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J Rural Health. 2017 Apr;33(2):190-197. doi: 10.1111/jrh.12170. Epub 2016 Jan 28.

Changes in Body Mass Index and the Trajectory of Depressive Symptoms Among Rural Men and Women.

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Department of Epidemiology, Saint Louis University College for Public Health and Social Justice, St. Louis, Missouri.
Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, Missouri.
Department of Health Management and Policy, Saint Louis University College for Public Health and Social Justice, St. Louis, Missouri.
SSM Health Care, St. Louis, Missouri.
The Prevention Research Center in St. Louis, the Brown School and the Department of Surgery (Division of Public Health Sciences) and Alvin J. Siteman Cancer Center, School of Medicine, Washington University, St. Louis, Missouri.



This study examined the association between body mass index (BMI) changes over time and the risk of elevated depressive symptoms in a cohort of Midwestern rural adults.


The longitudinal study used data from a telephone survey in 2005 including 1,475 men and women enrolled in the Walk the Ozarks to Wellness Project from 12 rural communities in Missouri, Arkansas, and Tennessee. Multilevel random intercept mixed models were used to estimate adjusted odds ratios (aOR) and 95% confidence intervals (CI) for the association between BMI calculated from self-reported height and body weight and elevated depressive symptoms, adjusting for sociodemographic, behavioral, and medical variables.


Elevated depressive symptoms were common in this rural population (17%-19%) and the mean BMI was 28 kg/m2 . For each unit increase in BMI over time, representing an average increase of about 5.8 pounds from baseline weight, there was a 6% increased odds of elevated depressive symptoms (aOR: 1.06, 95% CI: 1.02-1.12).


Our findings hold important public health implications given the increasing rates of overweight and obesity over the past couple of decades, particularly among rural adults.


body mass index; depression; obesity; overweight; rural health

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