Mediating roles of emotional eating and physical activity in the depression-obesity association

Background

Depression and obesity are major, multifactorial public health issues. This study examined their association with adults attending family health centres in Ankara, Türkiye, and tested the mediating roles of emotional eating and physical activity.

Methods

A cross-sectional study was conducted from July to October 2025 in two family health centres in Ankara. From a target population of 16,061 registered individuals, a sample size of 376 was calculated (5% margin of error, 50% assumed prevalence), and 379 volunteers were enrolled. Data were collected with a structured questionnaire, the Beck Depression Inventory (BDI), the emotional eating subscale of the Dutch Eating Behaviour Questionnaire, and the Global Physical Activity Questionnaire. Body mass index is classified according to the WHO criteria. Analyses in SPSS 30.0 used chi-square tests, multivariate regression, and bootstrap mediation (Hayes PROCESS, Model 4); p < 0.05 was considered significant.

Results

Mean age was 39.1±12.3 years; 59.6% were women. Overall, 39.1% were overweight and 24.5% obese; the mean BDI was 10.5, with 18.2% scoring ≥17. Obesity was higher in men (OR = 2.80; 95% CI 1.58-4.98), in those with a psychiatric diagnosis (OR = 3.50; 1.40-8.38) and with an overweight/obese household member (OR = 3.98; 2.23-7.38). Higher education (OR = 0.31; 0.14-0.68) and good self-rated health (OR = 0.31; 0.18-0.55) were protective against obesity. For depression, higher income, good self-rated health (OR = 0.27; 0.15-0.51) and 7-hour sleep (OR = 0.28; 0.09-0.86) were protective. Emotional eating showed a significant indirect effect on the depression-BMI association; physical activity showed no consistent effect.

Conclusions

Overweight/obesity prevalence was high, and emotional eating significantly mediated the depression-BMI association. Primary care programmes that integrate psychological support with nutrition and physical activity are recommended over weight-focused approaches.

Key messages

• Emotional eating mediates the depression-obesity association in primary care.

• Holistic primary care interventions are needed for depression and obesity.