Furthermore, results from multiple regression analysis are consistent with the statements of Avila et al. claiming that obesity is significantly associated with reduced QoL.

In accordance with that, mental illnesses such as depression seem to be significantly associated with obesity and may also lead to a considerable decrease in QoL.

In the case of co-occurrence of these two conditions, effects seem to amplify significantly. Despite the existing public awareness and corresponding efforts made, the rising prevalence of both mental illness and obesity is still a fundamental issue Correll et al.

suggest that the majority of mentally ill individuals live with obesity, respectively overweight, hinting at a possible link between mental illness and obesity Accordingly, our findings agree with previous research from Corell et al. in terms of identifying a significant relationship between BMI and depression status 26 in the sense that obesity leads to increased depression scores.

However, results obtained from our investigation also reveal that people living with underweight show significantly reduced QoL and increased depression scores as well, even though the effect size is at its lowest here.

The core finding of this investigation is in line with the suggestions by De Hert and colleagues who postulate that people living with obesity are more likely to have a mental illness However, this concordance, according to our result, may only apply to the constructs depression and QoL.

Considering that the relationship between obesity and mental health seems to be more pronounced in older adults than in younger populations, our major finding, that is, BMI is significantly associated with increased mental health issues, is consistent with the claims made by 43 , Another important point is the effect of taking psychotropic medication, that is, antidepressants 34 — 39 and antipsychotics, which are considered major leading factors causing obesity and may contribute to the outcome of this study.

Hence, this might be a possible explanation for our result indicating BMI predicting mental health but not vice versa. Additionally, another explanation could be the fact that many respondents of advanced age with a lower BMI were included in our study, which could also have an impact on this outcome.

In contrast to the performance of randomized control trials RCTs for investigating causal effects among study populations, longitudinal studies of observational data such as the Survey of Health, Ageing and Retirement in Europe SHARE offers the opportunity to study long-term, and hypothesized bi-directional associations over a defined time-lag.

Although results can never prove complete causality. Nevertheless, this study provides a longitudinal design that is highly desirable in order to investigate cause-effect associations between mental health and overweight over time. Despite a large sample size, including respondents from all over Europe, this study does not account for further possible confounding factors such as physical activity, eating behavior, physical comorbidities or the use of psychotropic medication, which may substantially contribute to causing obesity and metabolic side effects In fact, information on the intake of psychotropic drugs of respondents may have an impact on results considering that prior research 34 — 39 suggests that certain antidepressants are suspected to potentially increase the risk of weight gain, in addition to antipsychotic drugs.

Following the suggestions from an early review conducted by Fava, older antidepressants such as mirtazapine, within the subgroup of tricyclic antidepressants TCAs , and monoamine oxidase inhibitors MAOIs , may more frequently increase body weight compared to the newer generation of selective serotonin reuptake inhibitors SSRIs 35 , which is also in accordance with suggestions by Serretti and Mandelli who claim in their meta-analysis that mirtazapine, among other antidepressants, is considered a cause of weight gain 36 , 37 , Gaining weight from these medications may in some cases result from complex hormonal mechanisms, including the antihistaminergic effect of both antipsychotics and certain antidepressants on H 1 histamine receptors, and imbalances of the orexigenic and anorexigenic hormones ghrelin and leptin 77 — Yet, it should be considered that the mechanisms through which antidepressants may potentially be associated with weight gain are unclear and poorly understood 80 assuming that these findings may not warrant causal inference, while the effect of residual covariates possibly contribute to overrate this association According to Rogosa, investigating long-term effects using a two-wave cross-lagged procedure is not useful for determining causal inference 82 , whereas Selig and Little suggest that this panel design may generate more insight, better understanding of longitudinal associations, and stimulate further research Another limitation of this study is that the anthropometric characteristic body weight was self-reported, which carries the risk of response bias.

Individuals who live with obesity often experience weight bias and being targeted for jokes because of their body weight, especially via the media, which further promotes the stereotype that larger body size does not comply with the norm, and is socially not acceptable In fact, one strength of this study is that the analysis is based on observational data derived from a large-scale panel approach which may significantly contribute to generating an adequate sample population encompassing the older adults in their private household setting.

The analysis of longitudinal data provides a reliable tool for identifying cause-effect- and bi-directional associations in the long term. Since data collection was performed on people of the general population from 15 European countries, the sample population is assumed to be representative and provides an appropriate sample size yielding generalizable results.

Given that both mental illness and overweight are public health issues of great importance, gaining more insight into the complexity of their relationship and exploring the underlying nature of these two entities seem to be crucial in respect of disease prevention and developing innovative treatment strategies considering that mental health issues have often been overlooked in the past The findings of this study should initiate further research focusing on this subject, accounting for links between mental health issues and their impact on body weight, and vice versa, particularly, in the older adults among whom overweight and obesity is highly prevalent.

Thus, integrating mental health status into treatment strategies following a biopsychosocial approach and implementing new evidence in clinical settings could improve future treatment and prevention strategies. In this regard, this study should encourage researchers to set up innovative investigations addressing associations between mental health and obesity, and further analyze interactions between common mental illnesses such as depression and anxiety, with respect to overweight and obesity, particularly with regard to bi-directional long-term effects and corresponding casualties in terms of a cause-effect principle.

In fact, evidence on associations between mental health and obesity is still inconclusive 45 and most of the studies that have been carried out in the past are based on a cross-sectional approach, while prospective studies using repeated measurements of both mental illness and overweight are scarce.

In particular, further large-scale investigations are required in order to provide profound studies by which potential cumulative effects can be analyzed and discussed in a broader sense.

Moreover, generalizability of previous findings needs to be verified Nowadays, both mental illness and obesity are among the greatest global public health challenges. Exploring and understanding the underlying nature of these complex relationships is crucial and highly desirable, considering that the associations between obesity and mental health highlight the importance of addressing both physical and mental health when treating obesity.

By addressing mental health concerns, individuals with obesity may be better equipped to manage their weight and improve their overall health and well-being.

This work is intended to create stronger awareness and to stimulate further discussion on this issue. In particular, this research provides multiple measuring points within a panel approach, which is highly necessary to assess reciprocal interactions. Most of the prior research focusing on the relationship between obesity and mental health predominantly determines synchronous effects of a given population leading to results that are generally rather inconsistent Our investigation provides a longitudinal design that allows us to estimate reciprocal interactions, which is quite rare in view of the existing evidence.

Since it is well known that both obesity and mental health issues do often occur among older individuals, indicating a highly prevalent issue, our findings provide valuable statements about the associations over a long period of time, and hint to possible causal influences that need to be further analyzed by future research activities.

Moreover, most of the studies carried out previously yielded results that do not allow an overall conclusion to be drawn for all age groups, which may have an impact on respective results This study contributes to obtaining a more detailed picture of long-term effects and interactions among older people, which is essential in terms of determining the direction of the relationship.

On this foundation, treatment strategies and prevention programs could be further improved by identifying potential risk factors, considering that obesity may be a risk factor for the development of depression, interventions that target overweight and obesity may improve the prevention of depression and low QoL.

Furthermore, the results of our investigation should serve as an important foundation for clinical practice suggesting that clinicians and professional care providers should account for mood monitoring in patients living with overweight and obesity, especially when treating older patients with long-term obesity, which may further facilitate the establishment of treatment guidelines.

In addition, we hope that the findings of this study strengthens public awareness about the importance of addressing both obesity and mental health in order to reduce stigmatization and encourage affected individuals to seek treatment.

This work should further contribute to identifying early signs of pathological developments and improving interventions for people at a higher risk. We really hope that this research stimulates further scientific discussions and investigation to verify the nature of the relationship between mental health and obesity.

Based on our findings, we do believe that further epidemiological research is warranted to determine these underlying mechanisms, notably with regard to possible moderators and confounding factors within the European population.

Finally, we hope that our findings inform policy decisions related to public health. However, this study does not verify any considerable bi-directional associations in the long term corresponding to previous investigations on this topic 12 , 45 , 46 , 48 , Even though models show significance regarding explained variances, overall corresponding beta coefficients proved to be rather small.

These findings should be taken as weak evidence of a possible association, although this is not proof of a causal relationship. Generally, results should be seen as an impetus for further research on this topic.

Gaining knowledge, not only among older populations, but also in terms of detecting early onsets of pathologies among younger populations involving children and adolescents seems to be crucial for preventing illnesses.

GR, AG, and WF: conceptualization and writing—review and editing. GR and WF: methodology, formal analysis, interpretation of data, and visualization. GR: writing—original draft preparation.

WF: supervision and project administration. All authors contributed to the article and approved the submitted version. The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers.

Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher. Alwan, A, Armstrong, T, Bettcher, D, et al. Global status report on noncommunicable diseases World Health Organization Google Scholar.

Popkin, BM, Kim, S, Rusev, ER, Du, S, and Zizza, C. Measuring the full economic costs of diet, physical activity and obesity-related chronic diseases. Obes Rev. doi: PubMed Abstract CrossRef Full Text Google Scholar.

World Health Organization. Obesity: preventing and managing the global epidemic. Report of a WHO consultation. Geneva: WHO Technical Report Series ; 1— Physical status: the use and interpretation of anthropometry. Report of a WHO expert committee. WHO Technical Report Series Geneva: World Health Organization American Psychiatric Association.

Diagnostic and statistical manual of mental disorders 5th. Arlington: American Psychiatric Publishing; Ferrari, AJ, Norman, RE, Freedman, G, Baxter, AJ, Pirkis, JE, Harris, MG, et al. The burden attributable to mental and substance use disorders as risk factors for suicide: findings from the global burden of disease study PLoS One.

Global Burden of Disease Collaborative Network. Global Burden of Disease Study GBD Results by cause — Seattle, United States of America: Institute for Health Metrics and Evaluation IHME. Carney, CP, and Jones, LE.

Medical comorbidity in women and men with bipolar disorders: a population-based controlled study. Psychosom Med.

Ceilley, JW, Cruz, M, and Denko, T. Active medical conditions among patients on an assertive community treatment team. Community Ment Health J. Koran, LM, Sheline, Y, Imai, K, Kelsey, TG, Freedland, KE, Mathews, J, et al. Medical disorders among patients admitted to a public-sector psychiatric inpatient unit.

Psychiatr Serv. Oud, MJ, and Meyboom-De Jong, B. Somatic diseases in patients with schizophrenia in general practice: their prevalence and health care.

BMC Fam Pract. CrossRef Full Text Google Scholar. Avila, C, Holloway, AC, Hahn, MK, Morrison, KM, Restivo, M, Anglin, R, et al. An overview of links between obesity and mental health. Curr Obes Rep. Sampogna, G, Fiorillo, A, Luciano, M, Del Vecchio, V, Steardo, L, Pocai, B, et al.

A randomized controlled trial on the efficacy of a psychosocial behavioral intervention to improve the lifestyle of patients with severe mental disorders: study protocol. Correll, CU, Solmi, M, Veronese, N, Bortolato, B, Rosson, S, Santonastaso, P, et al.

Prevalence, incidence and mortality from cardiovascular disease in patients with pooled and specific severe mental illness: a large-scale meta-analysis of 3,, patients and ,, controls.

World Psychiatry. Molero, P, Martinez-Gonzalez, MA, Ruiz-Canela, M, Lahortiga, F, Sánchez-Villegas, A, Perez-Cornago, A, et al. Cardiovascular risk and incidence of depression in young and older adults: evidence from the SUN cohort study.

Rosenbaum, L. Closing the mortality gap — mental illness and medical care. N Engl J Med. Vancampfort, D, Firth, J, Schuch, FB, Rosenbaum, S, Mugisha, J, Hallgren, M, et al.

Sedentary behavior and physical activity levels in people with schizophrenia, bipolar disorder and major depressive disorder: a global systematic review and meta-analysis.

Teasdale, SB, Latimer, G, Byron, A, Schuldt, V, Pizzinga, J, Plain, J, et al. Expanding collaborative care: integrating the role of dietitians and nutrition interventions in services for people with mental illness. Austr Psychiatr. Teasdale, SB, Samaras, K, Wade, T, Jarman, R, and Ward, PB.

A review of the nutritional challenges experienced by people living with severe mental illness: a role for dietitians in addressing physical health gaps. J Hum Nutr Diet. Joshelson, K, and Majrowski, B. Clearing the air: debating smoke-free policies in psychiatric units.

Substance Abuse and Mental Health Services Administration SAMHSA. The NSDUH report: smoking and mental illness. Smith, PH, Mazure, CM, and McKee, SA.

Smoking and mental illness in the U. Tob Control. Nicholson, WM. Emotional factors in obesity. Am J Med Sci. Cameron, AJ, Magliano, DJ, Dunstan, DW, Zimmet, PZ, Hesketh, K, Peeters, A, et al. A bi-directional relationship between obesity and health-related quality of life: evidence from the longitudinal AusDiab study.

Int J Obes. de Hert, MARC, Correll, CU, Bobes, J, Cetkovich-Bakmas, M, Cohen, D, Asai, I, et al. Physical illness in patients with severe mental disorders.

Prevalence, impact of medications and disparities in health care. Findings of a US national cardiometabolic screening program among 10, psychiatric outpatients. Holt, RIG, and Peveler, RC. Obesity, serious mental illness and antipsychotic drugs.

Diabetes Obes Metab. Allison, DB, Mentore, JL, Heo, M, Chandler, LP, Cappelleri, JC, Infante, MC, et al. Antipsychotic-induced weight gain: a comprehensive research synthesis. Am J Psychiatry. Alvarez-Jimenez, M, Gonzalez-Blanch, C, Crespo-Facorro, B, Hetrick, S, Rodriguez-Sanchez, JM, Perez-Iglesias, R, et al.

Antipsychotic-induced weight gain in chronic and first-episode psychotic disorders: a systematic critical reappraisal. CNS Drugs. Foley, D, and Morley, KI. Systematic review of early cardio-metabolic outcomes of the first treated episode of psychosis.

Arch Gen Psychiatry. McCloughen, A, and Foster, K. Weight gain associated with taking psychotropic: an integrative review. Int J Ment Health Nurs. Baptista, T. Body weight gain induced by antipsychotic drugs: mechanisms and management. Acta Psychiatr Scand. Stanton, JM.

Weight gain associated with neuroleptic medication: a review. Schizophr Bull. Alonso-Pedrero, L, Bes-Rastrollo, M, and Marti, A. Effects of antidepressant and antipsychotic use on weight gain: a systematic review.

Fava, M. Weight gain and antidepressants. J Clin Psychiatry. Montgomery, SA, Reimitz, PE, and Zivkov, M. Mirtazapine versus amitriptyline in the long-term treatment of depression: a double-blind placebo-controlled study.

Int Clin Psychopharmacol. Blumenthal, S. An electronic health records study of long-term weight gain following antidepressant use. JAMA psychiatry, 71 8 , — Serretti, A, and Mandelli, L. Antidepressants and body weight: a comprehensive review and meta-analysis.

Solmi, M, Fornaro, M, Ostinelli, EG, Zangani, C, Croatto, G, Monaco, F, et al. Uher, R, Mors, O, Hauser, J, Rietschel, M, Maier, W, Kozel, D, et al. Changes in body weight during pharmacological treatment of depression. Int J Neuropsychopharmacol.

Patel, A, Shanthakumaran, Y, Rasheed, R, and Nazir, I. Metabolic effects of antidepressants; is it time to change the conversation?

BJPsych Open. McCreadie, R, Macdonald, E, Blacklock, C, Tilak-Singh, D, Wiles, D, Halliday, J, et al. Dietary intake of schizophrenic patients in Nithsdale, Scotland: case-control study. Br Med J. McCreadie, R. Diet, smoking and cardiovascular risk in people with schizophrenia.

Br J Psychiatry. Kivimaki, M, Lawlor, DA, Singh-Manoux, A, Batty, GD, Ferrie, JE, Shipley, MJ, et al.

Common mental disorder and obesity-insight from 4 repeat measures over 19 years: prospective Whitehall II cohort study. De Las Cuevas, C, Ramallo, Y, and Sanz, EJ. Están relacionadas la obesidad y otras comorbilidades físicas con la enfermedad mental?

Rev Psiquiatr Salud Ment. McElroy, SL, Kotwal, R, Malhotra, S, Nelson, EB, Keck, PE, and Nemeroff, CB. Are mood disorders and obesity related? A review for the mental health professional.

Pickering, RP, Grant, BF, Chou, SP, and Compton, WM. Are overweight, obesity, and extreme obesity associated with psychopathology? Results from the national epidemiologic survey on alcohol and related conditions.

Mitchell, AJ, Vancampfort, D, Sweers, K, van Winkel, R, Yu, W, and de Hert, M. Prevalence of metabolic syndrome and metabolic abnormalities in schizophrenia and related disorders—a systematic review and meta-analysis.

Luppino, FS, de Wit, LM, Bouvy, PF, Stijnen, T, Cuijpers, P, Penninx, BW, et al. Overweight, obesity, and depression: a systematic review and meta-analysis of longitudinal studies. Zabelina, DL, Erickson, AL, Kolotkin, RL, and Crosby, RD. The effect of age on weightrelated quality of life in overweight and obese individuals.

Mannan, M, Mamun, A, Doi, S, and Clavarino, A. Prospective associations between depression and obesity for adolescent males and females- a systematic review and meta-analysis of longitudinal studies. Kearns, K, Dee, A, Fitzgerald, AP, Doherty, E, and Perry, IJ.

Chronic disease burden associated with overweight and obesity in Ireland: the effects of a small BMI reduction at population level. BMC Public Health. Must, A, Spadano, J, Coakley, EH, Field, AE, Colditz, G, and Dietz, WH. The disease burden associated with overweight and obesity.

Rajan, TM, and Menon, V. Psychiatric disorders and obesity: a review of association studies. J Postgrad Med. Survey of Health, Ageing and Retirement in Europe SHARE , Retrieved March 14, Börsch-Supan, A. Survey of health, ageing and retirement in Europe SHARE wave 4.

Release version: 8. Data set. Quetelet, A. Prince, MJ, Reischies, F, Beekman, ATF, Fuhrer, R, Jonker, C, Kivela, SL, et al. Development of the EURO-D scale — a European Union initiative to compare symptoms of depression in 14 European centres. Hyde, M, Wiggins, RD, Higgs, P, and Blane, DB.

A measure of quality of life in early old age: the theory, development and properties of a needs satisfaction model CASP Aging Ment Health. Artiga, S, and Hinton, E. Beyond health care: the role of social determinants in promoting health and health equity. Mao, W, and Agyapong, VIO. The role of social determinants in mental health and resilience after disasters: implications for public health policy and practice.

Front Public Health. Lee, A, Cardel, M, and Donahoo, WT. KR Feingold, B Anawalt, and MR Blackman, et al. South Dartmouth MA : MDText. com, Inc; Castro-Costa, E, Dewey, M, Stewart, R, Banerjee, S, Huppert, F, Mendonca-Lima, C, et al.

Ascertaining late life depressive symptoms in Europe: an evaluation of the survey version of the EURO-D scale in 10 nations. The SHARE project. International journal of methods in psychiatric research. Int J Methods Psychiatr Res. In contrast, substance use disorders were associated with significantly lower risk of obesity.

These associations were not explained by confounding due to age, sex, smoking, or comorbid psychiatric disorders. Mood and anxiety disorders each made independent contributions to obesity risk. The positive associations between obesity and mood or anxiety disorders were generally modest, with ORs in the range of 1.

This calculation illustrates the public health importance of the association but does not indicate a direction for the causal relationship.

We have no way of distinguishing the direction of the causal relationship between obesity and psychiatric disorders or the possibility that unmeasured common causes induce an association between them. The NCS-R offers several advantages over previous community surveys used to examine associations between psychiatric disorders and obesity.

First, the sample was designed to be an accurate representation of the noninstitutionalized population of the 48 contiguous United States.

Results can be generalized to this population. Second, the survey assessed a full range of psychiatric and substance use disorders, allowing us to examine associations with anxiety disorders, bipolar disorder, and substance use disorders.

Third, mental disorders were assessed using a well-validated structured diagnostic interview, which allowed the association of obesity with these disorders to be assessed with accuracy.

Fourth, the assessment considered lifetime diagnoses and current state. The associations between obesity and psychiatric disorders in this sample did not vary between men and women. This contrasts with findings in other US national surveys 17 - 20 that indicate that positive associations between obesity and depression exist among women, whereas negative or absent associations exist among men.

We are unable to identify any consistent differences in methods between our study and previous studies that would explain why earlier studies found no association between obesity and depression in men, whereas such an association was observed in the NCS-R sample.

In one earlier study, 20 the magnitude of the OR between obesity and depression in men was similar to that in women, but the lower prevalence of depression in men led to a wider CI and a statistically insignificant result.

A similar phenomenon is seen in this sample for both mood and anxiety disorders. Because we observe no statistically significant interaction with sex, we conclude that this discrepancy significant association in women but not in men probably reflects differences in statistical power rather than differences in magnitude of the association.

Most previous research has focused on the association between obesity and depression, and various mechanisms have been proposed to explain this relationship.

Increased appetite and weight gain are common symptoms of depression, 43 , 44 and tendency to gain weight remains stable across depressive episodes. Depression may increase risk of weight gain through its effect on binge eating, 46 , 47 especially among women. The stigma attached to obesity especially for women may contribute to depression.

We observed an interesting variation in the relationship between obesity and mood disorder across sociodemographic groups. Only the interaction with educational attainment, however, was significant at the.

Approximately 40 years ago, The Midtown Manhattan Study 21 also observed that, among women, the association between obesity and depression was confined to those with higher socioeconomic status. In the NCS-R sample, the groups that showed the strongest association between obesity and mood disorder were also the groups with the lowest overall rates of obesity.

A similar phenomenon has been observed regarding the association between depression and tobacco use; as rates of tobacco use decline, the association between tobacco use and depression grows stronger. Our findings are consistent with either direction of causal relationship between obesity and mood or anxiety disorders.

If stigmatization of overweight and obesity causes or contributes to mood and anxiety disorders, the effects of stigma might be more powerful in sociodemographic groups with lower obesity rates.

Some previous research suggests that self-perception of overweight 54 , 55 and the perceived stigma associated with obesity 56 - 59 may both be greater in white populations and those with higher income or educational attainment.

Alternatively, if mood or anxiety disorders contribute to obesity through an effect on health behaviors reduced physical activity, increased caloric intake , then this effect could be more easily expressed in sociodemographic groups with lower obesity rates.

This cross-sectional study does not allow us to distinguish between causal mechanisms or examine how they might differ across sociodemographic groups. Our findings also do not indicate a specific mechanism or causal direction for the observed negative association between obesity and substance use disorders.

Although alcohol or other substances may have a direct effect on appetite or caloric intake, a negative association was also observed in those with histories of substance abuse ie, lifetime substance use disorder not active in the last 12 months. We conclude that obesity is meaningfully associated with a range of common mood and anxiety disorders in the general US population.

Obesity is associated with a moderately lower risk of substance use disorder. Clarifying the direction of causal relationships will require alternative research designs, including longitudinal and experimental studies.

Correspondence: Gregory E. Simon, MD, MPH, Center for Health Studies, Group Health Cooperative, Minor Ave, Suite , Seattle, WA simon. g ghc. Submitted for Publication: August 15, ; final revision received December 9, ; accepted December 13, Disclaimer: The views and opinions expressed in this article are those of the authors and should not be construed to represent the views of any of the sponsoring organizations or agencies or of the US government.

The NCS-R is supported by NIMH UMH with supplemental support from the National Institute of Drug Abuse NIDA , the Substance Abuse and Mental Health Services Administration SAMHSA , the Robert Wood Johnson Foundation RWJF; grant , and the John W.

Alden Trust. These activities were supported by the John D. and Catherine T. MacArthur Foundation, the Pfizer Foundation, the US Public Health Service RMH, RMH, and R01 DA , the Pan American Health Organization, Eli Lilly and Company, and GlaxoSmithKline. Acknowledgment: Collaborating NCS-R investigators include Ronald C.

Kessler, PhD principal investigator , Harvard Medical School, Boston, Mass; Kathleen Merikangas, PhD co-principal investigator , NIMH, Bethesda, Md; James Anthony, MSc, PhD Michigan State University, Lansing , William Eaton, PhD The Johns Hopkins University, Baltimore, Md , Meyer Glantz, PhD NIDA, Bethesda ; Doreen Koretz, PhD Harvard University, Cambridge, Mass , Jane McLeod, PhD Indiana University, Indianapolis , Mark Olfson, MD, MPH Columbia University College of Physicians and Surgeons, New York, NY , Harold Pincus, MD University of Pittsburgh, Pittsburgh, Pa , Gregory E.

Simon, MD, MPH Group Health Cooperative, Seattle, Wash , Michael Von Korff, ScD Group Health Cooperative, Seattle , Philip Wang, MD, DrPH Harvard Medical School , Kenneth Wells, MD, MPH University of California, Los Angeles , Elaine Wethington, PhD, DrPH Cornell University, Ithaca, NY , and Hans-Ulrich Wittchen Max Planck Institute of Psychiatry, Munich, Germany.

The NCS-R is carried out in conjunction with the World Health Organization World Mental Health WMH Survey Initiative. We thank the staff of the WMH Data Collection and Data Analysis Coordination Centres for assistance with instrumentation, fieldwork, and consultation on data analysis.

full text icon Full Text. Download PDF Top of Article Abstract Methods Results Comment Article Information References. Table 1. View Large Download. Lifetime Prevalence of Selected Mental Disorders by BMI.

Flegal KMCarroll MDOgden CLJohnson CL Prevalence and trends in obesity among US adults: JAMA ; PubMed Google Scholar Crossref. Hedley AAOgden CLJohnson CLCarroll MDCurtin LRFlegal KM Prevalence of overweight and obesity among US children, adolescents, and adults: Olshansky SJPassaro DJHershow RCLayden JCarnes BABordy JHawflick LButler RNAllison DBLudwig DS A potential decline in life expectancy in the United States in the 21st century.

N Engl J Med ; PubMed Google Scholar Crossref. Drewnowski ASpecter S Povery and obesity: the role of energy density and energy costs. Am J Clin Nutr ; 16 PubMed Google Scholar. Zhang QWang Y Trends in association between obesity and socioeconomic status in US adults: Obes Res ; PubMed Google Scholar Crossref.

Sarlio-Lahteenkorva SSilventoinen KLahelma E Relative weight and income at different levels of socioeconomic status. Am J Public Health ; PubMed Google Scholar Crossref. Pereira MAKartashov AIEbbeling CBVan Horn LSlattery MLJacobs DR JrLudwig DS Fast-food habits, weight gain, and insulin resistance the CARDIA study : year prospective analysis.

Lancet ; 42 PubMed Google Scholar Crossref. Am J Prev Med ; PubMed Google Scholar. Frank LDAndresen MASchmid TL Obesity relationships with community design, physical activity, and time spent in cars.

Am J Prev Med ; 96 PubMed Google Scholar Crossref. Vandegrift DYoked T Obesity rates, income, and suburban sprawl: an analysis of US states. Health Place ; PubMed Google Scholar Crossref.

Stunkard AJFaith MSAllison KC Depression and obesity. Biol Psychiatry ; PubMed Google Scholar Crossref. Faith MSMatz PEJorge MA Obesity-depression associations in the population. J Psychosom Res ; PubMed Google Scholar Crossref. Johnston EJohnston SMcLeod PJohnston M The relation of body mass index to depressive symptoms.

Can J Public Health ; PubMed Google Scholar. Heo MPietrobelli AFontaine KRSirey JAFaity MS Depressive mood and obesity in US adults: comparison and moderation by sex, age, and race. Int J Obes Lond ; Google Scholar Crossref. Dong CSanchez LPrice R Relationship of obesity to depression: a family-based study.

Int J Obes Relat Metab Disord ; PubMed Google Scholar Crossref. Roberts REStrawbridge WJDeleger SKaplan GA Are the fat more jolly? Ann Behav Med ; PubMed Google Scholar Crossref. J Psychosom Res ; 66 PubMed Google Scholar Crossref. Istvan JZavela KWeidner G Body weight and psychological distress in NHANES I.

Int J Obes Relat Metab Disord ; PubMed Google Scholar. Carpenter KMHasin DSAllison DBFaith MS Relationships between obesity and DSM-IV major depressive disorder, suicide ideation, and suicide attempts: results from a general population study. Onyike CUCrum RMLee HBLyketsos CGEaton WW Is obesity associated with major depression?

results from the Third National Health and Nutrition Examination Survey. Am J Epidemiol ; PubMed Google Scholar Crossref. Moore MEStunkard ASrole L Obesity, social class, and mental illness.

Li ZBHo SYChan WMHo KSLi MPLeung GMLam TH Obesity and depressive symptoms in Chinese elderly. Int J Geriatr Psychiatry ; 74 PubMed Google Scholar Crossref. Womens Health Issues ; PubMed Google Scholar Crossref.

Hasler GPine DSGamma AMilos GAjdacic VEich DRossler WAngst J The associations between psychopathology and being overweight: a year prospective study. Psychol Med ; PubMed Google Scholar Crossref.

Goodman EWhitaker R A prospective study of the role of depression in the development and persistence of adolescent obesity. Pediatrics ; PubMed Google Scholar Crossref. Roberts REDeleger SStrawbridge WJKaplan GA Prospective association between obesity and depression: evidence from the Alameda County Study.

Dixon JBDixon MEO'Brien PE Depression in association with severe obesity: changes with weight loss. Arch Intern Med ; PubMed Google Scholar Crossref.

Linde JAJeffery RWLevy RLSherwood NEUtter JPronk NPBoyle RG Binge eating disorder, weight control self-efficacy, and depression in overweight men and women. McGuire MTWing RRKlem MLLang WHill JO What predicts weight regain in a group of successful weight losers? J Consult Clin Psychol ; PubMed Google Scholar Crossref.

Jorm AFKorten AEChristensen HJacomb PARidgers BParslow RA Association of obesity with anxiety, depression, and emotional well-being: a community survey. Aust N Z J Public Health ; PubMed Google Scholar Crossref. Cilli MDe Rosa RPandolfi CVacca KCugini PCeni ZhBella S Quantification of sub-clinical anxiety and depression in essentially obese patients and normal-weight health subjects.

Eat Weight Disord ; PubMed Google Scholar Crossref. Davis EMRovi SJohnson MS Mental health, family function and obesity in African-American women. J Natl Med Assoc ; PubMed Google Scholar. John UMeyer CRumpf HHapke U Relationships of psychiatric disorders with overweight and obesity in an adult general population.

Kessler RCMerikangass KR The National Comorbidity Survey Replication NCS-R : background and aims. Int J Methods Psychiatr Res ; 68 PubMed Google Scholar Crossref. Kessler RCBerglund PChiu WTDemler OHerringa SHiripi EJin RPennell BEWalters EEZaslavsky AZheng H The US National Comorbidity Survey Replication NCS-R : design and field procedures.

Int J Methods Psychiatr Res ; 92 PubMed Google Scholar Crossref. Kessler RCUstun TB The World Mental Health WMH Survey Initiative version of the World Health Organization WHO Composite International Diagnostic Interview CIDI. Int J Methods Psychiatr Res ; PubMed Google Scholar Crossref. Stevens JKeil JWaid LGazes P Accuracy of current, 4-year, and year self-reported body weight in an elderly population.

Am J Epidemiol ; PubMed Google Scholar.

There is also evidence that mental health impacts cardiovascular health through both direct biological mechanisms and indirect behavioral effects. You may have noticed this connection in your everyday life experiences, too. Ever been stressed and unable to sleep? What about feeling sick to your stomach or having GI issues when you are nervous?

If you pay attention, you will probably find your own evidence that the health of your mind and body are closely related. While we know that obesity and mental health are related, not everyone who has obesity has mental health issues, and vice versa.

Describing the nature of the relationship, understanding issues of causality, and sorting through how to address the connection of mental health and obesity are all important questions that are yet to be fully answered.

We do know that there is a complex relationship between obesity and mental health and it is equally important to care for both your physical and mental health in a proactive way. Moreover, many people with obesity experience teasing, shaming, bullying and discrimination, as children and as adults.

Such negative experiences, which can occur across multiple domains including but not limited to families, friend groups, workplaces, communities and health care settings likely contribute to poorer mental health. Not everyone who has obesity has an eating disorder and vice versa.

However, there is significant co-occurrence in these issues. Binge Eating Disorder and Bulimia Nervosa are the two most commonly studied eating disorders in people with obesity and data indicate that these eating disorders and obesity likely exacerbate one another.

Importantly, people who have both obesity and an eating disorder are likely to experience significant medical and psychological effects. There are many ways that mental health issues can affect your weight.

Mental health issues may make a person less likely to seek obesity treatment. In addition to diagnosable mental health conditions, other mental health-related factors affect treatment, too.

And, people who have relied on using food as a means of coping with stress, anxiety, or other uncomfortable emotional or psychological experiences may have difficulty changing their eating patterns without help.

Mental health issues are sometimes ignored because they are mostly invisible. The stigma attached to obesity especially for women may contribute to depression. We observed an interesting variation in the relationship between obesity and mood disorder across sociodemographic groups.

Only the interaction with educational attainment, however, was significant at the. Approximately 40 years ago, The Midtown Manhattan Study 21 also observed that, among women, the association between obesity and depression was confined to those with higher socioeconomic status.

In the NCS-R sample, the groups that showed the strongest association between obesity and mood disorder were also the groups with the lowest overall rates of obesity.

A similar phenomenon has been observed regarding the association between depression and tobacco use; as rates of tobacco use decline, the association between tobacco use and depression grows stronger.

Our findings are consistent with either direction of causal relationship between obesity and mood or anxiety disorders. If stigmatization of overweight and obesity causes or contributes to mood and anxiety disorders, the effects of stigma might be more powerful in sociodemographic groups with lower obesity rates.

Some previous research suggests that self-perception of overweight 54 , 55 and the perceived stigma associated with obesity 56 - 59 may both be greater in white populations and those with higher income or educational attainment.

Alternatively, if mood or anxiety disorders contribute to obesity through an effect on health behaviors reduced physical activity, increased caloric intake , then this effect could be more easily expressed in sociodemographic groups with lower obesity rates.

This cross-sectional study does not allow us to distinguish between causal mechanisms or examine how they might differ across sociodemographic groups.

Our findings also do not indicate a specific mechanism or causal direction for the observed negative association between obesity and substance use disorders.

Although alcohol or other substances may have a direct effect on appetite or caloric intake, a negative association was also observed in those with histories of substance abuse ie, lifetime substance use disorder not active in the last 12 months.

We conclude that obesity is meaningfully associated with a range of common mood and anxiety disorders in the general US population. Obesity is associated with a moderately lower risk of substance use disorder.

Clarifying the direction of causal relationships will require alternative research designs, including longitudinal and experimental studies.

Correspondence: Gregory E. Simon, MD, MPH, Center for Health Studies, Group Health Cooperative, Minor Ave, Suite , Seattle, WA simon. g ghc. Submitted for Publication: August 15, ; final revision received December 9, ; accepted December 13, Disclaimer: The views and opinions expressed in this article are those of the authors and should not be construed to represent the views of any of the sponsoring organizations or agencies or of the US government.

The NCS-R is supported by NIMH UMH with supplemental support from the National Institute of Drug Abuse NIDA , the Substance Abuse and Mental Health Services Administration SAMHSA , the Robert Wood Johnson Foundation RWJF; grant , and the John W.

Alden Trust. These activities were supported by the John D. and Catherine T. MacArthur Foundation, the Pfizer Foundation, the US Public Health Service RMH, RMH, and R01 DA , the Pan American Health Organization, Eli Lilly and Company, and GlaxoSmithKline.

Acknowledgment: Collaborating NCS-R investigators include Ronald C. Kessler, PhD principal investigator , Harvard Medical School, Boston, Mass; Kathleen Merikangas, PhD co-principal investigator , NIMH, Bethesda, Md; James Anthony, MSc, PhD Michigan State University, Lansing , William Eaton, PhD The Johns Hopkins University, Baltimore, Md , Meyer Glantz, PhD NIDA, Bethesda ; Doreen Koretz, PhD Harvard University, Cambridge, Mass , Jane McLeod, PhD Indiana University, Indianapolis , Mark Olfson, MD, MPH Columbia University College of Physicians and Surgeons, New York, NY , Harold Pincus, MD University of Pittsburgh, Pittsburgh, Pa , Gregory E.

Simon, MD, MPH Group Health Cooperative, Seattle, Wash , Michael Von Korff, ScD Group Health Cooperative, Seattle , Philip Wang, MD, DrPH Harvard Medical School , Kenneth Wells, MD, MPH University of California, Los Angeles , Elaine Wethington, PhD, DrPH Cornell University, Ithaca, NY , and Hans-Ulrich Wittchen Max Planck Institute of Psychiatry, Munich, Germany.

The NCS-R is carried out in conjunction with the World Health Organization World Mental Health WMH Survey Initiative. We thank the staff of the WMH Data Collection and Data Analysis Coordination Centres for assistance with instrumentation, fieldwork, and consultation on data analysis.

full text icon Full Text. Download PDF Top of Article Abstract Methods Results Comment Article Information References. Table 1. View Large Download. Lifetime Prevalence of Selected Mental Disorders by BMI.

Flegal KMCarroll MDOgden CLJohnson CL Prevalence and trends in obesity among US adults: JAMA ; PubMed Google Scholar Crossref. Hedley AAOgden CLJohnson CLCarroll MDCurtin LRFlegal KM Prevalence of overweight and obesity among US children, adolescents, and adults: Olshansky SJPassaro DJHershow RCLayden JCarnes BABordy JHawflick LButler RNAllison DBLudwig DS A potential decline in life expectancy in the United States in the 21st century.

N Engl J Med ; PubMed Google Scholar Crossref. Drewnowski ASpecter S Povery and obesity: the role of energy density and energy costs. Am J Clin Nutr ; 16 PubMed Google Scholar.

Zhang QWang Y Trends in association between obesity and socioeconomic status in US adults: Obes Res ; PubMed Google Scholar Crossref. Sarlio-Lahteenkorva SSilventoinen KLahelma E Relative weight and income at different levels of socioeconomic status. Am J Public Health ; PubMed Google Scholar Crossref.

Pereira MAKartashov AIEbbeling CBVan Horn LSlattery MLJacobs DR JrLudwig DS Fast-food habits, weight gain, and insulin resistance the CARDIA study : year prospective analysis.

Lancet ; 42 PubMed Google Scholar Crossref. Am J Prev Med ; PubMed Google Scholar. Frank LDAndresen MASchmid TL Obesity relationships with community design, physical activity, and time spent in cars. Am J Prev Med ; 96 PubMed Google Scholar Crossref. Vandegrift DYoked T Obesity rates, income, and suburban sprawl: an analysis of US states.

Health Place ; PubMed Google Scholar Crossref. Stunkard AJFaith MSAllison KC Depression and obesity. Biol Psychiatry ; PubMed Google Scholar Crossref.

Faith MSMatz PEJorge MA Obesity-depression associations in the population. J Psychosom Res ; PubMed Google Scholar Crossref. Johnston EJohnston SMcLeod PJohnston M The relation of body mass index to depressive symptoms.

Can J Public Health ; PubMed Google Scholar. Heo MPietrobelli AFontaine KRSirey JAFaity MS Depressive mood and obesity in US adults: comparison and moderation by sex, age, and race. Int J Obes Lond ; Google Scholar Crossref.

Dong CSanchez LPrice R Relationship of obesity to depression: a family-based study. Int J Obes Relat Metab Disord ; PubMed Google Scholar Crossref.

Roberts REStrawbridge WJDeleger SKaplan GA Are the fat more jolly? Ann Behav Med ; PubMed Google Scholar Crossref.

J Psychosom Res ; 66 PubMed Google Scholar Crossref. Istvan JZavela KWeidner G Body weight and psychological distress in NHANES I. Int J Obes Relat Metab Disord ; PubMed Google Scholar. Carpenter KMHasin DSAllison DBFaith MS Relationships between obesity and DSM-IV major depressive disorder, suicide ideation, and suicide attempts: results from a general population study.

Onyike CUCrum RMLee HBLyketsos CGEaton WW Is obesity associated with major depression? results from the Third National Health and Nutrition Examination Survey. Am J Epidemiol ; PubMed Google Scholar Crossref. Moore MEStunkard ASrole L Obesity, social class, and mental illness. Li ZBHo SYChan WMHo KSLi MPLeung GMLam TH Obesity and depressive symptoms in Chinese elderly.

Int J Geriatr Psychiatry ; 74 PubMed Google Scholar Crossref. Womens Health Issues ; PubMed Google Scholar Crossref. Hasler GPine DSGamma AMilos GAjdacic VEich DRossler WAngst J The associations between psychopathology and being overweight: a year prospective study.

Psychol Med ; PubMed Google Scholar Crossref. Goodman EWhitaker R A prospective study of the role of depression in the development and persistence of adolescent obesity. Pediatrics ; PubMed Google Scholar Crossref. Roberts REDeleger SStrawbridge WJKaplan GA Prospective association between obesity and depression: evidence from the Alameda County Study.

Dixon JBDixon MEO'Brien PE Depression in association with severe obesity: changes with weight loss. Arch Intern Med ; PubMed Google Scholar Crossref. Linde JAJeffery RWLevy RLSherwood NEUtter JPronk NPBoyle RG Binge eating disorder, weight control self-efficacy, and depression in overweight men and women.

McGuire MTWing RRKlem MLLang WHill JO What predicts weight regain in a group of successful weight losers? J Consult Clin Psychol ; PubMed Google Scholar Crossref. Jorm AFKorten AEChristensen HJacomb PARidgers BParslow RA Association of obesity with anxiety, depression, and emotional well-being: a community survey.

Aust N Z J Public Health ; PubMed Google Scholar Crossref. Cilli MDe Rosa RPandolfi CVacca KCugini PCeni ZhBella S Quantification of sub-clinical anxiety and depression in essentially obese patients and normal-weight health subjects. Eat Weight Disord ; PubMed Google Scholar Crossref.

Davis EMRovi SJohnson MS Mental health, family function and obesity in African-American women. J Natl Med Assoc ; PubMed Google Scholar.

John UMeyer CRumpf HHapke U Relationships of psychiatric disorders with overweight and obesity in an adult general population. Kessler RCMerikangass KR The National Comorbidity Survey Replication NCS-R : background and aims.

Int J Methods Psychiatr Res ; 68 PubMed Google Scholar Crossref. Kessler RCBerglund PChiu WTDemler OHerringa SHiripi EJin RPennell BEWalters EEZaslavsky AZheng H The US National Comorbidity Survey Replication NCS-R : design and field procedures.

Int J Methods Psychiatr Res ; 92 PubMed Google Scholar Crossref. Kessler RCUstun TB The World Mental Health WMH Survey Initiative version of the World Health Organization WHO Composite International Diagnostic Interview CIDI.

Int J Methods Psychiatr Res ; PubMed Google Scholar Crossref. Stevens JKeil JWaid LGazes P Accuracy of current, 4-year, and year self-reported body weight in an elderly population.

Am J Epidemiol ; PubMed Google Scholar. Kuczmarski MFKuczmarski RJNajjar M Effect of age on validity of self-reported height, weight, and body mass index: findings from the Third National Health and Nutrition Examination Survey: J Am Diet Assoc ; 34 PubMed Google Scholar Crossref.

Niedhammer IBugel IBonenfant SGoldberg MLeclerc A Validity of self-reported weight and height in the French GAZE cohort. Flood VWebb KLazarus RPang G Use of self-report to monitor overweight and obesity in populations: some issues for consideration. Aust N Z J Public Health ; 99 PubMed Google Scholar Crossref.

Roberts RJ Can self-reported data accurately describe the prevalence of overweight? Public Health ; PubMed Google Scholar Crossref. McElroy SLKotwal RMalhotra SNelson ENKeck PENemeroff CB Are mood disorders and obesity related? a review for the mental health professional. J Clin Psychiatry ; PubMed Google Scholar Crossref.

Stunkard AJFernstrom MHPrice AFrank EKupfer DJ Direction of weight gain in recurrent depression: consistency across episodes. Arch Gen Psychiatry ; PubMed Google Scholar Crossref. Carter FABulik CMJoyce PR Direction of weight change in depression.

J Affect Disord ; 60 PubMed Google Scholar Crossref. Cassidy KKotynia-English RAcres JFlicker LLautenshlager NAlmeida O Association between lifestyle factors and mental health measures among community-dwelling older women. Aust N Z J Psychiatry ; PubMed Google Scholar Crossref. Sherwood NEJeffery RWWing RR Binge status as a predictor of weight loss treatment outcome.

French SAJeffery RWSherwood NENeumark-Sztainer D Prevalence and correlates of binge eating in a nonclinical sample of women enrolled in a weight gain prevention program.

Musante GJCostanzo PRFriedman KE The comorbidity of depression and eating dysregulation processes in a diet-seeking obese population: a matter of gender specificity. Int J Eat Disord ; 75 PubMed Google Scholar Crossref. Schwartz TLNihalani NJindal SVirk SJones N Psychiatric medication-induced obesity: a review.