title: The Combined Effects of Obesity, Abdominal Obesity and Major Depression/Anxiety on Health-Related Quality of Life: the LifeLines Cohort Study.
abstract: BACKGROUND
  Obesity and major depressive disorder (MDD)/anxiety disorders often co-occur and aggravate each other resulting in adverse health-related outcomes. As little is known about the potential effects of interaction between obesity and MDD and/or anxiety disorders on health-related quality of life (HR-QoL), this study was aimed at examining these combined effects.
  
  
  METHODS
  We collected data among N = 89,332 participants from the LifeLines cohort study. We categorized body weight using body mass index (kg/m2) as normal weight (18.5-24.99), overweight (25-29.9), mild obesity (30-34.9) and moderate/severe obesity (≥ 35); we measured abdominal obesity using a waist circumference of ≥102 and ≥ 88 cm for males and females, respectively. MDD and anxiety disorders were diagnosed with the Mini-International Neuropsychiatric Interview. HR-QoL was assessed using the RAND-36 questionnaire to compute physical and mental quality of life scores. We used binary logistic and linear regression analyses.
  
  
  RESULTS
  The combined effect of obesity and MDD and/or anxiety disorders on physical QoL was larger than the sum of their separate effects; regression coefficients, B (95%-confidence interval, 95%-CI) were: - 1.32 (-1.75; -0.90). However, the combined effect of obesity and major depression alone on mental QoL was less than the additive effect. With increasing body weight participants report poorer physical QoL; when they also have MDD and/or anxiety disorders participants report even poorer physical QoL. In persons without MDD and/or anxiety disorders, obesity was associated with a better mental QoL.
  
  
  CONCLUSIONS
  Obesity and MDD and/or anxiety disorders act synergistically on physical and mental QoL. The management of MDD and/or anxiety disorders and weight loss may be important routes to improve HR-QoL.
authors: Department of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
authors: Yeshambel T
authors: YT
authors: Nigatu
authors: Department of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
authors: Sijmen A
authors: SA
authors: Reijneveld
authors: Interdisciplinary Center Psychopathology and Emotion Regulation, Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
authors: Peter
authors: P
authors: de Jonge
authors: Department of Internal Medicine, Erasmus Medical Center, Rotterdam, the Netherlands.
authors: Elisabeth
authors: E
authors: van Rossum
authors: Department of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
authors: Ute
authors: U
authors: Bültmann
mesh_terms: D000293:Adolescent; D000328:Adult; D000886:Anthropometry; D001008:Anxiety Disorders / Q000150:complications* / Q000523:psychology; D015992:Body Mass Index; D001835:Body Weight; D015331:Cohort Studies; D003865:Major Depressive Disorder / Q000150:complications* / Q000523:psychology; D005260:Female; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009426:Netherlands; D009765:Obesity / Q000150:complications* / Q000523:psychology; D056128:Obesity, Abdominal / Q000150:complications*; D016017:Odds Ratio; D017063:Outcome Assessment, Health Care; D011446:Prospective Studies; D011788:Quality of Life; D012044:Regression Analysis; D055815:Young Adult