Results section

Ricardo Ugarte’s results section of the literature review

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Gossi

CHS 211

University of Nevada

• Is there a relationship of Obesity with depression and if so, what are possible risk factors for the comorbidity?

In this review, it is meant to explain the relationship of Obesity and Depression. It then goes into the possible risk factors of what causes the two disorders to become common with each other and last part is the discussion of the disorders, risk factors and also reasons why it is important to know these risk factors. The review first started with prevalence because the most important part of this essay is getting the reader to know that this is a common problem and shows it is an important topic. Then put how both depression and obesity may lead to each other. This was second because it shows that if one disorder comes it is highly likely that the second disorder is on its way, no matter which disorder comes first. After the bidirectional morbidity is talked about, genetics seemed next because one can base their chances of getting the disorder if their parents have it. Last is environment because as it plays a big role with how depression and obesity works, there isn't much that can be done to help this other then clean the neighborhoods.

2. Obesity and Depression in Adolescence

2.1. Prevalence

Thus it appears that obesity and depression seem to come together and it is a growing problem when it comes to adolescence. This is shown when 1512 participants were selected from the Minnesota Twin Family Study.  During this study kids are first assessed at age 11 and then returned to be reassessed at age 14 and 24. After the study is completed it is shown that adolescence with one of the disorders at some point during their lifetimes are 1.5 to 2 times more likely of being diagnosed with the other disorder when compared to adolescence that don’t contain obesity or depression. (Marmorstein, 2014) On first glance the last sentence may be misleading by saying it will happen in the future as in a long time from the first diagnosis, but both depression and obesity first occurring anytime by age 24 is shown to be 7.8% of males and 11.9%. When considering the following data it shows about one out of every ten people by the age of 24 will have depression and obesity. (Marmorstein, 2014)

2.1.  Obesity leading to depression

Childhood obesity has grown into a worldwide problem and is now known to come with other disorders. (Gallai et al., 2014) This causes concern of depression being a comorbidity with obesity. A study is done comparing adolescents with obesity to adolescents in a healthy weight range. The children got their BMI checked; which stands for Body Mass Index and is measured by dividing one's weight in kilograms by their height in centimeters squared. A BMI score of 25 to 30 is overweight and any score over 30 is known as obese. Once this is done the children now participate in the Children’s Depression Inventory (CDI) to test for depressive symptoms that may occur in children and adolescents between the ages of 8 to 17. The way it works is the higher the score means the more depressive symptoms the individual has. This study also took into account external factors; such as environment and to make sure there were no other factors in play all the children were selected from the same area and are also all middle class when it comes to Socioeconomic status. The results show that there is a significantly higher level of depressive symptoms in obese adolescents compared to normal weight children (16.827.73 vs. 8.22.9). (Gallai et al., 2014)

The above study shows that obesity can lead to depression and this study is for finding out why. A 1491 questionnaires were filled out between 2004 to 2008 and these questionnaires were filled out over 20 middle and high schools. After the questionnaires were completed each student got their BMI measured. These scores were written directly on the participant’s questionnaires to make sure there is no mix up of data. After the BMI is calculated the students then took the Body Esteem Scale for Adolescents and Adults (BESAA) and the Dutch Eating Behavior Questionnaire (DEBQ). The BESAA test is used to measure what the individual's belief of their body or their appearance is on a 5 point likert scale, while the DEBQ is used to measure topics of never eating, eating often, emotional eating and external eating; while using the same 5 point likert scale. The BESAA shows that kids who are obese show significantly less reports of body satisfaction and weight satisfaction compared to overweight kids. The interesting part is that overweight kids get the same result when compared to kids with normal body weight. This study shows that there is a relationship to BMI score and one's belief of body and weight satisfaction.  (Goldfield et al., 2010) The DEBQ showed that obese kids get a higher score of Dietary restraint; watching what they eat compared to overweight, the same is found when comparing overweight kids to normal weight. These results are possibly why overweight and obese kids reported having more symptoms of anhedonia and negative self-esteem than all other kids. (Goldfield et al., 2010) The high amount of body dissatisfaction and also constantly watching what is consumed may cause a toll, especially if one does not see change for a period of time.

2.2. Depression leading to obesity

Given the knowledge that obesity leads to depression, many may find it hard to believe that depression can lead to obesity. This is the reason Goodman and Whitaker did their study on 9347 adolescents between the 7th-12th grade. The adolescents completed an in-home interview and have a one year follow up making this a longitudinal study. Obesity is measured by BMI and the depression is calculated using a slightly modified version of the Center of Epidemiologic Studies Depression Scale (CES-D). At baseline it is shown that 12.9% were overweight, 9.7% were obese and 8.8% had depressed moods. (Goodman & Whitaker, 2002) The interesting part is at this time the baseline depressed mood is not significantly associated with baseline obesity because 9% of those depressed at baseline were obese compared to the 9.8% of the non-depressed that were obese. At the one year follow up 12.4% of those with depressed mood at baseline were obese at follow up. This made the relationship significant when using baseline depressed mood independently predicting for follow up obesity. It actually showed that those who were depressed and not obese at baseline, were twice as likely to be obese at the follow up. (Goodman & Whitaker, 2002) This leads to the fact that Adult BMI increase is associated with depressive symptoms when they were adolescents.  

To expand proof of the comorbidity, a study done by Mannan and partners showed that adolescents who are depressed are actually 70% more at risk of obesity when compared to those who did not experience depression. (Mannan, Mamun, Doi &Clavarino, 2016) This helps show that in two studies they found that where you twice as likely or even 70% more likely to become obese if depressive symptoms were found during adolescents. (Mcelroy et al., 2004)

2.3. Genetics being the cause

Thus, it appears that the disorders are the cause of each other, but genetics play a factor on why these two disorders seem to come together. The University of Washington Twin registry decided to test this factor by comparing Monozygotic twins (MZ) and Dizygotic twins (DZ). This is done because the University Twin registry receives a list of twins when they are getting their license to make sure there are no duplicates of the same license. These twins are invited to join the registry and complete a survey that involved multiple topics; including obesity and depression.  The data used from the survey is used to compare depression and obesity between MZ to DZ. This is done because if there is a greater similarity of MZ compared to DZ than it means there is a genetic component that is possibly the cause because MZ have the same genes because these twins are made with the same DNA. The study shows that there is a larger MZ than DZ correlation for both depression (0.55 vs. 0.36) and obesity (0.81 vs 0.51). This shows there is a genetic basis for each trait. (Afari et al., 2010)

It is even reported by Pervanidou et al that this could be due to an imbalance in hypothalamic-pituitary-adrenal axis, because this is to be involved in both depression and obesity. (Gallai et al., 2014) This is the system that releases the corticotropic releasing hormone that then travels down the anterior pituitary gland; which then releases the adrenal corticotropic hormone that travels to the adrenal gland to cause other hormones to be released. The hormone most noticed to cause these disorders is cortisol. This is the stress hormone known to cause increased amount of adiposity to the human body; leading to obesity and also high amounts of stress is known to cause disorders such as depression.

2.4. Environment being the cause

Chronic stress is shown to be a concern to increased obesity and it is related to other consequences such as hypertension and dyslipidemia. this stress may be linked to living in a hostile environments that could lead to brain morphology. This could be the reason why places in lower Socioeconomic status (SES) tends to have higher rates of obesity and depression. (Goodman & Whitaker, 2002)

To test if SES is a factor for this comorbidity 15,484 subjects were chosen and completed the parental interview and the children whose parents answered the questions were included.  The parental interview is used to get the SES of the individuals and were separated into five quintiles of income. The BMI is calculated for the adolescents to check for obesity rates. Also, the adolescents were tested for depression by using the Center for Epidemiologic study-depression Scale (CES-D). The mean age of the children came out to be 16.1 meeting the criteria for adolescents and the test showed that the lowest quintile for household income show the greatest impact of depression and obesity compared to all other quintiles. (Goodman, Slap & Huan, 2003)

Since it is now known that obesity does lead to depression another factor that could impact the comorbidity is food deserts. A food desert is when there is no grocery store or a place to buy groceries within a walking distance (1 mile). A study is done to test 160 school districts and of the 160 they specifically looked at fifth graders. They had their BMI tested that year and then are retested when they are in seventh grade. It is shown during the study that food deserts are most common in low SES and in these areas it is also shown there are higher rates of overweight kids. Having more overweight kids is already a problem, but it also showed that there is a greater increase of overweight kids within the three years. (Schafft, Jensen & Hinrichs, 2009)

3. Discussion

Thus, it is shown that obesity and depression are comorbid and you are likely to get the second disorder once the first disorder appears. It is known to be bidirectional, meaning that not just one disorder leads to the other but if one appears, you are at increased risk of be diagnosed for the second. This could be because with depression, physical activity tends to drop due to anhedonia and other symptoms. This causes calories not to be burned, stored and over a period of time will lead to weight gain. For obesity to depression a lifetime of judgement and not feeling confident of one's appearance can take a toll to the human mind. Though it is known that the disorders can cause each other, there are more factors that could play role in this and they are genetics and environment. The genetics aspects show that if parents have the symptoms it is possible to be inherited and one day express the disorders. It is shown that there is a part of the brain that releases hormones and could be the cause for the relationship. The environment shows that one's living lifestyle may cause the disorders to happen. Majority of the findings were based on SES and showed that living in a lower class actually puts you at risk for the diseases. This is due to many things from lack of exercise, or high stress due to living in a violent neighborhoods and also not having the proper food or access to care. The importance of this paper is that now a link of obesity to depression is found, healthcare providers and loved ones may look for symptoms of depression to help prevent it from happening or at least minimizing the effects of obese children. The same will work for depression leading to obesity and can help if it is known to look for the growth in weight. Though genetics can't be fixed, it is just helping by education allowing those whose parents have the disorders know to watch out and also for parents who are diagnosed with the disorder may pay close attention to their children for the disorders. Last is fixing one's environment and possible stress. Stress levels are known to create higher cortisol levels; which is linked to both depression and obesity and that is why it is important to bring down stress. Reducing stress can be accomplished through exercise and has actually been shown to have a correlation when it comes to children with high cardiorespiratory fitness and lower total adiposity. It is also shown that increased fitness may even have a direct effect on serotonin and endorphins. These are hormones used in the human body to help elevate one’s mood.  (Ortega, Ruiz, Castillo & Sjostrom, 2008)

References

Afari, N., Noonan, C., Goldberg, J., Roy-Byrne, P., Schur, E., Golnari, G., & Buchwald, D. (2010). Depression and obesity: do shared genes explain the relationship? Depression and Anxiety,27(9), 799-806. doi:10.1002/da.20704

Gallai, B., Esposito, M., Roccella, M., Marotta, R., Lavano, F., Lavano, S. M., . . . Carotenuto, M. (2014). Anxiety and depression levels in prepubertal obese children: a case-control study. Neuropsychiatric Disease and Treatment, 1897. doi:10.2147/ndt.s69795

Goldfield, G. S., Moore, C., Henderson, K., Buchholz, A., Obeid, N., & Flament, M. F. (2010). Body Dissatisfaction, Dietary Restraint, Depression, and Weight Status in Adolescents. Journal of School Health, 80(4), 186-192.  doi:10.1111/j.1746-1561.2009.00485.x

Goodman, E., Slap, G. B., & Huang, B. (2003). The Public Health Impact of Socioeconomic Status on Adolescent Depression and Obesity. American Journal of Public Health, 93(11), 1844-1850. doi:10.2105/ajph.93.11.1844

Goodman, E., & Whitaker, R. C. (2002). A Prospective Study of the Role of Depression in the Development and Persistence of Adolescent Obesity. Pediatrics, 110(3), 497-504. doi:10.1542/peds.110.3.497

Marmorstein, N.R., et al. "Obesity and depression in adolescence and beyond: reciprocal risks." International Journal of Obesity, vol. 38, no. 7, 2014, p. 906+. Health Reference Center Academic, go.galegroup.com/ps/i.do?p=HRCA&sw=w&u=reno&v=2.1&it=r&id=GALE%7CA377531025&sid=summon&asid=175ca23f80a0dadae78e1277cb8992bb. Accessed 14 Mar. 2017.

Mannan, M., Mamun, A., Doi, S., & Clavarino, A. (2016). Prospective Associations between Depression and Obesity for Adolescent Males and Females- A Systematic Review and Meta-Analysis of Longitudinal Studies. Plos One, 11(6). doi:10.1371/journal.pone.0157240

Mcelroy, S. L., Kotwal, R., Malhotra, S., Nelson, E. B., Keck, P. E., & Nemeroff, C. B. (2004). Are Mood Disorders and Obesity Related? A Review for the Mental Health Professional. The Journal of Clinical Psychiatry, 65(5), 634-651. doi:10.4088/jcp.v65n0507

Ortega, F. B., Ruiz, J. R., Castillo, M. J., & Sjostrom, M. (2008). Physical fitness in childhood and adolescence: a powerful marker of health. International Journal of Obesity, 32(1), 1+. Retrieved from http://go.galegroup.com.unr.idm.oclc.org/ps/i.do?p=HRCA&sw=w&u=reno&v=2.1&it=r&id=GALE%7CA190151552&sid=summon&asid=9dd3d7c3150fac76996c4627e79a6c4f

Schafft, K. A., Jensen, E. B., & Hinrichs, C. C. (2009). Food deserts and overweight schoolchildren: Evidence from pennsylvania*. Rural Sociology, 74(2), 153-177. Retrieved from http://unr.idm.oclc.org/login?url=http://search.proquest.com.unr.idm.oclc.org/docview/199367471?accountid=452