The Relationship between Obesity, Elevated Depressive Symptoms, and Physical Functioning among United Methodist Clergy: A Longitudinal Study

Abstract

Background: Employees in occupations with high job-related distress are at a higher risk of depression and obesity, both of which relate to worse physical functioning. Poor physical functioning can, in turn, lead to several adverse health outcomes. There is a high co-occurrence of obesity and depression and we, hence, sought to assess the independent and joint effects of obesity and elevated depressive symptoms on physical functioning among United Methodist Church clergy in North Carolina, the United States. Methods: We analyzed data from 1,422 clergy who participated in the Clergy Health Initiative Longitudinal Survey in both 2014 and 2016. Elevated depressive symptoms were assessed using Patient Health Questionnaire-9 and obesity was defined based on participants’ Body Mass Index. The physical functioning score was measured using the Physical Component Summary of Medical Outcomes Study 12-Item Short Form Survey. We described the participants’ characteristics in 2014 and analyzed the data from the 2014 and 2016 waves to assess the association between obesity, elevated depressive symptoms, and physical functioning by using Ordinary Least Squares regression. The joint effect was assessed by including the interaction term between elevated depressive symptoms and obesity in the regression model. We further adjusted covariates including age, gender, race, educational attainment, marital status, physical exercise, financial distress, and work hours per week in the regression model to control for confounding factors. Results: The study population was largely composed of male (69.90%) and white (91.84%) individuals. Additionally, the vast majority of participants (82.56%) held a master's degree or higher level of education. The prevalence of obesity and elevated depressive symptoms was 39.52% and 7.17%, respectively, among United Methodist Church clergy in North Carolina in 2014. Obesity and elevated depressive symptoms were both independently related to poor physical functioning. The co-occurrence of obesity and elevated depressive symptoms in 2014 had a larger negative effect (β = -4.34; 95% Confidence Interval: -7.87, -0.81) on physical functioning in 2016 than the sum of the individual effects of obesity (β = -4.02; 95% Confidence Interval: -4.93, -3.11) and elevated depressive symptoms (β = -3.25; 95% Confidence Interval: -4.63, -1.17) on physical functioning. Conclusions: The results suggest that there is a joint effect of obesity and elevated depressive symptoms on worse physical functioning among United Methodist Church clergy in North Carolina. More attention should be paid to the diagnosis and treatment of depression and obesity in this population to prevent the negative health sequelae of worse physical functioning.