By Anne Harding

NEW YORK (Reuters Health) - Alcohol abuse, obesity and depression seem to go hand in hand for many women, according to the first study to look at how the three relate to one another over time in young adults.

Dr. Carolyn A. McCarty of Seattle Children's Research Institute and her colleagues also found that almost half of the men and women in their study suffered from at least one of these problems between the ages of 21 and 30.

"That's big," McCarty told Reuters Health, and is likely only "the tip of the iceberg," because she and her colleagues used fairly stringent definitions of alcohol abuse, depression and obesity in their study.

The young men and women in the current study have been followed since 1985, when they were in fifth grade. McCarty and her team looked at data from interviews conducted when the study participants were 24, 27 and 30 years old to understand the interrelationships among depression, obesity and alcohol use disorders.

At age 21, 8 percent of women and 12 percent of men had at least two of the three problems. Over time, having more than one of the problems became more common for women, but less so for men.

For men, the only association the researchers saw was for obese 27-year-olds, who were less likely to be depressed at age 30. But women who were depressed at 27 were more than three times as likely to meet criteria for alcohol abuse or dependence at age 30.

Women who had alcohol use problems at 24 were nearly four times as likely to be obese at 27, while being obese at age 27 more than doubled the risk of depression at 30.

And lower-income individuals of both sexes were at greater risk of depression and obesity.

A tendency to "ruminative coping"-in which a person replays and obsesses about negative events-may be one of the traits that links alcohol abuse, obesity and depression, McCarty noted in an interview.

Dr. Susan Nolen-Hoeksma, a psychologist at Yale, has referred to the three as a "toxic triangle" of "eating, drinking and overthinking," the researcher added, and has shown that women-and men-who ruminate are more depressed and more likely to drink or to binge eat to cope with emotional problems.

There are interventions that target all three legs of this toxic triangle, McCarty said, including physical exercise, mindfulness training, and stress management. Strategies for treating depression, alcohol use problems, and obesity-all of which are characterized by problems with the brain's "reward system"--also need to help people find alternatives to rewarding themselves with food or alcohol, she added.

"We have to think about how people can start to build in naturally rewarding experiences in their lives," she said.

SOURCE: General Hospital Psychiatry, September/October 2009

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