Body Mass Index Category Moderates the Relationship Between Depressive Symptoms and Diet Quality in Overweight and Obese Rural-Dwelling Adults

Purpose: This study was conducted to (1) compare diet quality among depressed and nondepressed overweight and obese rural-dwelling adults and (2) determine whether body mass index (BMI) category moderates the relationship between depressive symptoms and overall diet quality. Methods: Rural adults in Kentucky (n = 907) completed the 9-item Patient Health Questionnaire (PHQ-9) that assessed depressive symptoms and a food frequency questionnaire that generated 2005 Healthy Eating Index (HEI) scores. Participants were grouped into overweight (BMI 25-29.9 kg/m²) and obese (≥30 kg/m²), and nondepressed (PHQ-9 < 10) and depressed (PHQ-9 ≥ 10) groups. Bootstrapped ANCOVAs were used to compare diet quality among the 4 groups. Ordinary least-squares regression using PROCESS was used to determine whether BMI category (overweight vs obese) moderated the association between depressive symptoms and overall diet quality. Results: Overall diet quality was poorer in the obese depressed group than in the obese nondepressed group. Intake of fruit and dark green/orange vegetables and legumes was lower in the obese depressed group than in the overweight nondepressed group. Depressive symptoms predicted poor overall diet quality (B = −0.287, P <.001) and the relationship was moderated by BMI category (coefficient of BMI category^*depressive symptom interaction term = 0.355, P <.049). A significant inverse relationship between depressive symptoms and overall diet quality was observed in the overweight group but not in the obese group. Conclusion: Components of diet quality vary according to BMI category and depressive symptom status. The relationship between depressive symptoms and diet quality is influenced by BMI category.