Psychological and behavioral characteristics of overweight and obese Chinese college students with high stress

Background: The synergistic effects of psychological stress and behavioral factors on health outcomes in obese college students remain poorly understood, particularly within China’s unique campus environments. This study aimed to investigate the interrelationships between psychological distress, physical activity, eating behaviors, and sleep patterns among overweight/obese Chinese college students under high stress, with the ultimate goal of identifying key intervention targets to improve both mental and physical health outcomes in this vulnerable population. Methods: We conducted a cross-sectional study of 79 overweight/obese Chinese college students (age 19.62 ± 1.75 years; 27 females and 52 males) stratified by stress levels using the Perceived Stress Scale (PSS) questionnaire. Comprehensive assessments included psychological measures (PSS, Hospital Anxiety and Depression Scale [HAMA], Self-Rating Depression Scale [SDS]), behavioral evaluations (International Physical Activity Questionnaire [IPAQ], Three-Factor Eating Questionnaire-R21 [TFEQR21]), and health status indicators (36-Item Short Form Health Survey [SF36], Pittsburgh Sleep Quality Index [PSQI]). Independent Samples T-tests were used to examine differences in psychological and behavioral aspects between high-stress and low-to-moderate-stress Chinese university students with overweight/obesity. Correlation analyses were conducted to explore associations among these variables and identify key predictors of physical and mental health outcomes. Results: Overweight/obese Chinese college students with high stress showed significantly poorer sleep quality (p = 0.04) and worse general health (p = 0.02) compared with their lower-stress peers. Paradoxically, they reported better mental health scores (p = 0.02) and higher levels of moderate-intensity physical activity (p = 0.02). Strong intercorrelations were observed among depression, anxiety symptoms, and maladaptive eating behaviors, suggesting shared psychopathological pathways in this population. Conclusion: These findings underscore the need for integrated interventions addressing sleep, physical activity, and mental health in high-stress obese students, with particular attention to China’s unique campus environment constraints. Future research should explore culturally adapted mind-body interventions like tai chi to break the stressobesity cycle.