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March 2010

Overweight, Obesity, and Depression: A Systematic Review and Meta-analysis of Longitudinal Studies

Author Affiliations

Authors Affiliations: Departments of Psychiatry (Drs Luppino, Penninx, and Zitman) and Medical Statistics and Bioinformatics (Dr Stijnen), Leiden University Medical Center, and GGZ Rivierduinen (Drs Luppino, Penninx, and Zitman), Leiden, Department of Clinical Psychology, VU University (Ms de Wit and Dr Cuijpers), and Department of Psychiatry and EMGO Institute for Health and Care Research, VU University Medical Center (Dr Penninx), Amsterdam, Department of Psychiatry, Erasmus Medical Centre, Rotterdam (Dr Bouvy), and Department of Psychiatry, University Medical Center Groningen, Groningen (Dr Penninx), the Netherlands.

Arch Gen Psychiatry. 2010;67(3):220-229. doi:10.1001/archgenpsychiatry.2010.2

Context  Association between obesity and depression has repeatedly been established. For treatment and prevention purposes, it is important to acquire more insight into their longitudinal interaction.

Objective  To conduct a systematic review and meta-analysis on the longitudinal relationship between depression, overweight, and obesity and to identify possible influencing factors.

Data Sources  Studies were found using PubMed, PsycINFO, and EMBASE databases and selected on several criteria.

Study Selection  Studies examining the longitudinal bidirectional relation between depression and overweight (body mass index 25-29.99) or obesity (body mass index ≥30) were selected.

Data Extraction  Unadjusted and adjusted odds ratios (ORs) were extracted or provided by the authors.

Data Synthesis  Overall, unadjusted ORs were calculated and subgroup analyses were performed for the 15 included studies (N = 58 745) to estimate the effect of possible moderators (sex, age, depression severity). Obesity at baseline increased the risk of onset of depression at follow-up (unadjusted OR, 1.55; 95% confidence interval [CI], 1.22-1.98; P < .001). This association was more pronounced among Americans than among Europeans (P = .05) and for depressive disorder than for depressive symptoms (P = .05). Overweight increased the risk of onset of depression at follow-up (unadjusted OR, 1.27; 95% CI, 1.07-1.51; P < .01). This association was statistically significant among adults (aged 20-59 years and ≥60 years) but not among younger persons (aged <20 years). Baseline depression (symptoms and disorder) was not predictive of overweight over time. However, depression increased the odds for developing obesity (OR, 1.58; 95% CI, 1.33-1.87; P < .001). Subgroup analyses did not reveal specific moderators of the association.

Conclusions  This meta-analysis confirms a reciprocal link between depression and obesity. Obesity was found to increase the risk of depression, most pronounced among Americans and for clinically diagnosed depression. In addition, depression was found to be predictive of developing obesity.