Associations Between Depressive Symptomatology, Diet, and Body Mass Index Among Participants in the Supplemental Nutrition Assistance Program

Published in: Journal of the Academy of Nutrition and Dietetics, 2015

Posted on on March 11, 2015

by Karen Rocío Flórez, Tamara Dubowitz, Bonnie Ghosh-Dastidar, Robin L. Beckman, Rebecca L. Collins

Read More

Access further information on this document at Journal of the Academy of Nutrition and Dietetics

This article was published outside of RAND. The full text of the article can be found at the link above.

Research Question

  1. What is the link between depression, diet, and weight in low-income, primarily African-American residents of food deserts in Pittsburgh, Pennsylvania?

BACKGROUND: Participation in the Supplemental Nutrition Assistance Program (SNAP) has been shown to increase food security, or access to adequate food; however, SNAP participation has also been associated with obesity among certain demographic groups (eg, women, but not men and children), possibly due to poorer dietary quality. Depressive symptomatology is an understudied factor, which is associated with obesity across the lifespan. OBJECTIVE: This study examined the relationship between depressive symptomatology, dietary quality, and body weight among a sample of SNAP participants (n=639). DESIGN: The analysis was cross-sectional; survey data were collected in May to December 2011 by trained data collector. PARTICIPANTS/SETTING: Adults who self-identified as the primary food shopper of the household in two predominantly low-income African-American neighborhoods characterized as "food deserts" in Pittsburgh, PA, were recruited to participate in this study. MEASURES: Dietary quality was calculated using the US Department of Agriculture's Healthy Eating Index-2005. Body mass index (BMI; calculated as kg/m2) was based on objective measurements taken by the interviewer. Current depressive symptomatology was assessed by a trained interviewer using the Patient Health Questionnaire-2. STATISTICAL ANALYSES PERFORMED: Descriptive statistics (means and percentages); two multivariate ordinary least-square regression analyses predicting BMI and dietary quality from depressive symptomatology while controlling for sociodemographic factors and food insecurity were performed. RESULTS: Depression was a strong and statistically significant predictor of both dietary quality and BMI; higher score in depressive symptomatology was associated with lower scores in dietary quality (β=−1.26; P<0.0001). A higher score in depressive symptomatology was associated with higher BMI (β=.63; P=0.0031). CONCLUSIONS: These findings show that depressive symptomatology is significantly associated with weight-related outcomes and suggests that understanding the risk of depression among SNAP participants could be important to understanding the relationships among SNAP participation, diet, and weight. The association between depressive symptomology, elevated BMI, and lower dietary quality among low-income, primarily African-American residents living in a food desert suggests the potential for mental health interventions to have broader benefits in this population. However, the directionality of this association is unclear and improving diet and reducing weight might also improve mental health symptoms. Additional longitudinal studies should assess these possibilities.

Key Findings

  • Among participants in the Supplemental Nutrition Assistance Program (SNAP), formerly known as the Food Stamp Program, depression was a strong and statistically significant predictor of both diet and weight.
  • People with higher levels of depressive signs and symptoms had both lower dietary quality and higher body mass indexes.


Future studies on the direction of causality between depression and weight outcomes—that is, does depression lead to weight gain, or does weight gain lead to depression—will help address the gap in our understanding of the link between depression and negative weight outcomes in low income families who receive food assistance.

This report is part of the RAND Corporation External publication series. Many RAND studies are published in peer-reviewed scholarly journals, as chapters in commercial books, or as documents published by other organizations.

The RAND Corporation is a nonprofit institution that helps improve policy and decisionmaking through research and analysis. RAND's publications do not necessarily reflect the opinions of its research clients and sponsors.