Obesity and Mental Health in Childhood and Adolescence: A Scoping Review of Recent Scientific Evidence
Highlights
- The evidence supports the existence of a relationship between obesity and mood disorders, especially depression,
- The relationship is multifactorial, bidirectional, and influenced by psychosocial, biological, and environmental factors.
- There is a need for early and comprehensive assessments, including not only weight and nutritional parameters but also emotional status.
- The evidence underscores the need for multidisciplinary interventions that integrate nutritional, psychological, and behavioral dimensions.
Abstract
1. Introduction
2. Methods
2.1. Design
2.2. Search Strategy
- (“obesity” OR “overweight” OR “body mass index”)
- AND (“adolescence” OR “youth”)
- AND (“mental health” OR “depression” OR “psychological well-being”).
2.3. Eligibility Criteria
- Original articles, including observational and intervention studies.
- Participants aged between 10 and 19 years.
- Assessment of overweight or obesity through anthropometric indicators such as BMI, waist circumference, or waist-to-height ratio.
- Evaluation of mental health outcomes, including depressive symptoms, depression, or other psychological variables.
- Articles published in English or Spanish.
- Investigated populations with chronic diseases not related to obesity.
- Focused exclusively on adults or on children under 10 years of age.
- Were classified as editorials, commentaries, or conference abstracts.
2.4. Article Selection and Data Extraction and Synthesis
- study design,
- population characteristics,
- anthropometric measures used,
- psychological assessment tools applied,
- main findings, and
- reported limitations.
3. Results
3.1. Observational Studies
3.1.1. Direct Association Between BMI and Mental Health
3.1.2. No Direct Association Between BMI and Mental Health
3.2. Intervention Studies
3.2.1. Cognitive Behavioral Therapies
3.2.2. Restrictive Therapies
3.2.3. Surgical Therapies
4. Discussion
4.1. Strengths and Limitations
4.2. Future Directions
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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| BMI Classification | Adult Population (≥18 Years) | Pediatric Population (5–19 Years) |
|---|---|---|
| Underweight | <18.5 | <−2 SD |
| Normal weight | 18.5–24.9 | ≥−2 SD and ≤+1 SD |
| Overweight | 25.0–29.9 | >+1 SD and ≤+2 SD |
| Obesity (Class I) | 30.0–34.9 | >+2 SD and ≤+3 SD |
| Obesity (Class II) | 35.0–39.9 | >+3 SD |
| Obesity (Class III) | ≥40.0 | — |
| Author (Year) | Sample | Study Design | Objective | Assessment Methods | Results | Conclusions | Limitations |
|---|---|---|---|---|---|---|---|
| Ocampo et al., 2017 [36] | N = 180 (Females), 14–19 years | Cross-sectional | To determine the relationship between BMI and depressive symptoms in adolescent females. | - Depression: BDI-IA - BMI | 25.56% presented depressive symptoms. Elevated BMI was associated with depression, relative risk 8.55 (p < 0.05). | Adolescents with overweight or obesity have higher risk of depressive symptoms, highlighting the need to address emotional factors in prevention. | Cross-sectional design, female-only sample, and self-reported measures, limiting generalizability and causal inference. |
| Zhao et al., 2019 [30] | N = 1081 (Males and Females), 10–12 years | Cross-sectional | To explore the relationship between obesity and depressive symptoms in Chinese adolescents, analyzing sex differences and specific depression dimensions. | - Depression: CES-D - BMI | Prevalence of depression 23.22%. Significant association between obesity and depression (OR = 1.47; 95% CI: 1.14–1.91; p = 0.004), stronger in males. | There is a significant relationship between obesity and depressive symptoms, with greater vulnerability in males. In males, several depressive aspects were associated with obesity, while in females only a lack of positive affect was associated with obesity. | Cross-sectional design that prevents establishing causality; self-reported BMI; possible bidirectionality between obesity and depression; no follow-up. |
| Alsaleem et al., 2021 [42] | N = 398 (Males), 14–19 years | Cross-sectional | To determine the relationship between obesity and depressive, anxiety, and stress symptoms in male adolescents in Saudi Arabia. | - Mental health: DASS-21 - BMI | 65.7% of obese adolescents exhibited depressive symptoms. Obesity was significantly associated with depression (OR = 1.90), anxiety (OR = 1.97), and stress (OR = 1.89), p < 0.05. | Obesity in male adolescents is associated with higher prevalence of depression, anxiety, and stress. | Cross-sectional design, exclusively male sample, and reliance on self-reports limit generalizability and causal inference. |
| Al Dweik et al., 2022 [46] | N = 395 (Males and Females), 12–18 years | Prospective longitudinal | To examine the relationship between obesity, sleep duration, and depressive symptoms in adolescents in the UAE. | - Depression: MSPHQ - BMI | Significant positive correlation between BMI and depression levels (p < 0.001). Shorter sleep duration was associated with higher depression scores and higher BMI. | Obesity and insufficient sleep are linked to greater risk of depressive symptoms in adolescents. | Limited longitudinal design, self-reported measures, and no sex-specific analysis, limiting generalizability. |
| Morán et al., 2024 [2] | N = 397 (Males and Females), 10–19 years | Cross-sectional | To analyze the association between BMI, body dissatisfaction, self-esteem, and depressive symptoms in adolescents. | - Depression: BDI-II (>14 years), Birleson Children’s Depression Inventory (<14 years) - Body dissatisfaction: BSQ - Self-esteem: Rosenberg - BMI | Significant correlations were found between BMI z-score and depression (r = 0.36), body dissatisfaction (r = 0.56), and self-esteem (r = −0.42), all p < 0.001. Females exhibited higher levels of psychological distress. | Excess weight in adolescents is associated with greater psychological distress, particularly in females, and with poorer body image and self-esteem. | Cross-sectional design, self-reported measures, and sample limited to a single Chilean city, restricting generalizability. |
| Author (Year) | Sample | Study Design | Objective | Assessment Methods | Results | Conclusions | Limitations |
|---|---|---|---|---|---|---|---|
| Lim et al., 2016 [48] | N = 759 (Males and Females), 10–18 years | Prospective longitudinal | To identify factors associated with depressive symptoms in Korean primary, secondary, and high school students. | - Depression: CDI - Self-esteem: single-item question on feeling valued and respected - BMI | Prevalence of depressive symptoms: 11.5% primary, 11.4% secondary, 10.1% high school. Low self-esteem was the most associated factor (OR = 0.048–0.100; p < 0.001). In high school, being female (OR = 3.319; p = 0.001) was associated with higher risk. | Body perception and self-esteem are more relevant than BMI for depressive symptoms, especially in girls. School and family environment influence outcomes. | Loss to follow-up; no hormonal biomarkers included, limiting sex-specific analysis. |
| Roberts & Duong, 2015 [15] | N = 4175 (Males and Females), 11–17 years | Prospective longitudinal | To evaluate whether body image mediates the relationship between obesity and depression and sex differences. | - Depression: DSM-IV - Body image: perceived weight - BMI | Major depression predicted future obesity only in adolescents perceiving themselves as overweight. Perceived overweight increased obesity risk 30-fold (40-fold in females). Adjusting for perception, the depression-obesity relationship disappeared (full mediation). | Negative body image explains the relationship between obesity and depression, especially in girls. Actual weight has less impact than body perception. | Not a national sample; BMI only used for adiposity; body image measured only via weight perception; no life-course data. |
| Eitle & Eitle, 2018 [28] | N = 7461 (Males and Females), 12–18 years | Prospective longitudinal | To examine the relationship between overweight, perceived overweight, and depressive symptoms in adolescents. | - Depression: CES-D - BMI | No significant association was found between actual BMI and depressive symptoms. Perceived overweight was associated with higher depressive symptomatology, especially in African-American males. | Perceived overweight, more than objective weight, is related to greater depression in adolescents, highlighting the role of stigma and body image. | Self-reported data; limitations in establishing causality and bidirectionality; data are outdated. |
| Carriere et al., 2019 [35] | N = 115 (Males and Females), 11–18 years | Cross-sectional | To explore the association between emotional disorders, personality dimensions, and binge eating disorder (BED) in obese adolescents. | - Depression: BDI - Anxiety: BAI - Eating behavior: BES - Alexithymia: TAS - Impulsivity: BIS - BMI | Adolescents with medium-high or high adiposity presented higher risk of depressive symptoms (OR = 1.38 and 1.59) and greater psychological distress (OR = 1.28 and 1.62) versus stable-normal weight. They reported lower mental well-being. | BMI is associated with BED, and depression is also associated with BED; however, no direct association between BMI and depression was found. | Use of self-reports, potential recall bias, and lack of control for psychosocial factors affecting mental health. |
| Lima et al., 2020 [27] | N = 1296 (Males and Females), 15 years | Cross-sectional | To investigate the relationship between social anxiety, depression, and abdominal obesity, analyzing sex differences. | - Depression: CES-D - Social anxiety: SAS-A - Waist circumference | Females showed higher social anxiety and depression (p < 0.001). Social anxiety was associated with greater waist circumference (β = 0.08; p = 0.005) and depressive symptoms (β = 0.42; p < 0.001). Depression was not associated with obesity nor acted as a mediator. | Female adolescents present higher social anxiety and depression. Social anxiety is related to obesity, but depression has no direct association with waist circumference or mediation. | Cross-sectional design limits causality; sample from one region in Brazil; only social anxiety evaluated. |
| Wang et al., 2020 [37] | N = 153 (Males and Females), 12–13 years | Prospective longitudinal | To evaluate body dissatisfaction and depressive symptoms by weight and bidirectional relationships in Black adolescents. | - Depression: BDI-I - Body dissatisfaction: silhouette scale - BMI | In overweight/obese adolescents, body dissatisfaction predicted future depressive symptoms (β = 0.42; p < 0.001), and depression predicted higher body dissatisfaction (β = 0.25; p = 0.012). No effect was observed in healthy-weight adolescents. | Body dissatisfaction and depression are bidirectionally related in overweight adolescents, reflecting stigma and negative self-evaluation. | Small sample for sex differences; high proportion of low-income families; possible bias using BDI instead of CDI; non-causal design. |
| López et al., 2021 [29] | N = 76 (Males and Females), 14–18 years | Prospective longitudinal | To analyze demographic, psychosocial, and intervention-type factors predicting participation in overweight/obese adolescents in treatment. | - Depression: CES-DC - Executive function: BRIEF-2 - BMI | No significant relationship was found between depressive symptoms or executive function and treatment adherence. Over 25% had moderate/severe depression at baseline. No sex differences observed. | Individual characteristics do not predict participation; family support appears key for treatment engagement. | Small sample size; potential uncontrolled variables; results not generalizable to adolescents not seeking treatment. |
| Öz & Kıvrak, 2023 [16] | N = 98 (Males and Females), 11–17 years | Cross-sectional | To evaluate the impact of obesity on anxiety, depression, self-esteem, and emotional regulation in children and adolescents. | - Depression and anxiety: RCADS - Self-esteem: Rosenberg - Emotional regulation: DERS - Self-concept: PHCSCS - BMI | Significant differences (p < 0.05) were observed in anxiety, depression, emotional regulation, and self-esteem between groups, w | Obesity in children and adolescents is associated with increased anxiety, depression, low self-esteem, and difficulties in emotional regulation, which can negatively affect treatment. A relationship was also identified between poor regulation and emotional eating, with no significant differences by gender, age, or BMI. |
| Author (Year) | Sample | Design | Objective | Instruments | Main Results | Conclusions | Limitations |
|---|---|---|---|---|---|---|---|
| Hoare et al., 2016 [68] | N = 634 (13–15 years, Males and Females) | Prospective longitudinal | To analyze association between lifestyle, obesity, and depressive symptoms | SMFQ, ABAKQ, BMI | Physical activity was associated with lower depression in males. Poor diet was associated with higher symptoms in females. | A healthy lifestyle is linked to better mental health in adolescents with obesity. | Use of self-reports, no control group, high non-participation rate. |
| Naar-King et al., 2016 [67] | N = 186 (12–16 years, Males and Females) | Prospective longitudinal | To develop an adaptive behavioral treatment for African-American adolescents with obesity | CDI, BMI | Weight reduction (2.96%) without significant changes in depression. Better outcomes in adolescents with higher executive function. | Intervention reduced overweight, without clear impact on depression. | Small sample, self-reported data, need for further analyses. |
| Nobles et al., 2016 [60] | N = 435 (10–15 years, Males and Females) | Retrospective longitudinal | To evaluate effectiveness of the SHINE program on BMI, mental health, and adherence | BMI, Self-esteem (Rosenberg), Anxiety, Depression | Sustained BMI reduction and mental health improvements up to 12 months. 54% retention. | SHINE program demonstrated effectiveness in reducing BMI and improving psychological well-being. | No control group, limited follow-up and adherence data. |
| Gulley et al., 2019 [53] | N = 119 (12–17 years, M) | Prospective longitudinal | To evaluate whether reduction of depressive symptoms via CBT influences BMI and metabolic markers | CES-D, BMI | CBT did not directly reduce BMI, but decreases in depressive symptoms were associated with greater BMI reduction (B = 0.05). | CBT improves mental health and may influence BMI when depression is severe. | Limited sample size, small effects, risk of type I error, restricted generalizability. |
| Tronieri et al., 2019 [56] | N = 7 (12–17 years) | Pilot, longitudinal | To evaluate feasibility of ACT + lifestyle change | PHQ-9, PSS-14, EDI-3, IWQOL-Kids, BMI | High acceptance; reductions in BMI and improvements in depressive symptoms, body image, and quality of life. | ACT combined with lifestyle changes is promising for adolescents with obesity. | No control group, very small sample, need for adaptation of techniques. |
| Ramalho et al., 2020 [57] | N = 210 (13–18 years, Males and Females) | Prospective longitudinal | To evaluate effectiveness of online CBT intervention in Portuguese adolescents | DASS-21, ChEAT, BMI | High comorbidity between psychological symptoms and obesity, especially in females. Significant correlations between distress and quality of life. | Intervention relevant for assessing gender disparities and mental health. | Convenience sample, self-report bias, cross-sectional design. |
| Tulloch et al., 2020 [59] | N = 228 (14–18 years) | Prospective longitudinal | To analyze relationship between depressive symptoms, stress, self-efficacy, and physical fitness | CDI, PSS, BMI | Self-efficacy predicted better aerobic fitness. Initial depression was associated with lower performance, especially in females. | Psychological factors influence physical performance in adolescents with obesity. | Gender-imbalanced, low diversity, limitations in exercise assessment. |
| Darling et al., 2021 [63] | N = 66 (13–17 years, Males and Females) | Prospective longitudinal | To evaluate changes in depression and eating behavior after behavioral intervention | CDI-2, EDE-Q, BMI | No overall changes, but weight and shape concerns decreased in females. | Positive effects on body image without worsening mental health. | Small sample, no control group, no analysis by gender identity. |
| Lemstra & Rogers, 2022 [54] | N = 2292 (11–17 years, Males and Females) | Prospective longitudinal | To evaluate a free community program for mood improvement | CES-D, NLSCY, SF-12, BMI | Significant reduction in depressive symptoms (d = 0.94) at 12 weeks and 1 year. | Community intervention effective for improving mental health in youth with obesity. | No control group or randomization; results show associations, not causality. |
| Author (Year) | Sample | Study Design | Objective | Assessment Instruments | Main Results | Conclusions | Limitations |
|---|---|---|---|---|---|---|---|
| Jebeile et al., 2024 [55] | N = 141 (13–17 yrs) | Prospective longitudinal trial | To evaluate changes in depressive symptoms, eating disorders, and binge eating during the Fast Track to Health program | CESDR-10, EDE-Q, BES, BMI | Significant reduction in depressive symptoms (22% to 9%) and eating disorder symptoms (110 to 56 participants) over 52 weeks | Dietary intervention showed positive effects on mental health and eating behaviors in adolescents with obesity; some required additional follow-up | Self-reports, possible overlap between EDE-Q subscales and treatment content, influence of COVID-19 pandemic context |
| Author (Year) | Sample | Study Design | Objective | Assessment Instruments | Main Results | Conclusions | Limitations |
|---|---|---|---|---|---|---|---|
| Järvholm et al., 2015 [61] | N = 88 (13–18 yrs, M/F) | Prospective longitudinal study | To evaluate mental health changes over 2 years in adolescents undergoing gastric bypass | BYI, BDI-2, Rosenberg Self-Esteem, BMI | Significant reductions in anxiety, depression, anger, and disruptive behavior (p = 0.001–0.022), with improved self-esteem and mood (p < 0.001–0.025), especially during the first year. At 2 years, 19% still had clinical depressive symptoms | Gastric bypass significantly improves mental health in adolescents with obesity, but a considerable proportion requires ongoing psychological follow-up | No control group, reliance on self-reports, assessment norms not adjusted for >18 yrs, possibly underestimating persistent psychological issues |
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Morales-Suárez-Varela, M.; López-García, E.; Peraita-Costa, I.; Pérez Puente, J.M.; Llopis-Morales, A.; Llopis-Gonzalez, A.; Guallar-Castillón, P. Obesity and Mental Health in Childhood and Adolescence: A Scoping Review of Recent Scientific Evidence. Children 2025, 12, 1512. https://doi.org/10.3390/children12111512
Morales-Suárez-Varela M, López-García E, Peraita-Costa I, Pérez Puente JM, Llopis-Morales A, Llopis-Gonzalez A, Guallar-Castillón P. Obesity and Mental Health in Childhood and Adolescence: A Scoping Review of Recent Scientific Evidence. Children. 2025; 12(11):1512. https://doi.org/10.3390/children12111512
Chicago/Turabian StyleMorales-Suárez-Varela, María, Esther López-García, Isabel Peraita-Costa, José Manuel Pérez Puente, Agustín Llopis-Morales, Agustín Llopis-Gonzalez, and Pilar Guallar-Castillón. 2025. "Obesity and Mental Health in Childhood and Adolescence: A Scoping Review of Recent Scientific Evidence" Children 12, no. 11: 1512. https://doi.org/10.3390/children12111512
APA StyleMorales-Suárez-Varela, M., López-García, E., Peraita-Costa, I., Pérez Puente, J. M., Llopis-Morales, A., Llopis-Gonzalez, A., & Guallar-Castillón, P. (2025). Obesity and Mental Health in Childhood and Adolescence: A Scoping Review of Recent Scientific Evidence. Children, 12(11), 1512. https://doi.org/10.3390/children12111512

