Background: Overweight/obesity—a national epidemic affecting more than 70% of U.S. adults—is defined as Body Mass Index (BMI) ≥ 25kg/m2. It is associated with hypertension, diabetes, and cardiovascular disease. Overweight/obesity may be associated with depression which has been linked to poor health behaviors. The prevalence of overweight/obesity is disproportionally high among U.S. Blacks However, limited information is known about differences in the relationship between overweight/obesity and depression among Black U.S. born and foreign-born adults. We hypothesized that BMI would be associated with depression among a sample of Black adults in the U.S., and nativity would be an effect modifier of this association.
Methods: We analyzed data on Black adults who participated in the 2009-2014 National Health and Nutrition Examination Surveys. The main predictor variable was depression on the Patient Health Questionnaire (PHQ-9). The main outcome variable was BMI. Linear regressions were performed to examine the relationship between BMI and depression adjusting for known confounders. Results were stratified by nativity (i.e., U.S. born versus foreign-born).
Results: A total of 1,974 Black adults were included in this study. The mean age (±SD) was 46.8 (±17.9), nearly half (49.2%; n=972) were female, and 13.7% (n=270) identified as foreign-born. Overall, 79.8% (n=1360) of U.S. born and 83.1% (n-226) of U.S. foreign-born were overweight/obese. Additionally, 10.6% (n= 180) U.S. born and 6.7% (n=18) of foreign-born adults met criteria for mild, moderate, and moderately severe depression. After adjusting for age, sex, household income, and level of education, depression was a significant predictor of BMI among Black U.S. born and foreign-born adults (F (5, 1816) = 22.851, p<001) accounting for 38.8% of the variation in BMI (adjusted R2=.386). We fitted an interaction term for nativity and BMI which was significant (p<.001). However, depression was only a significant predictor of BMI in Black female U.S. natives (F (4,775) = 2.93, p=.020) but not among Black male U.S. natives (F ((4, 775) = 2.93, p=.164). Depression remained a significant predictor among U.S. born and foreign-born Black males and females.
Conclusion: In Black adults residing in the U.S., we observed a positive association between depression scores and BMI with nativity status modifying this association. While depression was associated with BMI for females in both categories, depression was only associated with BMI in foreign-born Black males and not U.S. born Black males. Unique experiences among foreign-born populations may help explain the co-morbidity between depression and BMI, particularly among foreign-born males. Behavioral health interventions should be developed to account for differences among foreign-born Blacks that may increase risk for depression and associated health outcomes.