Correlation between obesity and emotional, social, and behavioral problems associated with physical limitation among children and adolescents in Western Saudi Arabia (2024)

Abstract

Childhood obesity has become a worldwide health hazard. It is accompanied by serious and severe co-morbidities, including anxiety, depression, stress, and degenerative joint diseases affecting weight bearing joints. Furthermore, it is associated with social and behavioral problems.1,2 The prevalence of childhood obesity has increased over the years and the number of children suffering from obesity continues to increase worldwide. Obesity is attributed to many diseases and health conditions. Many authors have identified a strong link between obesity and internalizing difficulties, poorer quality of life, more profound social issues, and increased behavioral problems. Obese children and adolescents are at greater risk for joint problems, as well as social and psychological problems, such as anxiety, stress, depression, and poor self-esteem.1-5 Many studies have confirmed that obesity is the strongest predictor of stress in childhood; obesity has a significant effect on childhood depressive symptoms, low self-esteem, and social isolation due to negative relationships with school peers.3,4 Physical inactivity has been identified as one of the core risk factors associated with pediatric obesity.6 Several studies have shown that obesity influences school performance. However, little is known regarding the effect of obesity on school attendance.7,8 In this study, we aimed to examine the relationship between emotional, behavioral, and social problems associated with physical limitation in obese children in Jeddah, Kingdom of Saudi Arabia (KSA).

Methods

Results

The study included 281 children (girls 130/281 [46.3%] and boys 151/281 [53.7%]). Descriptive characteristics of the children according to BMI and age among boys and girls are provided in Table 1. At baseline, children with higher BMI experienced greater physical limitation, as assessed by responses to questions related to the activities of walking, running, sport, and exercise (Table 2). Walking problems were identified in 50.6% (p=0.018, r=0.164) of obese children; those children who experienced problems had a higher BMI than those who did not. Further, 55.8% (p=0.006, r=0.189) of obese children experienced problems with running, and 44.3% (p=0.060 r=0.132) of obese children had problems with the practice of sports and exercise, which affected their social activity and lowered their self-steam. We also observed that 42.8% of obese children reported not being able to do things that other children could do (p=0.002, r=0.213); 46% of obese children reported feeling severe stress, which prevented them from playing with other children (p=0.071, r=0.127), and 33.4% of obese children reported having problems in continuing to play with other children (p=0.001, r=0.224).

Obese children had particularly high rates of other problems, for example, 37.4% had problems with maintaining attention in school (p=0.043, r=0.142), which affected their performance, and 31.3% had problem in follow-up duties fade (p=0.068, r=0.118). The latter was significantly related to BMI, with children who suffered from the problem of having higher BMI than those who did not (Table 3). On the other hand, there was no significant correlation between BMI and attendance/absenteeism in school. Furthermore, there was no significant correlation between BMI and emotional problems.

Discussion

Obesity and depression among school-aged children have a negative impact on school performance and relationships with peers, which are important precursors to psychopathy. Previous studies9 have reported higher incidences of depression, stress, and anxiety in obese children. In contrast, other studies1,10,11 have found no significant correlation between obesity and depression, anxiety, and psychological stress. An Italian study1 composed of 148 obese children (79 girls and 69 boys; mean age 8.9 ± 1.23 years) showed a significantly higher level of depressive symptoms in obese children in comparison with normal-weight children. A Brazilian study10 enrolling 50 children reported opposing results with no correlation between BMI and anxiety and depressive symptoms. In a Korean study,11 with 2305 elementary school-aged participants, the authors confirmed a positive correlation between obesity and stress and depression symptoms. Other published studies1,10,11 have shown obese children to be more depressed, to feel hopeless, and to have lower self-esteem, and lower life satisfaction compared with non-obese healthy children. In the present study, there was no significant correlation between BMI and emotional problems; we found that sadness, depression, and worry were not correlated with BMI. The exact mechanisms, which might explain the relationship between obesity and physical activity, remain unclear. One possibility is that symptoms of joint pain promote excess weight gain during adolescence via reduced physical activity, exercise, or sport participation. In our study, we confirmed a significant correlation between BMI and frequency of physical activity difficulties, such as walking, running, and exercise. We found that 50.6% of obese children had problems with walking, 55.8% with running, and 44.3% with exercise. Previous studies have examined the correlation between being obese and pain in the knee joint, which can lead to limitation in physical activity.6,12 According to a recent systemic review,6 6 studies examining the relationship between motor proficiency and body composition found that children with poor motor proficiency had significantly higher BMI. In a Canadian study,6 which involved 103 children in the fourth-grade (aged 8-10 years) who were enrolled in public school system in Canada, a significant negative relationship was found between BMI and total physical activity performance. Furthermore, a 2-way interaction between time and physical activity was significant for BMI only, suggesting a reverse correlation between BMI and duration of physical activity.6 In an Italian study,12 obese children were reported to have poorer motor performance when performing standing long jump and basketball throw than their non-obese peers. The New Hampshire School Health Care Coalition assessed the correlation between obesity and fitness among 6511 student participants aged 6-14 years, and concluded that there was no significant association between obesity and fitness.13 Childhood obesity has dramatically increased over the last 2 decades, and is associated with poor health status and general health. In a study14 of 43,297 American children aged from 10 to 17 years, reported in 2007, 15% were considered obese. The study reported14 that obese children were more likely to have poor health, activity restrictions, school problems, missed school days, and learning disability. Many obese adolescent girls and boys are socially marginalized among their peers. After controlling for other factors, obese respondents were found to receive fewer friendship nominations than their normal-weight peers. Overall, the relationship between obesity and social isolation was moderate in strength. In the present study, we found that 42.8% of obese children could not do things that other children could do, which lead to reduced self-esteem; that 46% of obese children felt severe stress, which prevented them from playing with other children; and that 33.4% of obese children had problems in continuing to play with other children. All of these problems affected their relationships with their peers. In the National Longitudinal Study,3 the total population consisted of 90,118 children aged 13-18 years were assessed for height and weight. Obese adolescents were more likely to be socially isolated, participate less in sports, and have fewer friendships; the isolation may aggravate the social and emotional problems in obese children.3 In a further American study,7 which enrolled 93,151 children aged from 10 to 17 years, it was reported that the odds of missing more than 11 days of school was greater among obese children than non-obese children, as spending more time in preparation themself for school. In light of these findings, they hypothesized that social marginalization of obese individuals contributes to reduced self-esteem and increased depressive symptoms among obese adolescents.3,7 In Philadelphia,15 the American School Health Association analyzed 291,040 students including 165,056 obese students (grades 1 to 12), and concluded that obesity was not strongly associated with school absence, except among extremely obese children.15 In an American study16 of 920 children, the authors reported a negative relationship between BMI and attendance in school.16 Likewise, in this study, we excluded the correlation between obesity and attendance/absenteeism in school for any reason. However, we confirmed the relationship between some school problems and BMI ratio; 37.4% of obese children had problems in maintaining attention in school, which affected their performance, and 31.3% of obese children had problem in follow-up of duties fade.

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