Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Body mass index and common mental disorders: exploring the shape of the association and its moderation by age, gender and education

Abstract

Background:

Obesity is known to be associated with increased prevalence of common mental disorders (for example, depression and anxiety), and there is evidence of age and gender differences in this relationship. However, categorisation of body mass index (BMI) and age has limited our ability to understand the nature of these differences. This study used continuous values of BMI and age to explore the shape of the association between common mental disorders and BMI and whether it varied with age, gender and education.

Method:

The analysis used cross-sectional data on 7043 adults from the English 2007 Adult Psychiatric Morbidity Survey. Common mental disorders were assessed using the revised Clinical Interview Schedule (CIS-R). Cubic splines allowed BMI and age to have non-linear effects in the logistic regression analysis.

Results:

BMI was strongly associated with the presence of common mental disorders, and there was clear evidence that this association varied with gender and age. In young women the probability of having a disorder increased as BMI increased, whereas in young men the relationship was U-shaped—probabilities were higher for both underweight and obese men. These associations diminished in older age groups, particularly when potential confounders such as physical health were taken into account. There was no evidence that the relationship varied with education.

Conclusions:

Age and gender differences must be taken into account when investigating the link between BMI or obesity and common mental disorders. Furthermore, results of studies that categorise BMI may be highly sensitive to the width of the ‘normal weight’ reference category.

This is a preview of subscription content, access via your institution

Access options

Buy this article

Prices may be subject to local taxes which are calculated during checkout

Figure 1
Figure 2
Figure 3
Figure 4

Similar content being viewed by others

References

  1. Atlantis E, Baker M . Obesity effects on depression: systematic review of epidemiological studies. Int J Obes 2008; 32: 881–891.

    Article  CAS  Google Scholar 

  2. 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.

    Article  Google Scholar 

  3. Scott KM, Bruffaerts R, Simon GE, Alonso J, Angermeyer M, De Girolamo G et al. Obesity and mental disorders in the general population: results from the world mental health surveys. Int J Obes 2008; 32: 192–200.

    Article  CAS  Google Scholar 

  4. Mather AA, Cox BJ, Enns MW, Sareen J . Associations of obesity with psychiatric disorders and suicidal behaviors in a nationally representative sample. J Psychosom Res 2009; 66: 277–285.

    Article  Google Scholar 

  5. Luppino FS, de Wit LM, Bouvy PF, Stijnen T, Cuijpers P, Penninx BWJH et al. Overweight, obesity, and depression: a systematic review and meta-analysis of longitudinal studies. Arch Gen Psychiatry 2010; 67: 220–229.

    Article  Google Scholar 

  6. de Wit LM, van Straten A, van Herten M, Penninx BWJH, Cuijpers P . Depression and body mass index, a u-shaped association. BMC Public Health 2009; 9: 14.

    Article  Google Scholar 

  7. Zhao G, Ford ES, Dhingra S, Li C, Strine TW, Mokdad AH . Depression and anxiety among US adults: Associations with body mass index. Int J Obes 2009; 33: 257–266.

    Article  CAS  Google Scholar 

  8. Heo M, Pietrobelli A, Fontaine KR, Sirey JA, Faith MS . Depressive mood and obesity in US adults: Comparison and moderation by sex, age, and race. Int J Obes 2006; 30: 513–519.

    Article  CAS  Google Scholar 

  9. Chen Y, Jiang Y, Mao Y . Association between obesity and depression in Canadians. J Womens Health 2009; 18: 1687–1692.

    Article  Google Scholar 

  10. National Centre for Social Research and University of Leicester. Adult Psychiatric Morbidity Survey, 2007 (data file). 2nd Edition. UK Data Archive: Colchester, Essex, April 2010. SN: 6379.

  11. National Centre for Social Research. Adult psychiatric morbidity in England, 2007: Results of a household survey. National Centre for Social Research: London, 2009. Available at URL http://www.ic.nhs.uk/statistics-and-data-collections/mental-health/mental-health-surveys/adult-psychiatric-morbidity-in-england-2007:-results-of-a-household-survey (Accessed on 24 June 2009).

  12. Lewis G, Pelosi AJ, Araya R, Dunn G . Measuring psychiatric disorder in the community: a standardized assessment for use by lay interviewers. Psychol Med 1992; 22: 465–486.

    Article  CAS  Google Scholar 

  13. National Centre for Social Research. Adult psychiatric morbidity in England, 2007: Results of a household survey, Appendices and Glossary. National Centre for Social Research: London, 2009. Available at URL http://www.ic.nhs.uk/statistics-and-data-collections/mental-health/mental-health-surveys/adult-psychiatric-morbidity-in-england-2007:-results-of-a-household-survey (Accessed on 24 June 2009).

  14. World Health Organization. The ICD-10 classification of mental and behavioural disorders: diagnostic criteria for research. World Health Organization: Geneva, 1993.

  15. Harrell FE . Regression modeling strategies: with applications to linear models, logistic regression, and survival analysis. Springer-Verlag: New York, 2001.

    Book  Google Scholar 

  16. World Health Organization. Obesity: Preventing and managing the global epidemic. World Health Organization: Geneva, 2000. Available at URL http://apps.who.int/bmi/index.jsp?introPage=intro_5.html (Accessed on 26 August 2009).

  17. World Health Organization. AUDIT—The alcohol use disorders identification test: Guidelines for use in primary care (Second edition). World Health Organization: Geneva, 2001. Available at URL http://www.who.int/substance_abuse/publications/alcohol/en/index.html (Accessed on 28 August 2009).

  18. Stockwell T, Sitharthan T, Mcgrath D, Lang E . The measurement of alcohol dependence and impaired control in community samples. Addiction 1994; 89: 167–174.

    Article  CAS  Google Scholar 

  19. Korn EL, Graubard BI . Analysis of large health surveys - Accounting for the sampling design. J R Stat Soc Ser A-Stat Soc 1995; 158: 263–295.

    Article  Google Scholar 

  20. Alzola C, Harrell F . An introduction to S and the Hmisc and Design libraries 2006. Available at URL http://biostat.mc.vanderbilt.edu/wiki/pub/Main/RS/sintro.pdf (Accessed on 30 August 2009).

  21. Barry D, Pietrzak RH, Petry NM . Gender differences in associations between body mass index and DSM-IV mood and anxiety disorders: Results from the National Epidemiologic Survey on Alcohol and Related Conditions. Ann Epidemiol 2008; 18: 458–466.

    Article  Google Scholar 

  22. McLaren L, Beck CA, Patten SB, Fick GH, Adair CE . The relationship between body mass index and mental health - A population-based study of the effects of the definition of mental health. Soc Psychiatry Psychiatr Epidemiol 2008; 43: 63–71.

    Article  Google Scholar 

  23. Simon GE, Von Korff M, Saunders K, Miglioretti DL, Crane PK, van Belle G et al. Association between obesity and psychiatric disorders in the US adult population. Arch Gen Psychiatry 2006; 63: 824–830.

    Article  Google Scholar 

  24. Royston P, Altman DG, Sauerbrei W . Dichotomizing continuous predictors in multiple regression: A bad idea. Stat Med 2006; 25: 127–141.

    Article  Google Scholar 

  25. Gorber SC, Tremblay M, Moher D, Gorber B . A comparison of direct vs. self-report measures for assessing height, weight and body mass index: A systematic review. Obes Rev 2007; 8: 307–326.

    Article  Google Scholar 

  26. Spencer EA, Appleby PN, Davey GK, Key TJ . Validity of self-reported height and weight in 4808 EPIC-Oxford participants. Public Health Nutr 2002; 5: 561–565.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to R L McCrea.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Cite this article

McCrea, R., Berger, Y. & King, M. Body mass index and common mental disorders: exploring the shape of the association and its moderation by age, gender and education. Int J Obes 36, 414–421 (2012). https://doi.org/10.1038/ijo.2011.65

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/ijo.2011.65

Keywords

This article is cited by

Search

Quick links