Skip to main content

Gender differences in the associations between body mass index, depression, anxiety, and stress among endocrinologists in China



Depression, anxiety, and stress symptoms have been found to be associated with overweight or obesity, but the gender differences in the associations have not been well-examined. Based on a national sample of endocrinologists in China, we examined such associations with a focus on gender differences.


Data were collected from endocrinologists in China using an online questionnaire, which included demographic data, body weight, and height. Depression, anxiety, and stress symptoms were assessed using the Depression, Anxiety, and Stress Scale-21 (DASS-21).


In total, 679 endocrinologists (174 males and 505 females) completed the survey. One-fourth (25.6%) were classified as overweight, with a significant gender difference (48.9% in males vs. 17.6% in females, p < 0.05). Overall, 43.4% of the participants endorsed probable depressive symptoms (54.6% in males and 39.6% in females, p = 0.004), 47.6% for anxiety (51.7% in males vs. 46.1% in females, p = 0.203), and 29.6% for stress symptoms (34.5% in males vs. 27.92% in females, p = 0.102). After controlling for confounders, in the whole group, male gender (aOR = 4.07, 95% CI:2.70–6.14, p < 0.001), depression (aOR = 1.05, 95% CI:1.00-1.10, p = 0.034) and age (aOR = 1.03, 95% CI:1.00-1.05, p = 0.018) were positively associated with overweight. In males, depression (aOR = 1.14, 95% CI:1.05–1.25, p = 0.002), administration position (aOR = 4.36, 95% CI:1.69–11.24, p = 0.002), and night shifts/month (aOR = 1.26, 95% CI:1.06–1.49, p = 0.008) were positively associated with overweight, while anxiety (aOR = 0.90, 95% CI:0.82–0.98, p = 0.020) was negatively associated with overweight. In females, only age (aOR = 1.04, 95% CI:1.01–1.07, p = 0.014) was significantly associated with overweight status, while depression and anxiety were not associated with overweight. Stress symptoms were not associated with overweight in either gender.


One-fourth of endocrinologists in China are overweight, with a rate in males nearly triple the one in females. Depression and anxiety are significantly associated with overweight in males but not females. This suggests possible differences in the mechanism. Our findings also highlight the need to screen depression and overweight in male physicians and the importance of developing gender-specific interventions.

Peer Review reports


Overweight and obesity, abnormal or excessive fat accumulation in the body, have become a worsening public health concern in China [1]. In recent years, the prevalence of overweight increased rapidly, parallel to Chinese social, economic, and environmental transitions [2]. According to a recent national survey, more than half of Chinese adults were overweight or obese [3]. The increase in overweight and obesity is believed to impact the burden of non-communicable diseases, such as type 2 diabetes, cardiovascular disease, and cancer [4,5,6].

Overweight and obesity are often multifactorial, including factors contributing to gaining and retaining excess weight. Commonly mentioned factors include social and environmental factors (such as fast food culture, sedentary work environment, etc.), and personal factors (such as diet, lack of exercise, genetics, and mental health symptoms) [7,8,9,10,11,12].

Mental health symptoms and body weight may interact in several manners. First, mental health symptoms may lead to changes in eating habits and levels of physical activity [13, 14]. Depression, anxiety, and stress can disrupt normal eating habits and lead to overeating or loss of appetite, both of which can contribute to weight gain [15]. Second, overweight or obesity can lead to mental health symptoms. Being overweight or obese can lead to low self-esteem, body dissatisfaction, and depression [16]. Overweight or obesity can also lead to medical problems that can cause pain, limited mobility, and decreased quality of life, all of which can contribute to anxiety and stress [17]. Third, mental health problems and overweight share some common risk factors, such as genetics [18], biological mechanisms [19], and environmental factors [20]. For example, high-calorie foods, lack of physical activity, and high levels of stress can contribute to both mental health symptoms and overweight/obesity [21].

With respect to the relationship between mental health symptoms and overweight/obesity, gender may be a potential moderating factor [22]. On one hand, males and females have different physiological responses to stress, with men being more likely to overeat and women being more likely to lose their appetite. Women may be more likely to cope with depression through emotional eating, while men may be more likely to cope through binge drinking or other behaviors. These differences may be due to differences in hormonal responses to depression, as cortisol is a key intermediate factor in this relationship [23, 24]. On the other hand, there are often different cultural and societal expectations for men and women. Women are often expected to conform to a thinner body image, which can contribute to increased levels of body dissatisfaction, anxiety, and depression. In contrast, men are often expected to be strong and muscular, which can lead to increased pressure to maintain a larger body size [25, 26].

The gender differences in the relationship between mental health symptoms and body weight highlight the importance of including gender in health research and interventions. Interventions tailored to gender-specific challenges may improve healthy body weight and mental health. Such interventions may also better address the unique challenges faced by each gender.

Due to the high prevalence of diabetes and other metabolic disorders, endocrinologists play an important and unique role in the Chinese healthcare system. For example, diabetes is a major public health challenge in China with a prevalence of 9.7% or over 114 million people living with the disease in 2017 [27]. This statistic is estimated to rise to over 131 million people living with the disease by 2040 [28]. Thyroid disorders are also a major health concern in mainland China, where a significant portion of the population is affected by thyroid nodules and subclinical hypothyroidism. The prevalence of thyroid nodules in China is reported to be 20.43%, while subclinical hypothyroidism affects 12.93% of the population [29]. Endocrinologists are medical specialists who have the necessary training and expertise to diagnose, treat and manage diabetes and other endocrine disorders. Endocrinologists often provide comprehensive care to patients with diabetes, including medical management, lifestyle modifications, and ongoing monitoring of diabetes-related complications. Endocrinologists are also equipped to manage other metabolic disorders, such as obesity, which is a major risk factor for diabetes in China. Through their specialized training, they can provide effective interventions to help prevent the development of obesity and related conditions [30].

While they may have a better awareness of the importance of keeping a healthy weight and have more professional knowledge of healthy diets and lifestyles [31], they may also experience mental health symptoms, owing to stress related to heavy caseloads, long working hours, and difficulty maintaining work-life balance. To date, the prevalence of overweight and obesity and their correlates in Chinese endocrinologists have not been examined, especially in a large, national sample. Additionally, the relationships between overweight and mental health symptoms are of interest, as they may shed light on interventions.

In this study, based on a nationwide survey of practicing endocrinologists, we aimed to examine: (1) the prevalence of overweight and obesity and their correlates, (2) the prevalence of probable depressive, anxiety, and stress symptoms, (3) the associations between overweight and mental health symptoms, and (4) gender differences in the associations. We hypothesize that: (1) there is a significant association between obesity and depression among women, but not in men, and (2) there is a significant association between obesity and anxiety/stress in both genders.

Materials and methods

Study design and participants

The study was conducted between March 18th and 31st, 2019. It was part of the China Healthcare Improvement Initiative (CHII) supported by the National Health Committee [32]. The goal of CHII was to improve the health and well-being of medical staff and healthcare quality in China’s province-level top-tier general hospitals. The Provincial People’s Hospitals of each province in mainland China were purposely selected by CHII, as they are the top-tier hospitals in the region. In the Chinese healthcare system, each province has one Provincial People’s Hospital and it often has the best resources in budget, equipment, and staffing. It also usually serves as a tertiary referral center for the province. We recruited 31 hospitals, which are all government-owned, province-level, general tertiary hospitals. They accounted for 1.85% of the beds of all tertiary hospitals and 2.68% of all patient care among tertiary hospitals in mainland China [33]. All endocrinologists working in those hospitals were invited to participate in an anonymous online survey, which was delivered using WeChat, a popular Social App in China. To avoid duplicate responses, each cell phone could only submit responses once.

The survey protocol was reviewed and approved by the Ethics Committee of Emergency General Hospital in Beijing. Each participant had to complete the consent form before they could proceed to the survey.


The basic sociodemographic features and work-related information were collected based on a literature review [34,35,36]. They included age, gender, number of children, education, relationship status, height, weight, cigarette smoker or not, professional title, administration position, sleep hours/day, work hours/week, and night shifts/month.

Body mass index (BMI) was calculated using the participants’ self-reported height and weight. According to the Working Group on Obesity in China, the cutoff values for BMI (unit: kg/m²) in Chinese adults are: underweight: <18.5; normal: 18.5–24.0; overweight but not obesity: 24.0 ≤ BMI<30.0; obesity:≥30.0 [1, 2, 37].

Mental health symptoms were assessed using the Chinese version of the Depression, Anxiety, and Stress Scales-21 (DASS-21) [38, 39]. DASS-21 is a 21-item self-report questionnaire to investigate three symptom domains, including depressive, anxious, and stress symptoms. The instrument uses a 4-point Likert scale. Each item was scored from 0 (did not apply to me at all over the last week) to 3 (applied to me very much over the past week). As the DASS-21 is a short-form version of the Long Form DASS, the final score of each item was multiplied by two. The level of symptoms was ranked as normal, mild, moderate, severe, and extremely severe, according to certain cut-off values [38]. The Cronbach’s alpha of DASS-21 was 0.96 in this study.

Data analysis

The normality of research data was detected through a one-sample K-S test. Quantitative variables were expressed as mean (SD) or median (IQR), and qualitative variables were expressed as frequencies (percentages). The mean/median scores and prevalence rates of depression, anxiety, and stress were calculated.

Depression, anxiety, and stress scores were compared using the Mann-Whitney test or Kruskal-Wallis test among different BMI groups and different gender groups, as appropriate. The gender and BMI groups interactions were also tested in the same process with a newly generated variable of gender×BMI groups. Depression, anxiety, and stress prevalence rates were compared using Pearson’s χ2 test or Fisher’s exact test, among different BMI groups and different gender groups.

We used the Pearson correlation analysis to test the correlation between depression, anxiety, stress scores, and continuous BMI values between males and females, respectively.

We performed separate multilevel binary logistic regression analyses with endocrinologists in level 1 and hospitals in level 2. Only the overweight and normal BMI groups (reference group) were involved in the logistic regression, and the weight status was treated as the dependent variable. Depression, anxiety, and stress scores were treated as continuous independent variables and were purposely included in the regression, while other confounders were screened through backward stepwise regression. We performed the regression models in entire groups, male and female subgroups, respectively.

We performed all analyses using the STATA software version 16.0 (Stata Corporation, College Station, TX, USA). Two-sided p < 0.05 was considered significant.


Sample characteristics

At the beginning of the survey, 879 endocrinologists were invited to participate in this survey, and 711 endocrinologists responded (response rate = 80.9%). Finally, 679 endocrinologists completed the questionnaire without logical errors. Table 1 shows their detailed sociodemographic features, job-related factors, and gender differences.

Table 1 Basic Characteristics of 679 endocrinologists in China

Categorical variables are reported as N (%). Continuous variables (age, sleep hours, work hours, and BMI) were reported as Mean (SD) unless indicated otherwise. Based on the Chinese criteria, 24.0% of the endocrinologists were classified as overweight but not obese, 1.62% were obese. As the sample of obese participants was small, we combined the two groups as “overweight” in our analysis unless specified otherwise.

After merging the overweight and obese groups, about one-fourth (25.6%) were overweight, 48.85% in males, 17.6% in females; 5.6% underweight, 1.2% in males, and 7.1% in females. A significant gender difference was found in BMI categories (p < 0.001). Nearly one-quarter (24.7%) of overweight endocrinologists were less than 35 years old, 39.7% were between 35 and 44 years old, and 35.6% were in the group of 45 years or older.

In this sample, we found the overall prevalence of probable depression was 43.4%, with a significant gender difference (54.6% in males and 39.6% in females, p = 0.004). We also found a significant gender difference (p = 0.032) and gender×BMI category interaction for depression scores (p = 0.035).

Nearly one-half (47.6%) of endocrinologists endorsed probable anxious symptoms, 51.7% in males and 46.1% in females (p = 0.203), respectively. We did not find a significant gender difference (p = 0.549) nor gender×BMI category interaction for anxiety scores (p = 0.615).

The rate of probable stress symptoms was 29.6% in this sample, 34.5% in males, and 27.92% in females (p = 0.102), respectively. There was a gender difference (p = 0.036) in stress scores, but no gender×BMI category interaction for anxiety scores (p = 0.087) (see Table 2).

Table 2 DASS scores in male and female endocrinologists in China

We performed Pearson correlations between depression, anxiety, stress scores, and continuous BMI values, but did not find significant correlations (Supplemental Table 1).

Supplemental Table 2 shows detailed information on depression, anxiety, and stress symptoms in categories.

We then performed stepwise multilevel logistic regression analysis, using overweight status (overweight + obesity) as a dependent variable, and others as independent variables. Depression, anxiety, and stress scores were purposely maintained. We performed the analysis in the whole sample, and male and female participants, separately.

In the whole group, male gender (aOR = 4.07, 95% CI:2.70–6.14, p < 0.001), depression scores (aOR = 1.05, 95% CI:1.00-1.10, p = 0.034) and age (aOR = 1.03, 95% CI:1.00-1.05, p = 0.018) were positively associated with overweight status.

In the male group, depression scores (aOR = 1.14, 95% CI:1.05–1.25, p = 0.002), administration position (aOR = 4.36, 95% CI:1.69–11.24, p = 0.002), and night shifts/month (aOR = 1.26, 95% CI:1.06–1.49, p = 0.008), were positively associated with overweight status, while anxiety scores (aOR = 0.90, 95% CI:0.82–0.98, p = 0.020) were negatively associated with overweight status. Stress scores were not associated with overweight status in males.

In the female group, only age (aOR = 1.04, 95% CI:1.01–1.07, p = 0.014) was positively associated with overweight status. While depression, anxiety, and stress scores were not associated with overweight status. For details, please see Table 3.

Table 3 Gender differences in the association between DASS scores and overweight status in male and female endocrinologists

In the sensitivity analysis, we excluded the participants who were classified as obese (5 males and 6 females), and the overall findings remained largely unchanged compared with the analysis which included obese participants (see supplemental Table 3).


This research was one of the first to focus on overweight and mental health among Chinese physicians. Our main findings include: (1) one-fourth of endocrinologists were overweight, nearly half of the participants endorsed depression or anxiety, and one-third endorsed feeling stressed; (2) overweight was significantly associated with depression and anxiety scores in male endocrinologists, but not in females; (3) stress scores were not significantly associated with overweight in males or females. Our findings suggest that gender might moderate the relationship between depression/anxiety and body weight.

In this survey, the prevalence of overweight/obese among endocrinologists was 25.6% (1.62% for obese only). This figure is lower than the average level of Chinese adults, as the China Chronic Disease and Nutrition Surveillance 2015-19 survey showed that the prevalence for overweight and obesity was 34.3% and 16.4% in people aged 18 years and older [1]. This encouraging finding may be related to better awareness and body weight management skills in this population [31].

Our findings show that a significant association between overweight status and depression was only found in males (not in females), which is contrary to our hypothesis but is consistent with one prior study, a survey involving German and Chinese participants [40]. Another study showed that a lack of positive emotion was associated with being overweight in females, whereas significant associations were found between all dimensions of depression and overweight in males [36].

Similar to the association between overweight and depression, we also found that the association between overweight/obesity and anxiety was only significant in males, not in females, which partially aligned with the research hypothesis. This is in line with the findings of an international study. In their study of 9,007 Chinese university students and 364 German students, Lavallee et al. only found significant associations in Chinese male students between overweight and mental health symptoms, as assessed using DASS-21 [40]. Other studies have reported no gender-specific association between overweight and anxiety [41,42,43], while one reported the association only in female empty nesters [44]. Therefore, this interesting finding needs further research.

The finding that stress was not significantly associated with overweight in both genders was not consistent with our hypothesis. The relationships between stress and obesity in susceptible individuals can be partly traced back to a third key player: increased glucocorticoid (GC) action, which is influenced by individual GC sensitivity [45]. Multiple genetic and disease-related factors can influence GC sensitivity with variations among different populations [46]. The biological characteristics of Chinese endocrinologists might be the potential factors for lack of the association.

We found that depression and anxiety may contribute to being overweight in males but not in females, which has theoretical and held practical implications for the understanding of the complex relationship between mental health and body weight. Gender-specific pathways may moderate the relationship between mental health and body weight. Identifying these pathways could lead to gender-specific interventions which may help prevent and treat overweight. These findings highlight the importance of considering gender when evaluating and treating overweight, as well as addressing depression and anxiety symptoms. Healthcare providers should take a gender-specific approach when working with patients to manage weight, considering the potential role of mental health in the development and maintenance of overweight. The results of this research have implications for public health as well as the role of gender-specific factors, including the role of depression and anxiety, which should be considered when developing interventions for overweight or obesity.

The present study has a few limitations. First, the findings were based on a cross-sectional survey, and it is difficult to infer causality between different variables. Second, the survey data may have recall bias, as collected through self-report. Third, the sample was only from 31 tertiary public hospitals in China, so the generalizability of the study conclusions may be limited. Fourth, mental health was measured by questionnaires, and no clinical diagnoses can be provided. Finally, some important information related to BMI and mental health, such as health status and other lifestyle information (such as diet, exercise, etc.) were not collected.


In a large national sample, we found that one-fourth of endocrinologists were overweight, which is lower than the data in the general population. Depression and anxiety may be significant contributors to overweight in males, but not in females, which suggests the mechanism of the association between overweight and mental health in males and females are different. Further studies are needed to identify mechanisms that lead to more gender-dependent screening and therapies. Different interventional strategies may also be needed when addressing overweight issues in male and female physicians.

Data Availability

The datasets generated and analyzed for the current study are not publicly available due to the necessity to ensure participant confidentiality policies and laws of the country. But they are available from the corresponding author upon reasonable request.


  1. Pan XF, Wang L, Pan A. Epidemiology and determinants of obesity in China. Lancet Diabetes Endocrinol. 2021;9(6):373–92.

    Article  PubMed  Google Scholar 

  2. Wang L, Zhou B, Zhao Z, Yang L, Zhang M, Jiang Y, Li Y, Zhou M, Wang L, Huang Z, et al. Body-mass index and obesity in urban and rural China: findings from consecutive nationally representative surveys during 2004-18. Lancet. 2021;398(10294):53–63.

    Article  PubMed  Google Scholar 

  3. Press briefing for the Report on Chinese Residents’ Chronic Diseases and Nutrition. 2020 []

  4. Okunogbe A, Nugent R, Spencer G, Ralston J, Wilding J. Economic impacts of overweight and obesity: current and future estimates for eight countries. BMJ Glob Health 2021, 6(10).

  5. Riquelme R, Rezende LFM, Guzmán-Habinger J, Chávez JL, Celis-Morales C, Ferreccio C, Ferrari G. Non-communicable diseases deaths attributable to high body mass index in Chile. Sci Rep. 2021;11(1):15500.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Afshin A, Forouzanfar MH, Reitsma MB, Sur P, Estep K, Lee A, Marczak L, Mokdad AH, Moradi-Lakeh M, Naghavi M, et al. Health Effects of overweight and obesity in 195 countries over 25 years. New Engl J Med. 2017;377(1):13–27.

    Article  PubMed  Google Scholar 

  7. Zhu J, Tan Y, Lu W, He Y, Yu Z. Current Assessment of Weight, Dietary and Physical Activity Behaviors among Middle and High School Students in Shanghai, China-A 2019 Cross-Sectional Study. Nutrients 2021, 13(12).

  8. Verdú E, Homs J, Boadas-Vaello P. Physiological Changes and Pathological Pain Associated with Sedentary Lifestyle-Induced Body Systems Fat Accumulation and Their Modulation by Physical Exercise. Int J Env Res Public Health 2021, 18(24).

  9. Mazurek-Kusiak AK, Kobyłka A, Korcz N, Sosnowska M. Analysis of Eating Habits and Body Composition of Young Adult Poles. Nutrients 2021, 13(11).

  10. Dhurandhar NV, Petersen KS, Webster C. Key causes and contributors of obesity: a perspective. Nurs Clin North Am. 2021;56(4):449–64.

    Article  PubMed  Google Scholar 

  11. Ramírez V, Robles-Aguilera V, Salcedo-Bellido I, Gálvez-Ontiveros Y, Rodrigo L, Martinez-Gonzalez LJ, Monteagudo C, Álvarez-Cubero MJ, Rivas A. Effects of genetic polymorphisms in body mass index according to dietary exposure to bisphenols and parabens. Chemosphere 2021:133421.

  12. Hu L, Huang X, You C, Li J, Hong K, Li P, Wu Y, Wu Q, Wang Z, Gao R, et al. Prevalence of overweight, obesity, abdominal obesity and obesity-related risk factors in southern China. PLoS ONE. 2017;12(9):e0183934.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Braden A, Musher-Eizenman D, Watford T, Emley E. Eating when depressed, anxious, bored, or happy: Are emotional eating types associated with unique psychological and physical health correlates? Appetite 2018, 125:410–417.

  14. Chekroud SR, Gueorguieva R, Zheutlin AB, Paulus M, Krumholz HM, Krystal JH, Chekroud AM. Association between physical exercise and mental health in 1.2 million individuals in the USA between 2011 and 2015: a cross-sectional study. Lancet Psychiatry. 2018;5(9):739–46.

    Article  PubMed  Google Scholar 

  15. Stults-Kolehmainen MA, Sinha R. The effects of stress on physical activity and exercise. Sports Med. 2014;44(1):81–121.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Moradi M, Mozaffari H, Askari M, Azadbakht L. Association between overweight/obesity with depression, anxiety, low self-esteem, and body dissatisfaction in children and adolescents: a systematic review and meta-analysis of observational studies. Crit Rev Food Sci Nutr. 2022;62(2):555–70.

    Article  PubMed  Google Scholar 

  17. Taylor R Jr, Pergolizzi JV, Raffa RB, Nalamachu S, Balestrieri PJ. Pain and obesity in the older adult. Curr Pharm Des. 2014;20(38):6037–41.

    Article  PubMed  Google Scholar 

  18. Zarza-Rebollo JA, Molina E, Rivera M. The role of the FTO gene in the relationship between depression and obesity. A systematic review. Neurosci Biobehav Rev. 2021;127:630–7.

    Article  PubMed  Google Scholar 

  19. Milaneschi Y, Simmons WK, van Rossum EFC, Penninx BW. Depression and obesity: evidence of shared biological mechanisms. Mol Psychiatry. 2019;24(1):18–33.

    Article  PubMed  Google Scholar 

  20. McCurdy K, Tovar A, Kaar JL, Vadiveloo M. Pathways between maternal depression, the family environment, and child BMI z scores. Appetite. 2019;134:148–54.

    Article  PubMed  Google Scholar 

  21. Gostoli S, Roncuzzi R, Urbinati S, Morisky DE, Rafanelli C. Unhealthy behaviour modification, psychological distress, and 1-year survival in cardiac rehabilitation. Br J Health Psychol. 2016;21(4):894–916.

    Article  PubMed  Google Scholar 

  22. Tronieri JS, Wurst CM, Pearl RL, Allison KC. Sex differences in obesity and Mental Health. Curr Psychiatry Rep. 2017;19(6):29.

    Article  PubMed  Google Scholar 

  23. Du C, Adjepong M, Zan MCH, Cho MJ, Fenton JI, Hsiao PY, Keaver L, Lee H, Ludy MJ, Shen W et al. Gender Differences in the Relationships between Perceived Stress, Eating Behaviors, Sleep, Dietary Risk, and Body Mass Index. Nutrients 2022, 14(5).

  24. Wang P, Garcia ER, Yim IS. Acculturative stress and eating disinhibition among asian young adults: the role of depressive symptoms and gender. Appetite. 2022;169:105826.

    Article  PubMed  Google Scholar 

  25. Gualdi-Russo E, Rinaldo N, Masotti S, Bramanti B, Zaccagni L. Sex Differences in Body Image Perception and Ideals: Analysis of Possible Determinants. Int J Env Res Public Health 2022, 19(5).

  26. He J, Sun S, Zickgraf HF, Lin Z, Fan X. Meta-analysis of gender differences in body appreciation. Body Image. 2020;33:90–100.

    Article  PubMed  Google Scholar 

  27. Yang W, Lu J, Weng J, Jia W, Ji L, Xiao J, Shan Z, Liu J, Tian H, Ji Q, et al. Prevalence of diabetes among men and women in China. New Engl J Med. 2010;362(12):1090–101.

    Article  PubMed  Google Scholar 

  28. Tu WJ, Xue Y, Nie D. The prevalence and treatment of diabetes in China from 2013 to 2018. JAMA. 2022;327(17):1706.

    Article  PubMed  Google Scholar 

  29. Li Y, Teng D, Ba J, Chen B, Du J, He L, Lai X, Teng X, Shi X, Li Y, et al. Efficacy and safety of long-term Universal Salt iodization on thyroid Disorders: epidemiological evidence from 31 provinces of Mainland China. Thyroid. 2020;30(4):568–79.

    Article  PubMed  Google Scholar 

  30. Zhang B, Zhang S. Letter to the Editor: “Our Response to COVID-19 as Endocrinologists and Diabetologists”. J Clin Endocrinol Metab 2020, 105(7).

  31. Agarwal M, Nadolsky K. Attitudes, Perceptions, and Practices in Managing Obesity Among Endocrinologists. Endocr Pract 2021.

  32. Zhou H, Han X, Zhang J, Sun J, Hu L, Hu G, Wu S, Zhao P, Jiang F, Liu Y. Job satisfaction and Associated factors among medical staff in Tertiary Public Hospitals: results from a National Cross-Sectional Survey in China. Int J Env Res Public Health. 2018;15(7):1528.

    Article  Google Scholar 

  33. National Health Commission of the People’s Republic of China. China Health Statistical Yearbook. Beijing: Press of Peking Union Medical College; 2020.

    Google Scholar 

  34. Moradi M, Mozaffari H, Askari M, Azadbakht L. Association between overweight/obesity with depression, anxiety, low self-esteem, and body dissatisfaction in children and adolescents: a systematic review and meta-analysis of observational studies. Crit Rev Food Sci Nutr 2020:1–16.

  35. Luppino FS, de Wit LM, Bouvy PF, Stijnen T, Cuijpers P, Penninx BW, Zitman FG. Overweight, obesity, and depression: a systematic review and meta-analysis of longitudinal studies. Arch Gen Psychiatry. 2010;67(3):220–9.

    Article  PubMed  Google Scholar 

  36. Zhao Z, Ding N, Song S, Liu Y, Wen D. Association between depression and overweight in chinese adolescents: a cross-sectional study. BMJ Open. 2019;9(2):e024177.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Zhou BF. Predictive values of body mass index and waist circumference for risk factors of certain related diseases in chinese adults–study on optimal cut-off points of body mass index and waist circumference in chinese adults. Biomed Environ Sci. 2002;15(1):83–96.

    PubMed  Google Scholar 

  38. Lovibond SH, Lovibond PF. Manual for the Depression, anxiety and stress scales (DASS). 2nd ed. Sydney: Psychology Foundation of Australia; 1995.

    Google Scholar 

  39. Jiang LC, Yan YJ, Jin ZS, Hu ML, Wang L, Song Y, Li NN, Su J, Wu DX, Xiao T. The Depression anxiety stress Scale-21 in Chinese Hospital Workers: reliability, latent structure, and Measurement Invariance Across Genders. Front Psychol. 2020;11:247.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Lavallee KL, Zhang XC, Schneider S, Margraf J. Obesity and Mental Health: a Longitudinal, cross-cultural examination in Germany and China. Front Psychol. 2021;12:712567.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Amiri S, Behnezhad S. Obesity and anxiety symptoms: a systematic review and meta-analysis. Neuropsychiatr. 2019;33(2):72–89.

    Article  PubMed  Google Scholar 

  42. Gariepy G, Nitka D, Schmitz N. The association between obesity and anxiety disorders in the population: a systematic review and meta-analysis. Int J Obes (Lond). 2010;34(3):407–19.

    Article  PubMed  Google Scholar 

  43. Scott KM, Bruffaerts R, Simon GE, Alonso J, Angermeyer M, de Girolamo G, Demyttenaere K, Gasquet I, Haro JM, Karam E, et al. Obesity and mental disorders in the general population: results from the world mental health surveys. Int J Obes (Lond). 2008;32(1):192–200.

    Article  PubMed  Google Scholar 

  44. Zhang C, Li M, Zhao H, Zhu R, Zheng X, Lu J, Du Y, Yu L, Yang T. Are overweight people more susceptible to anxiety? Int J Geriatr Psychiatry. 2019;34(4):555–62.

    Article  PubMed  Google Scholar 

  45. van der Valk ES, Savas M, van Rossum EFC. Stress and obesity: are there more susceptible individuals? Curr Obes Rep. 2018;7(2):193–203.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Lengton R, Iyer AM, van der Valk ES, Hoogeveen EK, Meijer OC, van der Voorn B, van Rossum EFC. Variation in glucocorticoid sensitivity and the relation with obesity. Obes Rev. 2022;23(3):e13401.

    Article  PubMed  Google Scholar 

Download references


The participating institutions and physicians are thanked for their contribution. We would also like to thank Ms. Brianna Wong, BS, CCRC, at the Atlanta VA Medical Center for her editing of this manuscript.


This study was supported by the National Health Committee(2019).

Author information

Authors and Affiliations



YL.L. F.J. and YN.W. made substantial contributions to the study design; MX.W. and YN.W. collected data; F.X., LC.J. analyzed the data; F.X., LC.J., HZ.L. and F.J. interpreted the analysis results and completed the manuscripts. YL.T. contributed to data interpretation, presentation and critical revision of the manuscript. All authors have read and approved the published version of the manuscript.

Corresponding authors

Correspondence to Feng Jiang or Yinuo Wu.

Ethics declarations

Ethics approval and consent to participate

The present study was conducted in terms of the principles of the revised Declaration of Helsinki. The Ethics Committee of Emergency General Hospital in Beijing approved the survey. The participants were informed that their consent to participate in the survey was completely voluntary and that they would be able to withdraw from the survey at any time without consequence. All subjects were asked to sign the written informed consent form if they were willing to participate.

Consent for publication

Not applicable.

Competing interests

The authors have no competing interests to declare.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary Material 1

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and Permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Xie, F., Jiang, L., Liu, Y. et al. Gender differences in the associations between body mass index, depression, anxiety, and stress among endocrinologists in China. BMC Psychol 11, 116 (2023).

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI:


  • Endocrinologists
  • Body mass index
  • Overweight
  • Mental health
  • Gender difference