People who suffer from depression or anxiety are much more likely to be obese and to smoke both major risk factors for chronic disease according to a large nationwide study.

"The relationship between obesity and depression is plausible for several reasons," said lead author Tara Strine, of the Division of Adult and Community Health in the Centers for Disease Control and Prevention. "First, some patients who are overweight may be prone to depression because of societal attitudes towards obesity. Also, while depression can lead to decreased appetite and weight loss in some individuals, others eat more and gain weight."

The study, in the March/April issue of the journal General Hospital Psychiatry, compiled data from more than 200,000 adults in 38 states, the District of Columbia, Puerto Rico and the U.S. Virgin Islands. All participated in the 2006 Behavioral Risk Factor Surveillance System, a large telephone survey that monitors the prevalence of key health behaviors.

The survey asked respondents if they were currently depressed or had ever had a diagnosis of depression or anxiety. Other questions addressed smoking habits, weight, physical activity and alcohol consumption.

About 8.7 percent of the respondents had current depression, 15.7 percent had a previous depression diagnosis and 11.3 percent had had an anxiety diagnosis at some time.

People with current depression or a previous diagnosis of depression were 60 percent more likely to be obese and twice as likely to smoke as those who were not depressed, the research found. Those with an anxiety disorder were 30 percent more likely to be obese and twice as likely to smoke as those without anxiety were. The study also said that those with depression and anxiety were more likely to be physically inactive and to be binge or heavy drinkers.

"Chronic diseases are risk factors for depression, so [the health care system] must be attuned to recognizing and treating the depression that often coexists with such chronic diseases," Strine said.

"This is an important and well-done study that will hopefully reach a large audience and continue to raise awareness," said Evette Joy Ludman, Ph.D., of Seattle-based Group Health Cooperative.

"Although health care providers have increasingly become aware of the link between chronic conditions such as diabetes and depression and the links between smoking and mood disorders, I think they are only now beginning to be aware of the broader link between depression, obesity and unhealthful behaviors," Ludman said.

General Hospital Psychiatry is a peer-reviewed research journal published bimonthly by Elsevier Science. For information about the journal, contact Wayne Katon, M.D., at (206) 543-7177.

Strine TW, et al. The association of depression and anxiety with obesity and unhealthy behaviors among community-dwelling US adults. Gen Hosp Psychiatry 30(2), 2008.

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