Depression, Cortisol Reactivity, and Obesity in Childhood and Adolescence



      Depression in childhood is associated with higher body mass index (BMI), a relative measure of overweight, and overweight is associated with cortisol reactivity, indexed by heightened secretion of cortisol in response to a stressor. The current study uses a mediation model to examine the associations between symptoms of depression, cortisol reactivity and BMI in a cross-sectional study.


      Children (N = 111) 8 to 13 years old and a parent completed structured interviews. The Child Behavior Checklist was used to assess symptoms of depression, and cortisol reactivity to the Trier Social Stress Test for Children was measured. Physical examinations were used to determine BMI (kg/m2) and pubertal stage.


      Depression was positively associated with BMI in both sexes. Age and pubertal stage were not significantly associated with BMI, nor was physical activity and BMI in a model including depression. In girls, but not in boys, the association between depression and BMI was mediated by cortisol reactivity.


      The current findings attest to the significance of psychologic states as potential components in models of childhood obesity, and provide conceptual and empirical support for the inclusion of cortisol reactivity in these models.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Adolescent Health
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Gordon-Larsen P.
        • Adair L.S.
        • Nelson M.C.
        • et al.
        Five-year obesity incidence in the transition period between adolescence and adulthood: the National Longitudinal Study of Adolescent Health.
        Am J Clin Nutr. 2004; 80: 569-575
        • Troiano R.P.
        • Briefel R.R.
        • Carroll M.D.
        • et al.
        Energy and fat intakes of children and adolescents in the United States: data from the National health and Nutrition Examination Surveys.
        Am J Clin Nutr. 2000; 72: 1343S-1353S
        • Blaine B.
        Does depression cause obesity?: A meta-analysis of longitudinal studies of depression and weight control.
        J Health Psychol. 2008; 13: 1190-1197
        • Field A.E.
        • Camargo Jr., C.A.
        • Taylor C.B.
        • et al.
        Overweight, weight concerns, and bulimic behaviors among girls and boys.
        J Am Acad Child Adolesc Psychiatry. 1999; 38: 754-760
        • Rosmond R.
        Obesity and depression: same disease, different names?.
        Med Hypotheses. 2004; 62: 976-979
        • Pine D.S.
        • Cohen P.
        • Brook J.
        • et al.
        Psychiatric symptoms in adolescence as predictors of obesity in early adulthood: a longitudinal study.
        Am J Public Health. 1997; 87: 1303-1310
        • Goodman E.
        • Whitaker R.C.
        A prospective study of the role of depression in the development and persistence of adolescent obesity.
        Pediatrics. 2002; 110: 497-504
        • Rosmond R.
        • Baghei F.
        • Holm G.
        • et al.
        Relationships between personality disorders and anthropometry, hormones and metabolism in women.
        J Endocrinol Invest. 2001; 24: 159-165
        • Marniemi J.
        • Kronholm E.
        • Aunola S.
        • et al.
        Visceral fat and psychosocial stress in identical twins discordant for obesity.
        J Intern Med. 2002; 251: 35-43
        • Roemmich J.N.
        • Gurgol C.M.
        • Epstein L.H.
        Influence of an interpersonal laboratory stressor on youths' choice to be physically active.
        Obes Res. 2003; 11: 1080-1087
        • Susman E.J.
        • Dockray S.
        • Schiefelbein V.L.
        • et al.
        Morningness/eveningness, morning-to-afternoon cortisol ratio, and antisocial behavior problems during puberty.
        Dev Psychol. 2007; 43: 811-822
        • Achenbach T.
        • Edelbrock C.S.
        Behavioural problems and competencies reported by parents of normal and disturbed children aged four through sixteen.
        Monogr Soc Res Child Dev. 1981; 46: 1-82
        • Kudielka B.M.
        • Buske-Kirschbaum A.
        • Hellhammer D.H.
        • et al.
        Differential heart rate reactivity and recovery after psychosocial stress (TSST) in healthy children, younger adults, and elderly adults: the impact of age and gender.
        Int J Behav Med. 2004; 11: 116-121
        • Dickerson S.S.
        • Kemeny M.E.
        Acute stressors and cortisol responses: a theoretical integration and synthesis of laboratory research.
        Psychol Bull. 2004; 130: 355-391
        • Pruessner J.C.
        • Kirschbaum C.
        • Meinlschmid G.
        • et al.
        Two formulas for computation of the area under the curve represent measures of total hormone concentration versus time-dependent change.
        Psychoneuroendocrinology. 2003; 28: 916-931
        • Starfield B.
        • Riley A.W.
        • Green B.F.
        • et al.
        The adolescent child health and illness profile. A population-based measure of health.
        Med Care. 1995; 33: 553-566
        • Marshall W.A.
        • Tanner J.M.
        Growth and physiological development during adolescence.
        Annu Rev Med. 1968; 19: 283-300
        • Frishanco R.
        Anthropometric Standards for the Assessment of Growth and Nutritional Status.
        University of Michigan Press, Ann Arbor, MI1990
        • Baron R.M.
        • Kenny D.A.
        The moderator–mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations.
        J Pers Soc Psychol. 1986; 51: 1173-1182
        • Kuczmarski R.J.
        • Flegal K.M.
        Criteria for definition of overweight in transition: background and recommendations for the United States.
        Am J Clin Nutr. 2000; 72: 1074-1081
        • MacKinnon D.P.
        • Fairchild A.J.
        Current directions in mediation analysis.
        Curr Direct Psychol Sci. 2009; 18: 16-20
        • Cohen J.
        • Cohen P.
        • West S.G.
        • Aiken L.S.
        Applied Multiple Regression/Correlation Analysis for the Behavioral Sciences.
        Lawrence Earlbaum Associates, Mahwah, NJ2003
        • Pine D.S.
        • Goldstein R.B.
        • Wolk S.
        • et al.
        The association between childhood depression and adulthood body mass index.
        Pediatrics. 2001; 107: 1049-1056
        • Ogden C.L.
        • Carroll M.D.
        • Flegal K.M.
        High body mass index for age among US children and adolescents, 2003–2006.
        JAMA. 2008; 299: 2401-2405
        • MacKinnon D.P.
        • Fairchild A.J.
        • Fritz M.S.
        Mediation analysis.
        Annu Rev Psychol. 2007; 58: 593-614
        • Preacher K.J.
        • Hayes A.F.
        SPSS and SAS procedures for estimating indirect effects in simple mediation models.
        Behav Res Methods Instrum Comput. 2004; 36: 717-731
        • Eisenmann J.C.
        Secular trends in variables associated with the metabolic syndrome of North American children and adolescents: a review and synthesis.
        Am J Hum Biol. 2003; 15: 786-794
        • McCabe M.P.
        • Ricciardelli L.
        • Finemore J.
        The role of puberty, media and popularity with peers on strategies to increase weight, decrease weight and increase muscle tone among adolescent boys and girls.
        J Psychosom Res. 2002; 52: 145-154
        • Berkey C.S.
        • Rockett H.R.
        • Field A.E.
        • et al.
        Activity, dietary intake, and weight changes in a longitudinal study of preadolescent and adolescent boys and girls.
        Pediatrics. 2000; 105: E56
        • Istvan J.
        • Zavela K.
        • Weidner G.
        Body weight and psychological distress in NHANES I.
        Int J Obes Relat Metab Disord. 1992; 16: 999-1003
        • Mustillo S.
        • Worthman C.
        • Erkanli A.
        • et al.
        Obesity and psychiatric disorder: developmental trajectories.
        Pediatrics. 2003; 111: 851-859
        • Vila G.
        • Zipper E.
        • Dabbas M.
        • et al.
        Mental disorders in obese children and adolescents.
        Psychosom Med. 2004; 66: 387-394
        • Bjorntorp P.
        Do stress reactions cause abdominal obesity and comorbidities?.
        Obes Rev. 2001; 2: 73-86
        • Wurtman J.J.
        Depression and weight gain: the serotonin connection.
        J Affect Disord. 1993; 29: 183-192
        • McEwen B.S.
        Protective and damaging effects of stress mediators.
        N Engl J Med. 1998; 338: 171-179
        • Chrousos G.P.
        The role of stress and the hypothalamic–pituitary–adrenal axis in the pathogenesis of the metabolic syndrome: neuro-endocrine and target tissue-related causes.
        Int J Obes Related Metab Dis. 2000; 24: S50-S55
        • Faith M.S.
        • Flint J.
        • Fairburn C.G.
        • et al.
        Gender differences in the relationship between personality dimensions and relative body weight.
        Obes Res. 2001; 9: 647-650
        • Young E.A.
        • Nolen-Hoeksema S.
        Effect of ruminations on the saliva cortisol response to a social stressor.
        Psychoneuroendocrinology. 2001; 26: 319-329
        • McEwen B.S.
        Stress, adaptation, and disease. Allostasis and allostatic load.
        Ann N Y Acad Sci. 1998; 840: 33-44
        • Bjorntorp P.
        Neuroendocrine factors in obesity.
        J Endocrinol. 1997; 155: 193-195
        • Derogatis L.R.
        • Melisaratos N.
        The Brief Symptom Inventory: an introductory report.
        Psychol Med. 1983; 13: 595-605
        • Murphy K.R.
        • Myors B.
        Statistical Power Analysis: A Simple and General Model for Traditional and Modern Hypothesis Tests.
        2nd ed. Lawrence Erlbaum., Mahwah, NJ2004