Association of metabolically healthy obesity with depressive symptoms: pooled analysis of eight studies
Open accessAbstract
The hypothesis of metabolically healthy obesity posits that adverse health effects of obesity are largely avoided when obesity is accompanied by a favorable metabolic profile. We tested this hypothesis with depressive symptoms as the outcome using cross-sectional data on obesity, metabolic health and depressive symptoms. Data were extracted from eight studies and pooled for individual-participant meta-analysis with 30,337 men and women aged 15-105 years (mean age=46.1). Clinic measures included height, weight and metabolic risk factors (high blood pressure, high triglycerides, low high-density lipoprotein cholesterol, high C-reactive protein and high glycated hemoglobin). Depressive symptoms were assessed using clinical interview or standardized rating scales. The pooled sample comprised 7673 (25%) obese participants (body mass index ⩾30 kg m(-2)). Compared to all non-obese individuals, the OR for depressive symptoms was higher in metabolically unhealthy obese individuals with two or more metabolic risk factors (1.45; 95% confidence interval (CI)=1.30, 1.61) and for metabolically healthy obese with ⩽1 metabolic risk factor (1.19; 95% CI=1.03, 1.37), adjusted for sex, age and race/ethnicity. Metabolically unhealthy obesity was associated with higher depression risk (OR=1.23; 95% CI=1.05, 1.45) compared with metabolically healthy obesity. These associations were consistent across studies with no evidence for heterogeneity in estimates (all I(2)-values<4%). In conclusion, obese persons with a favorable metabolic profile have a slightly increased risk of depressive symptoms compared with non-obese, but the risk is greater when obesity is combined with an adverse metabolic profile. These findings suggest that metabolically healthy obesity is not a completely benign condition in relation to depression risk.
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The odds of developing major depressive disorder and anxiety increase as a function of the number of coexisting metabolic impairments, such as those characteristic of metabolic syndrome.
“The odds of developing major depressive disorder (MDD) and anxiety increase as a function of the number of coexisting metabolic impairments, such as those characteristic of metabolic syndrome [3,4].”
From The menace of obesity to depression and anxiety prevalence (2022) · cites this paper as [3]
Obese individuals characterized as metabolically healthy present either no increased risk or a modest elevated risk of depression diagnosis as compared with nonobese controls.
“In a consistent manner, obese individuals characterized as metabolically healthy (normal blood pressure, C-reactive protein, triglycerides, and glycaemia) present either no increased risk [161] or a modest elevated risk [3] of depression diagnosis as compared with nonobese controls.”
From The menace of obesity to depression and anxiety prevalence (2022) · cites this paper as [3]
In both sexes, negative mood state is more robustly associated with metabolic impairments such as inflammation, hypertension, and insulin resistance rather than body weight itself.
“In both sexes, negative mood state is more robustly associated with metabolic impairments such as inflammation, hypertension, and insulin resistance rather than body weight itself [3].”
From The menace of obesity to depression and anxiety prevalence (2022) · cites this paper as [3]
Abdominal adipose expansion plays a central role in the transmission of peripheral inflammation to the central nervous system because immunometabolic consequences heighten the risk of depression.
“As these immunometabolic consequences heighten the risk of depression [3], abdominal adipose expansion plays a central role in the transmission of peripheral inflammation to the CNS.”
From The menace of obesity to depression and anxiety prevalence (2022) · cites this paper as [3]
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- Authors
- Jokela, M., Hamer, M., Singh-Manoux, A., Batty, G. D., & Kivimäki, M.
- Affiliations
- University of Helsinki (FI)
- University College London (GB)
- Alzheimer Scotland (GB)
- Corresponding author
- Jokela, M
- Venue
- Molecular Psychiatry
- Published
- 2013-12-03
- Volume
- 19
- Issue
- 8
- Pages
- 910-914
- ISSN
- 1359-4184 (ISSN-L)
- 1476-5578
- PMC
- PMC4921125
- OpenAlex
- W2137252782
- Cited by
- 132
- References
- 52
- Citations by year
- 2026: 9 · 2025: 11 · 2024: 8 · 2023: 12 · 2022: 12 · 2021: 14 · 2020: 6 · 2019: 10 · 2018: 16 · 2017: 11 · 2016: 13 · 2015: 7 · 2014: 2
- FWCI
- 5.74
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Molecular Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- HAL (submittedVersion, other-oa)
- UCL Discovery (University College London) (submittedVersion)
- Funders
- Wellcome Trust
- British Heart Foundation (RE/10/005/28296)
- Medical Research Council (MR/K013351/1)
- Economic and Social Research Council (ES/J023299/1)
- National Institute on Aging (R01AG034454)
- National Heart, Lung, and Blood Institute (R01HL036310)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
- Health Sciences › Medicine › Epidemiology › Adipokines, Inflammation, and Metabolic Diseases
- Keywords
- metabolically healthy obesity, metabolically unhealthy obesity, depressive symptoms, depression risk, metabolic risk factors, obesity, C-reactive protein, HbA1c, triglycerides, HDL cholesterol, blood pressure
- MeSH terms
- Adolescent, Adult, Aged, Aged, 80 and over, Blood Pressure, C-Reactive Protein, Cross-Sectional Studies, Depression, Female, Health Status, Glycated Hemoglobin, Humans, Lipids, Male, Middle Aged, Obesity, Psychiatric Status Rating Scales, Risk Factors, Body Mass Index, Age Distribution, Young Adult
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