Exercise adherence plays a crucial role in both physical health and psychological development among adolescents. Grounded in Self-Determination Theory, this study examined whether body image dissatisfaction and exercise motivation serve as sequential mediators in the association between psychological need frustration and exercise adherence among obese adolescents. The goal was to uncover key psychological mechanisms linking maladaptive experiences to exercise behaviors. We conducted a questionnaire-based survey with a randomly selected sample of 487 obese adolescents in China. Participants completed a set of standardized psychological scales. The proposed chain mediation model was tested using SPSS Statistics 26 and the PROCESS macro (version 4.0, Model 6). Psychological need frustration was significantly and negatively associated with exercise adherence. Both body image dissatisfaction and exercise motivation significantly mediated this relationship in sequence. The chain mediation effect accounted for an additional 7.784% of the total effect, indicating partial mediation. The findings highlight the important roles of psychological need frustration, body image dissatisfaction, and exercise motivation in understanding exercise adherence among obese adolescents. The results clarify how body image dissatisfaction and exercise motivation jointly mediate this relationship, offering empirical support for the application of Self-Determination Theory in high-risk adolescent populations. This study also provides theoretical and practical implications for school-based physical education, family support, and individual-level interventions.
Chen et al. (Sat,) studied this question.