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Clinical Research

The association between metabolically healthy obesity and risk of depression: a systematic review and meta-analysis

International Journal of Obesity volume 49, pages 980–991 (2025)Cite this article

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Abstract

This review aimed to explore the association between metabolically healthy obesity (MHO) and the risk of depression. Databases (EMBASE, PubMed, Web of Science, Cochrane Library) were searched up to 20 June 2024. Observational studies were included if they compared groups with MHO, metabolically unhealthy nonobesity, and metabolically unhealthy obesity to groups with metabolically healthy nonobesity for the risk of depression. The random-effect model was used to calculate the pooled odds ratios (ORs). Subgroup analyses and meta-regressions were conducted according to age, study design, definition of MHO, BMI cut-off value, depression assessment method, geographic location, ethnicity, development status, and gender to explore the sources of heterogeneity. Three cohorts and 9 cross-sectional studies (N = 1,277,267 participants) were included in this review. Individuals with MHO (OR 1.08 [95% CI 1.04, 1.12], I² = 88.3%), metabolically unhealthy nonobesity (OR 1.15 [95% CI 1.04, 1.28], I² = 99.6%), and metabolically unhealthy obesity (OR 1.30 [95% CI 1.12, 1.51], I² = 99.8%) had an increased risk of depression than individuals with metabolically healthy nonobesity. The association between MHO and risk of depression was stronger in women (OR = 1.14; 95% CI: 1.08–1.20) and populations from North America (OR = 1.26; 95% CI: 1.01–1.58) and Europe (OR = 1.23; 95% CI: 1.07–1.41). Inconsistencies in MHO definitions and BMI cutoff values across studies were important sources of heterogeneity (subgroup analysis: PQ = 29.87, p = 0.001; meta-regression: p = 0.015, R² = 100%). MHO was associated with an increased risk of depression, particularly among women and populations from North America and Europe. These high-risk groups need personalized interventions. Standardizing definition for MHO could enhance comparability across studies. Future prospective cohort studies are needed to validate our findings by including populations from developing nations and employing rigorous definitions.

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Fig. 1
Fig. 2: Meta-analysis of risk of depression in participants with different metabolic status compared with metabolically healthy nonobesity participants.
Fig. 3: Subgroup analysis of risk of depression in participants with different metabolic status compared with metabolically healthy nonobesity participants by geographic location.
Fig. 4: Subgroup analysis of risk of depression in participants with metabolically healthy obesity compared with metabolically healthy nonobesity participants by variables.

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Acknowledgements

We are very grateful to the editor and anonymous reviewers for their constructive comments.

Funding

This work was supported by National Training Program of Innovation and Entrepreneurship for Undergraduates (grant number 202110555106); The Key Research and Development Projects of Hunan Province (grant number 2020SK51826); Scientific research project of Hunan Provincial Health Commission (grant number 202218014518); Hunan Provincial Innovation Foundation For Postgraduate (grant number CX20221011); and Clinical Research 4310 Program of the First Affiliated Hospital of University of South China (grant number 20224310NHYCG03).

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  1. These authors contributed equally: Jialin Deng, Lu He, Luokai Zhang.

Authors and Affiliations

  1. Department of Radiology, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, 421001, Hunan, China

    Jialin Deng, Luokai Zhang, Jiaqi Wang, Rongqi Ding, Yimiao Jiang & Hong Zhou

  2. Hengyang Medical School, University of South China, Hengyang, 421001, Hunan, China

    Jialin Deng, Jiaqi Wang, Rongqi Ding & Yimiao Jiang

  3. Department of Neurosurgery, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, 421001, Hunan, China

    Lu He

  4. School of Pharmaceutical Science, University of South China, Hengyang, 421001, Hunan, China

    Qixiang Fu & Yunhao Lv

  5. Department of Metabolism and Endocrinology, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, 421001, Hunan, China

    Xinhua Xiao

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Contributions

JD: conceptualization, data curation, formal analysis, writing of original draft, and writing of review and editing. LH: data curation, writing of review and editing. LZ: formal analysis, writing of review and editing. JW, QF and RD: data curation and formal analysis. YL and YJ: formal analysis and writing of review. XX: writing of review and editing. HZ: conceptualization, writing of review and editing.

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Correspondence to Xinhua Xiao or Hong Zhou.

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Deng, J., He, L., Zhang, L. et al. The association between metabolically healthy obesity and risk of depression: a systematic review and meta-analysis. Int J Obes 49, 980–991 (2025). https://doi.org/10.1038/s41366-025-01741-5

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