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Adolescent Obesity and Risk for Subsequent Major Depressive Disorder and Anxiety Disorder: Prospective Evidence

From the Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy (S.E.A., P.F.J., A.M.), Tufts University, Boston, Massachusetts; Department of Psychiatry (P.C.), College of Physicians and Surgeons, Columbia University, and the Department of Epidemiology, New York State Psychiatric Institute, New York, New York; Department of Public Health and Family Medicine (E.N.N., A.M.), Tufts University School of Medicine, Boston, Massachusetts; and Nutritional Epidemiology Program (P.F.J.), Jean Mayer US Department of Agriculture Human Nutrition Research Center on Aging, Tufts University, Boston, Massachusetts.

Address correspondence and reprint requests to Sarah E. Anderson, Division of Epidemiology, College of Public Health, The Ohio State University, B-216 Starling Loving Hall, 320 West 10th Avenue, Columbus, OH 43210. E-mail: sanderson{at}cph.osu.edu

Objective: To assess whether adolescent obesity is associated with risk for development of major depressive disorder (MDD) or anxiety disorder. Obesity has been linked to psychosocial difficulties among youth.

Methods: Analysis of a prospective community-based cohort originally from upstate New York, assessed four times over 20 years. Participants (n = 776) were 9 to 18 years old in 1983; subsequent assessments took place in 1985 to 1986 (n = 775), 1991 to 1994 (n = 776), and 2001 to 2003 (n = 661). Using Cox proportional hazards analysis, we evaluated the association of adolescent (age range, 12–17.99 years) weight status with risk for subsequent MDD or anxiety disorder (assessed at each wave by structured diagnostic interviews) in males and females. A total of 701 participants were not missing data on adolescent weight status and had 1 subsequent assessments. MDD and anxiety disorder analyses included 674 and 559 participants (free of current or previous MDD or anxiety disorder), respectively. Adolescent obesity was defined as body mass index above the age- and gender-specific 95th percentile of the Centers for Disease Control and Prevention growth reference.

Results: Adolescent obesity in females predicted an increased risk for subsequent MDD (adjusted hazard ratio (HR) = 3.9; 95% confidence interval (CI) = 1.3, 11.8) and for anxiety disorder (HR = 3.8; CI = 1.3, 11.3). Adolescent obesity in males was not statistically significantly associated with risk for MDD (HR = 1.5; CI = 0.5, 3.5) or anxiety disorder (HR = 0.7; CI = 0.2, 2.9).

Conclusion: Females obese as adolescents may be at increased risk for development of depression or anxiety disorders.

Key Words: body mass index • depression • longitudinal study • obesity • prospective cohort • relative weight

Abbreviations: BMI = body mass index; CDC = Centers for Disease Control and Prevention; CI = confidence interval; CIC = Children in the Community Study; DSM = Diagnostic and Statistical Manual of Mental Disorders; DISC = Diagnostic Interview Schedule for Children; HR = hazard ratio; SCID-IV = Structured Clinical Interview for DSM-IV Disorders; SD = standard deviation; SES = socioeconomic status.

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