Obesity, Sleep Quality, and Emotional Intelligence in School-Aged Children: Behavioral Associations and Implications

Abstract

This cross-sectional study investigates the association between the behavior of children aged 8–12 years old and key factors such as body mass index (BMI), sleep quality, and emotional intelligence (EI). It aims to explore how these variables interrelate and impact children’s overall behavior during a crucial developmental stage. A sample of children was assessed using standardized measures for BMI, sleep quality, and emotional intelligence (EI), while their behaviors were evaluated using behavioral scales. Statistical analyses were conducted to determine significant associations between these factors. For the data collection, we used sociodemographic questionnaire and the family affluence scale (FAS), and for the evaluation of sleep quality, we used the Children’s Sleep Habits Questionnaire (CSHQ). Moreover, the Trait Emotional Intelligence Questionnaire—Child Short Form (TEIQue-CSF) and Child Behavior Checklist (CBCL) were used for the evaluation of emotional intelligence and behavior. The findings reveal noteworthy correlations between high BMI, poor sleep quality, and lower emotional intelligence with certain behavioral challenges, including emotional regulation and social interaction difficulties. The study underscores the importance of addressing these factors to support the healthy psychological and physical development of children. Further research is suggested to explore potential interventions.

1. Introduction

The prevalence of childhood obesity is high and increasing rapidly worldwide. Greece ranks second globally for overweight/obese boys (43.9%) and first for overweight/obese girls (40.4%). It also holds the fourth and fifth positions, respectively, for overweight/obese children worldwide [1]. The increased rates of childhood obesity are associated with physical and behavioral problems. It has been found that higher BMI in children is linked to increased behavioral issues, including both internalizing problems (e.g., anxiety, depression) and externalizing problems (e.g., aggression, rule-breaking behavior). Moreover, overweight and obese children may face bullying, social isolation, and difficulties in peer relationships, all of which can affect their social competence and self-esteem [2]. Also, obesity can impact academic performance through associated cognitive and attention problems [3]. Despite the fact that anxiety and depression are more common in children with obesity compared to children of normal weight, this correlation is not entirely clear as it is not evident whether obesity in children causes depression and stress or whether stress and depression cause obesity in children. Behavioral status encompasses a wide range of emotional, social, and behavioral functioning. The behavioral status in childhood includes internalizing behaviors, especially anxiety, depression, and social withdrawal, as well as externalizing behaviors, including aggression, hyperactivity, and conduct problems. It also involves social competence (that is, peer relationships and social skills) and academic performance (i.e., attention and learning difficulties) [4]. Among the variables that significantly affect these behavioral domains are BMI, sleep quality, and emotional intelligence (EI) [5]. Moreover, sleep quality is an important factor associated with the cognitive and emotional development of children [6]. Poor sleep seems to be associated with a variety of behavioral difficulties, including hyperactivity, irritability, and difficulty concentrating. Studies highlight that children who have poor sleep or difficulties in sleep patterns are at a higher risk of developing emotional problems such as anxiety and depression. Moreover, increased BMI is absolutely related to poor sleep quality. This is because of the body’s ability to regulate hormones that affect appetite and metabolism, potentially leading to weight gain and further behavioral complications [7]. As far as EI is concerned, it refers to the ability to recognize, understand, and manage one’s own emotions and the emotions of others. In children, poor emotional intelligence is associated with low social interactions, more behavioral problems, and poorer academic performance [8]. On the other hand, children with higher EI are generally more empathetic, can effectively manage their emotions, and are less likely to be aggressive [9].

The association between obesity/overweight, sleep quality, and emotional intelligence is complex and multifunctional. More particularly, a child with a high BMI may sleep inadequately due to physical discomfort, which in consequence can impair the child’s ability to manage stress and emotions ineffectively. In contrast, children with adequate sleep are more likely to have the physical, mental, and emotional ability to maintain a healthy BMI and potentially build strong emotional intelligence, leading to good and socially acceptable behavior [10].

Despite the fact that the association between obesity and behavior issues in children has been thoroughly investigated, the gap in understanding the effects of BMI, sleep quality, and EI on children’s behavioral development is still evident. Few studies have explored the interrelationships among BMI, sleep quality, and EI in relation to internalizing and externalizing behaviors, social competence, and academic performance. This study aims to fill this gap by examining the combined effects of obesity, sleep, and emotional intelligence on behavioral outcomes in school-aged children. By investigating these interconnected domains, the study seeks to provide a more comprehensive understanding of child development and inform holistic interventions that address the multifaceted needs of children’s physical, emotional, and social well-being.

2. Materials and Methods

2.1. Procedure

This cross-sectional study was conducted between November 2021 and November 2023. Participants were enrolled by voluntarily completing an anonymous questionnaire. The study sample consisted of 614 children aged 8–12 years, drawn from third to sixth grade in elementary schools across the Attica region, along with their parents. A convenience sample was obtained by randomly selecting elementary schools in Attica and contacting school principals and teachers. Schools that agreed to participate were included in the study. The questionnaire included an informed consent form for parents to sign. Out of the 28 schools contacted, 12 agreed to take part. A total of 2,320 questionnaires were distributed, of which 925 were returned. Among these, 311 were incomplete, and 614 were fully completed and included in the final analysis.

Sociodemographic data were gathered through the questionnaire, with sections for parents to provide details about their child’s age, gender, grade, and other relevant background information such as family income, parental education levels, and household composition. This data was crucial for contextualizing the study’s findings and analyzing the potential influence of sociodemographic factors on the study outcomes. BMI categories were determined using specific cutoffs based on self-reported height and weight provided in the questionnaire. These cutoffs were established according to standardized growth charts by Cole et al. [11] to ensure consistency and reliability in categorizing the children as underweight, normal weight, overweight, and obese. Using these standardized cutoffs allowed for accurate comparisons with other studies and helped in assessing the relationship between BMI, sleep, and EI within the study population.

Inclusion/Exclusion Criteria

The inclusion criteria for our study were as follows: children aged 8–12 years, fluency in Greek to ensure accurate completion of the CBCL, and written informed consent from a parent or guardian. The exclusion criteria included children younger than 8 or older than 12 years, children or caregivers who did not speak Greek fluently, as this might affect the validity of the CBCL responses, and lack of written informed consent from a parent or guardian.

2.2. Aim

The aim of our study was to investigate the relationship between the behavior of children aged 8–12 years and their BMI, sleep quality, and EI.

2.3. Ethics Approval of Research

The research was approved by the Ethics Committee of the University of West Attica (No. 93329—13 November 2020) and the scientific councils of the Ministry of Education and Religious Affairs in Athens, Greece (No. 32/25 June 2021). Approval was also obtained from the school principal and the Board of Teachers. Due to restrictions from the global pandemic, an electronic version of the questionnaire was created for distribution and collection. The questionnaires were completed using Microsoft Forms through an online platform that handles personal data. Additionally, the questionnaire did not include any personal data.

2.4. Instruments

The research tool included five sections:

1. Sociodemographic Questionnaire: This section, which includes 16 questions, collected information on participants’ gender, age, marital and educational status, place of residence, occupational status, eating habits, and self-reported weight and height. BMI was calculated based on the reported height and weight, with BMI for children determined using growth charts by Cole et al., which provide cutoff values for classifying children as underweight, normal weight, overweight, or obese [11].

2. Family Affluence Scale (FAS): Family wealth was assessed using four questions, and participants were categorized into low, moderate, or high affluence based on their responses [12]. The FAS has been effectively used in various countries, including Greece, and represents a valuable tool for health studies in a number of ways [13].

3. Trait Emotional Intelligence Questionnaire—Child Short Form (TEIQue-CSF): This 36-item questionnaire, designed for children aged 8 to 12, was rated on a five-point Likert scale. It measured emotional self-perceptions and tendencies that support emotional competence in daily life [14]. The overall score provided a measure of Trait Emotional Intelligence (TEI). The TEIQue-CF is a reliable and valid index of global trait EI for children between 8 and 12 years [15].

4. Children’s Sleep Habits Questionnaire (CSHQ): It is used to evaluate sleep-related problems in school-aged children (8–12 years old), with a total score of 41 or higher suggesting potential sleep issues. The CSHQ was completed by parents who provided written consent for their children’s participation [16]. The CSHQ is a reliable and valid tool used for screening and research purposes in the Greek language [16].

5. Child Behavior Checklist (CBCL): This 113-item, parent-rated assessment examines a child’s behavioral problems and social competence [17]. Raw scores were converted to T-scores across eight clinical scales, two composite clinical scales (internalizing and externalizing), a total clinical scale, and four competence scales. T-scores of 70 or higher on clinical scales, 64 or higher on composite and total scales, and 30 or lower on competence scales were considered within the clinical range [18]. The behavioral profiles of children, as assessed by the CBCL, have been explored in various populations, including Greek children [19].

2.5. Statistical Analysis

Means and standard deviations (SDs) were used to describe quantitative variables. Absolute (n) and relative (%) frequencies were used to describe qualitative variables. Based on the central limit theorem and the sample size, parametric tests were conducted. Student’s t-test was used to compare CBCL scores between BMI groups of children. Multivariate linear regression models were conducted with the dimensions of the CBCL scale as dependent variables, and the characteristics of children and parents, the EI scale, and the total score of the CSHQ scale as independent variables. Also, in order to test whether the effect of sleep problems differs according to the children’s BMI, the interaction term of BMI with the total score of the CSHQ scale was entered in each model and, where significant, was retained in the analysis. When non-significant, it was removed from the model. Regression coefficients (β) and their standard errors (SEs) emerged from the linear regression models. In linear regression analysis, “centered” values (values obtained by subtracting the mean from the original score) of the overall CSHQ scale score were used to improve the interpretability of the findings. The significance levels were two-tailed, and statistical significance was set at 0.05. Statistical analyses were performed using SPSS 26.0 software.

3. Results

The study included 614 participants, consisting of 54.4% girls and 45.6% boys, with an average age of 10 years old (SD = 1.5 years). The parents or guardians, who were mostly women (76.9%), had an average age of 41.8 years (SD = 5.3 years). The characteristics of the children and their parents/guardians are presented in

Table 1. Sample characteristics.

n = 614			n (%)
Children’s characteristics	Age (years), mean (SD)		10.0 (1.5)
	Gender	Girls	334 (54.4)
		Boys	280 (45.6)
	BMI	Underweight	14 (2.3)
		Normal	381 (62.1)
		Overweight	183 (29.8)
		Obese	36 (5.9)
	Greek nationality		595 (96.9)
	Class	3rd	194 (31.6)
		4th	120 (19.5)
		5th	135 (22)
		6th	165 (26.9)
	Living with:	Only mother	41 (6.7)
		Only father	7 (1.1)
		Both parents	566 (92.2)
Parents’ characteristics	Age (years), mean (SD)		41.8 (5.3)
	Gender	Women	472 (76.9)
		Men	142 (23.1)
	Relationship with child	Biological parent	610 (99.3)
		Step-parent	4 (0.7)
	Socioeconomical status (FAS)	Low	15 (2.4)
		Moderate	224 (36.5)
		High	375 (61.1)
	Highest parental educational level	High school	198 (32.2)
		Technical university	138 (22.5)
		University	133 (21.7)
		MSc	110 (17.9)
		PhD	35 (5.7)
	Married		564 (91.9)
TEIQue-CSF 1, mean (SD)			3.53 (0.51)
Total CSHQ 2, mean (SD)			46.04 (7.93)

Note: ¹ Trait Emotional Intelligence Questionnaire—Child Short Form; ² Children’s Sleep Habits Questionnaire.

.

The majority of the children (62.1%) had a normal BMI, while 29.8% were overweight. Most of the children (96.9%) were from Greece, and 31.6% were in the third grade of primary school. Additionally, 92.2% lived with both biological parents. Furthermore, almost all parents/guardians (99.3%) were biological parents, and 61.1% had a high socioeconomic status. Finally, most parents/guardians were married (91.9%). Mean TEIQue-CSF score was 3.53 (SD = 0.51) and mean total CSHQ was 46.04 (SD = 7.93). The children’s CBCL scores, both in total sample and according to their BMI, are presented in

Table 2. CBCL scores in total sample and by BMI.

	Total Sample		BMI				p Student’s t-Test
			Underweight/Normal		Overweight/Obese
	Mean	SD	Mean	SD	Mean	SD
Anxious/depressed 1	3.10	3.43	2.41	2.75	4.34	4.13	<0.001
Withdrawn/depressed 1	1.42	1.91	0.96	1.36	2.25	2.41	<0.001
Somatic complaints 1	0.60	1.67	0.47	0.96	0.84	2.47	0.008
Social problems 1	2.22	3.26	1.57	2.36	3.39	4.20	<0.001
Thought problems 1	1.55	2.63	0.92	2.00	2.68	3.19	<0.001
Attention problems 1	2.43	3.35	1.68	2.54	3.79	4.13	<0.001
Rule-breaking behavior 1	1.58	2.20	1.23	1.90	2.23	2.55	<0.001
Aggressive behavior 1	3.50	4.52	2.73	3.77	4.89	5.36	<0.001
Other problems 1	1.37	2.35	1.05	1.89	1.95	2.91	<0.001
Internalizing problems 1	4.92	6.04	3.66	4.29	7.19	7.82	<0.001
Externalizing problems 1	5.09	6.37	3.92	5.22	7.22	7.60	<0.001
Total problems 1	17.50	20.04	12.71	13.52	26.16	26.12	<0.001
Activities 2	9.46	2.78	9.77	2.69	8.91	2.86	<0.001
Social relations 2	8.14	2.19	8.38	2.20	7.73	2.10	<0.001
School 2	5.04	1.04	5.04	0.98	5.05	1.13	0.912
Total competence 2	22.65	4.87	23.20	4.81	21.66	4.82	<0.001

Note. ¹ Higher scores indicate more behavior problems; ² Higher scores indicate better performance.

.

Overweight/obese children had significantly greater scores on the problem subscales, indicating more problems. Also, overweight/obese children had significantly more internalizing, externalizing, and overall behavior problems. On the contrary, overweight/obese children scored significantly lower on the performance subscales, indicating poorer performance compared to underweight/normal BMI children. The only exception was school score, which did not differ between the children’s BMI categories. Multiple regression analysis revealed that the children’s gender and BMI were independently associated with anxious/depressed behavior (

Table 3. Multiple linear regression results with anxious/depressed, withdrawn/depressed, somatic complaints, and social problems scales as dependent variables.

	Anxious/Depressed		Withdrawn/Depressed		Somatic Complaints		Social Problems
	β (SE) +	p	β (SE) +	p	β (SE) +	p	β (SE) +	P
Children’s age	0.047 (0.092)	0.613	0.066 (0.05)	0.192	0.036 (0.048)	0.450	0.244 (0.087)	0.005
Children’s gender (boys vs. girls)	1.276 (0.267)	<0.001	0.256 (0.146)	0.079	0.048 (0.14)	0.732	0.276 (0.253)	0.274
Class	0.003 (0.273)	0.992	−0.025 (0.149)	0.866	−0.099 (0.143)	0.490	0.628 (0.259)	0.015
Living with both parents (yes vs. no)	−1.505 (1.326)	0.257	−0.023 (0.725)	0.975	0.806 (0.695)	0.246	−1.419 (1.258)	0.260
Parents’ age	0.039 (0.026)	0.131	0.033 (0.014)	0.018	0.01 (0.013)	0.454	0.017 (0.024)	0.476
Parents’ gender (men vs. women)	0.461 (0.325)	0.156	0.194 (0.178)	0.274	0.301 (0.17)	0.077	0.511 (0.308)	0.098
Married (yes vs. no)	1.405 (1.303)	0.281	−0.033 (0.713)	0.963	−0.614 (0.683)	0.369	1.172 (1.236)	0.343
Highest parental educational level	−0.006 (0.103)	0.957	−0.133 (0.056)	0.019	−0.053 (0.054)	0.327	−0.226 (0.098)	0.021
TEIQue-CSF 2	0.129 (0.286)	0.652	0.027 (0.156)	0.863	0.034 (0.15)	0.823	−0.449 (0.271)	0.099
Total CSHQ 3	−0.029 (0.023)	0.214	−0.023 (0.013)	0.070	−0.006 (0.012)	0.628	0.021 (0.022)	0.348
Children’s BMI 1 (overweight/obese vs. underweight/normal)	1.524 (0.283)	<0.001	1.111 (0.155)	<0.001	0.256 (0.148)	0.085	1.449 (0.269)	0.004
BMI 1 Total CSHQ 3 interaction	0.166 (0.033)	<0.001	0.11 (0.018)	<0.001	0.049 (0.017)	0.005	0.123 (0.031)	<0.001

⁺ Regression coefficient (standard error). Note: ¹ Body mass index; ² Trait Emotional Intelligence Questionnaire—Child Short Form; ³ Children’s Sleep Habits Questionnaire.

).

Specifically, boys had significantly more anxious/depressed problems compared to girls as well as overweight/obese children compared to underweight/normal ones. The children’s BMI as well as the age and educational level of the parents were independently associated with withdrawn/depressed behavior. Specifically, overweight/obese children had significantly more withdrawn/depressed problems compared to underweight/normal-weight children. Furthermore, older parental age and lower educational level were associated with significantly more withdrawn/depressed problems. Children who were of a high socioeconomic level as well as overweight/obese children had significantly more social problems. Also, a higher educational level of parents was associated with significantly fewer social problems in children, while the older the children were, the more social problems they had. Furthermore, it was found that only in overweight/obese children were sleep problems significantly related to more anxious/depressed problems, more withdrawn/depressed problems, more somatic complaints, and more social problems. Boys and overweight/obese children had significantly more thought problems, more conduct problems, more rule-breaking behavior, more aggressive behavior, and more other problems (

Table 4. Multiple linear regression results with thought problems, conduct problems, rule-breaking behavior, aggressive behavior, and other problems scales as dependent variables.

	Thought Problems		Conduct Problems		Rule-Breaking Behavior		Aggressive Behavior		Other Problems
	β (SE) +	p	β (SE) +	p	β (SE) +	p	β (SE) +	p	β (SE) +	p
Children’s age	0.043 (0.07)	0.533	0.261 (0.085)	0.002	0.116 (0.058)	0.044	0.161 (0.117)	0.169	−0.069 (0.062)	0.266
Children’s gender (boys vs. girls)	0.538 (0.201)	0.008	1.503 (0.248)	<0.001	1.086 (0.167)	<0.001	2.182 (0.339)	<0.001	0.791 (0.181)	<0.001
Class	−0.081 (0.207)	0.697	−0.037 (0.253)	0.883	0.036 (0.171)	0.835	0.337 (0.346)	0.331	0.456 (0.185)	0.014
Living with both parents (yes vs. no)	−0.176 (1.005)	0.861	−1.745 (1.231)	0.157	−2.024 (0.831)	0.015	−2.247 (1.685)	0.183	−0.466 (0.9)	0.605
Parents’ age	0.019 (0.019)	0.337	0.014 (0.024)	0.567	0.018 (0.016)	0.268	0.037 (0.033)	0.259	0 (0.017)	0.984
Parents’ gender (men vs. women)	0.43 (0.246)	0.081	0.406 (0.302)	0.179	0.57 (0.203)	0.005	0.823 (0.412)	0.046	0.161 (0.22)	0.465
Married (yes vs. no)	0.588 (0.988)	0.552	0.841 (1.21)	0.487	1.486 (0.816)	0.069	1.074 (1.656)	0.517	0.296 (0.885)	0.738
Highest parental educational level	0.035 (0.078)	0.657	−0.023 (0.096)	0.810	−0.088 (0.065)	0.174	−0.064 (0.131)	0.623	−0.173 (0.07)	0.014
TEIQue-CSF 2	−0.564 (0.216)	0.009	−0.732 (0.266)	0.006	−0.283 (0.179)	0.114	−1.152 (0.364)	0.002	−0.672 (0.194)	0.001
Total CSHQ 3	0.063 (0.013)	<0.001	0.008 (0.022)	0.700	0.026 (0.015)	0.079	0.042 (0.029)	0.152	0.004 (0.016)	0.776
Children’s BMI 1 (overweight/obese vs. underweight/normal)	1.308 (0.215)	<0.001	1.479 (0.263)	<0.001	0.558 (0.177)	0.002	1.137 (0.360)	0.002	0.390 (0.192)	0.043
BMI 1 Total CSHQ 3 interaction		Ns 4	0.134 (0.031)	<0.001	0.055 (0.021)	0.008	0.145 (0.042)	0.001	0.103 (0.022)	<0.001

⁺ Regression coefficient (standard error). Note: ¹ Body mass index; ² Trait Emotional Intelligence Questionnaire—Child Short Form; ³ Children’s Sleep Habits Questionnaire; ⁴ Non-significant.

).

Also, higher emotional intelligence was associated with significantly fewer thought and conduct problems and less aggressive behavior, while older age was associated with more conduct problems. Children of a high socioeconomic level had significantly more other problems. In addition, higher emotional intelligence and higher parental educational level were associated with fewer other problems. Children living with both parents had significantly less rule-breaking behavior. Also, older children’s age was associated with more rule-breaking behavior. Men reported significantly more rule-breaking and aggressive behavior for their children compared to women. Furthermore, sleep problems were found to be significantly related to more thought problems regardless of children’s BMI. On the contrary, it was found that only in overweight/obese children were sleep problems significantly associated with more conduct problems, more rule-breaking behavior, more aggressive behavior, and more other problems. Boys had significantly more internalizing, externalizing, and total problems compared to girls, as did overweight/obese children compared to underweight/normal-weight ones (

Table 5. Multiple linear regression results with internalizing, externalizing, and total problems as dependent variables.

	Internalizing Problems		Externalizing Problems		Total Problems
	β (SE) +	p	β (SE) +	p	β (SE) +	p
Children’s age	0.134 (0.161)	0.405	0.283 (0.162)	0.081	0.915 (0.501)	0.068
Children’s gender (boys vs. girls)	1.629 (0.467)	0.001	3.267 (0.469)	<0.001	8.039 (1.453)	<0.001
Class	−0.111 (0.478)	0.817	0.452 (0.48)	0.348	1.2 (1.487)	0.420
Living with both parents (yes vs. no)	−0.796 (2.326)	0.732	−4.225 (2.335)	0.071	−8.682 (7.229)	0.230
Parents’ age	0.078 (0.045)	0.084	0.053 (0.045)	0.245	0.193 (0.14)	0.169
Parents’ gender (men vs. women)	1.072 (0.569)	0.060	1.358 (0.572)	0.018	3.956 (1.77)	0.026
Married (yes vs. no)	0.653 (2.286)	0.775	2.554 (2.295)	0.266	6.171 (7.105)	0.385
Highest parental educational level	−0.208 (0.181)	0.251	−0.137 (0.182)	0.450	−0.737 (0.562)	0.191
TEIQue-CSF 1	0.088 (0.502)	0.860	−1.383 (0.504)	0.006	−3.759 (1.561)	0.016
Total CSHQ 2	−0.052 (0.041)	0.204	0.079 (0.041)	0.055	0.084 (0.126)	0.505
Children’s BMI 3 (overweight/obese vs. underweight/normal)	2.759 (0.497)	<0.001	1.848 (0.499)	<0.001	9.248 (1.545)	<0.001
BMI 3 Total CSHQ 2 interaction	0.316 (0.058)	<0.001	0.200 (0.058)	0.001	0.929 (0.18)	<0.001

⁺ Regression coefficient (standard error). Note: ¹ Trait Emotional Intelligence Questionnaire—Child Short Form; ² Children’s Sleep Habits Questionnaire; ³ Body mass index.

).

Higher EI was associated with fewer externalizing and total problems. Men reported significantly more externalizing and total problems for their children compared to women. Also, it was found that only in overweight/obese children were sleep problems significantly related to more internalizing, externalizing, and total problems. Overweight/obese children had significantly lower activities score, worse social relations, and less total competence score (

Table 6. Multiple linear regression results with activities, social relations, school, and total competence scales as dependent variables.

	Activities		Social Relations		School		Total Competence
	β (SE) +	p	β (SE) +	p	β (SE) +	p	β (SE) +	p
Children’s age	−0.325 (0.077)	<0.001	−0.3 (0.062)	<0.001	−0.132 (0.03)	<0.001	−0.73 (0.135)	<0.001
Children’s gender (boys vs. girls)	−0.093 (0.223)	0.676	0.096 (0.179)	0.592	−0.132 (0.087)	0.130	−0.297 (0.391)	0.448
Class	−0.378 (0.23)	0.100	−0.093 (0.184)	0.613	0.011 (0.089)	0.900	−0.505 (0.402)	0.209
Living with both parents (yes vs. no)	0.292 (1.117)	0.794	−0.433 (0.894)	0.628	−0.016 (0.434)	0.970	−0.448 (1.954)	0.819
Parents’ age	−0.077 (0.022)	<0.001	−0.011 (0.017)	0.518	0.002 (0.008)	0.811	−0.088 (0.038)	0.020
Parents’ gender (men vs. women)	−0.546 (0.273)	0.046	−0.121 (0.219)	0.579	−0.045 (0.106)	0.673	−0.733 (0.478)	0.126
Married (yes vs. no)	−0.01 (1.098)	0.993	0.627 (0.879)	0.476	0.048 (0.427)	0.910	1 (1.921)	0.603
Highest parental educational level	0.285 (0.087)	0.001	0.137 (0.07)	0.049	−0.017 (0.034)	0.614	0.398 (0.152)	0.009
TEIQue-CSF 1	0.048 (0.24)	0.841	0.162 (0.192)	0.401	−0.041 (0.093)	0.660	0.282 (0.42)	0.502
Total CSHQ 2	0.01 (0.015)	0.521	−0.02 (0.012)	0.101	−0.009 (0.006)	0.115	−0.02 (0.026)	0.435
Children’s BMI 3 (overweight/obese vs. underweight/normal)	−0.91 (0.239)	<0.001	−0.663 (0.191)	0.001	−0.01 (0.093)	0.913	−1.557 (0.417)	<0.001
BMI 3 Total CSHQ 2 interaction		Ns 4		Ns 4		Νs 4		Νs 4

⁺ Regression coefficient (standard error). Note: ¹ Trait Emotional Intelligence Questionnaire—Child Short Form; ² Children’s Sleep Habits Questionnaire; ³ Body mass index; ⁴ Non-significant.

).

Older child and parent age was associated with lower activities score, while higher educational level with greater activities score. Also, older child age was related to worse social relations and worse school performance, while a higher parental educational level was associated with better social relations. Also, older child and parent age was associated with lower total competence scores, while a higher educational level was significantly associated with greater total competence scores. Sleep problems and emotional intelligence were not related to activities, social relations, school, or total competence score.

4. Discussion

Childhood obesity is not merely a health issue but is closely linked to behavioral patterns [20]. Moreover, sleep deprivation in children is associated with increased hyperactivity, impulsivity, and difficulties in attention regulation. These behavioral manifestations can be particularly intense during critical developmental periods such as early childhood and adolescence. Additionally, children with sleep disorders are at a higher risk of developing mood disorders, anxiety, and depression [21]. Sleep disruption affects not only cognitive functions but also emotional regulation, making it harder for children to manage stress and interact socially in appropriate ways [21]. Our study results highlight significant differences in sleep quality between obese and non-obese children. Obese children scored significantly higher on dimensions such as “sleep resistance”, “sleep anxiety”, “night awakenings”, “parasomnia”, “disordered breathing during sleep”, and “daytime sleepiness”, as well as on the overall score, indicating poorer sleep quality compared to their non-obese peers. These findings suggest that obesity is associated with disrupted sleep patterns and greater challenges in maintaining healthy sleep habits, emphasizing the importance of addressing sleep-related issues as part of obesity management and prevention strategies. Aligned with these findings, Li’s [22] study highlights the significant correlation between sleep duration and excessive body weight in adults, revealing that insufficient or excessive sleep is associated with a higher prevalence of obesity. Similarly, this study emphasizes that childhood obesity is linked to disrupted sleep patterns, as evidenced by significantly worse scores on dimensions such as sleep resistance, sleep anxiety, and daytime sleepiness. Given that we found that older children’s age was associated with more rule-breaking behavior and that sleep problems were significantly related to more thought problems regardless of children’s BMI, the hypothesis is further reinforced that adolescents struggle with sleep problems, which in turn lead to behavioral problems [23]. These results align with our evidence indicating that sleep disturbances in children were significantly associated with more conduct problems, more rule-breaking behavior, more aggressive behavior, and more other problems. In fact, our findings reveal a significant relationship between sleep quality and emotional intelligence levels in children, with differences based on BMI. Overweight or obese children exhibited significantly lower emotional intelligence scores compared to their underweight/normal-weight peers. This finding suggests that obesity is associated not only with poorer sleep quality but also with reduced emotional intelligence, highlighting the interconnection between physical health, sleep habits, and children’s emotional development.

These results highlight the urgent need for interventions targeting both sleep quality and emotional intelligence, particularly in children struggling with obesity, to promote overall well-being. In alignment with these findings, the study by Mazurak et al. [24] highlights the interaction between childhood obesity, psychological factors, and sleep, demonstrating that obesity is strongly associated with poor sleep quality and increased psychological stress, which can further disrupt emotional regulation [24]. This complements the findings of the present study, showing that obesity in children is associated not only with poorer sleep quality but also with reduced emotional intelligence, highlighting the interconnection between physical health, sleep patterns, and emotional development. Thus, Mazurak’s study, as well as our study, highlights that obesity exacerbates psychological challenges such as anxiety and stress, which in turn negatively affect sleep and emotional abilities [24]. Together, these findings highlight the need for holistic interventions that address sleep, emotional development, and weight management as interrelated components of a child’s overall health, because high EI in children is associated with better social skills, lower levels of aggression, and improved academic performance [25]. To our knowledge, children with high EI are more adept at navigating social interactions, resolving conflicts, and demonstrating empathy, all of which are crucial for healthy behavioral development. In contrast, children with low EI may struggle with emotional regulation, leading to behaviors such as aggression, defiance, or social withdrawal [26]. These behavioral problems can hinder their ability to form positive relationships and succeed in different areas of life. In our study, we found a significant effect of emotional intelligence on obesity-related behaviors, such as emotional overeating and physical inactivity, as reflected in the differences observed in the behavioral and performance subscales of the CBCL between overweight/obese and underweight/normal-weight children. Specifically, overweight/obese children scored significantly higher on subscales related to anxiety/depression, withdrawal/depression, social problems, thinking problems, conduct problems, delinquent behavior, and aggressive behavior, indicating a higher prevalence of internalizing and externalizing problems. These findings suggest that children with lower emotional intelligence are more prone to negative emotional and social behaviors, which may contribute to obesity-related lifestyle behaviors. The study by Giusti et al. [27] explores the complex relationship between emotional intelligence, obesity, and eating disorders in children and adolescents, identifying that lower emotional intelligence is associated with maladaptive eating behaviors, such as emotional overeating and poor self-regulation. This aligns with the findings of the present study, suggesting that children with lower emotional intelligence are more prone to negative emotional and social behaviors, contributing to obesity-related challenges such as overeating and physical inactivity. In addition, performance-related subscales reveal that overweight/obese children scored significantly lower in areas such as activity and social performance, although academic performance did not differ between BMI categories. These lower performances highlight potential challenges in social and physical engagement, further reinforcing the behavioral and emotional barriers faced by obese children. The findings highlight the critical role of emotional intelligence in managing obesity-related behaviors, suggesting that interventions aimed at enhancing emotional intelligence could positively influence the reduction of behavioral problems and improved engagement in physical and social activities among obese children. The study by Favieri, Marini, and Casagrande [28] systematically examines the relationship between emotional regulation and binge eating behavior in children and adolescents, demonstrating that difficulties in emotional regulation are strongly associated with maladaptive eating behaviors and obesity. This is consistent with the findings of the present study, which show that emotional intelligence plays a crucial role in managing obesity-related behaviors, including reducing behavioral problems and promoting better engagement in physical and social activities. Adolescents who showed greater emotional recovery and clarity were found to have a reduced likelihood of engaging in aggressive behaviors and an increased likelihood of adopting healthy lifestyles [29]. In addition, adolescents with higher emotional intelligence typically have reduced involvement in risky activities, use more effective stress coping strategies, and show a greater tendency to engage in actions that benefit others [30]. This perspective is similar to our results, which show that higher emotional intelligence is associated with significantly fewer thought and behavioral problems and less aggressive behavior. Given the timing of the study and the growing awareness of the impact of the COVID-19 pandemic on mental health, it is important to consider how the pandemic may have affected the participants’ sleep and behavior, particularly in relation to restraint and school closures. The disruption of daily routines, including school closures, likely led to significant changes in children’s sleep patterns, with many experiencing sleep problems, which the results suggest were associated with a range of internalizing and externalizing behaviors [31]. The lack of social interaction, reduced physical activity, and increased screen time during the pandemic may have exacerbated issues such as anxiety, depression, and behavioral problems, particularly in children who were already at risk, such as those who were overweight or obese. These factors, combined with the increased anxiety and uncertainty caused by the pandemic, may have contributed to the observed negative effects on sleep, social relationships, and overall behavior among the study participants [31]. However, the results show significant gender differences, with boys exhibiting more internalized and externalized behaviors compared to girls. Several factors may contribute to this gender difference. Biologically, boys may be more prone to externalizing behaviors such as aggression due to higher levels of testosterone, which has been linked to such traits [32]. Additionally, societal expectations and gender norms often shape how boys and girls socialize. Boys are typically encouraged to exhibit more assertive or dominant behaviors, which may manifest as externalizing problems, while girls might socialize to express emotions more internally or passively, potentially leading to internalizing behaviors such as anxiety or depression. Furthermore, boys tend to face more challenges in terms of social interactions and academic performance, which could contribute to the higher rates of both internalizing and externalizing issues observed. The differences in educational level and parental age also suggest that these socioeconomic factors influence how boys and girls experience and express behavioral problems. Overall, gender differences in the expression of behavioral issues might reflect a complex interplay of biological, social, and environmental influences [33]. Finally, we acknowledge the overlap in data and methodology with our previous publication [34], particularly in terms of the use of common measures such as the TEIQue-CSF and CSHQ. However, the present study expands upon that work by incorporating an additional dimension—children’s behavioral outcomes, which were not examined in the earlier analysis. This added focus allows for a more comprehensive understanding of the associations explored [34].

Limitations

There are several limitations to this study. Firstly, as far as the sample is concerned, it was drawn from the Attica region, which may not be representative of the broader population. This means that the results cannot be generalized to the general population or to other regions and countries. Moreover, the participants in this study answered self-reported questionnaires, which may have yielded socially acceptable and predictable responses about their behaviors and experiences. Last but not least, self-reported measurement of BMI may be less accurate, leading to potential misclassification of participants’ weight status. These limitations may affect the applicability of the findings and highlight the need for further research using more objective measures and a larger sample.

5. Conclusions

To the best of our knowledge, the findings of this cross-section study reveal the correlation between obesity, overweight, negative behavioral traits, and poor EI. In fact, this relationship emphasizes the association between physical health and behavior, suggesting that effective interventions for prevention of childhood obesity must also include psychological and emotional enhancement. For this reason, health education should be included in school programs for health promotion among children. The health promotion strategy should include promoting behavioral change and encouraging adolescents to adopt healthier lifestyles such as sleep and diet. More particularly, healthy sleep habits should be promoted, because they have the potential to improve behavioral outcomes and support children’s overall mental well-being. However, evidence highlights that increased BMI in children places them at risk of significant social and emotional difficulties such as diminished self-esteem and higher rates of bullying. In fact, these factors contribute to behavioral problems such as withdrawal, anxiety, and depression. These challenges may be addressed using strategies for the emotional enhancement of students and building resilience for behavioral changes. Interventions that support healthy education must be designed for the promotion of a heathier lifestyle and mental, emotional, and behavioral improvement.

Given the increased prevalence of childhood obesity and its impact on psychological and behavioral health, continued research and intervention are essential. Therefore, future research should further investigate the correlation between these factors considering the impact of environmental factors, such as family and socioeconomic status.