Journal of Preventive Medicine

Introduction
Obesity as the 21st century epidemic and a major public health problem, is increasing dramatically in developing and developed countries. In Iran, according to a recent study in 2013 on people aged 20-84 years, the prevalence of overweight and obesity was 34.1% and 15.4%, respectively. Studies have shown the relationship between obesity and depression. Depression is considered as one of the most important causes of disability. In addition to reducing the quality of life, it is a risk factor for the complications of obesity in obese people. In some studies, the relationship between body mass index (BMI) and depression has been reported. Obesity can be caused by various reasons such as changes in the level of serotonin, cytokines and leptin. It can worsen the depressive symptoms.
Most of the studies conducted in Iran have examined the prevalence of overweight and obesity in depressed people, and there are limited studies on the emotional problems of overweight and obese people. In this regard and considering the importance attention to obesity and overweight as well as depression and their consequences, this study aims to investigate the relationship of weight and BMI with depression.

Methods
This is a cross-sectional study. Participants were 414 outpatients referred to nutrition and Diet Therapy Clinics in Qirokarzin City in Fars Province of Iran in 2023, who had overweight or obesity and were selected using simple random sampling method. Age of 20-60 years, BMI>25 kg/m2, and willingness to participate in the study were considered as inclusion criteria. Pregnancy, breastfeeding, taking antidepressants, taking vitamin and mineral supplements, having a weight loss diet in the last 6 months, and being a professional athlete were considered as exclusion criteria.
First, informed consent was obtained from all participants. Then, they were asked to complete the Beck depression inventory (BDI). A demographic form was also used to survey their sociodemographic characteristics, which was completed through an interview. Data analysis was done in SPSS software, version 24. The significance level was set at 0.05.

Results
Among 414 participants, 162(39.1%) were male and 252(60.9%) were women. Their mean age was 35.72±8.7 years and their mean waist circumference was 107.29±27.3 cm. Also, the majority (35.8%) had type 1 obesity based on BMI. Also, the majority (29.5%) had mild depression. There was a significant difference in the mean score of BDI between women and men, such that the mean score in women was 2.76 points higher than in men. Moreover, there was a significant difference in the BDI score between obese and overweight people, such that the mean score in obese people was 0.84 points higher than in overweight people. 
By adjusting the effect of other variables in the regression model, the association of gender with depression was found to be significant, such that the odds of depression in women was 2.64 units higher than in men. By integrating the depression severity levels (no depression and mild severity), logistic regression analysis showed that the odds of depression in women was 1.7 units higher than in men (P=0.016).

Conclusion
The prevalence of depression was significantly higher in women than in men. Also, overweight and obesity were significantly related to depression. The relationship between obesity and depression was not significant after adjusting the effect of gender. Therefore, it seems that gender is a confounding factor in the relationship found between obesity and depression. There was no statistically significant relationship between depression and the factors of age and waist circumference. A positive and significant correlation was observed between BMI and depression score.

Ethical Considerations
Compliance with ethical guidelines
The study protocol was approved by the institutional ethics committee of Larestan University of Medical Sciences, Larestan, Iran (Code: IR.LARUMSREC.1401.003).

Funding
The project was financially supported by Larestan University of Medical Sciences, Larestan, Iran. 

Authors' contributions
Methodology, sampling and data curation: Mohammad Reza Zare and Somaye Yosaee; Statistical analysis: Fatemeh Sarvi; Writing the original draft: Fatemeh Sarvi and Mohammad Reza Zare and Somaye Yosaee; Review, editing, investigation and resources: Fatemeh Zare.
Conflicts of interest
The authors declared no conflict of interest.

Acknowledgements
Larestan University of Medical Sciences, Larestan, Iran, is thanked and appreciated for the support.

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