Post-stroke depression (PSD) is a prevalent but often underdiagnosed complication affecting stroke survivors, with significant implications for recovery and quality of life. Emerging evidence suggests that central obesity, as measured by the weight-to-waist index (WWI), may play a crucial role in PSD risk and severity. Traditional obesity metrics, such as body mass index, may not accurately capture the impact of visceral fat distribution on neuropsychiatric outcomes. This letter highlights the growing recognition of WWI as a precise indicator of metabolic and inflammatory disturbances linked to post-stroke mental health. Integrating WWI into routine stroke rehabilitation assessments could facilitate early identification of high-risk patients and improve intervention strategies. Further research is needed to establish standardized WWI cutoff values and explore potential therapeutic targets for PSD prevention.