Depressive symptoms, anxiety and well-being among metabolic health obese subtypes

The metabolically healthy obese (MHO) phenotype is characterized by favorable lipid and inflammatory profiles, preserved insulin sensitivity and normal blood pressure. Limited data regards whether metabolically healthy obesity also confers beneficial effects on mental health and well-being exists.

We investigated depressive symptoms, anxiety and well-being among metabolically healthy and unhealthy obese and non-obese adults from a cross-sectional sample of 2047 middle-aged Irish men and women. Subjects were classified as obese (BMI ≥30kg/m(2)) and non-obese (BMI <30kg/m(2)). Metabolic health status was defined using three metabolic health definitions based on a range of cardiometabolic abnormalities including metabolic syndrome criteria, insulin resistance and inflammation. Depressive symptoms, anxiety and well-being were assessed using the Center for Epidemiologic Studies Depression Scale (CES-D), the Hospital Anxiety and Depression Scale (HADS) and the World Health Organization (WHO)-5 Well Being Index.

Relative to the metabolically healthy non-obese individuals the risk of anxiety and depressive symptoms was greater among the metabolically unhealthy obese subjects (odds ratios (ORs) 1.63-1.66 and ORs 1.82-1.83 for anxiety and depressive symptoms, respectively depending on metabolic health definition). Increased risk of these conditions was not observed among the MHO subjects.

Our data suggest that a favorable metabolic profile is positively associated with mental health among obese middle-aged adults, although findings were dependent on metabolic health definition. Improved understanding of the relationship between obesity associated metabolic health subtypes, anxiety and depressive symptoms may inform future targeted screening and interventions for those at greatest risk of adverse mental and cardiometabolic health outcomes.