Elsevier

Obesity Research & Clinical Practice

Volume 6, Issue 3, July–September 2012, Pages e197-e206
Obesity Research & Clinical Practice

Original Article
Relationship between obesity, depression, and disability in middle-aged women

https://doi.org/10.1016/j.orcp.2012.02.007Get rights and content

Summary

Background

Obesity and depression are closely linked, and each has been associated with disability. However, few studies have assessed inter-relationships between these conditions.

Design and methods

In this study, 4641 women aged 40–65 completed a structured telephone interview including self-reported height and weight, the Patient Health Questionnaire (PHQ) assessment of depression, and the World Health Organization Disability Assessment Schedule II (WHODAS II). The survey response rate was 62%. We used multivariable regression models to assess relationships between obesity, depression, and disability.

Results

The mean age was 52 years; 82% were White; and 80% were currently employed. One percent were underweight, 39% normal weight, 27% overweight, and 34% obese. Mild depressive symptoms were present in 23% and moderate-to-severe symptoms were present in 13%. After multivariable adjustment, depression was a strong independent predictor of worse disability in all 7 domains (cognition, mobility, self-care, social interaction, role functioning, household, and work), but obesity was only a significant predictor of greater mobility, role-functioning, household, and work limitations (P < 0.05) (overweight was not significantly associated with any disability domain). Overall, the effect on disability was stronger and more pervasive for depression than obesity, and there was no significant interaction between the two conditions (P > 0.05). Overweight and obesity were associated with 5760 days of absenteeism per 1000 person-years, and depression was associated with 18,240 days of absenteeism per 1000 person-years.

Conclusions

The strong relationships between depression, obesity and disability suggest that these conditions should be routinely screened and treated among middle-aged women.

Introduction

There is a strong bi-directional relationship between obesity and depression in women [1], [2], [3], [4], [5]. Our prior work indicates that the prevalence of moderate and severe depression increases fourfold when comparing women with a normal body mass index (BMI 18.5–24.9 kg/m2; prevalence of depression 7%) to those with severe obesity (BMI ≥35 kg/m2; prevalence of depression 26%) [1]. Similarly, the prevalence of obesity (BMI ≥30 kg/m2) is strongly associated with depression, occurring in 25% of women with no depressive symptoms and in 58% of women with moderate and severe depressive symptoms.

There is also strong evidence that obesity and depression are each associated with disability [6], [7], [8], [9], [10], [11], [12], and the World Health Organization currently ranks depression as the leading cause of disability worldwide [13]. However, few studies have assessed the inter-relationships between obesity, depression, and disability. One study found a relationship between obesity and disability in adults with diabetes, but they found no relationship between depression and disability in the same cohort [14]. Conversely, another study of preretirement adults found that depression was strongly associated with developing activities of daily living disability after adjustment for obesity; however, this study did not report on the inter-relationships between depression, obesity, and disability [15].

The present paper uses data from a large sample of middle-aged women enrolled in a prepaid health plan to assess [1] whether obesity and depression have independent effects on disability [2], whether obesity and depression have specific effects on different domains of disability [3], whether the combination of obesity and depression exacerbates disability (i.e., multiplicative effects), and [4] the overall population impact of obesity and depression on disability and absenteeism.

Section snippets

Materials/subjects and methods

We conducted this study at Group Health, a mixed-model, health insurance and care delivery system serving approximately 600,000 members in Washington State. Study procedures were approved by the Group Health Institutional Review Board. Group Health enrollment is predominately White (85%), with higher education levels than the regional community. Compared to the rest of the United States, Group Health members are more likely to be Asian or Pacific Islanders (9% versus 4%), but less likely to be

Survey response

Of the 8000 potential participants who were mailed invitation letters, 442 were found to be ineligible (had since died, moved away, or disenrolled from the health plan). Of the remaining 7558 eligible women, 865 could not be reached by telephone and 2033 declined to participate, leaving 4660 participants (62% of those eligible). Nineteen participants had missing data on one or more key variables, so 4641 were included in analyses presented here. Participation varied significantly across

Discussion

Obesity and depression are both very common health conditions among middle age women. In this large, representative cohort from a single health plan in Washington State, we found that obesity was a significant predictor of greater disability in the areas of mobility, role functioning, household functioning, and work, but not the cognition, self-care, and social domains. Notably, women who were overweight, but not obese, were no more likely to report disability than normal weight women after

Conflict of interest

The authors declare no conflict of interest.

Acknowledgments

This project was supported by NIH Research Grant #MH68127 funded by the National Institute of Mental Health and the Office of Behavioral Social Sciences Research. The funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript. Dr. Arterburn had full access to the data in the study and takes responsibility for the integrity of the data and accuracy of the data analysis.

References (34)

  • E.W. Gregg et al.

    Is disability obesity's price of longevity?

    J Am Med Assoc

    (2007)
  • J. Ormel et al.

    Common mental disorders and disability across cultures. Results from the WHO Collaborative Study on Psychological Problems in General Health Care

    J Am Med Assoc

    (1994)
  • R. Sturm et al.

    Increasing obesity rates and disability trends

    Health Aff (Millwood)

    (2004)
  • Mental health: depression

    (2011)
  • E.W. Gregg et al.

    Diabetes and incidence of functional disability in older women

    Diabetes Care

    (2002)
  • D.D. Dunlop et al.

    Incidence of disability among preretirement adults: the impact of depression

    Am J Public Health

    (2005)
  • S.H. Taplin et al.

    Revisions in the risk-based Breast Cancer Screening Program at Group Health Cooperative

    Cancer

    (1990)
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