In today’s fast-paced world, children’s well-being is a top priority. While pediatric obesity is commonly associated with physical health risks, such as diabetes and cardiovascular disease, its impact on a child’s mental and emotional state often goes unnoticed. However, it is becoming increasingly clear that pediatric obesity is a complex challenge that extends beyond physical appearance and lifestyle choices and affects mental health.
Children with obesity experience weight stigmatization that creates an occurrence of societal devaluation. Stigmatization may include weight bias, discrimination, bullying, and weight-based victimization, contributing to adverse mental and physical health. Adverse events and living environments can also create stress that may lead to disordered emotional eating (ie, using food as comfort), only adding to the problem. Adverse childhood experiences, including trauma and unstable living conditions, further compound the mental health effects. Additionally, limited access to healthy food due to socioeconomic factors can contribute to unhealthy eating habits, which have been linked to adverse health outcomes, including obesity, depression, and alcohol use disorder.
Weight-based victimization knows no boundaries, affecting male and female children of all ages and socioeconomic statuses. Negative comments from peers, family members, educators, healthcare professionals, and employers can lead to chronic stress, low self-esteem, depression, anxiety, sleep problems, disordered eating, substance abuse, self-harm, and an increased risk for suicide.
Several mental health conditions are more prevalent in children, including disordered eating, anxiety, depression, and oppositional defiant disorder. Children with diagnosed mental health disorders, such as bipolar or schizophrenia, may have disordered emotional eating and may take certain psychiatric medications that cause weight gain. Overall, clinicians should be aware of the dynamic of obesity and mental health, as well as mental health issues that have a comorbidity of obesity due to eating patterns and psychiatric medications contributing to weight gain.
The experiences that children with obesity encounter may lead to chronic stress and the release of stress hormones, leading to a hypothalamic-pituitary axis injury and subsequent energy dysregulation. This metabolic effect only adds to further weight gain and physical ailments. Unhealthy lifestyle patterns can persist to adulthood, increasing the risk for other metabolic disorders.
Healthcare professionals play a crucial role in addressing the challenges posed by pediatric obesity and mental health. A comprehensive approach is necessary to tackle these interconnected issues effectively. During clinic visits, clinicians can initiate safe, nonjudgmental communication by using patient-first language and seeking permission to discuss weight and mental health concerns. Just like the approach for any patient population, screening questions about depression, anxiety, and suicidal risk should be routinely addressed.
Clinicians should also apply principles of trauma-informed care. First, providers must realize that there is a problem. They should be trained to recognize signs and symptoms of trauma and mental health concerns in children with obesity. Then, clinicians should respond and help families resist re-traumatization. Clinicians should also discuss parental styles and skills. Discuss school, home, and clinic environments to develop strategies that may help prevent continued traumatization.
Clinicians should not hesitate to refer patients to a psychologist for treatment for mental health and disordered eating patterns. In addition to recommending professional mental health help, clinicians can advise parents and caregivers to enroll children in activities that naturally relieve stress, such as exercise and meditation, that help them learn healthy ways to cope with stress that does not involve eating. Working with a nutritionist or dietician, families can also learn how to create healthy meal plans, even on a budget.
The intricate relationship between pediatric obesity and mental health should not be ignored. By recognizing and addressing the psychosocial consequences, understanding the biological pathways involved, and implementing integrated approaches to care, we can foster a healthier future for our children. Empowering healthcare professionals, families, and communities to work together to nurture physical and mental well-being will pave the way for a brighter and more resilient generation.
The OMA’s journal, Obesity Pillars, has published several articles that have addressed mental health issues in children with obesity. In addition, clinicians can download the OMA Pediatric Algorithm for a comprehensive review of psychological evaluation and intervention for children with obesity.