Background Although the relationship between obesity and depression has been researched extensively, the relation of the wide range of body-weight problems, as indicated by the BMI, to emotional health problems has received little attention. Objectives To assess the rate of concomitant co-occurrence of emotional health and weight problems in Alexandria University students, and to investigate the relationship between their BMI and emotional status. Participants and methods A cross-sectional study was carried out on 842 university students (17-27 years), enrolled in four faculties of Alexandria University, Egypt, during the academic year 2012-2013. Participants of both sexes were interviewed to collect sociodemographic data. Weight and height were measured, and then the BMI was calculated and classified into underweight, normal weight, overweight, and obese according to age-corresponding and sex-corresponding standards. The Arabic version of Depression Anxiety Stress Scales was used to assess the emotional status of students. The curve of fit was used to test the statistical quadratic trend. Results Co-occurrence of depression, anxiety, or stress with any weight problem was prevalent among 7.4, 6.7, and 9.6% of the students, respectively. Obese and underweight students recorded higher rates of emotional problems compared with normal and overweight students, revealing a U-shaped relationship between the BMI and emotional states (R 2 =0.01). This relationship was significant only for anxiety and stress (P<0.05). A significant relationship (P<0.05) was found with the three emotional states among male participants (R 2 =0.02), but only for anxiety among female participants (R 2 =0.01). After controlling for age and sex, only being underweight increased the risk of anxiety and stress (odds ratio=2.95, P<0.001 and odds ratio=2.18, P=0.01, respectively). Conclusions and recommendations Findings revealed a U-shaped relationship between the BMI and the emotional status of university students, where sex differences were evident. University preventive strategies and treatment services should address such alarming coexisting problems among youth.
