Association of Depression and Anxiety Symptoms with Body Mass Index (for age cut offs) in non-clinical sample of adolescents studying in public schools of Delhi; cross sectional study




adolescent, depression, anxiety, malnutrition, BMI, mental health


Objectives: The present study was designed with the objective to study the prevalence of depression and anxiety symptoms among adolescents and to explore the association of these disorders with Body Mass Index. Settings and Design: School setting and Cross-Sectional study design. Participants: 546 adolescents, aged 13-15 years, studying in public schools (n=5) in Delhi (Purposive sampling). Methods and Material: Anthropometric measurements: Height of the subjects was measured using a stadiometer in cm (to nearest 0.5cm). Weight was assessed using TANITA’s Body Fat Monitor (UM-076). After gathering height and weight data, BMI (kg/m2) Z scores were calculated and classified into four categories: Underweight, Normal weight, Overweight and Obesity based on WHO’s growth standards for BMI for age cutoffs. Mental Health Assessment: For this purpose, we used the Child Behavior Checklist (CBCL) for ages 6-18 years; parent report version. Results: A V shaped curve (trend) was observed between the association of depression and anxiety scores in four BMI categories; with majority of the malnourished adolescents having higher scores for depression and anxiety symptoms. It was interesting to note that any deviation from normal weight, either underweight or overweight/obese was significantly associated with depression (p = <0.001) and anxiety (p = <0.001) scores. Conclusions: The study emphasizes the association between body weight and depression and anxiety symptoms among adolescents studying in public schools of Delhi. It adds to the growing body of research in the area of nutritional psychiatry which needs to be promoted for the prevention and management of these disorders through a healthy diet.


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UNICEF. Adolescence: An Age of opportunity. The state of the world’s children 2011. New York; 2011.

WHO. Health for the world’s adolescents a second chance in the second decade: Summary. Geneva; 2014.

Smolak L. Body image in children and adolescents: where do we go from here?. Body Image. 2004 Jan;1(1):15-28. doi: 10.1016/S1740-1445(03)00008-1. PubMed PMID: 18089138.[PubMed].

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (Fifth ed.). Arlington, VA: American Psychiatric Publishing; 2013. pp. 5–25.

Anderson SE, Cohen P, Naumova EN, Must A. Association of depression and anxiety disorders with weight change in a prospective community-based study of children followed up into adulthood. Arch Pediatr Adolesc Med. 2006 Mar;160(3):285-91. doi: 10.1001/archpedi.160.3.285. PubMed PMID: 16520448.[PubMed].

Anderson SE, Cohen P, Naumova EN, Must A. Relationship of childhood behavior disorders to weight gain from childhood into adulthood. Ambul Pediatr. 2006 Sep-Oct;6(5):297-301. doi: 10.1016/j.ambp.2006.06.002. PubMed PMID: 17000421.[PubMed]

Lumeng JC, Gannon K, Cabral HJ, Frank DA, Zuckerman B. Association between clinically meaningful behavior problems and overweight in children. Pediatrics. 2003 Nov;112(5):1138-45. doi: 10.1542/peds.112.5.1138. PubMed PMID: 14595059.[PubMed].

Pine DS, Goldstein RB, Wolk S, Weissman MM. The association between childhood depression and adulthood body mass index. Pediatrics. 2001 May;107(5):1049-56. doi: 10.1542/peds.107.5.1049. PubMed PMID: 11331685.[PubMed].

Hasler G, Pine DS, Kleinbaum DG, Gamma A, Luckenbaugh D, Ajdacic V, Eich D, Rössler W, Angst J. Depressive symptoms during childhood and adult obesity: the Zurich Cohort Study. Mol Psychiatry. 2005 Sep;10(9):842-50. doi: 10.1038/ PubMed PMID: 15838533.[PubMed]

Goodman E, Huang B. Socioeconomic status, depressive symptoms, and adolescent substance use. Arch Pediatr Adolesc Med. 2002 May;156(5):448-53. doi: 10.1001/archpedi.156.5.448. PubMed PMID: 11980549.[PubMed]

Richardson LP, Davis R, Poulton R, McCauley E, Moffitt TE, Caspi A, Connell F. A longitudinal evaluation of adolescent depression and adult obesity. Arch Pediatr Adolesc Med. 2003 Aug;157(8):739-45. doi: 10.1001/archpedi.157.8.739. PubMed PMID: 12912778.[PubMed].

Anderson SE, Cohen P, Naumova EN, Jacques PF, Must A. Adolescent obesity and risk for subsequent major depressive disorder and anxiety disorder: prospective evidence. Psychosom Med. 2007 Nov;69(8):740-7. doi: 10.1097/PSY.0b013e31815580b4. Epub 2007 Oct 17. PubMed PMID: 17942847.[PubMed].

Wit L, Straten A, et al. Depression and body mass index, a u-shaped association. BMC Public Health 2009.

Arora M, Nazar GP, Gupta VK, Perry CL, Reddy KS, Stigler MH. Association of breakfast intake with obesity, dietary and physical activity behavior among urban school-aged adolescents in Delhi, India: results of a cross-sectional study. BMC Public Health. 2012 Oct 17;12:881. doi: 10.1186/1471-2458-12-881. PubMed PMID: 23075030; PubMed Central PMCID: PMC3549919.[PubMed].

de Onis M, Onyango AW, Borghi E, Siyam A, Nishida C, Siekmann J. Development of a WHO growth reference for school-aged children and adolescents. Bull World Health Organ. 2007 Sep;85(9):660-7. doi: 10.2471/blt.07.043497. PubMed PMID: 18026621; PubMed Central PMCID: PMC2636412.[PubMed].

Achenbach T.M., & Rescorla, L.A. (2001). Manual for ASEBA School-Age Forms & Profiles. Burlington, VT: Research Center for Children, Youth & Families.

The burden of mental disorders across the states of India: the Global Burden of Disease Study 1990-2017. Lancet Psychiatry. 2020 Feb;7(2):148-161. doi: 10.1016/S2215-0366(19)30475-4. Epub 2019 Dec 23. PubMed PMID: 31879245; PubMed Central PMCID: PMC7029418.[PubMed].

Ministry of Health and Family Welfare (MoHFW), Government of India, UNICEF and Population Council. 2019. Comprehensive National Nutrition Survey (CNNS) National Report. New Delhi.

Thapar A, Collishaw S, Pine DS, Thapar AK. Depression in adolescence. Lancet. 2012 Mar 17;379(9820):1056-67. doi: 10.1016/S0140-6736(11)60871-4. Epub 2012 Feb 2. PubMed PMID: 22305766; PubMed Central PMCID: PMC3488279.[PubMed].

Osborn DP, Nazareth I, King MB. Physical activity, dietary habits and Coronary Heart Disease risk factor knowledge amongst people with severe mental illness: a cross sectional comparative study in primary care. Soc Psychiatry Psychiatr Epidemiol. 2007 Oct;42(10):787-93. doi: 10.1007/s00127-007-0247-3. Epub 2007 Aug 24. PubMed PMID: 17721669.[PubMed].

Dent R, Blackmore A, Peterson J, Habib R, Kay GP, Gervais A, Taylor V, Wells G. Changes in body weight and psychotropic drugs: a systematic synthesis of the literature. PLoS One. 2012;7(6):e36889. doi: 10.1371/journal.pone.0036889. Epub 2012 Jun 15. Review. PubMed PMID: 22719834; PubMed Central PMCID: PMC3376099.[PubMed]

Gariepy G, Nitka D, Schmitz N. The association between obesity and anxiety disorders in the population: a systematic review and meta-analysis. Int J Obes (Lond). 2010 Mar;34(3):407-19. doi: 10.1038/ijo.2009.252. Epub 2009 Dec 8. Review. PubMed PMID: 19997072.[PubMed].

Miller AH, Raison CL. The role of inflammation in depression: from evolutionary imperative to modern treatment target. Nat Rev Immunol. 2016 Jan;16(1):22-34. doi: 10.1038/nri.2015.5. Review. PubMed PMID: 26711676; PubMed Central PMCID: PMC5542678.[PubMed].

Casas, R., Sacanella, E., & Estruch, R. (2016). The immune protective effect of the Mediterranean diet against chronic low-grade inflammatory diseases. Endocrine, metabolic & immune disorders drug targets, 14(4), 245–254. doi:10.2174/1871530314666140922153350

O'Neil A, Quirk SE, Housden S, Brennan SL, Williams LJ, Pasco JA, Berk M, Jacka FN. Relationship between diet and mental health in children and adolescents: a systematic review. Am J Public Health. 2014 Oct;104(10):e31-42. doi: 10.2105/AJPH.2014.302110. Review. PubMed PMID: 25208008; PubMed Central PMCID: PMC4167107.[PubMed].

Popa TA, Ladea M. Nutrition and depression at the forefront of progress. J Med Life. 2012 Dec 15;5(4):414-9. Epub 2012 Dec 25. PubMed PMID: 23346242; PubMed Central PMCID: PMC3539842.[PubMed].

Klinitzke G, Steinig J, Blüher M, Kersting A, Wagner B. Obesity and suicide risk in adults--a systematic review. J Affect Disord. 2013 Mar 5;145(3):277-84. doi: 10.1016/j.jad.2012.07.010. Epub 2012 Aug 4. Review. PubMed PMID: 22871535.[PubMed].




How to Cite

Khanna P, Aeri BT. Association of Depression and Anxiety Symptoms with Body Mass Index (for age cut offs) in non-clinical sample of adolescents studying in public schools of Delhi; cross sectional study. Indian J Community Health [Internet]. 2020 Jun. 30 [cited 2024 May 22];32(2):386-93. Available from:



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