The Relationship between Obesity, Elevated Depressive Symptoms, and Physical Functioning Among United Methodist Clergy: A Longitudinal Study

BACKGROUND United Methodist Church (UMC) clergy face occupational stressors (e.g., unpredictable schedules, emotional labor, politically polarized congregations) that contribute to disproportionately elevated obesity and depression prevalence. Despite these conditions’ high comorbidity and independent links to physical functioning (PF) decline, few studies explore their interactive effects over time, especially in high-risk populations. This study examines the independent and joint prospective associations of obesity and elevated depressive symptoms with PF decline among North Carolina UMC clergy over two years. METHODS Data from 1422 North Carolina UMC clergy (2014–2016) were analyzed using ordinary least squares regression, including an interaction term to assess independent and synergistic prospective associations of baseline obesity (body mass index [BMI] ≥ 30 kg/m 2 ) and elevated depressive symptoms (Patient Health Questionnaire [PHQ-9] ≥ 10) with subsequent PF decline (measured by SF-12 Physical Component Summary scores), adjusting for demographic and lifestyle variables. Logistic regression estimated cross-sectional obesity-depression associations. RESULTS At baseline, 39.5% of clergy were obese and 7.2% had elevated depressive symptoms, with obesity positively associated with depression (odds ratio [OR]: 2.66; 95% confidence interval [CI]: 1.76–4.02). Both obesity and elevated depressive symptoms were independently associated with poorer physical functioning at follow-up. In the crude model, the joint effect of obesity and depressive symptoms was associated with PF decline (β = –4.34; 95% CI: –7.87, –0.81). This interaction was attenuated after adjustment for all covariates. LIMITATIONS Self-reported BMI, depressive symptoms, and PF may introduce recall bias; clergy-specific findings limit generalizability. CONCLUSIONS Obesity and depressive symptoms are independently associated with poorer future physical functioning; their co-occurrence suggests greater functional vulnerability among clergy. Approaches that integrate obesity and depression care warrant testing.