New research presented at this year's European Congress on Obesity in Istanbul, Turkey (12-15 May) shows that higher body mass index (BMI) is associated with more financial problems, loneliness, and stress. And these relationships may be bidirectional: higher BMI could lead to stigma, decreased work capacity, and increased healthcare costs, while financial strain may limit access to healthy food and physical activity. The study is by Renate Meeusen and Professor Elisabeth Van Rossum, Erasmus MC, University Medical Center Rotterdam and colleagues.
Obesity has a wide range of potential underlying causes, including mental and psychosocial factors. These factors include financial difficulties, mental stress and loneliness. This study aimed to examine whether these factors occur differently between people with normal weight, overweight or obesity.
The authors used data from the Dutch version of the online screening tool CheckCausesObesity.com This screening tool identifies possible underlying causes of obesity based on international guideline- and evidence-based algorithms. This is an online screening tool that helps identify the underlying causes of obesity in an individual. It systematically maps lifestyle factors, biological, psychological, social, and medication-related factors, as well as more rare medical (eg genetic) causes and also comorbidities, using guideline-based algorithms. All factors are explored in depth through detailed patient input. As part of a comprehensive assessment of multiple lifestyle factors, hormonal, genetic and medical factors which can contribute to overweight, this tool also includes questions about financial problems, loneliness and stress, as well as sex, weight, height and birthyear, enabling the researchers to calculate BMI and age. Patients complete the questions in this screening tool at home, and the results support a more personalized and medically informed treatment approach.
Statistical modelling was performed to explore the associations between financial problems, loneliness, stress and BMI classes (normal weight (BMI 20-24.9 kg/m2), overweight (BMI 25-29.9 kg/m2), obesity class 1 (BMI 30-34.9 kg/m2), obesity class 2 (BMI 35-39.9 kg/m2), and obesity class 3 (BMI ≥40 kg/m2)). Thereafter, statistical analyses were performed, adjusting for age and sex. Finally, potential sex differences in the results were assessed.
The screening tool was completed by 44.407 adults, between June 2024 and November 2025. Mean age was 52 years and the majority were female (76.7%). All the results reported below were statistically significant. The authors looked first at financial difficulties, which were present in 5.4% of the respondents with no difference between men and women. A higher proportion of respondents indicated having financial problems with increasing BMI (normal weight: 4.3%, overweight: 4.7%, obesity class 1: 5.0%, obesity class 2: 6.0% and obesity class 3: 7.2%). Respondents without financial problems had a lower BMI than those indicating they had financial problems (mean BMI: 33.2 kg/m2 and 34.5 kg/m2). The association between financial issues and BMI was comparable between men and women.
Secondly, they examined stress, which was reported more frequently by women (34.5%) than by men (22.5%). Respondents experienced more stress with increasing BMI (normal weight: 27.5%, overweight: 28.6%, obesity class 1: 31.2%, obesity class 2: 34.3% and obesity class 3: 37.3%). Accordingly, respondents indicating experiencing stress had a higher mean BMI compared to those without stress (mean BMI: 34.0 kg/m2 and BMI: 33.1 kg/m2 respectively). This association did not differ between men and women. To explore the reasons underlying respondents' stress, participants could elaborate on their stress experiences. These qualitative responses were analysed and organised into clusters representing the most frequently reported stress domains. According to these clusters, the three most experienced stress domains were work-related, focused on general well-being or concerns about family-members.
Thirdly, loneliness was more often reported in women (8.7%) than in men (6.3%), and more prevalent among respondents with increasing class of obesity (normal weight: 7.7%, overweight: 7.0%, obesity class 1: 7.6%, obesity class 2: 8.5%, obesity class 3: 11.7%). In addition, individuals who reported loneliness had a higher BMI (mean BMI 34.5 kg/m2) than those without loneliness (mean BMI 33.3 kg/m2). Interestingly, the results suggest that loneliness is more strongly associated with a higher BMI in men than in women.
The authors conclude: "This study shows that higher BMI is associated with more financial problems, loneliness, and stress. These relationships may be bidirectional. On the one hand, higher BMI may contribute to stigma and social isolation, reduced work capacity, and increased healthcare costs. On the other hand, financial strain, chronic stress and social isolation may influence lifestyle coping behaviours, and even biological processes that promote weight gain. Broader environmental factors may further reinforce these patterns. Further research is needed to better understand these mechanisms and to inform prevention and support strategies for individuals facing financial difficulties, mental stress, and loneliness in the context of obesity.
