMI=weight in kilograms divided by height in meters squared,
Wolper et al., 1994). Overweight is classified as a BMI of 25 to 30
and obesity as a BMI of 30 and above (National Heart, Lung, &
Blood Institute, 1998). These values have been arbitrarily defined
and there is no physiologically defined cutoff point for overweight or
obesity. For most practical purposes, the eyeball test is adequate, i.e.
if a person looks fat, the person is fat. People are classified as:
W.H.O. Criteria Recommendation
for Indians
Normal less than 25 kg per m2 less than 23
Overweight more than 25 kg per m2 more than 23
Obese more than 30 kg per m2 more than 27.5
Severe Obesity more than 35 kg per m2 more than 32.5
Morbid Obesity more than 40 kg per m2 more than 37.5
Source: Arun Prasad, MS, FRCS, FRCSEd, Senior Consultant
Surgeon, Gastro-Intestinal, and Minimal Access Surgery, Apollo
Hospital, New Delhi, India.
Obesity is a common disorder that is becoming ever more
common. National Family Health Survey (NFHS- 2, 1998-99)
shows 5.8 percent obese women with BMI (Body Mass Index) 30 or
more and 17.7 percent overweight women with BMI between 25-30
in urban India. The NFHS-2 shows that 9 percent women in Delhi are
obese and another 25 percent are overweight, which is highest among
all the states in country. Punjab comes after Delhi with 21.1 percent
overweight and 9.1 percent obese women. Also Haryana comes at
Correspondence should be sent to Dr. Neelam Rathee
Department of Psychology
Govt. College for Girls, Sector -11, Chandigarh
E-mail: neelamrathee@hotmail.com
third rank in north India with 12.3 percent overweight and 3.9
percent obese women. All together, these three north Indian states
comprise 18.5 percent overweight and 7.2 percent obese women.
Depression is an extremely common illness affecting people of all
ages, genders, different socioeconomic groups and religions in India
and all over the world. Looking at today's scenario, the slogan for
World Health Day, April, 2017 was “Depression Let's talk”.
Globally, an estimated 322 million people were affected by
depression in 2015. India is home to an estimated 57 million people
(18% of the global estimate) affected by depression (WHO, 2017).
With India witnessing significant changes (including globalization,
urbanization, migration, & modernization) that is coupled with
rapid socio-demographic transition, depression is likely to increase
in the coming years. Depression among children and adolescents, if
left unattended, can lead to protracted health and mental health
problems in later life. The NMHS (2015-16) reported a prevalence
rate of 0.8% (CI 0.31.4) for depression among 1317-year-old
children.
It is widely acknowledged that obese persons are at a greater risk
of having diabetes, high blood pressure, coronary artery disease, and
even arthritis (Saw & Rajan, 1997). Obesity increases the risk of
several reproductive disorders, abortion, negatively affecting
normal natural function and fertility. Obesity has also been
described as the “last remaining socially acceptable form of
prejudice” (Stunkard & Sobal, 1995). Due to various mediating
factors, obesity affects mental health of the individual also and leads
to depression. It's not only that obesity causes depression; it's the
other way round also.
Overweight and obesity combined afflict almost 65% of
Americans (Flegal et al., 2002). Since the prevalence of depression
has been estimated at 10% (Kessler et al., 1994) there is a strong
probability that the two disorders will occur together by chance. For
years it was assumed that any relationship of depression to obesity in
the general population was largely coincidental. Research in the
recent past, however, has uncovered a large number of moderating
and mediating variables that relate depression and obesity.
Depression influences obesity under some circumstances and
obesity influences depression under others. Review suggests
various moderating variables that relate depression and obesity,
 Indian Journal of Health and Well-being 2017, 8(12), 1472-1475
such as severity of depression i.e. major depression among children
and adolescents ages 6 to 17 was found to predict a greater BMI in
adult life than that of adults who had not been depressed as children
or adolescents (BMI of 26.1 versus 24.2, respectively). Also, a recent
finding indicates that the distribution of body fat may mediate the
relationship between obesity and depression (Woo et al., 2001).
Istvan et al. (1992) showed a positive relationship between
depression and obesity among women but not among men. A striking
example of the different relationship between depression and obesity
among men and women is shown by Carpenter et al. (2000). Obesity
in women was associated with a 37% increase in major depression
whereas among men, obesity was associated with a 37% decrease in
major depression.
It is vital to mention here that there are certain potential variables
that elucidate the relationship between obesity and depression.
Firstly, physical inactivity not only characterizes many people with
depression (Paluska & Schwenk, 2000) but also predicts weight gain.
Furthermore, physical activity has been used with modest success in
the treatment of depression (Babyak et al., 2000). Secondly, a study
by Thompson et al. (1995) found that the obesity status of
adolescents that elicited teasing, which, in turn, elicited depression
through their increased dissatisfaction with their appearance.
Jackson et al. (2000) also reported that obese women with binge-
eating disorder (BED) who experienced teasing about their
appearance developed body dissatisfaction and depression. Thirdly,
disordered eating (binge eating as well as night eating) may mediate
the relationship between depression and obesity (Marcus et al., 1996;
Gluck et al., 2001). Fourthly, stress may impact both depression and
obesity via its action on the hypothalamic-pituitary-adrenal (HPA)
axis. Elevated levels of cortisol, indicating (HPA activation) is
believed to give rise to so called abdominal obesity fat primarily
within the abdominal wall. Lastly, there is a fascinating relationship
between the treatment of depression as treatment of obesity often
leads to a decrease in depression. A dramatic example is the striking
improvement in mood that accompanies the large weight losses
achieved by gastric bypass surgery (Bjorntorp & Rosmond, 2000).
Moderate weight losses also lead to reduction in depression, but only
modestly. Just as severe obesity, but not modest obesity, is associated
with depression, large, but not modest, weight losses lead to large
decreases in depression.
However, obesity and depression traditionally have been
conceptualized as distinct and non-overlapping disorders with
respect to etiology and treatment. The data reviewed above challenge
this viewpoint and suggest the need to better understand why these
disorders co-occur in certain individuals and how to develop more
efficacious pharmacological and behavioral interventions.
Therefore, the present study is an endeavor towards making a humble
contribution to Health Psychology literature in India and also the
Table 1: Mean & S.D. of all the Groups for BMI (Body Mass Index) & Depression Score
Variables Descriptive Statistics
BMI Mean
S.D.
Depression Mean
S.D.
1473
results of the present study can be well thought as an alarming call
not only for the researchers, adolescents, parents, mental health
professionals but for the society altogether. The current picture
portrays that both the study variables i.e., awareness about how
obesity is related and effect one's depression level ought to be
imparted to youth as it will not just make them physically sound but
also help them in being healthy, positive and happy human beings.
Method
Participants
A total of ninety female students from Post Graduate Government
College for Girls, Sec 11 of Chandigarh were targeted for the study
and their consent was taken before administration of the tests with
30 subjects falling in each weight group i.e. Normal weight,
overweight, and obese. The inclusion criterion for the sample of the
study was as follows:
● Age would range from 17-20 years
● Students from intact families and urban middle class were
included
● Students from arts stream comprised the present study
Instruments
Body mass index (BMI) was calculated as per the formula
proposed by (Wolper et al., 1994) and its Indian recommendation
was followed as given by Arun Prasad. Secondly, Beck
Depression Inventory (BDI) by (Beck, 1967) was administered to
students which contain twenty one set of statements and each set
contains four or five statements and the subject is asked to select
any one statement that he/she feels most applicable to him or
her.
The data obtained was analyzed for studying the relationship
between obesity and depression. Descriptive statistics for Body
Mass Index and Depression score was found out for all the subjects.
The subjects were classified into 3 groups of Normal weight,
overweight, and obese based on their body mass index. The co-
efficient of correlation between BMI and depression score for each
group was calculated by Pearson product moment method.
Significance of difference between means of depression for
comparison of each weight group was also done to study whether the
subjects from different weight groups differed on the depression
scale or not.
Statistical analysis
Descriptive, t-test and correlation was used to analyze the results
Results and discussion
The obtained results are shown in Table 1, 2, 3, and 4 respectively.
Normal Weight Overweight Obese Group
Group (n=30) Group (n=30) (n=30)
20.07 25.13 30.53
1.88 1.47 1.90
18.23 25.20 35.27
6.53 10.25 9.14
1474 RATHEE/ OBESITY AND DEPRESSION: ARE THEY RELATED?

Table 2: Correlation between BMI and depression for all the groups
Groups Coefficient of Correlation (r)
Normal Wt. Group .28
Over Wt. Group .51**
Obese Group .60**
** Correlation is significant at the 0.01 level (2-tailed).

Table 3: Significance of difference between means for BMI (Paired samples t- test)
Paired Groups T Df Level of significance (2-tailed)
Normal Wt. & Overweight Group 13.195 29 .001
Overweight & Obese Group 10.255 29 .001
Normal Wt. & Obese Group 21.750 29 .001

Table 4: Significance of difference between means for depression (paired samples t- test)
Paired Groups T Df Level of significance (2-tailed)
Normal Wt. & Overweight Group 3.36 29 .002
Overweight & Obese Group 4.72 29 .001
Normal Wt. & Obese Group 8.29 29 .001

Table-1 shows means and standard deviations of obesity and
depression for the three categories i.e. normal weight, overweight
and obese group. The BMI mean scores of students for normal
weight (M = 20.07), followed by overweight group (M = 25.13) and
highest for obese group category (M = 30.53). Likewise, Depression
mean scores of students for normal weight (M = 18.23), followed by
overweight group (M = 25.20) and highest for obese group category
(M = 35.27). Also, the correlational analysis clearly indicates a
positive correlation between the level of obesity and depression of
normal weight group, (r = 0.28), followed by significant correlation
values for overweight group (r =0.51**) and the highest found for the
obese group students i.e. (r =0.60**), refer to table-2. Further, the
test of significance of difference (t-test) revealed significant
difference between the means of depression of the three groups (table
3 & 4). It is worthwhile to mention that normal weight and obese
group students (t = 21.750** & t = 8.29**) demonstrate significant
difference in depression between normal and obese group students. It
indicates that there is a major surge for global prevalence of obesity
among adolescents and that it is related with their depression level
too.
The results of the present study certainly support the research
literature concerning obesity and depression. It seems that the obese
group students would have not involved in any physical activity,
carried on with binge eating as well as eating at night thus leading to
weight gain and any perhaps any sort of stress or depression during
childhood could be a greater source of BMI in adult life (Paluska &
Schwenk, 2000; Jackson et al., 2000; Bjorntorp & Rosmond, 2000)
Likewise, the following research findings report the similar results as
discussed above. Mc Bride and Cole (2014) conducted a study and
examined examine four possible mediators of the depression to
obesity relation: physical activity, binge eating, body dissatisfaction,
and cortisol levels. Findings clearly indicated that depression has a
significant prospective association with overweight and obese status
in children and adolescents by decreasing likelihood of their being
physically active. The literature also suggests that binge eating to
cope with depressive symptoms may be another mechanism through
which depression leads to weight gain in youths.
Mannan et al. (2016) carried out a study that aimed to evaluate the
bi-directional associations between obesity and depression in
adolescents using longitudinal studies. Using a bias-adjusted quality
effects model for the meta-analysis, it was found that adolescents
who were depressed had a 70% (RR 1.70, 95% CI: 1.40, 2.07)
increased risk of being obese, conversely obese adolescents had an
increased risk of 40% (RR 1.40, 95% CI: 1.16, 1.70) of being
depressed. Overall, the findings of this study suggest a bi-directional
association between depression and obesity that was stronger for
female adolescents.
More recently, Quek, Tam, and Zhang, (2017) carried out a meta-
analysis which aimed to evaluate the association between childhood
and adolescent obesity and depression. Studies were systematically
searched from PubMed, PsycInfo, EMBASE, and Science Direct
that compared prevalence of depression and depressive symptoms
in normal weight and obese children and adolescents. Findings for a
total of 51, 272 participants were pooled across 18 studies and
examined. The analyses demonstrated a positive association
between childhood and adolescent obesity and depression (pooled
odds ratio = 1.34, 95% confidence interval [CI]: 1.11.64, p = 0.005)
and more severe depressive symptoms (SMD = 0.23, 95% CI:
0.0250.44, p = 0.028) in the obese groups. Overweight subjects were
not more likely to have either depression (pooled odds ratio = 1.16,
95% CI: 0.931.44, p = 0.19) or depressive symptoms (SMD = 0, 95%
CI: −0.101 to 0.102, p = 0.997). In conclusion, obese children and
adolescents are more likely to suffer from depression and depressive
symptoms, with women and non-Western people at higher risk.
 Indian Journal of Health and Well-being 2017, 8(12), 1472-1475
Conclusion
The findings of the present study revealed that obesity is associated
with high prevalence of psychopathological conditions that impacts
one's quality of life. Therefore, strengthening the health system
through appropriate physical exercise, promoting the concept of
healthy body image, nutritious and well-balanced diet, not only
would help prevent obesity but also, overcome depression levels too.
Practicing and imbibing such regime in our daily lifestyle would play
a critical role in overcoming barriers of sadness and depression. Also,
educational settings like schools and colleges should offer strategies
by means of psycho-educational plans or interventions aimed at early
recognition, mental health promotion and prevention and care of
depression. Most importantly, Life skills' training for students is the
need of the hour that can help in building greater resilience and
improve mental health of adolescents.
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