“This is the first time cortisol reactivity has been identified as a mediator between depressed mood and obesity in girls,” said Elizabeth J. Susman, the Jean Phillips Shibley professor of biobehavioral health at Penn State. “We really haven’t seen this connection in kids before, but it tells us that there are biological risk factors that are similar for obesity and depression.”

Cortisol, a hormone, regulates various metabolic functions in the body and is released as a reaction to stress. Researchers have long known that depression and cortisol are related to obesity, but they had not figured out the exact biological mechanism.

Although it is not clear why high cortisol reactions translate into obesity only for girls, scientists believe it may be due to physiological and behavioral differences — estrogen release and stress eating in girls — in the way the two genders cope with anxiety.

“The implications are to start treating depression early because we know that depression, cortisol and obesity are related in adults,” said Susman.

If depression were to be treated earlier, she noted, it could help reduce the level of cortisol, and thereby help reduce obesity.

“We know stress is a critical factor in many mental and physical health problems,” said Susman. “We are putting together the biology of stress, emotions and a clinical disorder to better understand a major public health problem.”

Susman and her colleagues Lorah D. Dorn, professor of pediatrics, Cincinnati Children’s Hospital Medical Center, and Samantha Dockray, postdoctoral fellow, University College London, used a child behavior checklist to assess 111 boys and girls ages 8 to 13 for symptoms of depression. Next they measured the children’s obesity and the level of cortisol in their saliva before and after various stress tests.

“We had the children tell a story, make up a story, and do a mental arithmetic test,” said Susman. “The children were also told that judges would evaluate the test results with those of other children.”

Statistical analyses of the data suggest that depression is associated with spikes in cortisol levels for boys and girls after the stress tests, but higher cortisol reactions to stress are associated with obesity only in girls. The team reported its findings in a recent issue of the Journal of Adolescent Health.

“In these children, it was mainly the peak in cortisol that was related to obesity,” Susman explained. “It was how they reacted to an immediate stress.”

The National Institutes of Health supported this work.

Source:
Amitabh Avasthi
Penn State

Results of this paper, co-authored by Beatrice Golomb, MD, PhD, associate professor of medicine at UCSD School of Medicine, will appear in the April 26 issue of Archives of Internal Medicine.

“Our study confirms long-held suspicions that eating chocolate is something that people do when they are feeling down,” said Dr. Golomb. “Because it was a cross sectional study, meaning a slice in time, it did not tell us whether the chocolate decreased or intensified the depression.”

Golomb and her colleagues examined the relationship of chocolate consumption to mood in an adult study sample of about 1,000 subjects who were not on antidepressant medications and did not have any known cardiovascular disease or diabetes. Participants were asked questions regarding how many servings of chocolate they ate in a week, and were screened using the Center for Epidemiologic Studies Depression Scale (CES-D) to measure mood.

The researchers found that both men and women who had higher depression scores consumed almost 12 servings of chocolate per month, those with lesser depression scores ate about eight servings of chocolate per month, and those with no depression had five servings per month. No differentiation was made between dark and milk chocolate; a medium serving of chocolate was one ounce, which is slightly less than an average chocolate candy bar.

“The findings did not appear to be explained by a general increase in caffeine, fat, carbohydrate or energy intake, suggesting that our findings are specific to chocolate,” said Golomb. There was also no difference in the consumption of other antioxidant-rich foods, such as fish, coffee, fruits and vegetables between those with depression and those without.

Golomb added that future studies will be required to determine the basis of this association, as well as the role of chocolate in depression, as cause or cure.

Additional contributors are Sabrina Koperski, University of California, San Diego, Department of Medicine, and Natalie Rose, University of California, Davis, Department of Obstetrics and Gynecology.

This study was funded by grants from the National Heart, Lung, and Blood Institute and the UCSD General Clinical Research Center.

Source: University of California San Diego Health Sciences

Dr. Ludman’s study included 190 female Group Health patients age 40 to 65 with a body mass index (BMI) of 30 or more: 65 with major depressive disorder and 125 without it. The women had not been seeking treatment, but they enrolled in a one-year behavioral weight loss intervention involving 26 group sessions. The intervention, developed at the University of Minnesota over the past 20 years, has proven at least as good as any other currently available non-medical treatment.

Some previous research had hinted that depression might worsen outcomes in behavioral weight loss programs. That’s why trials of weight loss interventions typically exclude people with major depression.

“We expected women with major depression to lose less weight, attend fewer sessions, eat more calories, and get less exercise than those without depression,” Dr. Ludman said. “We were surprised to find no significant differences between the women who had depression and those who did not have it.” Women had lost around the same amount of weight at 6 months (8 or 9 pounds) and 12 months (7 or 8 pounds), with no significant differences between the groups with and without depression.

“Instead, what made a difference was just showing up,” she said. Women who attended at least 12 sessions lost more weight (14 pounds at 6 months, and 11 pounds at 12 months) than did those who attended fewer sessions (4 pounds at both 6 and 12 months), regardless of whether they had depression. Being depressed didn’t lead them to attend fewer sessions or lose less weight.

“Because of our findings and the well-documented health risks of obesity, we think rigorous efforts should be taken to engage and retain all women in need of such services in intensive weight loss programs,” Dr. Ludman said.

For years, Dr. Ludman and her colleagues have been researching the link between depression and obesity. She is also the coauthor of a self-help workbook called Overcoming Bipolar Disorder: A Comprehensive Workbook for Managing Your Symptoms and Achieving Your Life Goals. Her Harvard coauthors include Mark Bauer, MD. Published in 2008, the book outlines the research-based Life Goals Program to help people live with bipolar disorder.

Dr. Ludman’s co-authors on this study are Group Health psychiatrist Gregory E. Simon, MD, MPH, who is also a senior investigator at Group Health Research Institute; Biostatistician Laura Ichikawa, MS, Project Manager Belinda H. Operskalski, MPH, and Assistant Investigator David Arterburn, MD, MPH of Group Health Research Institute; Jennifer A. Linde, PhD, and Robert W. Jeffery, PhD, of the University of Minnesota School of Public Health in Minneapolis; Paul Rohde, PhD, of the Oregon Research Institute in Eugene; and Emily A. Finch, MA, of Indiana University School of Medicine in Indianapolis.

The National Institute of Mental Health and the Office of Behavioral Social Sciences Research funded this study.

Source:
Joan DeClaire
Group Health Cooperative Center for Health Studies