IntroductIonSeveral studies have found high rates of depression in populations of clinically overweight and obese people. This relationship has also been found in community studies where a high BMI and depression have been associated. The association between BMI and depressive symptoms has been so frequently reported in various samples that it has been suggested that there might be an intrinsic biological link that predisposes to both of these conditions (1). For instance, similar dysregulations of an array of hormones, neurotransmitters and physiological functions have been found in obesity and depression. Despite this convincing evidence, one cannot exclude other, nonbiological explanations for this association; for instance, depressed individuals may have impaired exercise or dietary habits. But importantly, overweight individuals are stigmatized in most western societies, which might predispose to depression. Most of the studies on the association between overweight and depression have been carried out in western societies, but a study from Hong Kong found that both obese elderly men and women were less likely to suffer from depressive symptoms than were those of normal weight (2).In some societies, a plump body stature may be regarded as a sign of good health, and perhaps of wealth and social status. As mood has been shown to be influenced by social, psychological, and cultural factors (3), it is possible that the association between overweight and depression may vary between societies with differing attitudes toward overweight. The aim of this study was to examine whether the association between obesity and depression found in western societies would also be found in locations where obesity is not stigmatized.
Methods and Procedures ParticipantsSeventy percent of the Bangladeshi population resides in rural areas. This study was part of a large longitudinal epidemiological study on diabetes in rural Bangladesh which has been described previously (4). The only inclusion criteria were: ≥20 years of age, willing to participate, and being able to communicate. The exclusion criteria were: acute or chronic cardiac, renal or hepatic illness, and pregnancy. For the present study, 1,000 individuals were randomly selected from 10 villages in a rural area ~40 km north of Dhaka city (4). Of these, 768 (77%) agreed to participate. In addition, all of the diabetic patients previously identified from the epidemiological screening, 271 individuals, were asked to participate in the assessment of depression; 184 of these (75%) were willing to participate. A total of 952 subjects participated giving a response rate of 75-77%. The study was conducted in 2004.As ~70% of the adult population in Bangladesh is illiterate, verbal consent was obtained from each individual prior to inclusion in the study to avoid selection bias by literacy. The participants were also verbally informed of their right to withdraw from the study at any stage, or to restrict their data from the analysis. After verbal information, The aim of this study wa...