Depressive Symptoms and Weight in Midlife Women: The Role of Stress Eating and Menopause Status

Dana R. Schreiber, MS; Natalie D. Dautovich, PhD

Disclosures

Menopause. 2017;24(10):1190-1199. 

In This Article

Abstract and Introduction

Abstract

Objective: Obesity is prevalent in midlife women and contributes to poor health outcomes. Understanding mechanisms leading to weight gain in this population is of importance for prevention and intervention. The current study investigated the association between depressive symptoms and weight in midlife women by examining stress eating as a mediator between depressive symptoms and weight; and menopause status as a moderator of the associations of depressive symptoms, stress eating, and weight.

Methods: An archival analysis was performed using data from the Midlife in the United States II study. The sample consisted of 815 premenopausal and postmenopausal women. Measures included the Composite International Diagnostic Interview–Short Form, a coping questionnaire, and body mass index.

Results: Moderated mediation analyses were conducted with ordinary least squares path analyses using Hayes' PROCESS macro. Controlling for covariates, depressive symptoms were not directly associated with weight (b = −0.4, 95% confidence interval [CI] −0.4, 0.1). However, stress eating was a significant mediator between depressive symptoms and weight (b = 0.3, 95% CI 0.06, 0.3). The mediation was conditional on menopausal stage (b = 0.2, 95% CI 0.05, 0.4), with depressive symptoms and stress eating significantly associated in postmenopausal, not premenopausal women (b = 0.3, 95% CI 0.2, 0.5).

Conclusions: Both stress eating and menopause status significantly contributed to the depressive symptom—weight association. Psychosocial factors play an important role in the association between depressive symptoms and weight, and the results highlight the need to focus on both behavioral factors, and also menopause status, when identifying who is at risk for the development of poor weight outcomes.

Introduction

Women in midlife are at an increased risk for the development of poor weight outcomes including obesity.[1] Obesity, defined as having a body mass index (BMI) greater than or equal to 30,[2] increases the risk for insulin resistance, which can lead to weight-related diseases such as metabolic syndrome, diabetes, and cardiovascular disease.[3] As of 2014, 40% of women in midlife were classified as overweight or obese.[1] Many factors account for the change in weight status in this age group, one of which is the menopausal transition.[4–6] Given that weight gain during this time period is common and associated with extremely poor health outcomes, it is of importance to investigate mechanisms that contribute to increases in BMI in this population.

Although biological mechanisms such as fluctuating estrogen levels and changes in body fat distribution are commonly associated with weight gain during midlife,[1] psychosocial factors also contribute to increases in BMI during this time. Changes in health status, "empty-nest" adjustment issues, and financial difficulties have all been shown to relate to poor weight outcomes in midlife women populations.[1,7,8] One additional psychological factor that is linked to weight gain in midlife women is depression and depressive symptoms.[9] Depression is prevalent in this population, with the menopausal transition cited as a "window of vulnerability" for the development of depressive symptoms, given changes in hormonal levels and lifestyle factors.[10–12]

Whereas depression leads to poor weight outcomes across many different populations, it is of specific importance to investigate the association in midlife women, given the high prevalence of both conditions in this population.[1,9,13,14] Previous research has shown depression to be related to obesity and higher caloric intake in midlife women.[9] Depression and poor weight outcomes have also been linked to menopause status with women in the menopausal transition (peri and postmenopause) at greater risk for the development of both depression and obesity than women in premenopause.[8] Reasons for this increase in risk is due to the combination of hormonal changes and environmental stress.[8,15]

The co-occurrence of depression and weight gain in midlife women is particularly concerning, given that both conditions are linked to significant economic costs, high rates of disability, and are associated with health issues such as cardiovascular disease, stroke, metabolic syndrome, diabetes, and mental health problems such as anxiety and substance use.[9,16] Consequently, there is a need to investigate underlying mechanisms that connect these conditions to identify both prevention and intervention targets. As depression is commonly linked to increases in caloric intake, one potential mechanism linking depressive symptoms and weight gain is eating behavior. Certain eating behavior, such as stress eating, is related to mood fluctuations and depressive symptomology, and is also recognized as a risk factor for obesity.[17,18] Stress eating, defined as eating in response to stressors and/or negative emotions, involves overconsumption of food and/or consumption of energy-dense food.[19,20] Stress and/or negative emotion can influence appetite by either decreasing or increasing appetite, with a typical response to acute stress and emotion fluctuation (eg, threat to safety) presenting as decreased appetite,[15] and chronic stress and chronic distress (eg, job pressure, financial stress, caregiving responsibility) tending to increase appetite and desire for energy-dense food.[19]

Women in midlife experience significant stress and mood fluctuations, both of which are predictive of poor eating habits and maladaptive coping behavior such as stress eating.[19,21] In addition, the impact of depression, stress, and menopause can serve to exacerbate stress responses and biological processes.[15] For example, depression, menopause, and environmental stress are associated with lowered estrogen levels. Thus, the combination of biological, psychological, and social factors create a hormonal imbalance, which influences maladaptive coping responses including stress eating.[15] Furthermore, decreases in estrogen increases eating in response to emotion and stress.[22] As women in midlife experience fluctuations in estrogen, with the greatest decreases during and after the menopausal transition,[8,21] it is of value to investigate the interconnectedness between depression, menopause status, and stress eating on weight gain in this population. Furthermore, as postmenopausal women are more likely to experience increases in appetite due to depression compared with premenopausal women,[8] it is likely that the interconnectedness between depression, menopause status, and stress eating is relevant to explore in this population. This is especially important given the impact of these factors on subsequent weight gain.

Investigating stress eating as a potential link between depression and weight is relevant in midlife women, given that stress eating is empirically linked to both depression and weight[21,23] and is a common yet relatively unexplored behavior through which depression is linked to weight gain specifically in midlife women. Whereas depression has been linked to greater fast food consumption in midlife, and women have been shown to be more at risk for stress eating and emotional eating when depressed,[18,21] less is known about how stress eating may serve as a mediator between depression and weight in samples of midlife women; and how menopause status may affect the associations between depression, stress eating, and weight. Stress eating is an important factor to examine, given that it is a modifiable behavior to target for obesity prevention and weight loss in this population. Furthermore, understanding the role of menopausal stage in these associations can help to identify subsets of midlife women who may be most at risk for the development of obesity in combination with depression.

Therefore, the current study aims to examine the association between depressive symptoms and weight in midlife women; investigate stress eating as a mediator of the depressive symptom-weight association; and examine the moderating influence of menopause status on this association. We anticipate that that depressive symptom will be associated with higher weight outcomes in the current sample. Building on previous research, identifying a link between depressive symptoms and stress eating,[17,18] we also hypothesize that higher endorsement of depressive symptoms will be associated with greater endorsement of stress eating and thus higher weight outcomes. Given previous work that has demonstrated that postmenopausal women are more likely to endorse depressive symptoms and more likely to have higher BMI than women in premenopause,[8] we anticipate menopause status to be a moderator of the associations between depressive symptoms and weight, depressive symptoms and stress eating, and stress eating and weight. We anticipate that postmenopause status will exacerbate the depressive symptom-weight, depressive symptoms-stress eating, and stress eating-weight associations.

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