Relationship between Obesity, Depression, and Disability in Middle-Aged Women

Abstract

BACKGROUND: Obesity and depression are closely linked, and each has been associated with disability. However, few studies have assessed inter-relationships between these conditions. DESIGN AND METHODS: In this study, 4 641 women aged 40-65 completed a structured telephone interview including self-reported height and weight, the Patient Health Questionnaire (PHQ) assessment of depression, and the World Health Organization Disability Assessment Schedule II (WHODAS II). The survey response rate was 62%. We used multivariable regression models to assess relationships between obesity, depression, and disability. RESULTS: The mean age was 52 years; 82% were white; and 80% were currently employed. One percent were underweight, 39% normal weight, 27% overweight, and 34% obese. Mild depressive symptoms were present in 23% and moderate-to-severe symptoms were present in 13%. After multivariable adjustment, depression was a strong independent predictor of worse disability in all 7 domains (cognition, mobility, self-care, social interaction, role functioning, household, and work), but obesity was only a significant predictor of greater mobility, role-functioning, household, and work limitations (P<0.05) (overweight was not significantly associated with any disability domain). Overall, the effect on disability was stronger and more pervasive for depression than obesity, and there was no significant interaction between the two conditions (P>0.05). Overweight and obesity were associated with 5 760 days of absenteeism per 1 000 person-years, and depression was associated with 18 240 days of absenteeism per 1 000 person-years. CONCLUSIONS: The strong relationships between depression, obesity and disability suggest that these conditions should be routinely screened and treated among middle-aged women.

Figure 1

Multivariable Adjusted* Odds Ratios of Having Any Limitations in Seven Domains of Disability across Levels of Depressive Symptoms *First and third bars for each domain are adjusted for BMI, age, race, college education, smoking, and Rx Risk; second and fourth bars for each domain are not adjusted for BMI but are adjusted for age, race, college education, smoking, and Rx Risk; thin lines indicate 95% confidence intervals

Figure 2

Multivariable Adjusted* Odds Ratios of Having Any Limitations in Seven Domains of Disability across Categories of Body Mass Index *First and third bars for each domain are adjusted for PHQ, age, race, college education, smoking, and Rx Risk; second and fourth bars for each domain are not adjusted for PHQ but are adjusted for age, race, college education, smoking, and Rx Risk; thin lines indicate 95% confidence intervals

Figure 3

Proportions of employed women (80% of total sample) reporting mild, moderate, and severe difficulty carrying out their day-to-day work, by BMI category and PHQ score* *adjusted for age, race, education, smoking status, and a pharmacy-based risk adjuster (RxRisk)