Social Support and Emotional Eating in Adults with Metabolic Dysfunction-Associated Fatty Liver Disease: The Chain Mediation Effects of Weight Self-Stigma and Depression

Metabolic dysfunction-associated fatty liver disease (MAFLD) is a condition characterised by metabolic dysfunction, with an increasing prevalence among young and middle‑aged adults who are overweight or obese. Emotional eating, a common maladaptive eating behaviour, is frequently observed in overweight and obese populations. Although previous studies have indicated that social support is closely related to eating behaviours, its specific role in patients with MAFLD remains to be further elucidated.

A cross‑sectional study was conducted in Shihezi, Xinjiang, China, in November 2025, involving 457 young and middle‑aged overweight and obese patients with MAFLD. The Perceived Social Support Scale, Weight Self‑Stigma Questionnaire, Self‑Rating Depression Scale, and the emotional eating subscale of the Dutch Eating Behaviour Questionnaire were administered. The bias‑corrected bootstrap method (5,000 resamples, 95% confidence interval) was used to test the statistical significance of each pathway in the serial mediation model.

Using unstandardized coefficients, social support was negatively associated with emotional eating through a direct pathway (Effect = -0.112, 95% CI: -0.180 to -0.044). Bootstrap analysis showed that weight self-stigma and depression were independently and serially involved in the indirect association between social support and emotional eating. The indirect effect through weight self-stigma was -0.054 (95% CI: -0.101 to -0.013), accounting for 14.96% of the total effect. The indirect effect through depression was -0.105 (95% CI: -0.153 to -0.064), accounting for 29.09%. The serial indirect effect through weight self-stigma and depression was -0.091 (95% CI: -0.123 to -0.063), accounting for 25.21%.

Weight self‑stigma and depression play a serial mediating role in the relationship between social support and emotional eating among young and middle‑aged overweight and obese patients with MAFLD. The potential clinical implications of these findings warrant further investigation.