Neuroimmunological and Metabolic Correlation: A Multidimensional Review of the Links Between Obesity and Anxiety Disorders

Contemporary clinical medicine faces two global health crises: obesity and anxiety disorders. Although historically treated as independent entities, contemporary epidemiology points to a clear correlation between them – the risk of anxiety disorders in obese individuals is significantly higher. The aim of this systematic review of the literature is to provide a comprehensive, multi-level analysis of the mechanisms linking excess body weight to anxiety disorders. The study hypothesises the existence of a "metabolic-anxiety vicious circle" mediated by chronic inflammation, hypothalamic-pituitary-adrenal axis dysfunction, and gut-brain axis disorders. An extensive review was conducted in the PubMed, Scopus, Web of Science and Google Scholar databases, covering publications from 2000 to 2025. The selection included cohort studies (e.g., NEMESIS-2, LifeLines), meta-analyses, and translational studies. Analysis of the scientific evidence allows us to identify four key pathophysiological pillars. Firstly, visceral obesity generates chronic low-grade inflammation, which induces neuroinflammation in limbic structures through the blood-brain barrier. Secondly, chronic anxiety leads to dysregulation of the hypothalamic-pituitary-adrenal axis and hypercortisolemia, causing visceral obesity. Thirdly, genetic variants have pleiotropic effects. Fourthly, intestinal dysbiosis is a new key mediator in the communication between metabolism and the psyche. Obesity and anxiety are not coincidental co-occurring phenomena, but are manifestations of a common dysregulation of the body's homeostasis. This implies the need to change existing treatment patterns to an integrated model that combines somatic treatment with psychotherapeutic treatment.