Advertisement

Depression Severity, Diet Quality, and Physical Activity in Women with Obesity and Depression

Published:April 25, 2012DOI:https://doi.org/10.1016/j.jand.2012.02.006

      Abstract

      Major depressive disorder (MDD) is prevalent in clinical weight-loss settings and predicts poor weight-loss outcomes. It is unknown whether the severity of depressive symptoms among those with MDD is associated with diet quality or physical activity levels. This knowledge is important for improving weight-loss treatment for these patients. It was hypothesized that more severe depression is associated with poorer diet quality and lower physical activity levels among individuals with obesity and MDD. Participants were 161 women with current MDD and obesity enrolled in the baseline phase of a weight-loss trial between 2007 and 2010. Depression severity was measured with the Beck Depression Inventory II. The Alternate Healthy Eating Index was applied to data from three 24-hour diet recalls to capture overall diet quality. Daily metabolic equivalents expended per day were calculated from three 24-hour physical activity recalls. Greater depression severity was associated with poorer overall diet quality (estimate=−0.26, standard error 0.11; P=0.02), but not with physical activity (estimate=0.07, standard error 0.05; P=0.18), in linear regression models controlling for income, education, depression-related appetite change, binge eating disorder, and other potential confounds. Associations with diet quality were primarily driven by greater intake of sugar (r=0.20; P<0.01), saturated fat (r=0.21; P<0.01), and sodium (r=0.22; P<0.01). More severe depression was associated with poorer overall diet quality, but not physical activity, among treatment-seeking women with MDD and obesity. Future studies should identify mechanisms linking depression to diet quality and determine whether diet quality improves with depression treatment.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of the Academy of Nutrition and Dietetics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • de Wit L.
        • Luppino F.
        • van Straten A.
        • Penninx B.
        • Zitman F.
        • Cuijpers P.
        Depression and obesity: A meta-analysis of community-based studies.
        Psychiatry Res. 2010; 178: 230-235
        • Petry N.M.
        • Barry D.
        • Pietrzak R.H.
        • Wagner J.A.
        Overweight and obesity are associated with psychiatric disorders: Results from the National Epidemiologic Survey on Alcohol and Related Conditions.
        Psychosom Med. 2008; 70: 288-297
        • Luppino F.S.
        • de Wit L.M.
        • Bouvy P.F.
        • et al.
        Overweight, obesity, and depression: A systematic review and meta-analysis of longitudinal studies.
        Arch Gen Psychiatry. 2010; 67: 220-229
        • Ma J.
        • Xiao L.
        Obesity and depression in US women: Results from the 2005-2006 National Health and Nutritional Examination Survey.
        Obesity. 2010; 18: 347-353
        • Pagoto S.
        • Bodenlos J.S.
        • Kantor L.
        • Gitkind M.
        • Curtin C.
        • Ma Y.
        Association of major depression and binge eating disorder with weight loss in a clinical setting.
        Obesity. 2007; 15: 2557-2559
        • Gao S.K.
        • Beresford S.A.
        • Frank L.L.
        • Schreiner P.J.
        • Burke G.L.
        • Fitzpatrick A.L.
        Modifications to the Healthy Eating Index and its ability to predict obesity: The Multi-Ethnic Study of Atherosclerosis.
        Am J Clin Nutr. 2008; 88: 64-69
        • Wolongevicz D.M.
        • Zhu L.
        • Pencina M.J.
        • et al.
        Diet quality and obesity in women: The Framingham Nutrition Studies.
        Br J Nutr. 2010; 103: 1223-1229
        • Kuczmarski M.F.
        • Cremer Sees A.
        • et al.
        Higher Healthy Eating Index-2005 scores associated with reduced symptoms of depression in an urban population: Findings from the Healthy Aging in Neighborhoods of Diversity Across the Life Span (HANDLS) study.
        J Am Diet Assoc. 2010; 110: 383-389
        • Beydoun M.A.
        • Kuczmarski M.T.
        • Mason M.A.
        • Ling S.M.
        • Evans M.K.
        • Zonderman A.B.
        Role of depressive symptoms in explaining socioeconomic status disparities in dietary quality and central adiposity among US adults: A structural equation modeling approach.
        Am J Clin Nutr. 2009; 90: 1084-1095
        • Jacka F.N.
        • Pasco J.A.
        • Mykletun A.
        • et al.
        Association of western and traditional diets with depression and anxiety in women.
        Am J Psychiatry. 2010; 167: 305-311
        • Lorant V.
        • Deliege D.
        • Eaton W.
        • Robert A.
        • Philippot P.
        • Ansseau M.
        Socioeconomic inequalities in depression: A meta-analysis.
        Am J Epidemiol. 2003; 157: 98-112
        • Bernstein A.M.
        • Bloom D.E.
        • Rosner B.A.
        • Franz M.
        • Willett W.C.
        Relation of food cost to healthfulness of diet among US women.
        Am J Clin Nutr. 2010; 92: 1197-1203
        • Larson N.I.
        • Story M.T.
        • Nelson M.C.
        Neighborhood environments: Disparities in access to healthy foods in the US.
        Am J Prev Med. 2009; 36: 74-81
        • Beydoun M.A.
        • Wang Y.
        Pathways linking socioeconomic status to obesity through depression and lifestyle factors among young US adults.
        J Affect Disord. 2010; 123: 52-63
        • American Psychiatric Association
        Diagnostic and Statistical Manual of Mental Disorders.
        4th ed, text revision ed. American Psychiatric Association, Washington, DC2000
        • Javaras K.N.
        • Pope H.G.
        • Lalonde J.K.
        • et al.
        Co-occurrence of binge eating disorder with psychiatric and medical disorders.
        J Clin Psychiatry. 2008; 69: 266-273
        • Raymond N.C.
        • Bartholome L.T.
        • Lee S.S.
        • Peterson R.E.
        • Raatz S.K.
        A comparison of energy intake and food selection during laboratory binge eating episodes in obese women with and without a binge eating disorder diagnosis.
        Int J Eat Disord. 2007; 40: 67-71
        • Farmer M.E.
        • Locke B.Z.
        • Moscicki E.K.
        • Dannenberg A.L.
        • Larson D.B.
        • Radloff L.S.
        Physical activity and depressive symptoms: The NHANES I Epidemiologic Follow-Up Study.
        Am J Epidemiol. 1988; 128: 1340-1351
        • Wise L.A.
        • Adams-Campbell L.L.
        • Palmer J.R.
        • Rosenberg L.
        Leisure time physical activity in relation to depressive symptoms in the Black Women's Health Study.
        Ann Behav Med. 2006; 32: 68-76
        • Boone-Heinonen J.
        • Diez Roux A.V.
        • Kiefe C.I.
        • Lewis C.E.
        • Guilkey D.K.
        • Gordon-Larsen P.
        Neighborhood socioeconomic status predictors of physical activity through young to middle adulthood: The CARDIA study.
        Soc Sci Med. 2011; 72: 641-649
        • Schneider K.L.
        • Bodenlos J.S.
        • Ma Y.
        • et al.
        Design and methods for a randomized clinical trial treating comorbid obesity and major depressive disorder.
        BMC Psychiatry. 2008; 8
        • Hamilton M.
        A rating scale for depression.
        J Neurol Neurosurg Psychiatry. 1960; 23: 56-62
        • First M.B.
        • Spitzer R.L.
        • Gibbon M.
        • Williams J.B.W.
        Structured Clinical Interview for DSM-IV-TR Axis I Disorders, Research Version. Non-patient ed. Biometrics Research, New York State Psychiatric Institute, New York, NY2002
        • Svarstad B.L.
        • Chewning B.A.
        • Sleath B.L.
        • Claesson C.
        The Brief Medication Questionnaire: A tool for screening patient adherence and barriers to adherence.
        Patient Educ Couns. 1999; 37: 113-124
        • Beck A.T.
        The Beck Depression Inventory II.
        Harcourt Brace & Co, San Antonio, TX1996
        • McCullough M.L.
        • Willett W.C.
        Evaluating adherence to recommended diets in adults: The Alternate Healthy Eating Index.
        Public Health Nutr. 2006; 9: 152-157
        • McCullough M.L.
        • Feskanich D.
        • Stampfer M.J.
        • et al.
        Diet quality and major chronic disease risk in men and women: Moving toward improved dietary guidance.
        Am J Clin Nutr. 2002; 76: 1261-1271
        • de Koning L.
        • Chiuve S.E.
        • Fung T.T.
        • Willett W.C.
        • Rimm E.B.
        • Hu F.B.
        Diet-quality scores and the risk of type 2 diabetes in men.
        Diabetes Care. 2011; 34: 1150-1156
        • Matthews C.E.
        • Freedson P.S.
        • Hebert J.R.
        • Stanek 3rd, E.J.
        • Merriam P.A.
        • Ockene I.S.
        Comparing physical activity assessment methods in the seasonal variation of blood cholesterol study.
        Med Sci Sports Exerc. 2000; 32: 976-984
        • Shim R.S.
        • Baltrus P.
        • Ye J.
        • Rust G.
        Prevalence, treatment, and control of depressive symptoms in the United States: Results from the National Health and Nutrition Examination Survey (NHANES), 2005-2008.
        J Am Board Fam Med. 2011; 24: 33-38
        • Belin R.J.
        • Greenland P.
        • Allison M.
        • et al.
        Diet quality and the risk of cardiovascular disease: The Women's Health Initiative (WHI).
        Am J Clin Nutr. 2011; 94: 49-57
        • Jeffery R.W.
        • Linde J.A.
        • Simon G.E.
        • et al.
        Reported food choices in older women in relation to body mass index and depressive symptoms.
        Appetite. 2009; 52: 238-240
        • Crawford G.B.
        • Khedkar A.
        • Flaws J.A.
        • Sorkin J.D.
        • Gallicchio L.
        Depressive symptoms and self-reported fast-food intake in midlife women.
        Prev Med. 2011; 52: 254-257

      Biography

      B. M. Appelhans is an assistant professor, Departments of Preventive Medicine and Behavioral Sciences, Rush University Medical Center, Chicago, IL

      Biography

      M. C. Whited is a postdoctoral fellow, Department of Medicine, Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, Worcester, MA

      Biography

      K. L. Schneider is an assistant professor, Department of Medicine, Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, Worcester, MA

      Biography

      P. A. Merriam is an assistant professor, Department of Medicine, Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, Worcester, MA

      Biography

      Y. Ma is an associate professor, Department of Medicine, Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, Worcester, MA

      Biography

      S. L. Pagoto is an associate professor, Department of Medicine, Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, Worcester, MA

      Biography

      J. L. Oleski is a research project director, Department of Medicine, Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, Worcester, MA

      Biography

      B. C. Olendzki is a research assistant professor, Department of Medicine, Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, Worcester, MA

      Biography

      M. E. Waring is an assistant professor, Division of Epidemiology of Chronic Diseases and Vulnerable Populations, Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA

      Biography

      I. S. Ockene is the David and Barbara Milliken Professor of Preventive Cardiology, Department of Medicine, Division of Cardiovascular Medicine, University of Massachusetts Medical School, Worcester, MA

      Biography

      D. M. Mann is an assistant professor, Section of Preventive Medicine and Epidemiology, and Section of General Internal Medicine, Boston University School of Medicine, Boston, MA