Central or overall obesity: which one is a better predictor of depressive symptoms in children, adolescents, and youths?

  • Samad EsmaeilzadehEmail author
  • Reza Farzizadeh
  • Hassan-Ali Kalantari
  • Asghar Mahmoudi
  • Omid Yousefi Bilehsavar
  • Ali Mehranpour
Original Article


Background and purpose

Despite the strong effect of central obesity on individuals’ physical health outcomes, there is little evidence underlying the relationship between central obesity and mental disorders such as depression, especially in children, adolescents, and youths of the developing countries. This study explores the relationship between depressive symptoms (DS) with central and overall obesity in a sample of Iranian children, adolescents, and youths.


One thousand and fifty-two male participants ranging from 7 to 24 years old underwent standard anthropometry, and filled the DS questionnaire.


Having controlled the potential confounders (e.g., age, socioeconomic status, pubertal maturation status, and physical activity), we found waist circumference (WC) significantly related to DS in the children (standardized β = 0.14; P < 0.05) and adolescents (standardized β = 0.13; P < 0.05). No significant relationship was observed between WC and DS in the youths (standardized β = 0.09; P = 0.22). In addition, no significant relationship was observed between DS and the percentage of fat in the sampled children (standardized β = 0.085; P = 0.13), adolescents (standardized β = 0.10; P = 0.10), and youths (standardized β = −0.02; P = 0.75).


Central obesity (but not overall obesity) was a significant predictor of DS in the children and adolescents (7–18 years). However, DS in the youths (19–24 years) were not significantly associated with both the central and overall body obesity indices.


Adolescents Children Depressive symptoms Fat percentage Physical activity Waist circumference 



Beck Depression Inventory-II


Body mass index


Children’s Depression Inventory


Depressive symptoms


Physical activity


PA Questionnaire-Children


PA Questionnaire-Adolescents


Pubertal maturation status


Socioeconomic status


Waist circumference


Compliance with ethical standards

Conflict of interest

The authors declare no conflict of interest.

Informed consent

Informed consent was obtained from all individual participants included in the study.


No funding was received for performing the present study.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the Human Ethics Committee of Ardabil Department of Education and University of Mohaghegh Ardabili and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.


  1. 1.
    Flegal KM, Carroll MD, Ogden CL, Curtin LR (2010) Prevalence and trends in obesity among US adults, 1999–2008. JAMA 303:235–241. doi: 10.1001/jama.2009.2014 CrossRefPubMedGoogle Scholar
  2. 2.
    Freedman DS, Goodman A, Contreras OA et al (2012) Secular trends in BMI and blood pressure among children and adolescents: the Bogalusa heart study. Pediatrics 130:e159–e166. doi: 10.1542/peds.2011-3302 CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Sanders RH, Han A, Baker JS, Cobley S (2015) Childhood obesity and its physical and psychological co-morbidities: a systematic review of Australian children and adolescents. Eur J Pediatr 174:715–746. doi: 10.1007/s00431-015-2551-3 CrossRefPubMedGoogle Scholar
  4. 4.
    Esmaeilzadeh S (2014) Relationship between depressive symptoms with physical activity and physical fitness among children. Ment Health Prev 2:11–17. doi: 10.1016/j.mhp.2014.05.002 CrossRefGoogle Scholar
  5. 5.
    Esmaeilzadeh S (2015) The association between depressive symptoms and physical status including physical activity, aerobic and muscular fitness tests in children. Environ Health Prev Med 20:434–440. doi: 10.1007/s12199-015-0484-0 CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Nicklas BJ, Penninx BWJH, Cesari M et al (2004) Association of visceral adipose tissue with incident myocardial infarction in older men and women: the health, aging and body composition study. Am J Epidemiol 160:741–749. doi: 10.1093/aje/kwh281 CrossRefGoogle Scholar
  7. 7.
    Ohlson LO, Larsson B, Svardsudd K et al (1985) The influence of body fat distribution on the incidence of diabetes mellitus. 13.5 years of follow-up of the participants in the study of men born in 1913. Diabetes 34:1055–1058. doi: 10.2337/diab.34.10.1055 CrossRefGoogle Scholar
  8. 8.
    Rexrode KM, Carey VJ, Hennekens CH et al (1998) Abdominal adiposity and coronary heart disease in women. JAMA 280:1843–1848. doi: 10.1001/jama.280.21.1843 CrossRefGoogle Scholar
  9. 9.
    Rivenes AC, Harvey SB, Mykletun A (2009) The relationship between abdominal fat, obesity, and common mental disorders: results from the HUNT study. J Psychosom Res 66:269–275. doi: 10.1016/j.jpsychores.2008.07.012 CrossRefPubMedGoogle Scholar
  10. 10.
    Ting WH, Huang CY, Tu YK, Chien KL (2012) Association between weight status and depressive symptoms in adolescents: role of weight perception, weight concern, and dietary restraint. Eur J Pediatr 171:1247–1255. doi: 10.1007/s00431-012-1753-1 CrossRefPubMedGoogle Scholar
  11. 11.
    Xu Q, Anderson D, Lurie-Beck J (2011) The relationship between abdominal obesity and depression in the general population: a systematic review and meta-analysis. Obes Res Clin Pract 5:e267–e278. doi: 10.1016/j.orcp.2011.04.007 CrossRefPubMedGoogle Scholar
  12. 12.
    Moussavi S, Chatterji S, Verdes E et al (2007) Depression, chronic diseases, and decrements in health: results from the world health surveys. Lancet 370:851–858. doi: 10.1016/S0140-6736(07)61415-9 CrossRefPubMedGoogle Scholar
  13. 13.
    Hach I, Ruhl UE, Klose M et al (2007) Obesity and the risk for mental disorders in a representative German adult sample. Eur J Public Health 17:297–305CrossRefGoogle Scholar
  14. 14.
    Herva A, Laitinen J, Miettunen J (2006) Obesity and depression: results from the longitudinal Northern Finland 1966 birth cohort study. Int J Obes (Lond) 30:520–527. doi: 10.1038/sj.ijo.0803174 CrossRefGoogle Scholar
  15. 15.
    Pagoto SL, Ma Y, Bodenlos JS et al (2009) Association of depressive symptoms and lifestyle behaviors among Latinos at risk of type 2 diabetes. J Am Diet Assoc 109:1246–1250. doi: 10.1016/j.jada.2009.04.010 CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Turley M, Tobias M, Paul S (2006) Non-fatal disease burden associated with excess body mass index and waist circumference in New Zealand adults. Aust N Z J Public Health 30:231–237. doi: 10.1111/j.1467-842X.2006.tb00863.x CrossRefPubMedGoogle Scholar
  17. 17.
    Ho RC, Niti M, Kua EH, Ng TP (2008) Body mass index, waist circumference, waist-hip ratio and depressive symptoms in Chinese elderly: a population-based study. Int J Geriatr Psychiatry 23:401–408CrossRefGoogle Scholar
  18. 18.
    Ahlberg AC, Ljung T, Rosmond R et al (2002) Depression and anxiety symptoms in relation to anthropometry and metabolism in men. Psychiatry Res 112:101–110. doi: 10.1016/S0165-1781(02)00192-0 CrossRefPubMedGoogle Scholar
  19. 19.
    Everson-Rose SA, Lewis TT, Karavolos K et al (2009) Depressive symptoms and increased visceral fat in middle-aged women. Psychosom Med 71:410–416. doi: 10.1097/PSY.0b013e3181a20c9c CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Nooyens AC, Koppes LL, Visscher TL et al (2007) Adolescent skinfold thickness is a better predictor of high body fatness in adults than is body mass index: the Amsterdam growth and health longitudinal study. Am J Clin Nutr 85:1533–1539CrossRefGoogle Scholar
  21. 21.
    Sarrıa A, Garcı a-Llop LA, Moreno LA et al (1998) Skinfold thickness measurements are better predictors of body fat percentage than body mass index in male Spanish children and adolescents. Eur J Clin Nutr 52:573–576CrossRefGoogle Scholar
  22. 22.
    Kalantari HA, Esmaeilzadeh S (2016) Association between academic achievement and physical status including physical activity, aerobic and muscular fitness tests in adolescent boys. Environ Health Prev Med 21:27–33. doi: 10.1007/s12199-015-0495-x CrossRefPubMedGoogle Scholar
  23. 23.
    Esmaeilzadeh S (2014) Reaction time: does it relate to weight status in children? HOMO-J Compar Hum Biol 65:171–178. doi: 10.1016/j.jchb.2013.09.007 CrossRefGoogle Scholar
  24. 24.
    Moradi A, Esmaeilzadeh S (2015) Association between reaction time, speed and agility in schoolboys. Sport Sci Health 11:251–256. doi: 10.1007/s11332-015-0230-4 CrossRefGoogle Scholar
  25. 25.
    Esmaeilzadeh S, Kalantari HA (2013) Physical fitness, physical activity, sedentary behavior and academic performance among adolescent boys in different weight statuses. Mediterr J Nutr Metab 6:207–216. doi: 10.1007/s12349-013-0133-3 CrossRefGoogle Scholar
  26. 26.
    Slaughter MH, Lohman TG, Boileau RA et al (1988) Skinfold equations for estimation of body fatness in children and youth. Hum Biol 60:709–723Google Scholar
  27. 27.
    Jackson AS, Pollock ML (1978) Generalized equations for prediction body density of men. Br J Nutr 40:497–504CrossRefGoogle Scholar
  28. 28.
    Chumlea NC, Kuczmarski RJ (1995) Using a bony landmark to measure waist circumference. J Am Diet Assoc 95:12CrossRefGoogle Scholar
  29. 29.
    Kovacs M (1992) Manual for the children’s depression inventory (CDI). Multihealth System, NortonGoogle Scholar
  30. 30.
    Al-Balhan EM (2006) The children’s depression inventory as a reliable measure for post—Iraqi invasion Kuwaiti Youth. Soc Behav Pers 34:351–355CrossRefGoogle Scholar
  31. 31.
    Dehshiri GH, Najafi M, Sheykh M, Habibi A (2009) Investigating primary psychometric properties of children’s depression inventory (CDI). J Family Res 5:159–177 (Persian) Google Scholar
  32. 32.
    Beck AT, Steer RA, Brown GK, Lindfors J (2006) BDI-II: beck depression inventory: manual, svensk version. Stockholm, PsykologiförlagetGoogle Scholar
  33. 33.
    Ghassemzadeh H, Mojtabai R, Karamghadiri N, Ebrahimkhani N (2005) Psychometric properties of a Persian-language version of the Beck depression inventory-second edition: BDI-II-PERSIAN. Depression Anxiety 21:185–192CrossRefGoogle Scholar
  34. 34.
    Tanner JM, Whitehouse RH (1976) Clinical longitudinal standards for height, weight, height velocity and stages of puberty. Arch Dis Child 51:170–179CrossRefGoogle Scholar
  35. 35.
    Kowalski KC, Crocker PRE, Faulkner RA (1997) Validation of the physical activity questionnaire for older children. Pediatr Exerc Sci 9:174–186CrossRefGoogle Scholar
  36. 36.
    Kowalski KC, Crocker PRE, Kowalski NP (1997) Convergent validity of the physical activity questionnaire for adolescents. Pediatr Exerc Sci 9:342–352CrossRefGoogle Scholar
  37. 37.
    Crocker PRE, Bailey DA, Faukner RA (1997) Measuring general levels of physical activity: preliminary evidence for the physical activity questionnaire for older children. Med Sci Sports Exerc 29:1344–1349CrossRefGoogle Scholar
  38. 38.
    Janz KF, Lutuchy EM, Wenthe P, Levy SM (2008) Measuring activity in children and adolescents using self-report: PAQ-C and PAQ-A. Med Sci Sports Exerc 40:767–772. doi: 10.1249/MSS.0b013e3181620ed1 CrossRefPubMedGoogle Scholar
  39. 39.
    Baecke J, Burema J, Frijters J (1982) A short questionnaire for the measurement of habitual physical activity in epidemiological studies. Am J Clin Nutr 36:936–942CrossRefGoogle Scholar
  40. 40.
    Pereira MA, Fitzergerald SJ, Gregg EW et al (1997) A collection of physical activity questionnaires for health-related research. Med Sci Sports Exerc 29:S1–S205CrossRefGoogle Scholar
  41. 41.
    Westerterp KR (1999) Assessment of physical activity level in relation to obesity: current evidence and research issues. Med Sci Sports Exerc 31:S522–S525CrossRefGoogle Scholar
  42. 42.
    Zhao G, Ford ES, Li C et al (2011) Waist circumference, abdominal obesity, and depression among overweight and obese U.S. adults: national health and nutrition examination survey 2005–2006. BMC Psychiatry 11:130. doi: 10.1186/1471-244X-11-130 CrossRefPubMedPubMedCentralGoogle Scholar
  43. 43.
    Hach I, Ruhl UE, Klotsche J et al (2006) Associations between waist circumference and depressive disorders. J Affect Disord 92:305–308. doi: 10.1016/j.jad.2006.01.023 CrossRefPubMedGoogle Scholar
  44. 44.
    Vogelzangs N, Kritchevsky SB, Beekman AT et al (2008) Depressive symptoms and change in abdominal obesity among older persons. Arch Gen Psychiatry 65:1386–1393. doi: 10.1001/archpsyc.65.12.1386 CrossRefPubMedPubMedCentralGoogle Scholar
  45. 45.
    Chrousos GP, Gold PW (1992) The concepts of stress and stress system disorders. Overview of physical and behavioral homeostasis. JAMA 267:1244–1252. doi: 10.1001/jama.1992.03480090092034 CrossRefGoogle Scholar
  46. 46.
    Deuschle M, Weber B, Colla M et al (1998) Effects of major depression, aging and gender upon calculated diurnal free plasma cortisol concentrations: a re-evaluation study. Stress 2:281–287. doi: 10.3109/10253899809167292 CrossRefPubMedGoogle Scholar
  47. 47.
    Bronnegard M, Arner P, Hellstrom L et al (1990) Glucocorticoid receptor messenger ribonucleic acid in different regions of human adipose tissue. Endocrinology 127:1689–1696CrossRefGoogle Scholar
  48. 48.
    Bjorntorp P, Rosmond R (2000) Neuroendocrine abnormalities in visceral obesity. Int J Obes Relat Metab Disord 24(Suppl 2):S80–S85CrossRefGoogle Scholar
  49. 49.
    Penninx BW, Kritchevsky SB, Yaffe K et al (2003) Inflammatory markers and depressed mood in older persons: results from the health, aging and body composition study. Biol Psychiatry 54:566–572. doi: 10.1016/S0006-3223(02)01811-5 CrossRefPubMedGoogle Scholar
  50. 50.
    Kyrou I, Chrousos GP, Tsigos C (2006) Stress, visceral obesity, and metabolic complications. Ann N Y Acad Sci 1083:77–110. doi: 10.1196/annals.1367.008 CrossRefPubMedGoogle Scholar
  51. 51.
    Gold PW, Chrousos GP (2002) Organization of the stress system and its dysregulation in melancholic and atypical depression: high vs low CRH/NE states. Mol Psychiatry 7:254–275. doi: 10.1038/mp.2014.163 CrossRefPubMedGoogle Scholar
  52. 52.
    Jonsdottir IH, Rodjer L, Hadzibajramovic E et al (2010) A prospective study of leisure-time physical activity and mental health in Swedish health care workers and social insurance officers. Prev Med 51:373–377. doi: 10.1016/j.ypmed.2010.07.019 CrossRefPubMedGoogle Scholar
  53. 53.
    Brown HE, Pearson N, Braithwaite RE (2013) physical activity interventions and depression in children and adolescents. Sports Med 43:195–206. doi: 10.1007/s40279-012-0015-8 CrossRefPubMedGoogle Scholar
  54. 54.
    Birkeland MS, Torsheim T, Wold B (2009) A longitudinal study of the relationship between leisure-time physical activity and depressed mood among adolescents. Psychol Sport Exer 10:25–34. doi: 10.1016/j.psychsport.2008.01.005 CrossRefGoogle Scholar
  55. 55.
    Biddle SJH, Asare M (2011) Physical activity and mental health in children and adolescents: a review of reviews. Br J Sport Med 45:886–895. doi: 10.1136/bjsports-2011-090185 CrossRefGoogle Scholar
  56. 56.
    Janssen I, LeBlanc AG (2010) Review Systematic review of the health benefits of physical activity and fitness in school-aged children and youth. Int J Behav Nutr Phys Act 7:40. doi: 10.1186/1479-5868-7-40 CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  • Samad Esmaeilzadeh
    • 1
    Email author
  • Reza Farzizadeh
    • 1
  • Hassan-Ali Kalantari
    • 1
  • Asghar Mahmoudi
    • 1
  • Omid Yousefi Bilehsavar
    • 1
  • Ali Mehranpour
    • 2
  1. 1.Department of Physical Education and Exercise ScienceUniversity of Mohaghegh ArdabiliArdabilIran
  2. 2.Department of PsychologyAzad University of ArdabilArdabilIran

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