University of Michigan
Department of Pediatrics
Evidence-Based Pediatrics Web Site

Question

• Is depressed mood in adolescence predictive of obesity later in life?

Clinical Bottom Lines

1. Depressed mood in adolescence is associated with an increased risk for the development and persistence of obesity.¹
   
2. Having a low threshold to treat depression in the adolescent population can potentially prevent two chronic conditions, each with a potential for life-long morbidity.¹
   
3. Screen your adolescent patients for depression and calculate their BMI.
   
4. If depression is diagnosed, treat it. There are many pharmacologic therapies for depression, but once obesity is diagnosed, it is difficult to treat successfully.

Summary of Key Evidence

1. In a prospective cohort of 9374 adolescents obesity was defined at BMI > 95th percentile, overweight as BMI > 85th and < 95th percentile, and normal weight as BMI < 85th percentile for age and gender.¹
2. Depressed mood was assessed with the Center for Epidemiologic Studies Depression Scale.
3. Sociodemographic data and several covariates were additionally studied including: smoking, delinquency, low activity level, self-esteem. All four covariates were associated with baseline depressed mood, but not obesity at follow-up.
4. Baseline depressed mood was not significantly associated with baseline obesity. Number of obese parents was the strongest correlate of baseline obesity.
5. Obesity at follow-up was present in 79.7% of obese, 18.5% overweight, and 1.8% of normal weight at baseline.
6. In bivariate analysis,12.4% of those with depressed mood at baseline were obese at follow-up compared with 9.4% of those not depressed at baseline (P = .048).
7. In multivariable analysis, baseline depressed mood independently predicted follow-up obesity (OR: 2.05; 95% CI: 1.18, 3.56). The odds of a non-obese adolescent becoming obese doubled if they had a depressed mood at baseline.
8. Analysis also suggested that depressed mood causes worsening obesity in those who were obese at baseline.
9. Baseline obesity did not predict follow-up depressed mood, but the folow-up period may not have been long enough to document this definitively..

Additional Comments

• Is this the most sensitive and specific depression scale available for adolescents?
• It is likely a bias may exist regarding height and weight reporting. Height and weight were only measured at followup (initial values were by self-report).
• Little data was available regarding the reliability and validity for the psychological and behavioral scales.
• This study would be of greater benefit to clinicians had the follow-up time been longer.
  

Citation

1. Goodman E, Whitaker RC. A prospective study of the role of depression in the development and persistence of adolescent obesity. Pediatrics 2002;109:497-504.
   

CAT Author: Kristen M. Snyder, MD

CAT Appraisers: John G. Frohna, MD

Date appraised: September 9, 2002