This blog today comes at you in stereo from the Woodland of the Lifestyle and the Mental Elf as it covers the complex interaction between depression and obesity; obesity and depression. Both disorders are prevalent and have been repeatedly shown to be associated. However, the mechanisms and temporal sequence underlying this association are poorly understood.
Controversy followed Kate Moss in 2009 when she was asked in an interview if she had any mottos, she replied: “There are loads of mottos. There’s ‘Nothing tastes as good as skinny feels’. That’s one of them”. If this were accurate – does being overweight then make you feel depressed?
Major depressive disorder (MDD) is among the diseases with the greatest public health impact worldwide and confers an approximately 50% elevated mortality of various causes.
Obesity represents another major burden for public health and is also associated with elevated mortality.
Both depression and obesity are associated with various chronic diseases such as diabetes mellitus, hypertension and dyslipidaemias. Obesity could also be one explanation for the approximately doubled risk for cardiovascular disease (CVD) and cerebrovascular diseases and the excess mortality among depressed individuals. Accordingly, gaining a better understanding of the mechanisms underlying the association between MDD and obesity is of high clinical and scientific relevance.
Lasserre et al published the results of their prospective cohort study in JAMA Psychiatry in June this year. Their aim was to determine whether the subtypes of major depressive disorder (MDD; melancholic, atypical, combined, or unspecified) are predictive of adiposity in terms of the incidence of obesity and changes in body mass index (calculated as weight in kilograms divided by height in meters squared), waist circumference, and fat mass.
This was a prospective population-based cohort study; the Psychiatric arm of the CoLaus Study, with 5.5 years of follow-up included 3,054 randomly selected residents (mean age, 49.7 years; 53.1% were women) of the city of Lausanne, Switzerland (according to the civil register), aged 35 to 66 years in 2003, who accepted the physical and psychiatric baseline and physical follow-up evaluations.
Depression subtypes were classified according to the DSM-IV. Diagnostic criteria at baseline and follow-up, as well as sociodemographic characteristics, lifestyle (alcohol and tobacco use and physical activity), and medication, were elicited using the semistructured Diagnostic Interview for Genetic Studies.
Measures that were monitored included changes in body mass index, waist circumference, and fat mass during the follow-up period, and the incidence of obesity during the follow-up period among non-obese participants at baseline. Weight, height, waist circumference, and body fat were measured at baseline and follow-up by trained field interviewers.
The most salient findings were that:
- MDD with atypical features was prospectively associated over a 5.5-year period with a higher increase in adiposity in terms of BMI, incidence of obesity, and waist circumference in both sexes as well as fat mass in men
- The higher increase of adiposity in individuals with MDD with atypical features is not explained by potential confounders including sociodemographic and lifestyle characteristics, comorbid mental disorders, antidepressant medication, or other potentially weight-increasing medications
- The elevated BMI increase in individuals with MDD with atypical features is not a temporary phenomenon but persists after the remission of the depressive episode and is not attributable to new episodes
Only participants with the atypical subtype of MDD at baseline revealed a higher increase in adiposity during follow-up than participants without MDD
Although it is plausible that increased appetite during depressive episodes with atypical features can lead to temporary weight gain, the finding of persistently elevated BMI increase after a follow-up period of more than 5 years, even in individuals with remitted episodes, supports a potential obesity-related pathway from atypical depression to CVD and other chronic diseases related to obesity.
The atypical subtype of major depressive disorder is a strong predictor of sustained obesity.
This emphasizes the need to not only identify individuals with this subtype of depression, but also to consider therapeutic measures to help combat the associated increased appetite that can occur.
So, following a mash up of Elves and common disorders, here is a little musical mash up….
Lasserre A, Glaus J, Vandeleur C, marques-Vidal P, Vaucher J, Bastardot F, Waeber G, Vollenweider P, Preisig M. Depression With Atypical Features and Increase in Obesity, Body Mass Index, Waist Circumference, and Fat Mass. JAMA Psychiatry. 2014. 411.