NCHS Data Brief ■ No. 167 ■ October 2014

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Disease Control and Prevention

National Center for Health Statistics

Depression and Obesity in the U.S. Adult Household 

Population, 2005–2010

Laura A. Pratt, Ph.D.; and Debra J. Brody, M.P.H.

Key findings

Data from the National 

Health and Nutrition 

Examination Surveys, 

2005–2010

• Forty-three percent of adults

with depression were obese, 

and adults with depression were 

more likely to be obese than 

adults without depression.

• In every age group, women

with depression were more 

likely to be obese than women 

without depression.

• The prevalence of obesity

was higher for non-Hispanic 

white women with depression 

compared with non-Hispanic 

white women without 

depression, a relationship 

that was not present in nonHispanic black and MexicanAmerican women.

• The proportion of adults

with obesity rose as the severity 

of depressive symptoms 

increased. 

• Fifty-five percent of adults

who were taking antidepressant 

medication, but still reported 

moderate to severe depressive 

symptoms, were obese.

In 2005–2010, 34.6% of U.S. adults aged 20 and over were obese and 7.2% 

had depression, based on depressive symptoms experienced in the past 

2 weeks (1). Both obesity and depression are associated with many health 

risks, including cardiovascular disease, diabetes, and functional limitations 

(2–4). Studies have shown higher rates of obesity in persons with depression 

(5,6). This relationship may vary by sex (7). Almost 11% of adults take 

antidepressant medication (8) including persons who are responding well and 

persons who still have moderate to severe symptoms of depression. Use of 

some antidepressants is positively related to obesity (9). Understanding the 

relationship between depression (defined by moderate to severe symptoms) 

and antidepressant usage and obesity may inform treatment and prevention 

strategies for both conditions.

Keywords: NHANES • depressive symptoms • obese adults

Adults with depression were more likely to be obese than 

adults without depression.

No depression

Figure 1. Age-adjusted percentage of adults aged 20 and over who were obese, by sex and 

depression status: United States, 2005–2010

1

Significantly different from no depression.

2

Significantly different from women.

NOTES: Estimates were age-adjusted by the direct method to the 2000 U.S. census population using the age groups 20–39, 

40–59, and 60 and over. Depression is defined as moderate to severe depressive symptoms. Access data table for Figure 1 at: 

http://www.cdc.gov/nchs/data/databriefs/db167_table.pdf#1.

SOURCE: CDC/NCHS, National Health and Nutrition Examination Survey, 2005–2010. Percent

Depression

0

10

20

30

40

50

Total Men Women

1

43.2

33.0

2

36.8

32.6

1

46.7

33.4
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• Forty-three percent of adults with depression were obese, while 33% of adults without 

depression were obese (Figure 1).

• Among men, rates of obesity did not differ by depression status.

• Women with depression were more likely to be obese than women without depression.

• Among persons with depression, women were more likely to be obese than men.

In every age group, women with depression were more likely to be obese 

than women without depression.

• Men aged 60 and over with depression were more likely to be obese than men of the same 

age without depression, but obesity rates did not differ by depression status for men under 

age 60 (Figure 2).

• Among men with depression, those aged 60 and over were more likely to be obese than 

those aged 20–39. Obesity did not vary by age among women with depression.

• Among men and women without depression, younger adults aged 20–39 were less likely to 

be obese than those aged 40 and over.

Percent

Figure 2. Percentage of adults aged 20 and over who were obese, by age, sex, and depression status: United States, 

2005–2010

1

Significantly lower than ages 40–59.

2

Significantly lower than ages 60 and over.

3

Significantly different from no depression.

NOTES: Depression is defined as moderate to severe depressive symptoms. Access data table for Figure 2 at: http://www.cdc.gov/nchs/data/databriefs/

db167_table.pdf#2.

SOURCE: CDC/NCHS, National Health and Nutrition Examination Survey, 2005–2010.

0

10

20

30

40

50

60 Depression No depression

40–59 60 and over 20–39 40–59 60 and over

Men Women

20–39

1

30.9 1,229.4

41.9

36.9

3

46.6

35.1

3

45.3

1,230.0

3

49.2

37.6

3

46.6

36.6
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The relationship between obesity and depression varied by race and 

ethnicity only among women.

• Forty-five percent of non-Hispanic white women with depression were obese, while 32% of 

non-Hispanic white women who did not have depression were obese (Figure 3).

• Among non-Hispanic black and Mexican-American men and women, rates of obesity did 

not differ by depression status.

Figure 3. Age-adjusted percentage of adults aged 20 and over who were obese, by sex, race/ethnicity, and depression 

status: United States, 2005–2010

1

Significantly different from no depression.

NOTES: Estimates were age-adjusted by the direct method to the 2000 U.S. census population using the age groups 20–39, 40–59, and 60 and over. Depression 

is defined as moderate to severe depressive symptoms. Access data table for Figure 3 at: http://www.cdc.gov/nchs/ data/databriefs/db167_table.pdf#3.

SOURCE: CDC/NCHS, National Health and Nutrition Examination Survey, 2005–2010.

Depression No depression

Percent

0

10

20

30

40

50

60

NonHispanic

 white

NonHispanic

black

MexicanAmericanNonHispanic 

white

NonHispanic

black

MexicanAmerican

39.0

32.9

40.5

37.4 38.2

33.4

46.6

43.1

55.6

53.8

1

45.2

31.6

Men Women

The age-adjusted percentage of adults who were obese increased as 

depression severity increased.

• Obesity was related to depression severity only among women (Figure 4).

• One-half of women with severe depressive symptoms were obese compared with one-third 

of women with no depressive symptoms.

• Women at any level of depressive symptom severity were more likely to be obese than 

women with no depressive symptoms.
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Percent

Figure 4. Age-adjusted percentage of adults aged 20 and over who were obese, by sex and depression severity: 

United States, 2005–2010

1

Statistically significant trend.

2

Significantly different than other severity categories.

NOTES: Estimates were age-adjusted by the direct method to the 2000 U.S. census population using the age groups 20–39, 40–59, and 60 and over. Moderate 

and severe indicate depression, while mild indicates mild depressive symptoms, which are not included in the definition of depression. Access data table for 

Figure 4 at: http://www.cdc.gov/nchs/data/databriefs/db167_table.pdf#4.

SOURCE: CDC/NCHS, National Health and Nutrition Examination Survey, 2005–2010.

Severe

0

10

20

30

40

50

60 Moderate Mild None

Total Men Women

1

47.0

42.7

39.8

2

32.8

39.8

38.1

36.5

33.0

1

50.0

45.6

42.4

2

32.5

More than one-half of adults with moderate to severe depressive symptoms 

who were also taking antidepressant medication were obese.

• Among adults who took antidepressant medication, of those with moderate or severe 

depressive symptoms, 55% were obese while 38% with mild or no depressive symptoms 

were obese (Figure 5).

• Among adults not taking antidepressant medication, 39% of adults with moderate or severe 

depressive symptoms were obese compared with 33% of adults with mild or no depressive 

symptoms.

• Adults who took antidepressant medication were more likely to be obese than those not 

taking antidepressants both among adults with moderate to severe depressive symptoms and 

adults with mild or no depressive symptoms.
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Percent

Figure 5. Age-adjusted percentage of adults aged 20 and over who were obese, by depressive symptoms and use of 

antidepressants: United States, 2005–2010

1

Significantly different from mild or no depressive symptoms.

2

Significantly different from no antidepressants.

NOTES: Estimates were age-adjusted by the direct method to the 2000 U.S. census population using the age groups 20–39, 40–59, and 60 and over. Moderate to 

severe depressive symptoms indicate depression, while mild or no depressive symptoms indicate no depression. Access data table for Figure 5 at: http://www.cdc.

gov/nchs/data/databriefs/db167_table.pdf#5.

SOURCE: CDC/NCHS, National Health and Nutrition Examination Survey, 2005–2010.

Mild or no depressive

symptoms

Moderate to severe 

depressive symptoms

Antidepressants No antidepressants

0

10

20

30

40

50

60

2

38.2

1,254.6

1

39.4

33.3

Summary

Forty-three percent of adults with depression were obese as compared with 33% of adults 

without depression. Women with depression were more likely to be obese than women without 

depression. The relationship was consistent across all age groups among women and was also 

seen in men aged 60 and over. Non-Hispanic white women with depression were more likely to 

be obese than non-Hispanic white women without depression. This relationship was not seen in 

non-Hispanic black or Hispanic women or among men of any racial or ethnic background. As the 

severity of depression increased, the percentage of all adults and of women with obesity increased 

as well.

Both moderate to severe depressive symptoms and antidepressant use were associated with 

increased obesity. Moderate to severe depressive symptoms were associated with a higher rate of 

obesity both in persons who were taking antidepressant medication and those who were not, and 

antidepressant use was associated with a higher rate of obesity in persons with moderate to severe 

depressive symptoms and those with mild or no depressive symptoms. Of the four categories, 

the highest prevalence of obesity (54.6%) was found in persons who had moderate or severe 

depressive symptoms and took antidepressant medication.

In this study, it is not clear whether depression or obesity occurred first because they were both 

measured at the same time. Other studies have shown a bidirectional relationship, meaning 

obesity increases risk of depression and depression increases risk of obesity (10). Knowledge 
NCHS Data Brief ■ No. 167 ■ October 2014

■  6  ■

of these risks may help general medical practitioners and mental health professionals plan 

prevention and treatment.

Definitions

Obesity: Body mass index (BMI) is calculated as weight in kilograms divided by height in meters 

squared. Obesity in adults is defined as BMI greater than or equal to 30. 

Depression: Measured using the Patient Health Questionnaire (PHQ–9), a 9-item instrument that 

asks questions about the frequency of symptoms of depression over the past 2 weeks (11). In the 

PHQ–9, response categories “not at all,” “several days,” “more than half the days,” and “nearly 

every day” are given a score ranging from 0 (not at all) to 3 (nearly every day). A total score 

is calculated ranging from 0 to 27. Depression was defined as a PHQ–9 score of 10 or higher, 

a cut point that has been well validated and is commonly used in clinical studies that measure 

depression (11). No depression was defined as a PHQ–9 score of 0–9. 

PHQ–9 is based on the diagnostic criteria for major depressive disorder in the Diagnostic 

and Statistical Manual of Mental Disorders, Fourth Edition. Major depression includes mood 

symptoms such as feelings of sadness or irritability; loss of interest in usual activities; inability 

to experience pleasure; feelings of guilt or worthlessness; and thoughts of death or suicide; 

cognitive symptoms such as inability to concentrate and difficulty making decisions; and physical 

symptoms such as fatigue, lack of energy, feeling restless or slowed down, and changes in sleep, 

appetite, and activity levels (12).

Depression severity: Refers to the severity of depressive symptoms. The following four severity 

categories were defined based on the total score from the PHQ–9 (13): None or minimal (0–4), 

Mild (5–9), Moderate (10–14), and Severe (15 or more).

These depression severity categories are used in Figures 4 and 5. In Figures 1–3, none or minimal 

and mild depressive symptoms (PHQ–9 scores of 0–9) correspond to “no depression,” while 

moderate and severe depressive symptoms (scores of 10 or more) correspond to “depression.” 

Persons who have been diagnosed with depression, but who are not experiencing moderate or 

severe symptoms due to medication use or other factors, are not defined as having depression in 

this analysis.

Antidepressant medication: Prescription drugs were classified based on the three-level nested 

therapeutic classification scheme of Cerner Multum’s Lexicon (13). Antidepressants were 

identified using the second level of drug categorical codes, specifically code 249.

Data sources and methods

NHANES is a continuous survey conducted to assess the health and nutrition of the 

American people. The survey is designed to be nationally representative of the U.S. civilian 

noninstitutionalized population. Survey participants complete a household interview and visit a 

mobile examination center (MEC) for a physical examination and private interview. 

During the household interview, survey participants were asked if they had taken a prescription 

drug in the past month. Those who answered “yes” were asked to show the interviewer the 
NCHS Data Brief ■ No. 167 ■ October 2014

■  7  ■

medication containers of all prescription drugs. Height and weight, used to calculate BMI, were 

measured during the MEC physical examination. The questions on depression were asked in the 

private interview in the MEC.

NHANES sample examination weights, which account for the differential probabilities of 

selection, nonresponse, and noncoverage, were used for all analyses. Standard errors of the 

percentages were estimated using Taylor series linearization, a method that incorporates the 

sample design and weights.

Prevalence estimates for the total adult population were age-adjusted using the direct method to 

the 2000 U.S. census population using the age groups 20–39, 40–59, and 60 and over. Differences 

between groups were tested using a univariate t statistic at the p < 0.05 significance level. All 

differences reported are statistically significant unless otherwise indicated. No adjustments were 

made for multiple comparisons. A test for trends was done to evaluate changes in the estimates 

by depression severity (Figure 3). Statistical analyses were conducted using the SAS system 

for Windows, release 9.3 (SAS Institute Inc., Cary, N.C.) and SUDAAN, release 10.0 (RTI 

International, Research Triangle Park, N.C.). 

About the authors

Laura A. Pratt is with CDC’s National Center for Health Statistics, Office of Analysis and 

Epidemiology. Debra J. Brody is with CDC’s National Center for Health Statistics, Division of 

Health and Nutrition Examination Surveys.

References

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NCHS Data Brief ■ No. 167 ■ October 2014

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8. Pratt LA, Brody DJ, Gu Q. Antidepressant use in persons aged 12 and

over: United States, 2005–2008. NCHS data brief, no 76. Hyattsville, MD: 

National Center for Health Statistics. 2011.

9. Aronne LJ, Segal KR. Weight gain in the treatment of mood disorders.

J Clin Psychiatry 64(Suppl 8):22–9. 2003.

10. Luppino FS, de Wit LM, Bouvy PF, Stijnen T, Cuijpers P, Penninx BW,

Zitman FG. Overweight, obesity, and depression: A systematic review and 

meta-analysis of longitudinal studies. Arch Gen Psychiatry 67(3):220–9. 

2010.

11. Kroenke K, Spitzer RL, Williams JB. The PHQ-9: Validity of a brief

depression severity measure. J Gen Intern Med 16(9):606–13. 2001.

12. American Psychiatric Association. Diagnostic and Statistical Manual of

Mental Disorders. Fourth Edition. Washington, DC: American Psychiatric 

Association. 2000.

13. Multum Lexicon database. In: National Health and Nutrition

Examination Survey: 1988–2010 data documentation, codebook, and 

frequencies. 2012. Available from: http://www.cdc.gov/nchs/nhanes/

nhanes1999-2000/RXQ_DRUG.htm.

Suggested citation

Pratt LA, Brody DJ. Depression and obesity 

in the U.S. adult household population, 

2005–2010. NCHS data brief, no 167. 

Hyattsville, MD: National Center for Health 

Statistics. 2014.

Copyright information

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the public domain and may be reproduced 

or copied without permission; citation as to 

source, however, is appreciated.

National Center for Health 

Statistics

Charles J. Rothwell, M.S., M.B.A., Director

Jennifer H. Madans, Ph.D., Associate 

Director for Science

Office of Analysis and Epidemiology

Irma E. Arispe, Ph.D., Director

Division of Health and Nutrition

 Examination Surveys

Kathryn S. Porter, M.D., M.S., Director

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