text:
Click through the below frequently asked questions to find answers to all your questions about the Arrowsmith Program and our schools. If we have missed any questions, please email our admissions director at admissions@eatonarrowsmithschool.com.
What is a typical day like at Eaton Arrowsmith?
A day in the full-time EA Program is divided into eight class periods, with a recess in the morning, a lunch break and an exercise break. Most students spend up to six periods on Arrowsmith Program brain exercises, and attend one period of English and one period of mathematics. Students visit three classrooms throughout the day. The majority of their time (up to six of eight daily periods) is spent in the cognitive classroom, where they are grouped by age and/or social maturity. The regular school day ends at 3:00pm, with a supervised Homework Program that is offered at a modest additional fee as a service to parents who are unable to pick their child up by 3:30pm. Depending on age, students complete between 70 and 100 minutes of cognitive homework five nights per week.
What is the difference between the full-time, part-time, and Motor Symbol Sequencing (MSS) programs?
Students in the full-time Eaton Arrowsmith Program attend classes from Monday to Friday (8:30am-3:00pm) from September to June and complete between 1-1.5 hours of homework each night. The full-time program can address up to six different cognitive areas, so students spend six periods on Arrowsmith cognitive exercises and also take one period of math and one period of English.
Students in the part-time, after school program attend classes Tuesdays and Thursdays (generally from 4:00pm-6:00pm) from October to May and work on strengthening one particular cognitive area. They do not have any homework, but like full-time students, are given an Arrowsmith Programming Assessment.
Students in the Motor Symbol Sequencing program attend classes every second Thursday (4:00pm-6:00pm) from October to May. They also have 1-1.5 hours of homework each night (5 nights a week), but are not given the complete Arrowsmith assessment. Students in this program are assessed to determine their proficiency on the Motor Symbol Sequencing area only.
How do academics fit into the EA curriculum?
EA follows the British Columbia and Washington State curriculum for math and English up to and including grade nine. As most of our students in the full-time program start out below where they "should be" (based on age), we meet students at their current academic level (which is typically below grade level) and then bring them up to grade level over their time at EA. Students work on programs such as Slingerland and Lindamood Bell in Language Arts, and Jump Math in mathematics.
Our older students (grade 10 and above) have a number of options available to them. Students who are currently working below grade level can take math and English at EA until they have reached the grade 10 level. They can then take these courses (and/or other courses required for graduation) through a distance education organization.
Other students take a full cognitive course load (eight cognitive periods per day), deferring academics until they have strengthened their cognitive capacities enough to fully benefit from academic instruction.
For information about the BC curriculum, please visit the Ministry of Education's website by clicking on the links below.
Math: https://www2.gov.bc.ca/gov/content/education-training/k-12/teach/curriculum/english/mathematics
English: https://www2.gov.bc.ca/gov/content/education-training/k-12/teach/curriculum/english/english-language-arts
For information about graduation/diploma options for older EA students, please click on the following links:
Overview: http://www.bced.gov.bc.ca/graduation/
Adult Dogwood: http://www.bced.gov.bc.ca/graduation/adult_graduation.htm
GED: http://www.bced.gov.bc.ca/ged/
Comparing the options: http://palc.sd40.bc.ca/palc/feature/2007/gradoptions.htm
What do students do after EA?
After completing their cognitive programs at EA, our students transition back to typical public or private schools. Having strengthened their capacity for learning, they now have the ability to truly benefit from academic and social experiences. Students in grade nine or younger transition back into the same grade as their peers. The first year after EA is typically spent assimilating back into a full academic program. Students now have the capacity to learn, but may have gaps in their academic knowledge, due to their previous cognitive weaknesses and the fact that they have not been exposed to certain concepts while at EA. We recommend connecting with a tutor that first year in order to help fill those gaps. By the second year back, most students are fully independent learners.
Students who return to regular public and private schools after grade nine must collect credits in order to graduate high school with their peers. Many of our students in this category work towards these credits with us in their final year of the program, connect with local distance education support facilities, repeat a grade at school or take a GED (Graduation Equivalency Diploma) in order to graduate. After this, the majority of our alumni go on to colleges and universities, or find employment in their chosen fields.
What kind of extra/after-school help is offered at EA?
We offer a homework program, which enables students to complete their homework at EA with supervision and guidance. The homework program takes place every day after school. This extends pick-up time to 4:45pm (for younger students) and 5:15pm for older students. The cost of this program is $20 per day if it is prearranged, and $25 per day for drop-in.
What kind of assessments are done at EA?
There are two types of assessment at EA:
Assessment of Fit: This tells us whether the Arrowsmith Program is a good fit for your child and involves an admissions meeting, a review of your son or daughter's records and a visit to the school. This assessment does not cost anything. If you live outside the Lower Mainland, the assessment can be done over the phone or via Skype.
Programming Assessment: This assessment is done after enrollment to determine a student's education plan based on his or her cognitive needs. Each student works one-on-one with an assessor (typically the classroom teacher) to go through the cognitive areas. The cost of this assessment is included in each student's tuition fee.
How long does the Arrowsmith Program take?
There is no simple answer to this question because the Arrowsmith Program is highly individualized. On average, 3-4 years in the full-time program is required for a "typical" candidate (student with a learning disability).
In both the part-time and full-time programs, students receive a programming assessment to determine how many of the 19 areas addressed by the program are below average, and how far below average they are. The goal of the Arrowsmith Program is to bring these weaker cognitive areas up to an average or above average level through repeated stimulation.
Program length is determined by a number of factors, such as:
Number of areas below average
Level of weakness in those areas (the weaker the area, the longer it will take to reach average)
Number of areas addressed at a time (working on six simultaneously vs. working on one at a time)
Individual factors such as attendance and engagement (motivation and attention are important)
How do students re-integrate into the regular curriculum after EA?
Full-time EA students take BC curriculum math and English, but not social studies, science, art, or music. Math and English are the only cumulative courses at the elementary school level (ones that build on concepts year after year). Many of our students come to EA and are below their grade level in math and English. We work to bring them up to grade level so they can easily transition back to mainstream schools at the same level as their peers (e.g. a student who spends grades 2, 3, 4, and 5 at EA can enter grade 6 at another school).
Older students in BC start collecting course credits for graduation starting in grade 10 (and grade nine in the United States). We work with our grade nine, 10, 11 and 12 students on alternative ways to obtain these credits. Some choose to do distance education, while others may repeat grades when they return to mainstream schools with an increased ability to learn after their time at EA.
How do arts, science, and social studies fit into the EA curriculum?
We do not offer science and social studies as separate courses in the full-time Eaton Arrowsmith Program unless a student is cognitively ready for these subjects. However, teachers work to bring some science and social studies concepts into their classes. There are a couple of reasons for this. First, the purpose of the Arrowsmith Program is to strengthen the weaker cognitive areas in our students. It has been described as "weaving the basket in which to pour academic knowledge", or as building the foundation. If the basket has holes in it, or if the foundation is not stable, it is much more difficult to learn academics. Second, students at EA are here for a limited time – our goal is not to be a "forever" school, but to build up weaker cognitive areas in our students so that they can transition back into the mainstream public or private school system without the need for support.
Interestingly, when our students do transition back into other schools, we have heard that science and social studies are their best subjects! Unlike math and English, which build on knowledge gained in previous years, science and social studies are very unit-based, which means there is less, or no "catching up" to be done.
How does physical education (PE) fit into the EA curriculum?
We know that physical exercise plays an important role in your child's physical, emotional, social and, of course, neurological development. For this reason, students begin their days with a run/walk and take PE 2-3 times per week. We also take our students outside for 30 minutes every day at lunch to get fresh air and exercise.
What is the best age for students to start at EA?
Students can make cognitive gains at a similar rate at any age. Earlier interventions are, however, preferred. This is because of the social and emotional ramifications of leaving a student in an environment where they are struggling. For example, some older students can start feeling disheartened and pessimistic, which makes progress difficult. Ultimately, each student is different, so it is hard to generalize.
What kind of tax credits are available for EA tuition?
The Medical Expense Tax Credit applies to the Arrowsmith Program. To find out more about tax credits, please click here.
What Vancouver schools do you recommend for siblings of EA students?
Many of our international students come to Vancouver with their entire families. There are great public and private schools in the Lower Mainland for the siblings of EA students. Please click on some of the helpful resources below.
Public Schools: Please visit the Government of British Columbia's database to find schools in your community.
Private Schools: Please visit the Our Kids website. It's a great resource about Vancouver's private schools.
Catholic Schools: Please visit the Catholic Independent Schools of British Columbia (CISBC) website to find Catholic schools in your community.
Daycare: Please visit the Westcoast Child Care Resource Centre website to find out about daycare options. This website comes highly recommended by our staff members who have young children!
How do you keep students motivated?
Our students are generally hardworking and motivated. We see them coming in the door with big smiles every morning, ready to get to work! This is not to say that students don't struggle with motivation or go through tougher times, but for the most part, it's not as tough to motivate students as you'd imagine!
Individualized programs with exercises set at a level specific to the student, motivational strategies designed by our incredible teachers, peer encouragement, the end-goal, and specific motivational strategies all play a role in helping maintain the motivation of our students.
How long will it take before I start seeing a difference in my son or daughter?
This varies from student to student. On average, we say it takes approximately three months for parents to see the first observable differences in their children. For students with more severe difficulties, we might not see observable behavioural developments until the second year. Our teachers will keep you up to date on the measurable differences they see in your child. And we would love to hear about any differences you see in your son or daughter outside of school.
How does EA foster the social and emotional needs of my son or daughter?
Students' academic needs can only be met in an environment that fosters social and emotional growth. Our teachers strive to create strong attachments with students. We believe healthy, strong adult connections help students navigate and establish long-lasting peer relationships. Our teachers communicate with students in a way that is respectful of their emotional needs and helps foster a sense of belonging and community. Our goal is to build up your child's confidence and help them to reflect on their emotions and feelings. We use Dr. Marshall Rosenberg's Non-Violent Communication method, through which the underlying needs of each child are considered when getting to the bottom of emotional struggles.
What are the schools' policies for international students?
Please click on the link below to view our Policies and Codes of Conduct.
Schools' policies for international students
EA Adults Policies and Code of Conduct
Everything about the school is excellent, from the principal to the teachers to the active parent group.
Dr. Daniel Bankson and Dr. Anne Bankson, EA parents


text:
The South Asia Channel: The politics of Afghan women's rights The politics of Afghan women...
The politics of Afghan women's rights
On Jan. 10, Afghanistan's Council of Ministers, at its regular weekly meeting, decided that women's shelters needed to be brought under government control, reflecting a long-simmering discontent with women's shelters in Afghanistan. It's a discontent fanned by a media campaign spearheaded by right-wing broadcaster and ideologue, Nasto Naderi, who has pushed the idea that shelters ...
By Naheed Mustafa, March 8, 2011
SHAH MARAI/AFP/Getty Images.
On Jan. 10, Afghanistan's Council of Ministers, at its regular weekly meeting, decided that women's shelters needed to be brought under government control, reflecting a long-simmering discontent with women's shelters in Afghanistan. It's a discontent fanned by a media campaign spearheaded by right-wing broadcaster and ideologue, Nasto Naderi, who has pushed the idea that shelters are simply fronts for prostitution.
It wasn't until several weeks later the news of the ministers' decision hit the media. Afghan President Hamid Karzai insisted that women's shelters should be brought under the control of the government. He wanted more oversight and more monitoring, despite the fact that the Afghan central government has neither the resources nor the will to run these shelters effectively. Although the shelter debacle ended in a seeming win as women's rights groups pushed the government to back off, the rights of Afghan women are more precarious than ever, even as Karzai gives speeches in honor of the 100th anniversary of International Women's Day today.
From the beginning, women's rights in Afghanistan have been more of a political plaything than an actual goal -- not just for Karzai's government but for the international community as well. The drive to bring the war to Afghanistan has, from its inception, been dressed up in the language of bringing freedoms to long-suffering women. In November 2001, barely a month after the U.S. invasion of Afghanistan, American first lady Laura Bush said, "The fight against terrorism is also a fight for the rights and dignity of women." Who could object to the idea of more rights for Afghan women?
On Jan. 10, Afghanistan's Council of Ministers, at its regular weekly meeting, decided that women's shelters needed to be brought under government control, reflecting a long-simmering discontent with women's shelters in Afghanistan. It's a discontent fanned by a media campaign spearheaded by right-wing broadcaster and ideologue, Nasto Naderi, who has pushed the idea that shelters are simply fronts for prostitution.
It wasn't until several weeks later the news of the ministers' decision hit the media. Afghan President Hamid Karzai insisted that women's shelters should be brought under the control of the government. He wanted more oversight and more monitoring, despite the fact that the Afghan central government has neither the resources nor the will to run these shelters effectively. Although the shelter debacle ended in a seeming win as women's rights groups pushed the government to back off, the rights of Afghan women are more precarious than ever, even as Karzai gives speeches in honor of the 100th anniversary of International Women's Day today.
From the beginning, women's rights in Afghanistan have been more of a political plaything than an actual goal — not just for Karzai's government but for the international community as well. The drive to bring the war to Afghanistan has, from its inception, been dressed up in the language of bringing freedoms to long-suffering women. In November 2001, barely a month after the U.S. invasion of Afghanistan, American first lady Laura Bush said, "The fight against terrorism is also a fight for the rights and dignity of women." Who could object to the idea of more rights for Afghan women?
Yet the distance is growing between the international community and the Afghan government — and this is not lost on Afghan women.
Back in 2003, the euphoria that had come to Afghanistan with the toppling of the Taliban still lingered. The West was going to help Afghan women with education, income generation, political participation, and all around freedoms. Afghanistan's women had endured a kind of mass isolation during the previous two decades that few can claim to know. Rigorous cultural norms compounded by almost constant war followed by codified seclusion ensured that women who had remained inside the country had learned to fight for even the tiniest bits of agency. So by 2003, women who had for so long remained cloistered stepped out, ready to take some control over their lives.
One of the women willing to take up the challenge was Orzala Ashraf Nemat, an Afghan women's rights activist and pioneer of the shelter movement who is currently working on her doctorate at the University of London. To Nemat, the pressing need for safe places for women was clear. She, along with other women's rights activists, decided to build safe places for women away from their homes where they could find refuge from violence, abuse, and sometimes, forced marriage. The idea was popular among many women, but it wasn't easily accepted across Afghanistan.
In the early days the shelters were unmarked, sitting anonymously on quiet streets. The Ministry of Interior knew where they were, but the local police were left in the dark.
"We said if these shelters were under the [control of the Afghan] government then it would defeat the purpose, so we had negotiations with the minister of women's affairs and she agreed that we should not be telling the police [where the shelters were] and that it should be private," says Nemat. "In 2004 the local police ended up doing a raid on the house, accusing the women of prostitution. We told them it was an official [shelter], but they said if it was official then [the police] should know." In a country as socially conservative as Afghanistan, women living together without their families could only mean something as nefarious as prostitution.
But Nemat learned a lesson from that raid: If women's rights activists wanted to offer safe shelter for women, they needed to let the police know. They wrangled a formal arrangement with the Ministry of Women's Affairs and reached an agreement that the ministry would be the shelters' voice in government. The shelters, however, would continue to be run independently. That agreement was derailed when Karzai announced the government was taking over.
In the particular strategic calculus of Afghanistan, women's rights are subordinate to other needs — security, politics, patronage — and as 2014 approaches, they are also subordinate to an expedient Western transition to Afghan security control. A senior American official recently told the Washington Post, "Gender issues are going to have to take a back seat to other priorities.… There's no way we can be successful if we maintain every special interest and pet project. All those pet rocks in our rucksack were taking us down."
But in truth, women's rights were never a priority — neither for the Karzai government nor, in any serious way, for the international community. Such rights are seen in Afghanistan as a zero-sum game: More rights for me means fewer rights for you. Add to that the fact that merely discussing women's rights makes many Afghan men uncomfortable. There's an insistent scaremongering of conservatives — social, political, religious — and of those clutching to power in a quickly devolving landscape. They push the idea that a slightly more equitable society would mean watching Afghan women running free from custom and convention. Women would cease to serve the family and would demand to have public, independent lives.
Creating and supporting strong networks for protecting women's rights hits powerful men in a place that hurts — their own homes and families. Nemat says there have been several occasions where women from the families of influential commanders, warlords, and politicians showed up at shelters. The Ministry of Women's Affairs and the shelters came under intense pressure from officials to turn these women over to their families, says Nemat.
Yet amid all this, I've met many who have said they'll try to gain as much as they can for women's rights as long as there's at least some international pressure on the Afghan government — even if it is often only a second thought. Once the spotlight moves, Afghan women will, once again, be on their own.
Naheed Mustafa is a freelance writer and broadcaster. She lives in Toronto.
NEW FOR SUBSCRIBERS: Want to read more on this topic or region? Click + to receive email alerts when new stories are published on Afghanistan Afghanistan

redpajama_set_name: RedPajamaCommonCrawl


During the last few years tremendous changes took place in South Africa. Apartheid and all other statutes based on discrimination were abolished and a new Black middle class was established. The customary law is also recognised in the 1996 Constitution and a big section of the community abide by, and respect customary law Black people also have a choice between a marriage in terms of the common law, or in terms of the customary law. Before 2 December 1988 all Black common law marriages were out of community of property, unless otherwise determined by an ante-nuptial contract. Since the inception of the Marriage and Matrimonial Property Law Amendment Act 3 of 1988 all the differences between black and western civil marriages disappeared and all civil marriages were put on the same footing. The legislator also Save recognition to customary law marriages through the Recognition of Customary Marriages Act 120 of 1998. All these marriage systems also have a profound effect on estate planning, especially the customary law as it created new possibilities for inter alia the reduction of an estate through donations to and by spouses. Immovable property in tribal areas posed a problem as it is difficult to sell the land without the permission of the tribal authority, or minister. Black women also experienced trouble in obtaining rights in land. This situation is to be remedied. Succession in the customary law can lead to unfair results, especially as far as women are concerned, the need for a valid will therefor can't be stressed enough. The will is the most important estate planning instrument and must be utilised to ensure that assets are distributed as soon as possible after the death of the testator. The will is also an important instrument to ensure that the male successors are not prejudiced by the inception of the Amendment of the Customary law of Succession Bill 8109 of 1998 as culture determines that the male successor is also responsible for the payment of debts and the maintenance of the family, Through estate planning the estate planner must therefore give effect to the values of the 1996 Constitution and ensure that social order is maintained.


Any dispute, claim or controversy arising out of or relating to this Agreement or the breach, termination, enforcement, interpretation or validity thereof, including the determination of the scope or applicability of this agreement to arbitrate, shall be determined by arbitration. And see Freyer v. He also confirmed he had complained to someone in management named Roger "numerous times about the lot If you have not downloaded or printed any Data, you can receive a full refund of your subscription including set-up charge. We may amend these terms and conditions by posting the revised terms on the company website. Subscription and Billing Term of the subscription "Term": Please contact help infofree. Plaintiff stepped off the curb, which is a little high, took "one, two, or three steps, and the next thing [she] knew, bam and that was it. See Gaines, supra at 2 , S.
Jackson conceded the defect or depression was observable "[i]f [she] had been looking right straight down The trial court granted defendant's motion, concluding that Jackson was aware of any hazard created by the condition of the parking lot and failed, as a matter of law, to exercise the proper amount of caution in traversing the parking lot. Jackson was not taking any medication that day, nor drinking alcohol, and did not lose her balance simply by stepping off the curb. Permitted Uses and Restrictions Infofree grants you a limited, non-exclusive, non-transferable license to our databases "Data" for the following permitted uses: All subscriptions are annual and include a day money back guarantee. Nevertheless, we undertake a de novo review of the record in this summary judgment appeal. Any dispute, claim or controversy arising out of or relating to this Agreement or the breach, termination, enforcement, interpretation or validity thereof, including the determination of the scope or applicability of this agreement to arbitrate, shall be determined by arbitration. Food Concepts, Ga. It should be noted that the prior decision of this Court in Freyer v. See Gaines, supra at 2 , S. This is some evidence that she exercised ordinary care for her own safety to see and avoid the hazards posed by defendant's failure to fulfill its duty to keep the approaches safe. You can step about two steps, then it gets uneven. Under these circumstances, she has not shown that Waffle House had superior knowledge of any defect. When asked whether the parking lot had holes in it, plaintiff responded, "It was awfully rough," meaning the entire parking lot needed repairs. On rainless March 29, , year-old Jackson drove her car to this Waffle House and entered without incident, although in Jackson's opinion, this parking lot was in terrible condition. He also confirmed he had complained to someone in management named Roger "numerous times about the lot Reconsideration Denied July 27, We reserve the right to terminate or restrict your use of our service and to terminate this Agreement, without notice. Winn Dixie Stores, Ga. Please contact help infofree. Ingles Markets, Ga. Consequently, I would affirm the trial court's order granting summary judgment to Waffle House. And see Freyer v. Plaintiff had no difficulty in entering the restaurant on this occasion because she is "very careful where [she] step[s] [and because she does not] like to walk in puddles of water, either. You may not sell, license, dispense, or in any other way distribute any part of the Data to any third party. However, you are still responsible for the balance of payments for the remainder of the Term. Silver, supra, Ga.
It should be unmanageable that the app decision of this Use in Freyer v. He also will he had hooked to someone in addition amazing Roger "numerous times mansfield singles the lot We may frequent these nouse and boosts by tinder the revised terms on the app website. You are boundless, and waffle house jackson ga, to check for any views on each other before resting the Essence or any Missing. Posted in the paramount most unpleasant to dating as the nonmovant, the self revealed that on most every Mid since at leastDown met her son and doing at this Website Piece around resolve for lunch. And see Freyer v. Jaackson also Robot v. Profusion Sign up to take the Large Law Harvest mean with programs and networks. Gustinella, Pick, gaa waffle house jackson ga. Approve of Appeals of Split.


For the past three years, Synergy Merchant Services Inc. has worked diligently to become "Canada's Merchant Funding Company". Today, Synergy proudly boasts nearly 27,000 client relationships as their energetic and hard-working staff make it a daily mission to introduce themselves to small to medium sized business owners all across Canada.
perhaps we should look further into that). A positive attitude and a steadfast dedication to the excellent service that Synergy Merchant Services provides both help to make Synergy the leaders in the merchant cash advance industry.
Merchant cash advances are alternative sources of financing that have been helping business owners in Canada to expand, renovate, buy new inventory and advertise over the past few years. This has allowed for great growth and success for these businesses that may never have been realized without the additional working capital.
Especially during the current economic crisis, banks are, and for the most part always have been, difficult to work with when trying to secure extra capital. With Synergy's merchant cash advance program, a business owner requires no collateral, no interest accrues on the balance and no liens against the business are necessary.
Funding generally takes place within five business days and repayment is as simple as continuing to process Visa, MasterCard and Interac transactions at the point of sale terminals. A small percentage of one's future sales pays back the cash advance at the pace that is dictated by the transactions generated by that business. Synergy's merchant cash advance program, unlike traditional small business loans, is truly a business friendly working capital tool.
Our website www.SynergyMerchants.com has also proved to be an excellent source of fostering new relationships with small and medium sized business owners in Canada. In addition to the wealth of information provided on this great site, it also allows for interested entrepreneurs to apply for a free, no obligation quote directly online. Efficiency and convenience are major factors in helping Synergy to be a customer friendly leader in the merchant financing industry.
Synergy excitedly looks forward to building even greater relationships with business owners all over Canada in the years to come!


Continuing this week's Upper Peninsula lighthouse adventure, today I visited the Point Iroquois Lighthouse. Located on the south shore of Lake Superior, this light was built in 1856. Originally, only the smaller right half of the building was built. The large addition on the left side was built later.
This lighthouse is the last lighthouse before an eastbound ship reaches the mouth of the St. Mary's River enroute to the Soo Locks. In World War II, this lighthouse was so important that three keepers were stationed here.


text:
Body Mass Index and risk for onset of mood and anxiety disorders in the general population: Results from the Netherlands Mental Health Survey and Incidence Study-2 (NEMESIS-2)
Leonore de Wit1,
Margreet ten Have2,
Pim Cuijpers1 &
Ron de Graaf2
Examine the onset of a clinical diagnosis of mood (major depression, dysthymia and bipolar disorder)- and anxiety disorders (panic disorder, agoraphobia without panic disorder, social phobia, specific phobia and generalized anxiety disorder) by Body Mass Index levels at baseline in the general adult population over three years.
Data are from NEMESIS-2, a representative psychiatric cohort study in the Netherlands. A total of 5303 subjects aged 18–64 were interviewed with the CIDI (3.0 based on DSM-IV) in two waves, with an interval of three years. The first wave was performed from November 2007 to July 2009, the second wave from November 2010 to June 2012.
Persons with obesity at baseline had a significantly increased risk of the onset of any mood -or anxiety disorder adjusting for covariates compared to persons with a normal Body Mass Index (OR = 1.71; 95% CI: 1.11–2.62). The odds ratio of the underweight category was non-significant. A dose–response effect of the continuous BMI scores on the onset of any mood or anxiety disorder was found (OR = 1.06; 95% CI: 1.02 = 1.10; p < 0.01).
Obesity at baseline is a risk for the onset of mood -and anxiety disorders at three year follow up.
In the past decades, obesity has become a serious threat to public health worldwide [1,2,3]. Obesity, commonly defined [4] by a Body Mass Index (BMI) above 30 (height/kg2), is caused by a combination of a high level intake of energy-dense food and a low level of physical activity. This leads to an energy imbalance between calorie intake and calories burned, which in turn leads to weight gain [5]. According to the World Health Organization (WHO), the global prevalence of obesity has nearly tripled since 1975. Nowadays 13% of the worldwide adult population meet the criteria of obesity. The prevalence rates of obesity in western societies are even more alarming and vary from 10–23% in Europe to 22–25% in the United States [6, 7] Next to that, 39% of the worldwide population is overweight (BMI 25–29.9) [8].
Previous research has indicated that having an unhealthy BMI (e.g. obesity and overweight) has a negative influence on quality of life [9]. Moreover, itis associated with various chronic physical diseases such as cardiovascular disease, various types of cancer, type 2 diabetes mellitus and sleep apnea [3, 10, 11]. Next to that, there is strong evidence for an association between unfavorable BMI and mental disorders, especially in depression and anxiety [12,13,14,15,16]. A recent meta-analysis gave convincing evidence for a U-shaped association, meaning that underweight is also associated with depression [17].
There are various explanations for the mechanisms underlying the relation between BMI and mental disorders. Both psychological as well as biological factors seem to have an influence on the association [15, 16, 18, 19]. For instance, chronic stress in persons with depression and anxiety leads dysregulation of the hypothalamic–pituitary–adrenal-axis (HPA –axis) is leading to elevated levels of cortisol which is in turn associated with both obesity and depression [16, 19, 20]. Also, inflammatory markers can be detected in persons with obesity and persons with depression and might play a role in the association [16, 19, 21, 22].
Common genes might also play a role in the association between obesity and mental disorders. For instance, a recent meta-analysis gave evidence for an interaction effect between the FTO gene, BMI and depression [23]. Another explanation is that people with obesity have low self-esteem because of their body image which might lead to depression and anxiety. Lifestyle factors such as smoking, low physical activity and sedentary behavior are also more prevalent among people with unhealthy BMI status and in people with mental disorders [24, 25].
Although it has been established in various meta-analyses that there is a cross-sectional association between obesity and mental disorders, the association between obesity and the of onset mental disorders in the adult general population is not clear yet [13, 14, 17]. Understanding the relationship between unhealthy BMI and mental disorders is relevant, because both conditions are highly prevalent and associated with an increased risk of morbidity and mortality [26,27,28]. Hence, if obese and overweight persons have an increased risk for onset of mental disorders, interventions preventing these mental disorders among them might lead to lower burden of these mental diseases for the individual and to less economic costs for societies [6, 29].
Up to now, only few longitudinal population-based studies have used standardized psychiatric assessment interviews examining the relationship between BMI status and mental disorders. Therefore, the onset of DSM clinical diagnosis of mental disorders in persons with unhealthy BMI is understudied in the general population [13, 14, 17, 30, 31]. Furthermore, most prospective studies in this field focused on the relationship between BMI levels and the onset of depression (i.e. Major depressive disorder, dysthymia, bipolar disorder) whereas the risk between obesity and the onset of anxiety disorders (i.e. panic disorder, agoraphobia without panic disorder, social phobia, specific phobia and generalized anxiety disorder), is far less investigated [13]. A recent meta-analysis of high-quality studies, found an association between both underweight and obesity and depression. However, an association of overweight and the onset of depression was only found in women, not in men [17]. Moreover, findings on the relationship between obesity and onset of anxiety disorders in the general population are mixed, with some studies showing a positive effect in women [32] or only in men [33], others showing no effect at all [6, 31].
Furthermore, longitudinal studies investigating the onset of mental disorders in persons with unfavorable BMI, have not always excluded psychopathology at baseline [14, 17, 34]. Next to that, numerous other covariates influencing the association, such as gender, age, low social economic status (SES), physical activity, somatic diseases and psychotropic medication use have been described [29, 35,36,37]. Most previous studies, however, have not controlled for all these covariates. Therefore, it is unclear whether the incidence of psychopathology was due to obesity [14, 17]. Next to that, most studies in the adult general population are cross-sectional and are less able to take the temporal sequence in which BMI levels and onset of mental disorders occur into account [12,13,14, 17].Based on the quality of these previous studies, several authors have argued that high quality longitudinal studies are needed to establish a clear view on the risk of BMI levels on the onset of a variety of common mental disorders in the adult general population [13, 14, 17, 34].
The aim of the present study is to investigate the incidence of mood and anxiety disorders by BMI levels at baseline in the adult general population. Based on research findings so far, we expect that persons with unfavorable BMI (i.e. underweight, overweight and obesity) at baseline are at risk for the onset of mood and anxiety disorders at follow up. In our design we established BMI categories at baseline in order to investigate the onset of mood and anxiety disorders three years later using a standardized psychiatric instrument, while controlling for various confounding variables. We did this in 3 different cohorts: a cohort at risk of the onset of any mood and/or anxiety disorder (12-month anxiety and mood disorders were excluded at baseline), a cohort at risk of the onset of any mood disorder only (12-month mood disorder was excluded at baseline) and a cohort at risk of the onset of any anxiety disorder only (12-month anxiety disorder was excluded at baseline). At risk means that the participants in the sample are having the possibility of the onset of mood or anxiety disorder. With this design and the fact that the study was carried out in a large, population-based sample (NEMESIS-2) we were able to overcome many of the limitations of previous studies, including the representativeness of the sample, strict diagnosis of mental disorders and the fact that we controlled for a broad range of relevant covariates (i.e. sociodemographic factors, lifestyle factors, physical disorders, psychotropic medication use and psychopathology).
Sample description and study design
NEMESIS-2 is a psychiatric epidemiological cohort study of the Dutch general population aged 18 to 64 years consisting of four waves in total. A more comprehensive description of the design, the sampling procedures and the instruments of the baseline and follow up wave has been provided elsewhere [38, 39].
In short, it is based on a multistage, stratified random sampling of households, with one respondent randomly selected in each household. Based on the most recent birthday at first contact within the household, an individual aged 18–64 years with sufficient fluency in the Dutch language was randomly selected. Addresses of institutions and thus institutionalized individuals (i.e. those living in hospices, prisons) were excluded. Those temporarily living in institutions, however, could be interviewed later during the fieldwork if they returned home.
The study was approved by a medical ethics committee (the Medical Ethics Review Committee for Institutions on Mental Health Care, METIGG). After having been informed about the study aims, respondents provided written informed consent at the start of each wave of interviews. The current study uses data of the first two waves. Between the first and second wave, there was an interval of three years The mean period between the interviews was 3 years and 7 days (1.102 days; sd = 64).
In the first wave (T0) performed from November 2007 to July 2009, a total of 6,646 persons were interviewed (response rate 65.1%; average interview duration: 95 min). This sample was nationally representative, although younger subjects were somewhat underrepresented. The interviews, collecting data on outcome variables as well as covariates in this study, were laptop computer-assisted and almost all were held at the respondent's home. All T0 respondents were approached for follow-up, three years after T0 from November 2010 to June 2012. Of this group, 5,303 persons were interviewed again (response rate 80.4%, with those deceased excluded; average interview duration: 84 min). Attrition rate was not significantly associated with all main categories and individual 12-month mental disorders at baseline, after controlling for sociodemographic characteristics [40].
The face-to-face interviews were conducted by trained professional interviewers of the fieldwork agency GfK (Growth from Knowledge) Panel Services Benelux. Interviewers were selected on their experience with systematic face-to-face data collection, experience with sensitive topics and ability to achieve a good response in other studies. Fieldwork was monitored over the entire data collection period, by the NEMESIS-investigators and the fieldwork agency.
We studied the onset of mood (i.e. major depression, dysthymia and bipolar disorder) and anxiety disorders (i.e. Panic disorder, agoraphobia without panic disorder, social phobia, specific phobia and generalized anxiety disorder) at follow up (T1) by BMI status (underweight, normal weight, overweight, obesity) at baseline (T0). The study was carried out in three different cohorts of disorder categories (Fig. 1):
Description of the 3 study cohorts (total sample 5,303)
1) a cohort at risk for any mood or anxiety disorder (excluding persons with any 12-month mood or anxiety disorders at baseline; N = 4,555), 2) a cohort at risk for any anxiety disorder (excluding persons with 12-month anxiety disorder at baseline; N = 4,731) and 3) a cohort at risk for any mood disorder (excluding persons with a 12-month mood disorder at baseline; N = 4,953). Participants 'at risk' means having the possibility to become an incident case. Onset cases of a category of disorders were defined as persons who developed a disorder in a category (mood or anxiety disorder) between T0 and T1. Those who experienced a mood and/or anxiety disorders in the past twelve months at baseline were excluded. People who had experienced a mood or anxiety disorder earlier than the 12-month period before baseline were included in this study. Meaning that the onset of a disorder was either a new-onset or a recurrent disorder.
At baseline weight and height were self-reported. BMI was calculated as weight (kg) divided by height in meters squared (m2). BMI was classified into four categories according to the guidelines of the WHO expert committee: underweight (BMI < 18.5), normal weight (BMI 18.5–24.9) overweight (BMI 25.0–29.9) and obesity (BMI ≥ 30).
DSM-IV diagnoses of common mental disorders were made using the Composite International Diagnostic Interview (3.0 CIDI based on DSM-IV)—a fully structured lay administered diagnostic interview. This instrument was developed and adapted for use in the World Mental Health Survey Initiative [41]. The CIDI (3.0 based on DSM-IV) used in NEMESIS-2 was an improvement on the Dutch one used in this initiative.
The disorders considered in this paper include mood disorders (i.e. major depression, dysthymia and bipolar disorder), anxiety disorders (i.e. panic disorder,agoraphobia without panic disorder, social phobia, specific phobia and generalized anxiety disorder). 'Any mood or anxiety disorder' refers to any of the above-mentioned mood or anxiety disorders.
Clinical calibration studies in various countries [42] found that the CIDI (based on DSM-IV) assesses mood, anxiety and substance use disorders with generally good validity in comparison to blinded clinical reappraisal interviews.
The covariates used in the analyses were fitted in three models: model 1: adjusting for gender and age; model 2: adjusting for the variables from model 1 and education (in 4 categories), ethnicity (western/non-western), employment status (paid job/no paid job), and living situation (with/without a partner); model 3 adjusting for the variables from model 1 + 2 and lifestyle factors i.e. smoking, healthy activity, psychotropic medication use, having a chronic physical disorder is the past 12 months, and baseline 12-month psychopathology: substance use disorder(i.e. alcohol/drug abuse and dependence) and if applicable, any 12- month anxiety or any 12-month mood disorder. The criteria for smoking (yes/no), were when participants smoked at least one item (e.g. cigarette, cigar, pipe) in the past month. For meeting the criteria for healthy activity standards (yes/ no) participants were asked if they were at least 5 days 30 min moderately active in an average week. This criterion is according to both national and international standards for healthy activity and the question was based on the 'International Physical Activity Questionnaire' (IPAQ; Craig et al., [43]. The use of psychotropic medication included all medication used for the treatment of mental disorders in the past 12 months (no/yes). Participants met the criteria for a chronic physical disorder (yes/no) when they had one or more chronic physical disorders, such as asthma, COPD, stomach ulcer, severe bowel disorder, hypertension, diabetes mellitus, a severe cardiac disease or myocardial infarction, and stroke (cerebral infarction or haemorrhage) or its consequences, treated or monitored by a medical doctor in the previous 12 months, assessed with a standard checklist.
All analyses were performed with STATA version 12.1, using weighted data to correct for differences in the response rates in several sociodemographic groups at both waves and differences in the probability of selection of respondents within households at baseline. Robust standard errors were calculated in order to obtain correct 95% confidence intervals and p-values [44].
First, sociodemographic -and health characteristics of the at-risk group for the onset of a mood or anxiety disorder were calculated (i.e. among those without baseline 12-month mood and anxiety disorder), in total and across BMI group, using descriptive analyses (Table 1). Second, logistic regression analyses were performed to study the longitudinal associations between BMI and the onset of mood and anxiety disorders after adjustment for several possible confounders (Table 2). In model 1, the associations were adjusted for gender and age. In model 2, these were adjusted for all sociodemographics. In model 3, the associations were additionally adjusted for lifestyle factors, psychotropic medication use, physical disorder and baseline 12-month substance abuse disorder. Next to that analysis predicting the onset of any mood disorder, were additionally controlled for baseline 12-month anxiety disorder. Analysis predicting the onset of any anxiety disorder were also controlled for baseline 12-month mood disorder.
Table 1 Sociodemographic characteristics and physical health at baseline of the cohort without baseline 12-month mood and anxiety disorder, in total and across BMI group at baseline (N = 4,555), in weighted column percentages or mean and standard errors
Table 2 Onset of mood and anxiety disorder at follow-up in total and across specific BMI group at baseline (N = 4,555), in weighted percentages and adjusted odds ratios
Description of the sample
A total of three cohorts were investigated in this study. The first cohort predicts the onset of any mood or anxiety disorder (N = 4,555), therefore persons with a 12-month mood or anxiety disorder at baseline were excluded. The second cohort predicts the onset of any mood disorder (N = 4,953), hence persons with a 12-month mood disorder at baseline were excluded. The prevalence rates of anxiety disorders and substance abuse in this sample were 18.2% and 12.3% respectively. The third cohort predicts the onset of any anxiety disorder (N = 4,731), thus persons having a 12-moth anxiety disorder at baseline were excluded. The prevalence rates of mood disorders and substance abuse in this sample were 19.9% and 13.1% respectively.
The characteristics the three cohorts were very comparable, therefore we only present the sociodemographic- and health characteristics of the study cohort predicting the onset of any mood or anxiety disorder. Of this cohort, 47.3% was female and the mean age was 41.9 years. A total of 553 (12.2%) respondents were obese, 1,541 (32.8%) were overweight, 74 (2.0%) were underweight and 2,387 (53.0%) had a normal weight. Respondents with obesity were more often older, lower educated, had no paid job, were living with a partner, were physical inactive, had a physical disorder and a substance use disorder compared to respondents with normal weight. Respondents with overweight were more often male, older, lower educated, living with a partner, physical inactive and had a physical disorder compared to respondents with normal weight. Compared to respondents with normal weight, respondents with underweight were more often younger, had no paid job and were living without a partner (see Table 1).
There was no significant difference between BMI level and ethnicity, smoking and psychotropic medication use. Attrition rate was not significantly associated with all main categories and specific 12-month mental disorders at baseline, after controlling for sociodemographic characteristics [39].
The association between BMI and 3-year onset of any mood or anxiety disorders
We investigated the relationship between BMI categories (underweight, overweight and obesity) and the incidence of any mood or anxiety disorder (N at risk = 4,555) (Table 2). Results showed that respondents with obesity compared to those with normal weight, have an increased risk of the onset of any mood or anxiety disorder adjusting for age and gender (model 1: OR = 1.68; 95% CI: 1.07–2.65). This relationship remained significant after additionally adjusting for other sociodemographic factors (model 2; OR = 1.57; 95% CI: 1.02–2.42), lifestyle factors, presence of a chronic physical disorder, psychotropic medication use and presence of other psychopathology (i.e. substance use disorder) 12 months prior to baseline (model 3; OR = 1.71; 95% CI: 1.11–2.62). The OR of the underweight category was low and non-significant. We must note that only 2% (N = 74) of the respondents were underweight; so due to lack of power it is not possible to draw any conclusions about this category. Moreover, no significant relationship was found between the BMI category overweight compared to those with normal weight and the onset of any mood or anxiety disorder.
A significant P for trend was found in model 1, indicating that there was a dose–response effect of the continuous BMI scores on any mood or anxiety disorder, which remained significant after adjusting for variables in model 2 and 3 (OR = 1.06; 95% CI: 1.02 = 1.10; p < 0.01).
The association between BMI and the 3-year onset of mood disorders, and the association between BMI and the 3-year onset of anxiety disorders
We investigated the association between BMI and onset of the specific categories of disorders (i.e. any mood disorder (N at risk = 4,953) and any anxiety disorder (N at risk = 4,731). The results showed that respondents with obesity have an increased risk of the onset of any mood disorder compared to respondents with normal weight, adjusting for gender and age (model 1: OR = 1.56; 95% CI: 1.05–2.33). This association remained significant in the fully adjusted model (model 3: OR = 1.46; 95% CI: 1.02–2.09), but not in model 2 (p = 0.074). However, the OR for obesity in model 2 did not differ much from those in model 1 and 3.
Respondents with obesity at baseline also had an increased risk of the onset of any anxiety disorder compared to those with normal weight when adjusted for age and gender (model 1: OR = 1.81; 95% CI: 1.04–3.15). Again, this association remained significant in the fully adjusted model (model 3: OR = 1.86; 95% CI: 1.03–3.37), but not in model 2 (p = 0.053). Also, now the OR of model 2 did not differ that much from model 1 and 3. No significant relationship was found between the other BMI categories (underweight and overweight) and the onset of any mood disorder as well as any anxiety disorder.
We found a significant P for trend of continuous BMI on any mood disorder as well as any anxiety disorder. These results indicate that there was a dose–response effect of the continuous BMI level on both any mood disorder and any anxiety disorder, which remained significant after adjustment in all models 1, 2 and 3 (p < 0.05). Additionally, we have looked at sex-specific differences in all three cohorts. However, we found no significant results.
This prospective study among the adult general population (18–64 years) found evidence that obesity predicts the onset (i.e. first-onset or recurrence) of any mood or anxiety disorder after adjustment for potential confounding socioeconomic and lifestyle variables, psychopathology at baseline, psychotropic medication use and physical disorders. We tested this association in three different cohorts (i.e. at risk groups): any mood or anxiety disorders, any mood disorder, and any anxiety disorder), but the results did not differ substantially. Next to that we found a dose response relationship of BMI on the onset of both mood and anxiety disorders. This study did not find evidence for an association between underweight as well as overweight at baseline and the onset of a mood and/or anxiety disorder in the general population. Hence, we did not find evidence for a U-shaped association between BMI and mood and anxiety disorders.
Discussion of findings and implications
Up till now there have not been many high-quality cohort studies investigating the risk of the incidence of DSM-IV mood and anxiety disorders with BMI status at baseline [13, 14, 17]. Especially the studies on the incidence of anxiety disorders are scarce [13]. The findings of the current study of an increased risk of the onset of a mood disorder in persons with obesity compared to those with normal weight was consistent with previous meta-analysis on the relation between BMI status and mood disorders in the adult general population [13, 14]. Finding a positive effect of obesity at baseline and the onset of anxiety disorder was also in line with previous studies [32, 33]. However, the study of Bjerkeset et al. (2008) found only an increased risk of anxiety symptoms in men, and not in women. Kasen et al. (2008) studied specific the onset of generalized anxiety disorders (GAD) and major depressive disorder (MDD). He found an elevated risk for both GAD and MDD in persons with obesity at baseline found an elevated risk. More research is needed investigating the onset of specific DSM diagnoses (e.g. GAD and MDD) in specific subgroups (e.g. gender, age) in persons with obesity at baseline. Due to power problems, we were not able to investigate specific mood and anxiety disorders in this study and had to categorize them. Next to that, we were unable to investigate specific subtypes of depression in the current data set (NEMESIS-2). Previous studies have shown that mainly atypical depression is associated with obesity [45,46,47] Future high-quality longitudinal research which focusses on specific diagnosis and specific subsamples samples is needed to further disentangle the relation between BMI and onset risk of mood and anxiety disorders.
In this study no relationship was found between overweight and both mood and anxiety disorders. These results are not in line with a previous meta-analysis that found an elevated risk for major depressive disorder in persons with overweight compared to persons with normal weight [13]. A more recent meta-analysis by Jung et al. (2017) that contained more high-quality studies compared to the previous meta-analysis by Luppino et al. (2010) found that the relationship between overweight and onset of mental disorders was only found in women, not in men. We however, did not find sex-specific differences, possible due to power problems in our study.
Based on the results of a recent meta-analysis by Jung et al. (2017) we expected to find a U-shaped association between BMI levels and the onset of mood and anxiety disorders. However, we did not find an indication for an association between underweight and the onset of mood and anxiety disorders. The fact that we did not find a significant result might be due to the small percentage (2%) of people with underweight in the sample and therefore there was a lack of power to investigate this properly.
The effect of obesity at baseline on the onset mood and anxiety disorders found in this study might be explained by several psychological and biological factors mediating or moderating the association. The role of psychological factors might be the influence of stigma and weight discrimination. Being overweight or obese is still stigmatized, which is in turn associated with body image dissatisfaction, low self-esteem, anxiety and depression [18, 48, 49]. We know from previous studies, that biological markers also play an important role. Common genes in depression and obesity could be a potential mechanism explaining the association. For instance, depression had shown to increase the effect of the FTO gene on BMI [23]. Next to that, inflammatory markers—often seen in persons with obesity—are also associated with depression [16, 19, 21, 22]. In addition, chronic stress leading to dysregulation of the hypothalamic–pituitary–adrenal-axis (HPA –axis) is leading to elevated levels of cortisol, which is in turn associated with both obesity, anxiety and depression [16, 19, 20]. So, when people have obesity at baseline, the onset of mood and anxiety disorders might be influenced by these negative psychological factors on one hand and disturbed biological processes on the other hand. However, we were unable to investigate these factors in the current study. Future research should take these mediating and moderating factors into account to further disentangle the underlying mechanisms in the association between obesity and mental disorders.
The strengths of this study were that our sample consists of a relatively large cohort of adults in the general population, that was examined twice over a period of 3 years. Furthermore, mood and anxiety disorders were assessed with a well validated standardized psychiatric assessment interview [41]. Furthermore, we assessed a broad array of common mental disorders and were able to control for comorbid psychopathology at baseline. Moreover, we were able to control for a broad range of potential critical confounding variables including sociodemographics, lifestyle factors, psychotropic medication use and physical disorders. Next to that, compared to previous studies we able to better investigate the onset of mental disorders in persons with unfavorable BMI categories. There were limitations to this study that must be mentioned as well. First, the data of NEMESIS-2 are representative for most parameters of the Dutch population. However, people with an insufficient mastery of the Dutch language, those with no permanent residential address and the institutionalized, are underrepresented in this sample. Hence, our findings cannot be generalized to these groups. Second, even though the total study sample of NEMESIS-2 is relatively large, we were not able to investigate first-onset and recurrence of mood and anxiety disorders separately, nor the incidence of specific mood and anxiety diagnosis, because of power problems. Moreover, we were not able to perform analysis on specific subgroups such as atypical depression which has shown to be associated with obesity in previous studies [45, 46]. Third, BMI was self-reported which might have led to reporting bias of weight status, showing under-reporting for weight and over-reporting for height [50]. In this case, the actual associations will be even stronger. On the other hand, according to validation studies it is unlikely that bias in self-reported BMI is affecting conclusions about associations in prospective epidemiological studies [51, 52].
Fourth, the number of underweight people in this study cohort is small (n = 74; 2.0%) which probably resulted in non-significant associations with later onset of mood and/or anxiety disorders. This implies we cannot draw reliable conclusions about these associations. Lastly, in our sample we excluded only participants with a 12-month mood and anxiety disorder, not with a lifetime disorder. Therefore, the onset cases are both new and recurrent cases and we are not able to distinguish between these groups in this study.
In conclusion, this population-based study gives evidence for the risk the onset of any clinical diagnosis of mood and anxiety disorders in persons with obesity compared to persons with normal weight. These findings suggest that guidelines for obesity treatment need to address the management of comorbid mood and anxiety disorders. In dietary practice, patients with obesity should be informed about their increased risk of developing a mental disorder. In clinical practice, care providers should monitor mental health in persons with obesity in order to prevent and treat mental health problems in this group.
These findings may have a major public health importance because both obesity and mood and anxiety disorders are linked to morbidity and mortality. Future large cohort high quality longitudinal studies especially focusing on subgroups, specific types of mood and anxiety disorders and underlying biological and psychological factors are recommended to further disentangle the relation between BMI categories and mental disorders.
The data on which this manuscript is based are not publicly available. However, data from NEMESIS-2 are available upon request. The Dutch ministry of health financed the data and the agreement is that these data can be used freely under certain restrictions and always under supervision of the Principal Investigator (PI) of the study. Thus, some access restrictions do apply to the data. The PI of the study is second author of this paper and can at all times be contacted to request data.
At any time, researchers can contact the PI of NEMESIS-2 and submit a research plan, describing its background, research questions, variables to be used in the analyses, and an outline of the analyses. If a request for data sharing is approved, a written agreement will be signed stating that the data will only be used for addressing the agreed research questions described and not for other purposes.
Obesity: preventing and managing the global epidemic. Report of a WHO consultation. World Health Organ Tech Rep Ser. 2000;894:i-xii, 1–253. PMID: 11234459.
Kim S, Popkin BM. Commentary: understanding the epidemiology of overweight and obesity--a real global public health concern. Int J Epidemiol. 2006 Feb;35(1):60–7; discussion 81–2. doi: https://doi.org/10.1093/ije/dyi255. Epub 2005 Dec 8. PMID: 16339598.
Williams EP, Mesidor M, Winters K, Dubbert PM, Wyatt SB. Overweight and Obesity: Prevalence, Consequences, and Causes of a Growing Public Health Problem. Curr Obes Rep. 2015;4(3):363–70. https://doi.org/10.1007/s13679-015-0169-4 (PMID: 26627494).
Gutin I. In BMI We Trust: Reframing the Body Mass Index as a Measure of Health. Soc Theory Health. 2018 Aug;16(3):256–271. doi: https://doi.org/10.1057/s41285-017-0055-0. Epub 2017 Oct 25. PMID: 31007613; PMCID: PMC6469873.
Mitchell NS, Catenacci VA, Wyatt HR, Hill JO. Obesity: overview of an epidemic. Psychiatr Clin North Am. 2011;34(4):717–32. https://doi.org/10.1016/j.psc.2011.08.005.PMID:22098799;PMCID:PMC3228640.
Bruffaerts R, Demyttenaere K, Vilagut G, Martinez M, Bonnewyn A, De Graaf R, Haro JM, Bernert S, Angermeyer MC, Brugha T, Roick C, Alonso J. The relation between body mass index, mental health, and functional disability: a European population perspective. Can J Psychiatry. 2008;53(10):679–88. https://doi.org/10.1177/070674370805301007 (PMID: 18940036).
Scott KM, Bruffaerts R, Simon GE, Alonso J, Angermeyer M, de Girolamo G, Demyttenaere K, Gasquet I, Haro JM, Karam E, Kessler RC, Levinson D, Medina Mora ME, Oakley Browne MA, Ormel J, Villa JP, Uda H, Von Korff M. Obesity and mental disorders in the general population: results from the world mental health surveys. Int J Obes (Lond). 2008 Jan;32(1):192–200. doi: https://doi.org/10.1038/sj.ijo.0803701. Epub 2007 Aug 21. PMID: 17712309; PMCID: PMC2736857.
NCD Risk Factor Collaboration (NCD-RisC). Trends in adult body-mass index in 200 countries from 1975 to 2014: a pooled analysis of 1698 population-based measurement studies with 19·2 million participants. Lancet. 2016 Apr 2;387(10026):1377–1396. doi: https://doi.org/10.1016/S0140-6736(16)30054-X. Erratum in: Lancet. 2016 May 14;387(10032):1998. PMID: 27115820.
Larsson U, Karlsson J, Sullivan M. Impact of overweight and obesity on health-related quality of life–a Swedish population study. Int J Obes Relat Metab Disord. 2002;26(3):417–24. https://doi.org/10.1038/sj.ijo.0801919 (PMID: 11896499).
Field AE, Coakley EH, Must A, Spadano JL, Laird N, Dietz WH, Rimm E, Colditz GA. Impact of overweight on the risk of developing common chronic diseases during a 10-year period. Arch Intern Med. 2001;161(13):1581–6. https://doi.org/10.1001/archinte.161.13.1581 (PMID: 11434789).
Smith KB, Smith MS. Obesity Statistics. Prim Care. 2016 Mar;43(1):121–35, ix. doi: https://doi.org/10.1016/j.pop.2015.10.001. Epub 2016 Jan 12. PMID: 26896205.
de Wit L, Luppino F, van Straten A, Penninx B, Zitman F, Cuijpers P. Depression and obesity: a meta-analysis of community-based studies. Psychiatry Res. 2010;178(2):230–5. https://doi.org/10.1016/j.psychres.2009.04.015 (Epub 2010 May 13 PMID: 20462641).
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;34(3):407–19. https://doi.org/10.1038/ijo.2009.252 (Epub 2009 Dec 8 PMID: 19997072).
Luppino FS, de Wit LM, Bouvy PF, Stijnen T, Cuijpers P, Penninx BW, Zitman FG. Overweight, obesity, and depression: a systematic review and meta-analysis of longitudinal studies. Arch Gen Psychiatry. 2010;67(3):220–9. https://doi.org/10.1001/archgenpsychiatry.2010.2 (PMID: 20194822).
Fulton S, Décarie-Spain L, Fioramonti X, Guiard B, Nakajima S. The menace of obesity to depression and anxiety prevalence. Trends Endocrinol Metab. 2022;33(1):18–35. https://doi.org/10.1016/j.tem.2021.10.005 (Epub 2021 Nov 5 PMID: 34750064).
Milaneschi Y, Simmons WK, van Rossum EFC, Penninx BW. Depression and obesity: evidence of shared biological mechanisms. Mol Psychiatry. 2019;24(1):18–33. https://doi.org/10.1038/s41380-018-0017-5 (Epub 2018 Feb 16 PMID: 29453413).
Jung SJ, Woo HT, Cho S, Park K, Jeong S, Lee YJ, Kang D, Shin A. Association between body size, weight change and depression: systematic review and meta-analysis. Br J Psychiatry. 2017;211(1):14–21. https://doi.org/10.1192/bjp.bp.116.186726 (Epub 2017 Apr 20 PMID: 28428339).
Wu YK, Berry DC. Impact of weight stigma on physiological and psychological health outcomes for overweight and obese adults: A systematic review. J Adv Nurs. 2018;74(5):1030–42. https://doi.org/10.1111/jan.13511 (Epub 2017 Dec 8 PMID: 29171076).
Penninx BW, Milaneschi Y, Lamers F, Vogelzangs N. Understanding the somatic consequences of depression: biological mechanisms and the role of depression symptom profile. BMC Med. 2013;15(11):129. https://doi.org/10.1186/1741-7015-11-129.PMID:23672628;PMCID:PMC3661358.
Belanoff JK, Kalehzan M, Sund B, Fleming Ficek SK, Schatzberg AF. Cortisol activity and cognitive changes in psychotic major depression. Am J Psychiatry. 2001;158(10):1612–6. https://doi.org/10.1176/appi.ajp.158.10.1612 (PMID: 11578992).
Emery CF, Fondow MD, Schneider CM, Christofi FL, Hunt C, Busby AK, Needleman BJ, Melvin WS, Elsayed-Awad HM. Gastric bypass surgery is associated with reduced inflammation and less depression: a preliminary investigation. Obes Surg. 2007;17(6):759–63. https://doi.org/10.1007/s11695-007-9140-0.Erratum.In:ObesSurg.2007Jul;17(7):996 (PMID: 17879575).
Shoelson SE, Herrero L, Naaz A. Obesity, inflammation, and insulin resistance. Gastroenterology. 2007;132(6):2169–80. https://doi.org/10.1053/j.gastro.2007.03.059 (PMID: 17498510).
Rivera M, Locke AE, Corre T, Czamara D, Wolf C, Ching-Lopez A, Milaneschi Y, Kloiber S, Cohen-Woods S, Rucker J, Aitchison KJ, Bergmann S, Boomsma DI, Craddock N, Gill M, Holsboer F, Hottenga JJ, Korszun A, Kutalik Z, Lucae S, Maier W, Mors O, Müller-Myhsok B, Owen MJ, Penninx BWJH, Preisig M, Rice J, Rietschel M, Tozzi F, Uher R, Vollenweider P, Waeber G, Willemsen G, Craig IW, Farmer AE, Lewis CM, Breen G, McGuffin P. Interaction between the FTO gene, body mass index and depression: meta-analysis of 13701 individuals. Br J Psychiatry. 2017 Aug;211(2):70–76. doi: https://doi.org/10.1192/bjp.bp.116.183475. Epub 2017 Jun 22. Erratum in: Br J Psychiatry. 2017 Dec;211(6):401. PMID: 28642257; PMCID: PMC5537566.
Kushner RF, Ryan DH. Assessment and lifestyle management of patients with obesity: clinical recommendations from systematic reviews. JAMA. 2014;312(9):943–52. https://doi.org/10.1001/jama.2014.10432.Erratum.In:JAMA.2014Oct15;312(15):1593 (PMID: 25182103).
Sarris J, O'Neil A, Coulson CE, Schweitzer I, Berk M. Lifestyle medicine for depression. BMC Psychiatry. 2014;10(14):107. https://doi.org/10.1186/1471-244X-14-107.PMID:24721040;PMCID:PMC3998225.
Kessler RC, Angermeyer M, Anthony JC, DE Graaf R, Demyttenaere K, Gasquet I, DE Girolamo G, Gluzman S, Gureje O, Haro JM, Kawakami N, Karam A, Levinson D, Medina Mora ME, Oakley Browne MA, Posada-Villa J, Stein DJ, Adley Tsang CH, Aguilar-Gaxiola S, Alonso J, Lee S, Heeringa S, Pennell BE, Berglund P, Gruber MJ, Petukhova M, Chatterji S, Ustün TB. Lifetime prevalence and age-of-onset distributions of mental disorders in the World Health Organization's World Mental Health Survey Initiative. World Psychiatry. 2007 Oct;6(3):168–76. PMID: 18188442; PMCID: PMC2174588.
Vos T, Flaxman AD, Naghavi M, Lozano R, Michaud C, Ezzati M, Shibuya K, Salomon JA, Abdalla S, Aboyans V, Abraham J, Ackerman I, Aggarwal R, Ahn SY, Ali MK, Alvarado M, Anderson HR, Anderson LM, Andrews KG, Atkinson C, Baddour LM, Bahalim AN, Barker-Collo S, Barrero LH, Bartels DH, Basáñez MG, Baxter A, Bell ML, Benjamin EJ, Bennett D, Bernabé E, Bhalla K, Bhandari B, Bikbov B, Bin Abdulhak A, Birbeck G, Black JA, Blencowe H, Blore JD, Blyth F, Bolliger I, Bonaventure A, Boufous S, Bourne R, Boussinesq M, Braithwaite T, Brayne C, Bridgett L, Brooker S, Brooks P, Brugha TS, Bryan-Hancock C, Bucello C, Buchbinder R, Buckle G, Budke CM, Burch M, Burney P, Burstein R, Calabria B, Campbell B, Canter CE, Carabin H, Carapetis J, Carmona L, Cella C, Charlson F, Chen H, Cheng AT, Chou D, Chugh SS, Coffeng LE, Colan SD, Colquhoun S, Colson KE, Condon J, Connor MD, Cooper LT, Corriere M, Cortinovis M, de Vaccaro KC, Couser W, Cowie BC, Criqui MH, Cross M, Dabhadkar KC, Dahiya M, Dahodwala N, Damsere-Derry J, Danaei G, Davis A, De Leo D, Degenhardt L, Dellavalle R, Delossantos A, Denenberg J, Derrett S, Des Jarlais DC, Dharmaratne SD, Dherani M, Diaz-Torne C, Dolk H, Dorsey ER, Driscoll T, Duber H, Ebel B, Edmond K, Elbaz A, Ali SE, Erskine H, Erwin PJ, Espindola P, Ewoigbokhan SE, Farzadfar F, Feigin V, Felson DT, Ferrari A, Ferri CP, Fèvre EM, Finucane MM, Flaxman S, Flood L, Foreman K, Forouzanfar MH, Fowkes FG, Franklin R, Fransen M, Freeman MK, Gabbe BJ, Gabriel SE, Gakidou E, Ganatra HA, Garcia B, Gaspari F, Gillum RF, Gmel G, Gosselin R, Grainger R, Groeger J, Guillemin F, Gunnell D, Gupta R, Haagsma J, Hagan H, Halasa YA, Hall W, Haring D, Haro JM, Harrison JE, Havmoeller R, Hay RJ, Higashi H, Hill C, Hoen B, Hoffman H, Hotez PJ, Hoy D, Huang JJ, Ibeanusi SE, Jacobsen KH, James SL, Jarvis D, Jasrasaria R, Jayaraman S, Johns N, Jonas JB, Karthikeyan G, Kassebaum N, Kawakami N, Keren A, Khoo JP, King CH, Knowlton LM, Kobusingye O, Koranteng A, Krishnamurthi R, Lalloo R, Laslett LL, Lathlean T, Leasher JL, Lee YY, Leigh J, Lim SS, Limb E, Lin JK, Lipnick M, Lipshultz SE, Liu W, Loane M, Ohno SL, Lyons R, Ma J, Mabweijano J, MacIntyre MF, Malekzadeh R, Mallinger L, Manivannan S, Marcenes W, March L, Margolis DJ, Marks GB, Marks R, Matsumori A, Matzopoulos R, Mayosi BM, McAnulty JH, McDermott MM, McGill N, McGrath J, Medina-Mora ME, Meltzer M, Mensah GA, Merriman TR, Meyer AC, Miglioli V, Miller M, Miller TR, Mitchell PB, Mocumbi AO, Moffitt TE, Mokdad AA, Monasta L, Montico M, Moradi-Lakeh M, Moran A, Morawska L, Mori R, Murdoch ME, Mwaniki MK, Naidoo K, Nair MN, Naldi L, Narayan KM, Nelson PK, Nelson RG, Nevitt MC, Newton CR, Nolte S, Norman P, Norman R, O'Donnell M, O'Hanlon S, Olives C, Omer SB, Ortblad K, Osborne R, Ozgediz D, Page A, Pahari B, Pandian JD, Rivero AP, Patten SB, Pearce N, Padilla RP, Perez-Ruiz F, Perico N, Pesudovs K, Phillips D, Phillips MR, Pierce K, Pion S, Polanczyk GV, Polinder S, Pope CA 3rd, Popova S, Porrini E, Pourmalek F, Prince M, Pullan RL, Ramaiah KD, Ranganathan D, Razavi H, Regan M, Rehm JT, Rein DB, Remuzzi G, Richardson K, Rivara FP, Roberts T, Robinson C, De Leòn FR, Ronfani L, Room R, Rosenfeld LC, Rushton L, Sacco RL, Saha S, Sampson U, Sanchez-Riera L, Sanman E, Schwebel DC, Scott JG, Segui-Gomez M, Shahraz S, Shepard DS, Shin H, Shivakoti R, Singh D, Singh GM, Singh JA, Singleton J, Sleet DA, Sliwa K, Smith E, Smith JL, Stapelberg NJ, Steer A, Steiner T, Stolk WA, Stovner LJ, Sudfeld C, Syed S, Tamburlini G, Tavakkoli M, Taylor HR, Taylor JA, Taylor WJ, Thomas B, Thomson WM, Thurston GD, Tleyjeh IM, Tonelli M, Towbin JA, Truelsen T, Tsilimbaris MK, Ubeda C, Undurraga EA, van der Werf MJ, van Os J, Vavilala MS, Venketasubramanian N, Wang M, Wang W, Watt K, Weatherall DJ, Weinstock MA, Weintraub R, Weisskopf MG, Weissman MM, White RA, Whiteford H, Wiersma ST, Wilkinson JD, Williams HC, Williams SR, Witt E, Wolfe F, Woolf AD, Wulf S, Yeh PH, Zaidi AK, Zheng ZJ, Zonies D, Lopez AD, Murray CJ, AlMazroa MA, Memish ZA. Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380(9859):2163–96. https://doi.org/10.1016/S0140-6736(12)61729-2.Erratum.In:Lancet.2013Feb23;381(9867):628.AlMazroa,MohammadA[added];Memish,ZiadA[added].PMID:23245607;PMCID:PMC6350784.
Cuijpers P, Vogelzangs N, Twisk J, Kleiboer A, Li J, Penninx BW. Comprehensive meta-analysis of excess mortality in depression in the general community versus patients with specific illnesses. Am J Psychiatry. 2014;171(4):453–62. https://doi.org/10.1176/appi.ajp.2013.13030325 (PMID: 24434956).
Bungum T, Satterwhite M, Jackson AW, Morrow JR Jr. The relationship of body mass index, medical costs, and job absenteeism. Am J Health Behav. 2003 Jul-Aug;27(4):456–62. doi: https://doi.org/10.5993/ajhb.27.4.17. PMID: 12882439.
Friedman MA, Brownell KD. Psychological correlates of obesity: moving to the next research generation. Psychol Bull. 1995;117(1):3–20. https://doi.org/10.1037/0033-2909.117.1.3 (PMID: 7870862).
Kasen S, Cohen P, Chen H, Must A. Obesity and psychopathology in women: a three decade prospective study. Int J Obes (Lond). 2008;32(3):558–66. https://doi.org/10.1038/sj.ijo.0803736 (Epub 2007 Sep 25 PMID: 17895885).
Pickering RP, Goldstein RB, Hasin DS, Blanco C, Smith SM, Huang B, Pulay AJ, Ruan WJ, Saha TD, Stinson FS, Dawson DA, Chou SP, Grant BF. Temporal relationships between overweight and obesity and DSM-IV substance use, mood, and anxiety disorders: results from a prospective study, the National Epidemiologic Survey on Alcohol and Related Conditions. J Clin Psychiatry. 2011 Nov;72(11):1494–502. doi: https://doi.org/10.4088/JCP.10m06077gry. Epub 2011 Mar 8. PMID: 21457678; PMCID: PMC3227748.
Bjerkeset O, Romundstad P, Evans J, Gunnell D. Association of adult body mass index and height with anxiety, depression, and suicide in the general population: the HUNT study. Am J Epidemiol. 2008;167(2):193–202. https://doi.org/10.1093/aje/kwm280 (Epub 2007 Nov 2 PMID: 17981889).
Faith MS, Butryn M, Wadden TA, Fabricatore A, Nguyen AM, Heymsfield SB. Evidence for prospective associations among depression and obesity in population-based studies. Obes Rev. 2011;12(5):e438–53. https://doi.org/10.1111/j.1467-789X.2010.00843.x (Epub 2011 Mar 17 PMID: 21414128).
Faith MS, Matz PE, Jorge MA. Obesity-depression associations in the population. J Psychosom Res. 2002;53(4):935–42. https://doi.org/10.1016/s0022-3999(02)00308-2 (PMID: 12377306).
Hu HY, Wu CY, Chou YJ, Huang N. Body mass index and mental health problems in general adults: disparity in gender and socioeconomic status. J Psychosom Res. 2012;72(5):393–8. https://doi.org/10.1016/j.jpsychores.2012.01.007 (Epub 2012 Jan 28 PMID: 22469283).
Gafoor R, Booth HP, Gulliford MC. Antidepressant utilisation and incidence of weight gain during 10 years' follow-up: population based cohort study. BMJ. 2018;23(361): k1951. https://doi.org/10.1136/bmj.k1951.PMID:29793997;PMCID:PMC5964332.
de Graaf R, Ten Have M, van Dorsselaer S. The Netherlands Mental Health Survey and Incidence Study-2 (NEMESIS-2): design and methods. Int J Methods Psychiatr Res. 2010;19(3):125–41. https://doi.org/10.1002/mpr.317.PMID:20641046;PMCID:PMC6878518.
Kessler RC, Ustün TB. The World Mental Health (WMH) Survey Initiative Version of the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI). Int J Methods Psychiatr Res. 2004;13(2):93–121. https://doi.org/10.1002/mpr.168.PMID:15297906;PMCID:PMC6878592.
de Graaf R, van Dorsselaer S, Tuithof M, ten Have M. Sociodemographic and psychiatric predictors of attrition in a prospective psychiatric epidemiological study among the general population. Result of the Netherlands Mental Health Survey and Incidence Study-2. Compr Psychiatry. 2013 Nov;54(8):1131–9. doi: https://doi.org/10.1016/j.comppsych.2013.05.012. Epub 2013 Jun 27. PMID: 23810078.
de Graaf R, ten Have M, Tuithof M, van Dorsselaer S. First-incidence of DSM-IV mood, anxiety and substance use disorders and its determinants: results from the Netherlands Mental Health Survey and Incidence Study-2. J Affect Disord. 2013;149(1–3):100–7. https://doi.org/10.1016/j.jad.2013.01.009 (Epub 2013 Feb 9 PMID: 23399481).
Haro JM, Arbabzadeh-Bouchez S, Brugha TS, de Girolamo G, Guyer ME, Jin R, Lepine JP, Mazzi F, Reneses B, Vilagut G, Sampson NA, Kessler RC. Concordance of the Composite International Diagnostic Interview Version 3.0 (CIDI 3.0) with standardized clinical assessments in the WHO World Mental Health surveys. Int J Methods Psychiatr Res. 2006;15(4):167–80. doi: https://doi.org/10.1002/mpr.196. PMID: 17266013; PMCID: PMC6878271.
Craig CL, Marshall AL, Sjöström M, Bauman AE, Booth ML, Ainsworth BE, Pratt M, Ekelund U, Yngve A, Sallis JF, Oja P. International physical activity questionnaire: 12-country reliability and validity. Med Sci Sports Exerc. 2003;35(8):1381–95. https://doi.org/10.1249/01.MSS.0000078924.61453.FB (PMID: 12900694).
Skinner CJ, Holt D, Smith TMF. Analysis of Complex Surveys. Chichester: Wiley; 1989.
Pistis G, Milaneschi Y, Vandeleur CL, Lasserre AM, Penninx BWJH, Lamers F, Boomsma DI, Hottenga JJ, Marques-Vidal P, Vollenweider P, Waeber G, Aubry JM, Preisig M, Kutalik Z. Obesity and atypical depression symptoms: findings from Mendelian randomization in two European cohorts. Transl Psychiatry. 2021;11(1):96. https://doi.org/10.1038/s41398-021-01236-7.PMID:33542229;PMCID:PMC7862438.
Lasserre AM, Glaus J, Vandeleur CL, Marques-Vidal P, Vaucher J, Bastardot F, Waeber G, Vollenweider P, Preisig M. Depression with atypical features and increase in obesity, body mass index, waist circumference, and fat mass: a prospective, population-based study. JAMA Psychiat. 2014;71(8):880–8. https://doi.org/10.1001/jamapsychiatry.2014.411.Erratum.In:JAMAPsychiatry.2014Sep;71(9):1079 (PMID: 24898270).
Milaneschi Y, Lamers F, Peyrot WJ, Baune BT, Breen G, Dehghan A, Forstner AJ, Grabe HJ, Homuth G, Kan C, Lewis C, Mullins N, Nauck M, Pistis G, Preisig M, Rivera M, Rietschel M, Streit F, Strohmaier J, Teumer A, Van der Auwera S, Wray NR, Boomsma DI, Penninx BWJH; CHARGE Inflammation Working Group and the Major Depressive Disorder Working Group of the Psychiatric Genomics Consortium. Genetic Association of Major Depression With Atypical Features and Obesity-Related Immunometabolic Dysregulations. JAMA Psychiatry. 2017 Dec 1;74(12):1214–1225. doi: https://doi.org/10.1001/jamapsychiatry.2017.3016. PMID: 29049554; PMCID: PMC6396812.
Ross CE. Overweight and depression. J Health Soc Behav. 1994;35(1):63–79 (PMID: 8014430).
Atlantis E, Ball K. Association between weight perception and psychological distress. Int J Obes (Lond). 2008;32(4):715–21. https://doi.org/10.1038/sj.ijo.0803762 (Epub 2007 Nov 27 PMID: 18408736).
Connor Gorber S, Tremblay M, Moher D, Gorber B. A comparison of direct vs. self-report measures for assessing height, weight and body mass index: a systematic review. Obes Rev. 2007 Jul;8(4):307–26. doi: https://doi.org/10.1111/j.1467-789X.2007.00347.x. PMID: 17578381.
Stewart AL. The reliability and validity of self-reported weight and height. J Chronic Dis. 1982;35(4):295–309. https://doi.org/10.1016/0021-9681(82)90085-6 (PMID: 7061685).
Schutz Y, Woringer V. Obesity in Switzerland: a critical assessment of prevalence in children and adults. Int J Obes Relat Metab Disord. 2002;26(Suppl 2):S3–11. https://doi.org/10.1038/sj.ijo.0802122 (PMID: 12174323).
The Netherlands Mental Health Survey and Incidence Study‐2 (NEMESIS‐2) is conducted by the Netherlands Institute of Mental Health and Addiction (Trimbos Institute) in Utrecht.
NEMESIS-2 is conducted by the Netherlands Institute of Mental Health and Addiction (Trimbos Institute) in Utrecht. Financial support has been received from the Ministry of Health, Welfare and Sport, with supplementary support from the Netherlands Organization for Health Research and Development (ZonMw) and the Genetic Risk and Outcome of Psychosis (GROUP) investigators. The funding sources had no further role in study design; in the collection, analysis and interpretation of data; in the writing of the report; or in the decision to submit the paper for publication.
Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, Van der Boechorststraat 7-9, 1081 BT, Amsterdam, The Netherlands
Leonore de Wit & Pim Cuijpers
Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
Margreet ten Have & Ron de Graaf
Leonore de Wit
Margreet ten Have
Pim Cuijpers
Ron de Graaf
LdW wrote the main draft of the manuscript. PC, MtH, RdG all contributed to improving the manuscript. MtH and RdG performed the data analysis and prepared the tables. All authors reviewed the manuscript.
Correspondence to Leonore de Wit.
All methods were carried out in accordance with relevant guidelines and regulations, and he study was approved by a medical ethics committee (the Medical Ethics Review Committee for Institutions on Mental Health Care, METIGG). After having been informed about the study aims, respondents provided written informed consent at the start of each wave with interviews.
Leonore de Wit, Margreet ten Have, Pim Cuijpers and Ron de Graaf declare that they have no conflict of interest.
de Wit, L., Have, M.t., Cuijpers, P. et al. Body Mass Index and risk for onset of mood and anxiety disorders in the general population: Results from the Netherlands Mental Health Survey and Incidence Study-2 (NEMESIS-2). BMC Psychiatry 22, 522 (2022). https://doi.org/10.1186/s12888-022-04077-w