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Common mental disorder and obesity: insight from four repeat measures over 19 years: prospective Whitehall II cohort study

BMJ 2009; 339 doi: (Published 06 October 2009) Cite this as: BMJ 2009;339:b3765
  1. Mika Kivimäki, professor of social epidemiology12,
  2. Debbie A Lawlor, professor of epidemiology3,
  3. Archana Singh-Manoux, senior research fellow14,
  4. G David Batty, Wellcome Trust fellow567,
  5. Jane E Ferrie, senior research fellow1,
  6. Martin J Shipley, senior lecturer in medical statistics1,
  7. Hermann Nabi, research fellow4,
  8. Séverine Sabia, research fellow4,
  9. Michael G Marmot, head of department and director1,
  10. Markus Jokela, senior research fellow12
  1. 1Department of Epidemiology and Public Health, University College London, London WC1E 6BT
  2. 2Finnish Institute of Occupational Health, Helsinki, Finland
  3. 3MRC Centre for Causal Analyses in Translational Epidemiology, University of Bristol, Bristol
  4. 4INSERM U687-IFR69, Hôpital Paul Brousse, Villejuif Cedex, France
  5. 5MRC Social and Public Health Sciences Unit, University of Glasgow, Glasgow
  6. 6Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh
  7. 7The George Institute for International Health, University of Sydney, Sydney, Australia
  1. Correspondence to: M Kivimäki m.kivimaki{at}
  • Accepted 7 July 2009


Objectives To examine potential reciprocal associations between common mental disorders and obesity, and to assess whether dose-response relations exist.

Design Prospective cohort study with four measures of common mental disorders and obesity over 19 years (Whitehall II study).

Setting Civil service departments in London.

Participants 4363 adults (28% female, mean age 44 years at baseline).

Main outcome Common mental disorder defined as general health questionnaire “caseness;” overweight and obesity based on Word Health Organization definitions.

Results In models adjusted for age, sex, and body mass index at baseline, odds ratios for obesity at the fourth screening were 1.33 (95% confidence interval 1.00 to 1.77), 1.64 (1.13 to 2.36), and 2.01 (1.21 to 3.34) for participants with common mental disorder at one, two, or three preceding screenings compared with people free from common mental disorder (P for trend<0.001). The corresponding mean differences in body mass index at the most recent screening were 0.20, 0.31, and 0.50 (P for trend<0.001). These associations remained after adjustment for baseline characteristics related to mental health and exclusion of participants who were obese at baseline. In addition, obesity predicted future risk of common mental disorder, again with evidence of a dose-response relation (P for trend=0.02, multivariable model). However, this association was lost when people with common mental disorder at baseline were excluded (P for trend=0.33).

Conclusions These findings suggest that in British adults the direction of association between common mental disorders and obesity is from common mental disorder to increased future risk of obesity. This association is cumulative such that people with chronic or repeat episodes of common mental disorder are particularly at risk of weight gain.


  • We thank all participating civil service departments and their welfare personnel and establishment officers; the Occupational Health and Safety Agency; the Council of Civil Service Unions; all participating civil servants in the Whitehall II study; and all members of the Whitehall II Study Team. The Whitehall II Study Team comprises research scientists, statisticians, study coordinators, nurses, data managers, administrative assistants, and data entry staff, who make the study possible.

  • Contributors: All authors jointly designed the hypothesis, analysed and interpreted the data, and wrote the paper. MK is guarantor.

  • Funding: The Whitehall II study has been supported by grants from the Medical Research Council; British Heart Foundation; Health and Safety Executive; Department of Health; National Heart Lung and Blood Institute, US, NIH (R01HL036310-20A2); National Institute on Aging, US, NIH (R01AG034454-01 and R01AG013196); and the John D and Catherine T MacArthur Foundation Research Networks on Successful Midlife Development and Socio-economic Status and Health. MK is supported by the Academy of Finland; GDB is a Wellcome Trust research fellow; AS-M is supported by a “EURYI” award from the European Science Foundation; JEF is supported by the Medical Research Council; MJS is supported by the British Heart Foundation; and MGM is supported by an MRC research professorship. The funders did not contribute to the study design and had no role in data collection, data analysis, data interpretation, or writing of the report. The researchers were independent from the funders.

  • Competing interests: None declared.

  • Ethical approval: The University College London Medical School committee on the ethics of human research gave ethical approval for the Whitehall II study.

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