Association of Depressive Symptoms and Anti-Depressants with Body Mass Index and Waist Circumference in Elderly Men and Women: The ARIC Carotid MRI Study

Sherita Hill Golden1, 2, *, Hui-Chun Hsu2, Brad C. Astor4, Saurabh Malhotra5, Gary Wand1, Bruce A. Wasserman3
1 Departments of Medicine, Johns Hopkins University, Baltimore, MD
2 Epidemiology, Johns Hopkins University, Baltimore, MD
3 Radiology, Johns Hopkins University, Baltimore, MD
4 Epidemiology, University of Wisconsin School of Medicine and Public Health
5 Department of Medicine, Indiana University School of Medicine, USA

© 2013 Golden et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Johns Hopkins University School of Medicine, Division of Endocrinology and Metabolism, 1830 E. Monument Street, Suite 333, Baltimore, MD 21287; Tel: (410) 502-0993; Fax: (410) 955-8172; E-mail:



Depressive symptoms are associated with obesity, a precursor to type 2 diabetes and cardiovascular disease, and might in part explain the association of depressive symptoms with adverse metabolic outcomes. We determined the cross-sectional association between depressive symptoms and body mass index (BMI) and waist circumference (WC) in 1,314 elderly men and women age 60 to 83 years in the Atherosclerosis Risk in Communities (ARIC) Carotid MRI Study.


Depressive symptoms were assessed using the Center for Epidemiological Studies Depression (CES-D) Scale. Elevated depressive symptoms were defined as CES-D score !16 and/or anti-depressant medication use. CES-D score was also modeled continuously.


In unadjusted analyses, each 5-point higher CES-D score was associated with a 0.48 kg/m2 higher BMI (95% CI: 0.24 to 0.69) and a 1.23 cm higher WC (95% CI: 0.67 to 1.82). Adjustment for potential confounders, including physical activity, attenuated the associations with BMI (0.16 kg/m2; 95% CI: -0.07 to 0.39) and WC (0.45 cm; 95% CI: -0.11 to 1.01). Compared to individuals without elevated depressive symptoms, those with elevated symptoms had significantly greater BMI (0.99 kg/m2; 95% CI: 0.07 to 1.90) and WC (3.22 cm; 95% CI: 1.04 to 5.40), even after multivariable adjustment. In a subsidiary analysis, compared to individuals not taking anti-depressants, those taking anti-depressants had significantly higher waist circumference (1.54 cm; 95% CI: 0.18 to 2.90) and BMI (4.23 kg/m2; 95% CI: 0.90 to 7.55) following multivariable adjustment. All results were similar when individuals with diabetes and coronary heart disease were excluded and when waist to height ratio was used an alternative measure of body fat.


We found a significant cross-sectional association between depressive symptoms and BMI and WC in elderly individuals that was partially explained by health behaviors, particularly physical activity.

Keywords: Depressive symptoms, Waist circumference, Body mass index, Elderly.