​Depressive symptoms and weight loss behaviors in U.S. adults

Objective: We sought to determine whether depressive symptoms are associated with attempting to lose weight and engaging in weight loss behaviors in a large, diverse sample of adults representative of the U.S. population. Methods: Respondents were 23,106 adults, free of cardiovascular disease and diabetes, who participated in the 2005–2014 years of the National Health and Nutrition Examination Survey (NHANES). Depressive symptoms were measured using the Patient Health Questionnaire-9 (PHQ-9), and weight loss variables were obtained from a Weight History Questionnaire. Results: PHQ-9 total was not associated with attempting to lose weight in the past year (OR = 1.03, 95%CI = 1.00–1.06, p = 0.074; n = 23,106). Among respondents who attempted to lose weight (n = 9582), PHQ-9 total was associated with a lower odds of exercising (OR = 0.84, 95%CI = 0.79–0.89, p < 0.001) and a greater odds of skipping meals (OR = 1.31, 95%CI = 1.22–1.41, p < 0.001), eating diet foods/products (OR = 1.16, 95%CI = 1.08–1.24, p < 0.001), eating less food (OR = 1.09, 95%CI = 1.04–1.15, p < 0.001), taking non-prescription supplements (OR = 1.31, 95%CI = 1.23–1.41, p < 0.001), taking prescription diet pills (OR = 1.28, 95%CI = 1.10–1.49, p = 0.001), and taking laxatives/vomiting (OR = 1.55, 95%CI = 1.28–1.88, p < 0.001). Conclusions: Although depressive symptoms were not associated with attempting to lose weight in the past year, adults who attempted to lose weight tended to employ potentially ineffective/unhealthy weight loss behaviors and avoid effective behaviors. This pattern of behaviors may be another mechanism that explains the excess risk of obesity in depressed adults and may be a modifiable target for future interventions. Given the cross-sectional nature of this study, reverse causality is a possibility. Future studies should investigate the prospective associations between depressive symptoms and weight loss behaviors.