What question did this study set out to answer?

This research investigates how interpersonal moderators impact the relationship between BMI and parent-reported depression and anxiety in children.

May 22, 2026Open Access

Between the scales and the scars: The interpersonal moderators of the association between Body Mass Index and parent-reported depression/anxiety diagnoses in U.S. children: Evidence from the 2021–22 National Survey of Children’s Health (NSCH)

Key Points

This research investigates how interpersonal moderators impact the relationship between BMI and parent-reported depression and anxiety in children.
Cross-sectional analysis of 40,820 U.S. children aged 6–17 using NSCH data
Utilized survey-weighted logistic regression and adjusted for age, sex, race/ethnicity, and poverty
Examined effects of bullying, parents' mental health, family resilience, and friendships on BMI and mental health outcomes.
Obesity linked to 2.08 times higher odds of lifetime depression (aOR 2.08; 95% CI: 1.64-2.64)
Obese children had 1.48 times higher odds of lifetime anxiety (aOR 1.48; 95% CI: 1.25-1.76)
Significant effect modifiers included bullying and parental mental health, changing the obesity-mental health association per interpersonal context.

Abstract

Adverse childhood mental health outcomes have emerged as a significant public health concern, with an increasing body of evidence linking children’s obesity with increased risk of mental health outcomes. This is a cross-sectional study of 40,820 U.S. children aged 6–17 used survey-weighted logistic regression on the 2021–22 National Survey of Children’s Health (NSCH) data. The study examined whether interpersonal factors such as bullying, poor mothers’ or fathers’ mental health, poor family resilience and greater difficulty in making or keeping friends modified the associations between BMI category and parent-reported lifetime depression (LDD) or anxiety (LDA) mental health outcomes, using interaction terms and adjusting for age, sex, race/ethnicity and federal poverty levels. Obesity was significantly associated with higher odds of both LDD and LDA in children aged 6–17 years. Obese children had 2.08 times higher odds of LDD (aOR 2.08; 95% CI: 1.64-2.64) and 1.48 times higher odds of LDA (aOR 1.48; 95% CI: 1.25-1.76) compared to normal-weight peers. Significant effect modification in the statistical model was observed for LDD: never bullied (aOR = 2.12; 95% CI: 1.45-3.11), mother’s mental health (aOR = 1.70; 95% CI: 1.70- 2.70), and father’s mental health (aOR = 2.54; 95% CI: 1.51-4.29). For LDA , effect modification in the statistical model was seen for making friends (aOR = 1.91; 95% CI: 1.13-3.22) and father’s mental health (aOR = 2.14; 95% CI: 1.34-3.41). In this cross-sectional sample, obesity was associated with higher LDD and LDA, with associations varying by interpersonal and family factors. Given parent-reported, cross-sectional data, findings are associative and not causal. The results emphasize integrating mental health screening into obesity programs, strengthening anti-bullying efforts, and adopting family-centered approaches; future research should use longitudinal, multi-informant designs to establish temporal relationships and reduce bias.

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