Previous epidemiological studies have suggested that psychiatric symptoms are associated with obesity and abdominal distribution of body fat in women. The aim of the present study was to examine this in middle-aged men. In 1992 a cluster selected cohort of 1040 men born in 1944 (participation rate 79.9%) was examined. Registrations of symptoms of depression and anxiety, sleep disturbances, psychosomatic disease as well as degree of life satisfaction were analyzed in relation to body mass index (BMI) and the waist/hip circumference ratio (WHR). In univariate analyses both BMI and WHR correlated with these factors. BMI and WHR were, however, closely interrelated (p = 0.61), necessitating analyses of separate, independent relationships in multivariate analyses. When adjusted for WHR all the significant relationships with BMI disappeared. In contrast the WHR, adjusted for BMI, showed remaining significant associations with the use of anxiolytics (p = 0.018), hypnotics (p = 0.029), antidepressive drugs (p = 0.008), degree of melancholy (p = 0.002), and life satisfaction (p = 0.002, negative), difficulties to sleep (p = 0.014) and fall asleep (p = 0.047), tendency to wake up from sleep (borderline, p = 0.070) and dyspepsia (p < 0.001). Since smoking and alcohol are known to influence on the WHR, these factors were, in addition to BMI, entered into the analyses as confounding variables. The mentioned associations then remained statistical significant (use of hypnotics borderline, p = 0.074) except difficulties to fall asleep and tendency to wake up. It was concluded that in contrast to BMI, the WHR is associated with symptoms of depression and anxiety with associated sleep disturbances, as well as psychosomatic symptoms and dissatisfaction. It was hypothesized that the mechanism involved might be increased secretion of cortisol, directing storage fat to central adipose tissue depots.