Abstract
Background/Objectives: Sex and gender influence dietary habits, eating behaviors, mental health, and obesity risk. Women exhibit a higher prevalence of emotional eating and mental health problems, which may contribute to sex-specific differences in adiposity. This study aimed to explore the associations between adiposity, diet quality, eating behaviors, mental health, and well-being, and to examine whether eating behaviors mediate the relationship between mental health and adiposity, stratified by sex. Methods: One hundred twenty-three adults (35.6 ± 7.9 years; 63.4% women) with overweight and obesity participated in this cross-sectional study. Adiposity parameters (BMI, body fat, waist and hip circumferences), biochemical parameters, eating behaviors (Three-Factor Eating Questionnaire-R21), well-being (WHO-5), perceived stress (Perceived Stress Scale), diet quality (17-item MedDiet questionnaire), and physical activity (International Physical Activity Questionnaire) were evaluated. Linear regression and path analyses were used to examine associations and mediation effects. Results: Women reported higher emotional eating and cognitive restraint scores (p = 0.017 and p = 0.034, respectively) and greater adherence to the Mediterranean diet (p < 0.001) than men. In men, well-being was positively associated with diet quality, while higher stress, cognitive restraint, and poorer diet quality were linked to greater adiposity. In women, well-being and diet quality were inversely associated with adiposity, while emotional and uncontrolled eating were related to higher adiposity and poorer biochemical markers. Emotional and uncontrolled eating mediated the relationship between well-being and adiposity only in women. Conclusions: Our results underscore the importance of incorporating sex- and gender-sensitive approaches in obesity prevention and treatment. For women, interventions should focus on emotional regulation and coping strategies, whereas for men, improving diet quality may be more effective.