R.E.H. Meeusen1,2, M.R. Boon1,2, J. van Uhm2,3, E.L.T. van den Akker2,3, E.F.C. van Rossum1,2
1 Department of Internal Medicine, Division of Endocrinology, Erasmus MC, Rotterdam, The Netherlands
2 Obesity Center CGG, Erasmus MC, Rotterdam, The Netherlands
INTRODUCTION: Obesity has a wide range of potential underlying causes, including mental and psychosocial factors such as financial difficulties, mental stress and loneliness. We aim to examine whether these factors differ between people with normal weight, overweight or obesity.
METHODS: Data from the Dutch version of the online screening tool CheckCausesObesity.com was used. This tool identifies possible underlying causes of obesity based on guideline- and evidence-based algorithms.. Chi-Square tests and univariate general linear models were performed to explore the association between financial difficulties, loneliness, stress and BMI classes ranging from normal weight to obesity class 3.
RESULTS: Between June 2024 and March 2026, 64.582 responses were eligible for analysis. Mean age was 52 years and the majority was female (76.5%). A higher proportion of respondents indicated having financial problems with increasing BMI (normal weight: 4.5%, overweight: 4.6%, obesity class 1: 4.9%, obesity class 2: 5.8% and obesity class 3: 7.3%, p<0.001). In addition, respondents indicated to experience more stress with increasing BMI (normal weight: 26.9%, overweight: 27.2%, obesity class 1: 29.4%, obesity class 2: 32.4% and obesity class 3: 35.0%, p<0.001). Finally, loneliness was more prevalent among respondents with increasing class of obesity (normal weight: 7.2%, overweight: 6.0%, obesity class 1: 6.2%, obesity class 2: 7.2%, obesity class 3: 9.6%, p<0.001). This association was even stronger in men compared to women.
CONCLUSION: This study shows that higher BMI is associated with more financial difficulties, loneliness, and stress. These relationships may be bidirectional: higher BMI could lead to reduced work capacity, stigma, and increased healthcare costs, while financial difficulties may limit access to healthy food and physical activity. Further research is needed to clarify these associations and to inform prevention and support strategies for individuals with financial difficulties, mental stress, and loneliness in combination with obesity.