The Relationship Between Obesity, Overweight, and the Prevalence of Depression and Anxiety Among University Students: Evidence from a Nationally Representative Cross-Sectional Study in Greece

Q: What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Overweight, obesity, depression, and anxiety among university students (n=5298). Intervention: Depressive and anxiety symptoms (assessed via BDI-II and STAI-6) vs. Absence of depressive or anxiety symptoms. Primary outcome: Prevalence of overweight or obesity (assessed by measured BMI using WHO guidelines) (p=0.0015).

Q: What does this research mean for the field?

Depressive and anxiety symptoms are independently associated with more than double the odds of overweight or obesity among university students. Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.NEUTRAL.

Olga Alexatou; Konstantinos Papadimitriou; Exakousti-Petroula Angelakou; Sousana Κ. Papadopoulou; M. Hadjivassiliou Pappa; Apostolia Ntovoli; Aspasia Serdari; Konstantina Apostolidou; Theofanis Vorvolakos; Constantinos Giaginis

doi:10.3390/diseases14040136

April 8, 2026DiseasesOpen Access

The Relationship Between Obesity, Overweight, and the Prevalence of Depression and Anxiety Among University Students: Evidence from a Nationally Representative Cross-Sectional Study in Greece

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Key result

Depression and anxiety symptoms are linked to ~2-fold higher odds of overweight or obesity.

P=0.0015
n=5,298

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Why the study?

Obesity rates are rising among young people, and the transition to university involves pressures that may affect body weight control and mental health, warranting investigation into associations between excess weight and depressive or anxiety symptoms.

Are depressive and anxiety symptoms, along with lifestyle and sociodemographic factors, independently associated with overweight and obesity in Greek university students?

Key Points

To investigate associations between excess body weight and symptoms of depression and anxiety among university students across Greece.
Cross-sectional survey of N=5298 university students (mean age 21.4 ± 2.5 years; 52.0% female) across ten geographic regions of Greece.
Depressive and anxiety symptoms were assessed using the Beck Depression Inventory (BDI-II) and State Anxiety Inventory (STAI-6), alongside measured height and weight to calculate Body Mass Index.
Multivariate binary logistic regression was used to evaluate independent predictors of overweight and obesity.
Among participants, 14.4% were overweight, 8.9% were obese, 32.5% reported depressive symptoms, and 34.5% experienced anxiety symptoms.
In multivariate analysis, students experiencing depressive symptoms (p = 0.0015) or anxiety symptoms (p = 0.0012) had more than double the odds of being overweight or obese.
Overweight or obesity was also independently associated with poor Mediterranean diet adherence (>2-fold higher odds, p = 0.0005), low physical activity (85% higher odds, p = 0.0068), urban residence (45% higher odds, p = 0.0102), living alone (38% higher odds, p = 0.0203), and female sex (25% higher odds, p = 0.0103).

Study Design

Type

Cross-Sectional (n=5,298)

Multicenter

Yes

Structured PICO

Are depressive and anxiety symptoms, along with lifestyle and sociodemographic factors, independently associated with overweight and obesity in Greek university students?

P

Population

5,298 active university students across 10 regions in Greece (mean age 21.4 years, 52.0% female) without prior chronic cardiometabolic, psychiatric, or malignant conditions.

E

Exposure

Exposure to depressive symptoms (measured by Beck Depression Inventory [BDI-II]), anxiety symptoms (measured by short-form State Anxiety Inventory [STAI-6]), physical inactivity (IPAQ), and poor Mediterranean Diet adherence (KIDMED)

C

Comparator

Students without depressive or anxiety symptomatology, with moderate/high physical activity, and higher Mediterranean Diet adherence

O

Outcome

Prevalence of overweight or obesity determined by measured Body Mass Index (BMI) classified according to WHO guidelinessurrogate

Main Result

p-value: p=0.0015

In a large Greek university cohort, depressive and anxiety symptoms, physical inactivity, smoking, and poor Mediterranean diet adherence were independently linked to significantly higher odds of overweight and obesity, highlighting targets for early cardiometabolic and mental health prevention.

Limitations

Conducted solely among university students attending Greek universities, restricting generalizability to other countries
Self-reported questionnaire data collected via interviews remain subject to recall bias
Unmeasured confounders may still have influenced the results despite multivariable adjustment
Classification of academic performance based on the Greek grading system may not be generalizable to other countries
Wide confidence intervals for some variables (e.g., age, nationality) in logistic regression may suggest instability
Cross-sectional design prevents drawing conclusions about causal relationships
Restricted to university students in Greece, limiting generalizability to other populations
Recall bias cannot be fully excluded due to reliance on self-reported lifestyle and psychological information
Potential residual confounding from unmeasured variables
Academic performance classification is specific to the Greek grading system
Wide confidence intervals for certain variables (e.g., age, nationality) suggest potential statistical instability
Cross-sectional study design precludes causal inference

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Implication

May warrant integrated screening in students; hypothesis-generating and requires longitudinal data before guiding prevention.

Abstract

Background and Objectives: Rates of obesity have been consistently increasing in recent years across all age groups, with a notable rise among young people. Obesity represents a persistent inflammatory condition and a key contributor to various chronic health problems, such as cardiovascular disorders, metabolic abnormalities, cancer, and psychological conditions. The move from high school to university is a transitional phase accompanied by specific pressures that can affect both body weight control and mental health in students. This cross-sectional investigation aimed to investigate potential associations between excess weight and the presence of depressive and anxiety symptoms in university populations. Methods: This cross-sectional analysis included 5298 students enrolled at universities across ten geographic areas of Greece. Participants filled out questionnaires concerning demographic information and lifestyle behaviors. Levels of depression and anxiety were measured using the Beck Depression Inventory (BDI-II) and the short form of the State Anxiety Inventory (STAI-6), respectively. Measurements of height and body weight were obtained to compute Body Mass Index (BMI). Results: The presence of overweight or obesity among students was significantly and independently related to female sex, urban residence, living independently, tobacco use, and lower academic performance (p = 0.0103, p = 0.0102, p = 0.0203, p = 0.0075, and p = 0.0168, respectively). Individuals reporting insufficient physical activity had 85% higher odds of being overweight or obese (p = 0.0068). Similarly, participants experiencing depressive or anxious symptomatology had more than double odds of excess body weight compared with those without such symptoms (p = 0.0015 and p = 0.0012, respectively). Furthermore, poor Mediterranean diet adherence was linked to more than a twofold increase in the odds of overweight or obesity (p = 0.0005). Conclusions: These findings offer considerable evidence that symptoms of depression and anxiety may serve as significant contributors to the development of overweight and obesity among university students. Additional longitudinal studies are strongly encouraged to substantiate these observations.

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Cite This Study

Alexatou et al. (2026) conducted a cross-sectional in Overweight, obesity, depression, and anxiety among university students (n=5,298). Depressive and anxiety symptoms (assessed via BDI-II and STAI-6) vs. Absence of depressive or anxiety symptoms was evaluated on Prevalence of overweight or obesity (assessed by measured BMI using WHO guidelines) (p=0.0015). Depressive and anxiety symptoms were independently associated with more than double the odds of overweight or obesity among Greek university students.

synapsesocial.com/papers/69d895796c1944d70ce066cf https://doi.org/10.3390/diseases14040136

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The Relationship Between Obesity, Overweight, and the Prevalence of Depression and Anxiety Among University Students: Evidence from a Nationally Representative Cross-Sectional Study in Greece

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

The Relationship Between Obesity, Overweight, and the Prevalence of Depression and Anxiety Among University Students: Evidence from a Nationally Representative Cross-Sectional Study in Greece

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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