APPETITE DYSREGULATION AND BODY MASS INDEX AMONG ADULTS WITH DEPRESSION AND ANXIETY IN THE REAL-WORLD SETTING
Author(s)
Lawrence Rasouliyan, MPH1, Amanda G. Althoff, MS1, Danae Black, MPH, PhD2;
1OMNY Health, Atlanta, GA, USA, 2OMNY Health, Washington, DC, USA
1OMNY Health, Atlanta, GA, USA, 2OMNY Health, Washington, DC, USA
OBJECTIVES: To evaluate the relationship between appetite dysregulation severity, captured by Patient Health Questionnaire-9 (PHQ-9) item 5, and body mass index (BMI) outcomes among adults with depression and/or anxiety in real-world clinical practice.
METHODS: This retrospective cross-sectional study used electronic health records from the OMNY Health real-world data platform (2017-2025). Adult patient encounters for depression and/or anxiety with a recorded BMI and documented response to the PHQ-9 item 5 (“poor appetite or overeating”) on the same date were selected. Appetite dysregulation severity was defined as the response to PHQ-9 item 5. BMI outcomes comprised underweight (BMI < 18.5) and obese (BMI ≥ 30) with the obesity further subcategorized as class I (30 ≤ BMI < 35) and class II-III (BMI ≥ 35). The percentage of patients with each BMI outcome was computed across appetite dysregulation severity levels. Encounter-level analyses were conducted separately for depression only, anxiety only, and comorbid depression/anxiety.
RESULTS: Among 1.93 million encounters (995,382 unique patients) with depression and/or anxiety diagnosis codes, 38.7% were depression only, 28.6% were anxiety only, and 32.7% were both. Across all diagnostic groups, the proportion of underweight patients increased monotonically with greater appetite dysregulation severity (1.3-3.0% in depression; 1.7-3.4% in anxiety; 1.5-3.1% in comorbid depression/anxiety). Similarly, the proportion of patients with obesity (class I-III) increased with higher PHQ-9 item 5 scores (40.2-54.9% across diagnoses). Notably, obesity class I prevalence remained relatively stable across appetite dysregulation categories, whereas obesity class II-III exhibited a clear monotonic increase (23.6-33.2% in depression; 19.3-28.0% in anxiety; 22.5-30.8% in comorbid depression/anxiety).
CONCLUSIONS: Appetite dysregulation severity was associated with a shift toward extreme BMI phenotypes, characterized by higher prevalence of both underweight and severe obesity, independent of psychiatric diagnosis. These findings suggest that symptom-level phenotyping using routinely collected PHQ-9 data may improve identification of patients at elevated metabolic risk beyond diagnosis alone.
METHODS: This retrospective cross-sectional study used electronic health records from the OMNY Health real-world data platform (2017-2025). Adult patient encounters for depression and/or anxiety with a recorded BMI and documented response to the PHQ-9 item 5 (“poor appetite or overeating”) on the same date were selected. Appetite dysregulation severity was defined as the response to PHQ-9 item 5. BMI outcomes comprised underweight (BMI < 18.5) and obese (BMI ≥ 30) with the obesity further subcategorized as class I (30 ≤ BMI < 35) and class II-III (BMI ≥ 35). The percentage of patients with each BMI outcome was computed across appetite dysregulation severity levels. Encounter-level analyses were conducted separately for depression only, anxiety only, and comorbid depression/anxiety.
RESULTS: Among 1.93 million encounters (995,382 unique patients) with depression and/or anxiety diagnosis codes, 38.7% were depression only, 28.6% were anxiety only, and 32.7% were both. Across all diagnostic groups, the proportion of underweight patients increased monotonically with greater appetite dysregulation severity (1.3-3.0% in depression; 1.7-3.4% in anxiety; 1.5-3.1% in comorbid depression/anxiety). Similarly, the proportion of patients with obesity (class I-III) increased with higher PHQ-9 item 5 scores (40.2-54.9% across diagnoses). Notably, obesity class I prevalence remained relatively stable across appetite dysregulation categories, whereas obesity class II-III exhibited a clear monotonic increase (23.6-33.2% in depression; 19.3-28.0% in anxiety; 22.5-30.8% in comorbid depression/anxiety).
CONCLUSIONS: Appetite dysregulation severity was associated with a shift toward extreme BMI phenotypes, characterized by higher prevalence of both underweight and severe obesity, independent of psychiatric diagnosis. These findings suggest that symptom-level phenotyping using routinely collected PHQ-9 data may improve identification of patients at elevated metabolic risk beyond diagnosis alone.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
P29
Topic
Clinical Outcomes
Topic Subcategory
Clinical Outcomes Assessment
Disease
SDC: Neurological Disorders