Is obesity associated with depression in low- and middle-income countries? Longitudinal evidence from Indonesia.

Abstract

Background: In high-income countries, higher body weight is associated with increased risk of depressive symptoms. However, it is unclear whether this relationship applies to low-and-middle-income countries at earlier stages of the epidemiological transition. This study uses longitudinal data to examine the relationship between body weight and depressive symptoms in Indonesia.

Methods: The study employs a longitudinal sample of adolescents aged 14-19 (N = 3360) and adults aged ≥20 (N = 25,669) derived from the 2007 and 2015 Indonesia Family Life Survey. Depressive symptoms were assessed using the Centre for Epidemiologic Studies Depression ten-item scale (CES-D-10). Anthropometric measurements taken by trained nurses were used to calculate overweight/obesity (BMI ≥ 23), our outcome of interest. We use linear random and individual fixed effect models, stratified by gender and age group.

Results: In random effects models, there was no association between overweight and depressive symptoms among adolescents, while overweight was associated with lower depressive symptoms among adults. These results were confirmed in fixed effect models: there was no association for adolescents (-0.32, 95% Confidence Interval [CI] -0.84, 0.21), while among adults, becoming overweight was associated with a significant reduction in depressive symptoms (-0.25, 95% CI -0.43, -0.08). There was no evidence of significant differences by sex.

Conclusions: Contrary to high-income countries, we found no evidence of an association between depressive symptoms and overweight among adolescents in Indonesia, while depressive symptoms are associated with reduced risk of overweight among adults. Findings may be due to lower overweight stigma in Indonesia's socio-cultural environment, potential depressive symptom underestimation, and a moderating role of socioeconomic status. Given the rising overweight burden in Indonesia, our results highlight the need to prioritise policies addressing structural causes rather than individual factors, in order to avoid promoting overweight stigma and safeguard mental health.