Advertisement

Associations between Depressive Symptomatology, Diet, and Body Mass Index among Participants in the Supplemental Nutrition Assistance Program

Published:March 10, 2015DOI:https://doi.org/10.1016/j.jand.2015.01.001

      Abstract

      Background

      Participation in the Supplemental Nutrition Assistance Program (SNAP) has been shown to increase food security, or access to adequate food; however, SNAP participation has also been associated with obesity among certain demographic groups (eg, women, but not men and children), possibly due to poorer dietary quality. Depressive symptomatology is an understudied factor, which is associated with obesity across the lifespan.

      Objective

      This study examined the relationship between depressive symptomatology, dietary quality, and body weight among a sample of SNAP participants (n=639).

      Design

      The analysis was cross-sectional; survey data were collected in May to December 2011 by trained data collectors.

      Participants/setting

      Adults who self-identified as the primary food shopper of the household in two predominantly low-income African-American neighborhoods characterized as “food deserts” in Pittsburgh, PA, were recruited to participate in this study.

      Measures

      Dietary quality was calculated using the US Department of Agriculture’s Healthy Eating Index-2005. Body mass index (BMI; calculated as kg/m2) was based on objective measurements taken by the interviewer. Current depressive symptomatology was assessed by a trained interviewer using the Patient Health Questionnaire-2.

      Statistical analyses performed

      Descriptive statistics (means and percentages); two multivariate ordinary least-square regression analyses predicting BMI and dietary quality from depressive symptomatology while controlling for sociodemographic factors and food insecurity were performed.

      Results

      Depression was a strong and statistically significant predictor of both dietary quality and BMI; higher score in depressive symptomatology was associated with lower scores in dietary quality (β=−1.26; P<0.0001). A higher score in depressive symptomatology was associated with higher BMI (β=.63; P=0.0031).

      Conclusions

      These findings show that depressive symptomatology is significantly associated with weight-related outcomes and suggests that understanding the risk of depression among SNAP participants could be important to understanding the relationships among SNAP participation, diet, and weight. The association between depressive symptomology, elevated BMI, and lower dietary quality among low-income, primarily African-American residents living in a food desert suggests the potential for mental health interventions to have broader benefits in this population. However, the directionality of this association is unclear and improving diet and reducing weight might also improve mental health symptoms. Additional longitudinal studies should assess these possibilities.

      Keywords

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

      References

        • Ogden C.L.
        • Carroll M.D.
        • Kit B.K.
        • Flegal K.M.
        Prevalence of obesity among adults: United States, 2011-2012.
        NCHS Data Brief. 2013; : 1-8
        • Wang Y.
        • Beydoun M.A.
        The obesity epidemic in the United States—Gender, age, socioeconomic, racial/ethnic, and geographic characteristics: A systematic review and meta-regression analysis.
        Epidemiol Rev. 2007; 29: 6-28
        • Truong K.D.
        • Sturm R.
        Weight gain trends across sociodemographic groups in the United States.
        Am J Public Health. 2005; 95: 1602-1606
        • McLaren L.
        Socioeconomic status and obesity.
        Epidemiol Rev. 2007; 29: 29-48
        • Ogden C.L.
        • Lamb M.M.
        • Carroll M.D.
        • Flegal K.M.
        Obesity and socioeconomic status in adults: United States, 2005-2008.
        NCHS Data Brief. 2010; : 1-8
        • Kim D.
        • Leigh J.P.
        Estimating the effects of wages on obesity.
        J Occup Environ Med. 2010; 52: 495-500
        • Conklin A.I.
        • Forouhi N.G.
        • Suhrcke M.
        • Surtees P.
        • Wareham N.J.
        • Monsivais P.
        Socioeconomic status, financial hardship and measured obesity in older adults: A cross-sectional study of the EPIC-Norfolk cohort.
        BMC Public Health. 2013; 13: 1039
        • DeBono N.L.
        • Ross N.A.
        • Berrang-Ford L.
        Does the Food Stamp Program cause obesity? A realist review and a call for place-based research.
        Health Place. 2012; 18: 747-756
      1. Fox M, Hamilton W, Lin B, eds. Effects of Food Assistance and Nutrition Programs on Nutrition and Health. Vol. 3. Literature Review. Washington, DC: Economic Research Service, US Department of Agriculture; 2004.

        • Nord M.
        • Prell M.
        Food insecurity Improved Following the 2009 ARRA Increase in SNAP Benefits.
        US Department of Agriculture, Washington, DC2011
        • Leung C.W.
        • Villamor E.
        Is participation in food and income assistance programmes associated with obesity in California adults? Results from a state-wide survey.
        Public Health Nutr. 2011; 14: 645-652
        • Wilde P.
        • McNamara P.E.
        • Ranney C.K.
        The Effect on Dietary Quality of Participation in the Food Stamp and WIC Programs.
        Economic Research Service, US Department of Agriculture, Washington, DC2000
        • Hilmers A.
        • Chen T.A.
        • Dave J.M.
        • Thompson D.
        • Cullen K.W.
        Supplemental Nutrition Assistance Program participation did not help low income Hispanic women in Texas meet the dietary guidelines.
        Prev Med. 2014; 62: 44-48
        • Bleich S.N.
        • Vine S.
        • Wolfson J.A.
        American adults eligible for the Supplemental Nutritional Assistance Program consume more sugary beverages than ineligible adults.
        Prev Med. 2013; 57: 894-899
        • Turner R.J.
        • Lloyd D.A.
        The stress process and the social distribution of depression.
        J Health Soc Behav. 1999; 40: 374-404
        • 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
        • Laraia B.A.
        • Siega-Riz A.M.
        • Gundersen C.
        • Dole N.
        Psychosocial factors and socioeconomic indicators are associated with household food insecurity among pregnant women.
        J Nutr. 2006; 136: 177-182
        • Siefert K.
        • Heflin C.M.
        • Corcoran M.E.
        • Williams D.R.
        Food insufficiency and the physical and mental health of low-income women.
        Women Health. 2001; 32: 159-177
        • Campbell C.C.
        Food insecurity—A nutritional outcome or a predictor variable.
        J Nutr. 1991; 121: 408-415
        • Casey P.
        • Goolsby S.
        • Berkowitz C.
        • et al.
        Maternal depression, changing public assistance, food security, and child health status.
        Pediatrics. Feb 2004; 113: 298-304
        • Whitaker R.C.
        • Phillips S.M.
        • Orzol S.M.
        Food insecurity and the risks of depression and anxiety in mothers and behavior problems in their preschool-aged children.
        Pediatrics. 2006; 118: e859-e868
        • Weigel M.M.
        • Armijos R.X.
        • Hall Y.P.
        • Ramirez Y.
        • Orozco R.
        The household food insecurity and health outcomes of U.S.-Mexico border migrant and seasonal farmworkers.
        J Immigr Minor Health. Jul 2007; 9: 157-169
        • Zekeri A.A.
        Livelihood strategies of food-insecure poor, female-headed families in rural Alabama.
        Psychol Rep. 2007; 101: 1031-1036
        • Kim K.
        • Frongillo E.A.
        Participation in food assistance programs modifies the relation of food insecurity with weight and depression in elders.
        J Nutr. 2007; 137: 1005-1010
        • Gibson D.
        Food stamp program participation is positively related to obesity in low income women.
        J Nutr. 2003; 133: 2225-2231
        • Jones S.J.
        • Frongillo E.A.
        The modifying effects of Food Stamp Program participation on the relation between food insecurity and weight change in women.
        J Nutr. 2006; 136: 1091-1094
        • Zagorsky J.L.
        • Smith P.K.
        Does the US Food Stamp Program contribute to adult weight gain?.
        Econ Hum Biol. 2009; 7: 246-258
        • Morris M.S.
        • Fava M.
        • Jacques P.F.
        • Selhub J.
        • Rosenberg I.H.
        Depression and folate status in the US Population.
        Psychother Psychosom. 2003; 72: 80-87
        • Tucker K.L.
        • Qiao N.
        • Scott T.
        • Rosenberg I.
        • Spiro 3rd, A.
        High homocysteine and low B vitamins predict cognitive decline in aging men: The Veterans Affairs Normative Aging Study.
        Am J Clin Nutr. 2005; 82: 627-635
        • Williams A.L.
        • Katz D.
        • Ali A.
        • Girard C.
        • Goodman J.
        • Bell I.
        Do essential fatty acids have a role in the treatment of depression?.
        J Affect Disord. 2006; 93: 117-123
        • Kuczmarski M.F.
        • Cremer Sees A.
        • Hotchkiss L.
        • Cotugna N.
        • Evans M.K.
        • Zonderman A.B.
        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
        • Lai J.S.
        • Hiles S.
        • Bisquera A.
        • Hure A.J.
        • McEvoy M.
        • Attia J.
        A systematic review and meta-analysis of dietary patterns and depression in community-dwelling adults.
        Am J Clin Nutr. 2014; 99: 181-197
        • Psaltopoulou T.
        • Sergentanis T.N.
        • Panagiotakos D.B.
        • Sergentanis I.N.
        • Kosti R.
        • Scarmeas N.
        Mediterranean diet, stroke, cognitive impairment, and depression: A meta-analysis.
        Ann Neurol. 2013; 74: 580-591
        • Jacka F.N.
        • Cherbuin N.
        • Anstey K.J.
        • Butterworth P.
        Dietary patterns and depressive symptoms over time: Examining the relationships with socioeconomic position, health behaviours and cardiovascular risk.
        PloS One. 2014; 9: e87657
        • Kelley A.E.
        • Schiltz C.A.
        • Landry C.F.
        Neural systems recruited by drug- and food-related cues: Studies of gene activation in corticolimbic regions.
        Physiol Behav. 2005; 86: 11-14
        • Paterson N.E.
        • Markou A.
        Animal models and treatments for addiction and depression co-morbidity.
        Neurotox Res. 2007; 11: 1-32
        • Macht M.
        How emotions affect eating: A five-way model.
        Appetite. 2008; 50: 1-11
        • US Department of Health and Human Services and US Department of Agriculture
        Dietary Guidelines for Americans, 2005.
        6th ed. US Government Printing Office, Washington, DCJanuary 2005
        • Ghosh-Dastidar B.
        • Cohen D.
        • Hunter D.
        • et al.
        Distance to store, food prices, and obesity in urban food deserts.
        Am J Prev Med. 2014; 47: 587-595
      2. Cohen DA, Collins R, Hunter G, Ghosh-Dastidar B, Dubowitz T. Store impulse marketing strategies and body mass index [published online ahead of print December 18, 2014]. Am J Public Health. http://dx.doi.org/10.2105/AJPH.2014.302220.

        • Kroenke K.
        • Spitzer R.L.
        • Williams J.B.
        The Patient Health Questionnaire-2: Validity of a two-item depression screener.
        Med Care. 2003; 41: 1284-1292
        • Berg C.J.
        • Kirch M.
        • Hooper M.W.
        • et al.
        Ethnic group differences in the relationship between depressive symptoms and smoking.
        Ethn Health. 2012; 17: 55-69
        • Subar A.F.
        • Kirkpatrick S.I.
        • Mittl B.
        • et al.
        The Automated Self-Administered 24-hour dietary recall (ASA24): A resource for researchers, clinicians, and educators from the National Cancer Institute.
        J Acad Nutr Diet. 2012; 112: 1134-1137
        • Guenther P.M.
        • Reedy J.
        • Krebs-Smith S.M.
        Development of the Healthy Eating Index-2005.
        J Am Diet Assoc. 2008; 108: 1896-1901
        • Guenther P.M.
        • Reedy J.
        • Krebs-Smith S.M.
        • Reeve B.B.
        Evaluation of the Healthy Eating Index-2005.
        J Am Diet Assoc. 2008; 108: 1854-1864
      3. US Department of Agriculture. MyPyramid. http://www.foodpyramid.com/mypyramid/. Accessed January 27, 2014.

        • US Department of Agriculture
        Healthy Eating Index-2005.
        Center for Nutrition Policy and Promotion, Alexandria, VA2006
        • United Nations
        How to Weigh and Measure Children: Assessing the Nutritional Status of Young Children in Household Surveys.
        United Nations, New York, NY1986
      4. Anthropometry as Part of Household Surveys. Washington, DC: World Bank. In press.

        • Coates J.
        • Frongillo E.A.
        • Rogers B.L.
        • Webb P.
        • Wilde P.E.
        • Houser R.
        Commonalities in the experience of household food insecurity across cultures: What are measures missing?.
        J Nutr. 2006; 136: 1438S-1448S
      5. Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults—The Evidence Report. National Institutes of Health.
        Obes Res. 1998; 6: 51S-209S
        • Westreich D.
        • Greenland S.
        The table 2 fallacy: Presenting and interpreting confounder and modifier coefficients.
        Am J Epidemiol. 2013; 177: 292-298
        • Stunkard A.J.
        • Faith M.S.
        • Allison K.C.
        Depression and obesity.
        Biol Psychiatry. 2003; 54: 330-337
        • Johnston E.
        • Johnson S.
        • McLeod P.
        • Johnston M.
        The relation of body mass index to depressive symptoms.
        Can J Publ Health. 2004; 95: 179-183
        • Dong C.
        • Sanchez L.E.
        • Price R.A.
        Relationship of obesity to depression: A family-based study.
        Int J Obes Relat Metab Disord. 2004; 28: 790-795
        • Heflin C.M.
        • Ziliak J.P.
        Food insufficiency, food stamp participation, and mental health.
        Soc Sci Q. 2008; 89: 706-727
        • Edin K.
        • Boyd M.
        • Mabili J.
        • et al.
        SNAP Food Security In-Depth Interview Study.
        US Department of Agriculture, Alexandria, VA2013: xi
        • Spears D.
        Economic decision-making in poverty depletes behavioral control.
        B E J Econ Anal Pol. 2011; : 11
        • Wurtman R.J.
        • Wurtman J.J.
        Brain serotonin, carbohydrate-craving, obesity and depression.
        Obes Res. 1995; 3: S477-S480

      Biography

      K. R. Flórez is an associate social scientist, RAND Corporation, Santa Monica, CA.

      Biography

      R. Beckman is a research programmer, RAND Corporation, Santa Monica, CA.

      Biography

      R. L. Collins is a senior behavioral scientist, RAND Corporation, Santa Monica, CA.

      Biography

      T. Dubowitz is a senior policy researcher, RAND Corporation, Pittsburgh, PA.

      Biography

      M. Ghosh-Dastidar is a senior statistician, RAND Corporation, Washington, DC.