Associations of sleep–emotion symptom classes with weight self-stigma and psychosocial resources among adults with obesity

To explore sleep–emotion symptom patterns among adults with obesity and examine their cross-sectional associations with weight self-stigma, social support, eating self-efficacy, and exercise self-efficacy. A cross-sectional convenience sample of 469 adults with obesity was recruited from two tertiary hospitals in Wuhan, China, between March and December 2025. Latent class analysis used seven dichotomized Pittsburgh Sleep Quality Index (PSQI) components and dichotomized Hospital Anxiety and Depression Scale subscales. Exploratory hierarchical multinomial logistic regression examined associations with most-likely class membership, with an R3STEP sensitivity analysis accounting for classification uncertainty. Four sleep–emotion symptom classes were identified: low-symptom (56.5%), sleep disturbance with daytime impairment (18.6%), depressive symptoms with daytime impairment (12.6%), and combined high-symptom (12.4%). Classification precision was high (entropy = 0.923), although excluding daytime dysfunction changed the preferred solution from four classes to three. In fully adjusted conventional regression, higher weight self-stigma was associated with higher odds of combined high-symptom versus low-symptom membership (OR per point = 1.100, 95% CI 1.047–1.156). Higher social support was associated with lower odds of membership in all three higher-symptom classes, although this exploratory association should be interpreted cautiously given the limited internal consistency of the social support measure. Male sex and younger age were associated with lower odds of sleep disturbance with daytime impairment membership. Higher eating self-efficacy was associated with lower odds of depressive symptoms with daytime impairment membership. Male sex and no alcohol use were associated with lower odds of combined high-symptom membership. No statistically significant adjusted association with exercise self-efficacy was detected. The principal psychosocial associations were also observed in R3STEP. Adults with obesity in this clinic-based sample exhibited heterogeneous combinations of sleep disturbance, anxiety, and depressive symptoms. The four-class structure was sensitive to the inclusion of daytime dysfunction. Social support showed inverse associations across the three higher-symptom contrasts, whereas associations with eating self-efficacy and weight self-stigma were observed for selected contrasts. These exploratory cross-sectional findings may inform further evaluation of differentiated assessment approaches, but do not establish causal relationships or validate a clinical classification tool. Not applicable.