European archives of psychiatry and clinical neuroscience · 2026
The mediating effect of 24-h movement behaviors in the association between obesity-related comorbidities and depression: evidence from a large-scale cohort study.
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Shen Jiaxin, Cai Yutai, Gan Yujun, Mo Qiaoman, Zhang Yuan, Chen Jiade, Zhong Qingguang, Huang Yiting, Ye Rongrong, Chen Guanren, Zhang Tao, Wang Zhehao, Li Lixia, Lin Ziqiang, Zhang Fan, Gao Yanhui
Аннотация
OBJECTIVE: This study aims to ascertain the mediating role of 24-h movement behaviors, including moderate-to-vigorous intensity physical activity (MVPA), light-intensity physical activity, sedentary behavior (SB), and sleep, in the relationship between obesity, obesity-related comorbidities and depression.
METHODS: In a large-scale cohort study, 32,861 UK biobank participants aged 40-69 years with wrist-worn accelerometer data were included. The exposure were obesity and obesity-related comorbidities (obesity only, or with 1, 2, or ≥ 3 chronic conditions), with a non-obesity group as reference. Accelerometer-derived 24-h movement behaviors were served as mediators. The main outcome was depression at follow-up that was assessed by Patient Health Questionnaire-9. Compositional mediation model was applied to explore the mediating effect of 24-h movement behaviors. Subsequently, compositional logistic isotemporal substitution model was employed to quantify the changes in depression risk associated with reallocation among different physical activities in individuals with obesity.
RESULTS: Compared to the non-obesity group, individuals with obesity exhibited an elevated risk of depression that increased with the number of chronic conditions. 24-h movement behaviors mediated approximately 20% of the association between obesity, obesity-related comorbidities and depression, with significant total indirect odds ratios ranging from 1.16 [95% CI 1.13 to 1.19] to 1.31 [95% CI 1.24 to 1.38]. There was a significant negative association between replacing SB with MVPA and depression risk, which was consistent across all groups with obesity.
CONCLUSIONS: Depression risk among the individuals with obesity increased with the number of chronic conditions, and the association was partially mediated by 24-h movement behaviors. Replacing SB with MVPA provided consistent psychological health benefits regardless of the number of chronic conditions among individuals with obesity.
METHODS: In a large-scale cohort study, 32,861 UK biobank participants aged 40-69 years with wrist-worn accelerometer data were included. The exposure were obesity and obesity-related comorbidities (obesity only, or with 1, 2, or ≥ 3 chronic conditions), with a non-obesity group as reference. Accelerometer-derived 24-h movement behaviors were served as mediators. The main outcome was depression at follow-up that was assessed by Patient Health Questionnaire-9. Compositional mediation model was applied to explore the mediating effect of 24-h movement behaviors. Subsequently, compositional logistic isotemporal substitution model was employed to quantify the changes in depression risk associated with reallocation among different physical activities in individuals with obesity.
RESULTS: Compared to the non-obesity group, individuals with obesity exhibited an elevated risk of depression that increased with the number of chronic conditions. 24-h movement behaviors mediated approximately 20% of the association between obesity, obesity-related comorbidities and depression, with significant total indirect odds ratios ranging from 1.16 [95% CI 1.13 to 1.19] to 1.31 [95% CI 1.24 to 1.38]. There was a significant negative association between replacing SB with MVPA and depression risk, which was consistent across all groups with obesity.
CONCLUSIONS: Depression risk among the individuals with obesity increased with the number of chronic conditions, and the association was partially mediated by 24-h movement behaviors. Replacing SB with MVPA provided consistent psychological health benefits regardless of the number of chronic conditions among individuals with obesity.