Parental Perceived Stress and Its Association With Childhood Obesity in Spain: The PASOS Study

Introduction: Parental perceived stress (PPS) is proposed to be a factor influencing children's weight status through behavioral and environmental mechanisms. We assessed the association between PPS and weight status among Spanish children and adolescents. Methods: We used data from the first wave of the PASOS (Physical Activity, Sedentarism, and Obesity in Spanish Youth) study (2019-2020). The study included 1,023 children and adolescents whose parents completed the Perceived Stress Scale. Anthropometric measurements and data on physical activity, sleep, screen time, and dietary quality were collected. We classified parents into "low" stress (<50th percentile on Perceived Stress Scale) and "high" stress (≥50th percentile on Perceived Stress Scale). We assessed the association between PPS and obesity, adjusted for parents' perception of their own health and children's general fitness. We conducted linear regression analysis between PPS and children's body mass index (BMI) z score and waist-to-height ratio. Results: Children of parents with high PPS had higher mean BMI (19.9 [SD, 3.8] vs 19.5 [3.3]; P = .009) and poorer general fitness (P = .003) than children of parents with low PPS. The prevalence of obesity was higher among children of high-stress (vs low-stress) parents (4.0% vs 1.6%); this association remained significant after adjustment (adjusted OR = 2.76; 95% CI, 1.08-7.06; P = .03). The linear analysis showed positive associations between PPS and both children's BMI z score and waist-to-height ratio. Conclusion: Higher PPS was associated with an increased likelihood of obesity in Spanish children and adolescents. These findings underscore the importance of addressing family stress in strategies for preventing childhood obesity.