1. Introduction
Obesity is defined as an abnormal accumulation of body fat that adversely affects health, posing significant biomedical, economic, and psychosocial burdens [
1,
2]. According to the World Health Organization (WHO), the global prevalence of obesity has tripled since 1975. Childhood obesity has become a major health concern of the 21st century, affecting over 42 million children under five [
3,
4,
5].
In the Kingdom of Saudi Arabia (KSA), childhood overweight and obesity rates were reported at 13.4% and 18.2%, respectively, with girls showing a slightly higher prevalence than boys [
6].
Furthermore, the proportion of overweight children aged 4–12 increased from 5.4% in 2004 to 18.3% in 2016 [
7]. According to the Saudi Ministry of Health, more than 15% of children under five were overweight, and 6% were obese, while among children aged five and older, 23% were overweight and 9.3% were obese [
8].
Body mass index (BMI; kg/m
2)–for-age percentile is commonly used to assess obesity in children, with sex-specific percentiles accounting for their ongoing growth. The Centers for Disease Control and prevention (CDC) categorized teen and child BMI (kg/m
2) as follows: underweight as below the 5th percentile, healthy weight between the 5th and 85th percentiles, overweight as between the 85th and 95th percentiles, obesity as the 95th percentile or above, and severe obesity as a BMI (kg/m
2) of 35 or higher [
9].
Childhood obesity increases the risk of several medical complications, including diabetes mellitus, hypertension, coronary artery disease, stroke, gallbladder disease, osteoarthritis, sleep apnea, and hyperlipidaemia [
1]. Beyond these physical consequences, obesity also severely impacts psychological well-being. Children with obesity are more likely to experience low self-esteem, anxiety, depression, and social isolation. They may face bullying, stigma, and body dissatisfaction, all of which contribute to emotional distress and hinder academic and social development [
10,
11,
12].
A study in Egypt reported that 46.7% of children with obesity experienced bullying, which led to emotional difficulties and poor self-worth. Childhood Depression Inventory scores were positively correlated with BMI (kg/m
2) and waist circumference, and 26.7% of children with obesity had severely low self-esteem, compared to just 10% of their normal-weight peers [
13].
Obesity negatively affects body image and children’s well-being [
14]. A study conducted in Mexico, found that 74% of children were dissatisfied with their body image, with overweight or children with obesity being 6.73 times more likely to experience body dissatisfaction than their normal-weight counterparts [
15].
Cognitive function may also be affected by obesity. Studies have shown a decline in working memory and other cognitive scores as BMI (kg/m
2) increases. For instance, children with obesity in a Malaysian study scored, on average, 4.075 points lower than their normal-weight peers in cognitive assessment [
11,
16]. Psychological distress can create a vicious cycle, leading to poor eating habits and reduced physical activity, further worsening obesity and associated mental health challenges [
17,
18,
19].
Socioeconomic status (SES) is another key determinant. Numerous studies have shown that children from lower SEC backgrounds face a greater risk of obesity due to limited access to healthy food, safe physical activity environments, and exposure to chronic stress [
20,
21,
22,
23,
24,
25].
A 2022 systematic review examining Mexican children found that those with overweight or obesity, particularly girls, were more susceptible to depression [
26].
In 2016, a study from Western Saudi Arabia reported that higher BMI (kg/m
2) in children was associated with physical limitations, attention difficulties at school, and social challenges. Interestingly, no strong correlation was found with emotional issues or absenteeism [
27]. The psychological impact of obesity is not limited to childhood: a 2023 cross-sectional study in Riyadh found that one-third of adults with obesity also experienced increased levels of anxiety and depression [
28].
Due to the limited number of studies exploring the psychological implications of childhood obesity in the Saudi context, this study was conducted. The rapid increase in the prevalence of childhood overweight and obesity over the past two decades in Saudi Arabia raises concerns about both physical and psychological consequences [
29]. Unlike many prior studies—such as those conducted by Blanco et al. and Putra et al—which relied on self -administered questionnaires, this research employed structured face-to-face interviews. This approach reduces potential biases related to question misinterpretation and ensures more accurate data collection [
30,
31].
This paper aims to investigate the relationship between childhood overweight and obesity and various parameters of psychological well-being, with a focus on determining whether this association is predominantly positive or negative. While global studies on childhood obesity largely focus on Western contexts, the unique cultural and family-related influences in Saudi Arabia remain underexplored, particularly the role of parental obesity in shaping children’s psychological well-being. This study addresses this gap by examining the association between parental BMI (kg/m2) and the psychological health of children with obesity.
4. Discussion
The overall aim of the current study was to examine the relationship between childhood obesity and psychological well-being in Saudi children aged 8–12 years.
Contrary to results of earlier studies such as those conducted by Topçu et al. and Lindberg et al., our analysis revealed no statistically significant differences between overweight/obese and normal-weight children for the majority of the psychological well-being dimensions of the (PWSC) and the (SCWS) [
34,
35].
Previous studies have frequently reported high associations between childhood obesity and worse psychological health to suggest heightened vulnerability to anxiety, depression, and lower self-esteem in obese and overweight children [
13,
14,
15], like the study titled “Psychological Aspects of Obesity in Children and Adolescents” that was published in 2018, have extensively reported the relationship between childhood obesity and psychosocial well-being [
36].
In addition, a more recent European study, in 2023, found that higher BMI (kg/m
2) in children was negatively associated with psychological and emotional health to suggest a direct adverse influence of obesity on psychological outcomes [
37].
Similarly, a Spanish study revealed significantly lower self-esteem and heightened teasing in children with obesity compared to their peers of normal weight, thus emphasizing psychological burdens linked to excess weight. However, our findings did not align with these results, prompting further examination of possible explanations for this divergence [
30].
One explanation for our non-significant findings could be cultural differences. Living in an Islamic society, strictly following Islamic values which prohibit bulling is one of the important factors that impact the perception of self-image that might also be implicated. Saudi Arabia’s social and cultural dynamics might differ from Western populations, potentially providing protective psychological effects against weight stigma [
38].
More tolerance for body size differences among children within cultures, as well as stronger support within families, may counteract or mask the psychological distress usually associated with obesity [
39].
Our age group of participants (8–12 years) could also be the reason behind these non-significant results. Psychological disturbances related to obesity might become apparent at the adolescence stage, a period that is defined by heightened sensitivity towards self-esteem, peer acceptance, and social comparison [
40]. Younger children within our sample may have yet to experience the same level of psychological distress as compared to older age groups.
Longitudinal studies that follow children over time as they grow into adolescence would be helpful in determining the potential developing relationship between obesity and psychological well-being. Interestingly, our study found strong correlation between maternal BMI (kg/m2) and children’s psychology scores on the PWSC (χ2 = 6.217, p = 0.045). Specifically, children of mothers with higher BMI (kg/m2) reported differences in psychological well-being outcomes.
This is also aligned with current evidence that maternal health and household environment can significantly influence children’s emotional and behavioral development. Similar results were revealed by the previous European research that credited family BMI (kg/m
2) and way of life with the mental health of children and accentuated the indirect influence of the family background and lifestyle characteristics on children’s emotional well-being [
37].
We also obtained a statistically significant sex difference using the SCWS where males reported higher percentages in the “high” well-being group than females (χ2 = 7.798, p = 0.041).
This sex difference could reflect culturally conditioned social pressures or expectations for body image and behavior, which might differently affect girls and boys.
Additional research is recommended to explore these sex-specific psychological consequences more fully in local cultural contexts.
The absence of significant correlations with family income and educational level (grade at school) suggests that these socio-economic and educational determinants are possibly not strong predictors of children’s psychological well-being.
This is set against typical assumptions about socioeconomic impacts elsewhere and it shows the complexity and potential interaction of several determinants acting on psychological well-being regardless of economic status or grade at school.
Conflict in findings is present according to differences in study design, sample populations, and methodological approaches.
The key point drawn by previous research is that while obesity usually occurs with psychiatric struggles, not all children with obesity are faced with meaningful psychopathology. A couple of researchers found high correlations between obesity and psychopathology [
34,
35] whereas others did not document a direct association between these phenomena [
41,
42].
Additional variables such as sex, age, race, and obesity magnitude have been contended to be potential regulators of this relationship, highlighting the complexity of obesity’s psychological effects.
Moreover, our findings reiterate that obesity is associated with an increased threat of mental maladjustment in the form of depressive symptoms, anxiety, and self-esteem problems. In addition, past research highlighted the role played by family and social context, such as parenting styles, peer victimization, and social support in the psychological well-being of children with obesity [
43,
44,
45]. Our findings also emphasize the agency of these factors, validating the implication that social stressors play a central role in modulating the mental health effects of obesity. Similarly, existing studies show that women with obesity are disproportionately affected by psychological distress, particularly in terms of body image concerns [
46,
47]. Our findings are consistent with this perspective, indicating that sex exerts a powerful influence on the psychological impact of obesity such that girls are more distressed than boys.
This study applies standard, validated measurement tools to provide more consistent, better results. In addition, our research mixes both clinical samples and population samples, providing a larger perspective on the psychological effects of obesity in diverse settings. Empirical research regarding childhood obesity and mental health is still not commonly present in some parts of the world, particularly in South Asia and the Middle East. The current research fills the gap to some extent by concentrating on various populations, hence providing cross-cultural data on the psychological effects of obesity.
Our study builds upon previous research by integrating additional variables, such as parental BMI, as potential determinants of childhood psychological well-being.
Notably, Puhl and Brownell conducted a study that explored the impact of weight-based stigma on psychological health in overweight adults and adults with obesity, concluding that stigma alone was not directly predictive of mental health outcomes; rather, coping mechanisms played a mediating role. In contrast, our study shifts the focus to a younger population and examines psychological well-being without assuming stigma as an intermediary factor [
48].
In addition, Magallares and Pais-Ribeiro conducted a meta-analysis that questioned the assumption that obesity universally correlates with poor mental health, suggesting that some individuals—particularly men—exhibit better psychological well-being despite high BMI, a phenomenon described as the “Jolly Fat” hypothesis. Our study extends this perspective by demonstrating that children with higher-weight parents tend to report better well-being scores, suggesting that familial factors may modulate psychological responses to obesity [
49].
Key advancements over prior research are also evident in our study. Whereas most previous studies have examined adults, our study provides a novel contribution by focusing on children, thereby elucidating the early-life influences of obesity on psychological well-being. Unlike studies that primarily assess individual BMI, our research highlights the role of parental BMI (kg/m2) in shaping children’s psychological outcomes, suggesting an intergenerational transmission of psychological resilience related to weight status. Our study incorporates direct statistical comparisons using validated psychological well-being scales specifically designed for pediatric populations. In contrast to earlier research that has largely overlooked demographic moderators, our study integrates variables such as sex, school grade, and family income, enabling a more nuanced analysis of potential influencing factors. Our findings indicate that boys report higher psychological well-being than girls, adding a sex-based dimension to the discourse and providing new hypotheses regarding sociocultural influences on obesity and mental health.
4.1. Implications for Future Research
The findings of our study open several avenues for further investigation. Future studies should include larger sample sizes and mixed methods to capture complex psychological impacts and better grasp participants’ emotional experiences.
The future research should explore the role of parental attitudes, health behaviors, and psychosocial support as mediators in the association between parental BMI (kg/m2) and child well-being. Longitudinal studies are needed to assess whether the observed associations persist into adolescence and adulthood, providing deeper insights into the long-term psychological consequences of childhood obesity. Given the complex interplay between obesity and mental health, incorporating additional psychological constructs such as resilience, self-efficacy, and social support may enhance our understanding of the protective and risk factors involved. Further exploration of cultural and socioeconomic moderators is warranted to determine whether the observed relationships hold across diverse populations and socioeconomic strata.
4.2. Study Limitations
There are several limitations to this study. As a cross-sectional case-control study, it cannot assess causal relationships as the exposure and outcome data were collected at the same time, making it impossible to determine whether the exposure preceded the outcome, or was a result of the outcome. Also, recall bias could muddle responses to self-reported psychological and behavioral measures. Additionally, the participant bias measures in the study limit the findings if the cases and controls did not adequately represent the greater population. Furthermore, the design did not look at incidence or risk, but at prevalence of possibilities, limiting extrapolating findings about the progression of psychological outcomes over time. There may have also been unmeasured confounding variables regarding the relationships we made conclusions about.
Besides the methodological challenges, this study did not measure parental psychological well-being, which is a significant parent contributor to children’s mental health. Also, certain cultural aspects that would pertain to Saudi Arabian residents could have a bearing on how the perception of, and experiences of obesity and psychological distress are accounted for, which would affect generalizability. While there was an association between maternal BMI (kg/m2) and children’s well-being, underlying factors in the association were not measured, which could include parenting style, emotional dynamics within the household, or shared lifestyle behaviors. Lastly, the young age groups could not be represented adequately in the sample and may limit the generalizability for a younger child age group.