Depression Linked to Unhealthy Dieting Among Women

Women with depression engage in fewer healthy dieting behaviors such as eating fruits and vegetables, and more unhealthy dieting behaviors such as skipping meals, than do women who are not depressed.

The finding “suggests that a ‘healthy state of mind’ may be a precursor to the adoption of adaptive efforts to lose weight,” whereas unhealthy strategies “may represent a form of self-punishment due to disgust with their weight status or themselves in general,” according to Meghan M. Gillen, Ph.D., and her colleagues. The report was published in the April issue of Eating Behaviors.

Dr. Gillen, of Pennsylvania State University, Abington, looked at 198 adults in the region of her institution (51% female, mean age 24.8 years) who had volunteered for a larger study about romantic relationships and health. Three-quarters of the participants identified themselves as white (Eat. Behav. 2012;13;88-93).

The average body mass index for women in this sample was 23.93 (range: 17.45-47.71), and the average BMI for men was 27.45 (range: 18.79-49.66).

Overall, 40% of men were overweight, while 25% were obese, in line with national statistics; among women, 22% were overweight, and 8% were obese, a “relatively thin” sample, compared with national figures.

The participants were asked to fill out a questionnaire that dealt with health behaviors and attitudes. The study lasted about 1.5 hours, and each participant received about $25 as payment, except for 14% of the sample who opted to receive credit toward a psychology class instead.

Depression was measured using the Center for Epidemiological Studies Scale for Depression (CES-D), and the 24-item Weight Control Behavior Scale was used to assess weight loss behaviors, with 3 items removed (diet centers with food, weight loss groups, and other) “because it is not clear whether they constitute healthy or unhealthy dieting behaviors.”

“In the current study, subscales include healthy dieting behavior (12 items; for example, ‘eat more fruit and vegetables’) and unhealthy dieting behavior (9 items; for example, ‘skip meals’),” Dr. Gillen wrote.

In each case, participants indicated how often they used that strategy to lose weight in the past year, with a score of 0 meaning never, a score of 1 meaning “sometimes,” and a score of 2 being “always.”

A sum of items on each subscale was used by the investigators to assign an overall “healthy dieting behavior” and “unhealthy dieting behavior” score.

The authors found that even after controlling for BMI and depression, women reported using more healthy as well as unhealthy dieting tactics than men, and both men and women with higher BMIs were more likely to engage in both types of dieting behaviors.

When the authors assessed the effect of depression on the types of dieting behaviors, they determined that, among women, depression was negatively related to healthy dieting behaviors (significance test of the simple slope t(192) = –2.59) and positively related to unhealthy dieting behaviors (t[192] = 3.61), with P less than .01 for both.

Among men, depression had no effect on either healthy (t[192] = 0.63, P = .52) or unhealthy (t[192] = 1.93 P = .06) behaviors.

“These findings suggest that Stice and Bearman’s (2001) model, which predicts an association between weight management strategies and depression in female adolescents (but not their male counterparts), may be extended to adults,” the authors wrote.

Moreover, “an extension of the gender additive model may be that depression tends to lead to increasingly maladaptive dieting behaviors as women become both more desperate to lose weight and more psychologically unfit to make healthy choices,” Dr. Gillen added.

“Ultimately, maladaptive dieting behaviors may be associated not only with depression but with eating disorders as well, which suggests the need for health care professionals to reduce women’s unhealthy dieting behaviors before they become more complex long-term mental health problems.”

A coinvestigator was supported by an award from Rutgers University. The authors wrote that they had no conflicts of interest to disclose.

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