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ABSTRACT & COMMENTARY
Are Weight Gain and Mental Health Bidirectionally Connected?
June 30, 2025 4 minutes read
By Seema Gupta, MD, MSPH
Synopsis: In an adult population-based cohort study over four years, researchers found that both emotional eating and body dissatisfaction independently mediate the relationships between mental health factors and body mass index trajectories.
Source: Schrempft S, Jiménez-Sánchez C, Baysson H, et al. Pathways linking BMI trajectories and mental health in an adult population-based cohort: Role of emotional eating and body dissatisfaction. Int J Obes (Lond). 2025 Apr 7. https://doi.org/10.1038/s41366-025-01772-y. [Online ahead of print].
According to the Centers for Disease Control and Prevention (CDC), approximately 74% of adults aged 20 years and older are either overweight or obese.1 Obesity, as a disease, is both serious and expensive. Findings from the Milken Institute show that the annual cost and the economic effect of obesity in the United States exceeds $1.4 trillion.2
Obesity often is accompanied by other chronic medical conditions, such as diabetes and hypertension, as well as an elevated risk for certain cancers. Because obesity continues to affect individuals, the burden on the healthcare system is becoming increasingly alarming.
Extensive population-based epidemiological studies have consistently demonstrated that being overweight and obese are linked to an increased risk of poor mental health, particularly depression.3 Furthermore, the association between obesity and depression is reciprocal, with each condition potentially increasing the risk of the other. This bidirectional relationship has been observed across various populations, including middle-aged and older women, where both obesity and depression can influence the onset and progression of the other condition. Shared biological mechanisms, such as neuroinflammation, dysregulation of the hypothalamic-pituitary-adrenal axis, and dysfunction of the gut-brain axis, contribute to the co-occurrence of these conditions.4 Additionally, socio-behavioral factors, such as social withdrawal syndrome, also may play a role in the comorbidity of depression and obesity. Nevertheless, there is a scarcity of research investigating the long-term effects of weight fluctuations and mental health.
In their study, Schrempft et al conducted a four-year analysis using data from the Specchio cohort, a population-based digital study initiated in 2020 in Switzerland. This study attempted to investigate the relationship between weight gain and mental health by examining a range of behavioral and psychosocial predictors of body mass index (BMI) trajectories. Additionally, the study examined a range of mental health outcomes associated with these trajectories and factors contributing to the association, including a focus on emotional eating and body dissatisfaction as mediators.
The cohort comprised 7,388 adult participants (59% women; mean age 51 years) who self-reported their weight at registration and at three follow-up points (2022, 2023, and 2024) and their height at registration and two follow-up points (2023 and 2024). Questionnaires assessed behavioral factors (physical activity, diet, alcohol consumption, sleep patterns, leisure time, antidepressant use, and emotional eating) and psychosocial factors (social and psychological resources and risks). The relationships between behavioral and psychosocial factors and BMI trajectories, as well as the effect of these BMI trajectories on mental health outcomes, were analyzed using regressions adjusted for age, sex, education, and physical health conditions.
Researchers found that, over a four-year period, several behavioral and psychosocial factors were found to be associated with an increase in BMI among the study participants. These factors included reduced physical activity, increased leisure screen time, shorter sleep duration, antidepressant use, financial hardship, loneliness, and symptoms of depression and anxiety.
The relationship between emotional eating and BMI was particularly pronounced among women and individuals with low physical activity levels, suggesting that these groups may be more susceptible to weight gain through emotional eating. Additionally, while an increase in BMI was associated with greater body dissatisfaction and lower quality of life, it was not directly linked to symptoms of anxiety or depression at follow-up after adjusting for baseline mental health status.
Emotional eating seemed to partially mediate the relationship between baseline anxiety and depressive symptoms and subsequent increases in BMI as well as the association between financial hardship and BMI trajectories. Finally, the study authors also found that body dissatisfaction and poorer self-rated health partially mediated the association between increasing BMI and reduced quality of life at follow-up after adjusting for baseline anxiety and depressive symptoms.
Commentary
The findings by Schrempft et al underscore the complex interplay between weight gain, emotional eating, body dissatisfaction, and mental health, highlighting the need for integrated interventions that address both physical and psychological factors. This research highlights the multifaceted nature of obesity and underscores the importance of addressing both behavioral and psychosocial factors in public health and clinical strategies.
The study identified several key factors associated with an increase in BMI over the four-year period. At clinic visits, addressing physical activity, leisure screen time, sleep duration, loneliness, and symptoms of depression and anxiety may have a significant positive effect on patients’ weight gain. We also understand that emotional eating often serves as a coping mechanism for negative emotions, leading to overeating and subsequent weight gain. This cyclical pattern can exacerbate both physical and mental health issues, creating a vicious cycle that is challenging to break. Since emotional eating did emerge in this study as a significant mediator in these associations, particularly among women and individuals with low physical activity levels, it may be important to educate our patients on this phenomenon. Additionally, fostering a positive body image and improving self-rated health may contribute to better outcomes for individuals struggling with obesity.
Seema Gupta, MD, MSPH, is Clinical Assistant Professor, Department of Family and Community Health, Joan C. Edwards School of Medicine, Marshall University, Huntington, WV.
References
- Centers for Disease Control and Prevention. Obsesity and overweight. Reviewed Oct. 25, 2024. https://www.cdc.gov/nchs/fastats/obesity-overweight.htm
- Lopez C, Sagynbekov K. Weighing down America: 2020 update. Milken Institute. https://milkeninstitute.org/content-hub/research-and-reports/reports/weighing-down-america-2020-update
- Frank P, Jokela M, Batty GD, et al. Overweight, obesity, and individual symptoms of depression: A multicohort study with replication in UK Biobank. Brain Behav Immun. 2022;105:192-200.
- Pan A, Sun Q, Czernichow S, et al. Bidirectional association between depression and obesity in middle-aged and older women. Int J Obes (Lond). 2012;36(4):595-602.
In an adult population-based cohort study over four years, researchers found that both emotional eating and body dissatisfaction independently mediate the relationships between mental health factors and body mass index trajectories.
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