How diet therapy affects obesity-associated depressive symptoms: from mechanism to therapeutics

Obesity stands as a formidable 21st-century public health crisis, with its capacity to aggravate depressive symptoms gaining increasing clinical attention. Traditional treatment models often treat these two conditions separately. However, recent research evidence suggests a complex network linking obesity and depressive symptoms across metabolism, behavior, and mental health, with dietary patterns proposed as a key upstream modulator of both metabolic and psychological pathways. The specific mechanisms by which diet influences obesity and depressive symptoms remain unclear. Therefore, this narrative review focuses on analyzing molecular connections between diet, obesity, and depressive symptoms, including adipose tissue inflammation, the gut-brain axis, the hypothalamus-pituitary, adrenal axis, insulin and brain-derived neurotrophic factor levels, and neuroplasticity. We discuss the possible pathways and effects of different diet therapies in regulating metabolism and simultaneously impacting mental health, including calorie restriction diet, intermittent fasting, ketogenic diet, low glycemic index diet, plant-based diet, Mediterranean diet, Dietary Approaches to Stop Hypertension, among others. This review aims to provide a scientific basis for precision nutrition and personalized, sustainable diet therapies in clinical practice, promoting awareness and improving treatment strategies for depressive symptoms in obese patients.