Association of adolescent obesity and poor mental health: An assessment of the Youth Risk Behavior Surveillance System

Introduction: Adolescent obesity and mental health are two significant public health concerns. While studies suggest a relationship between the two, it remains unclear if this is due to elevated body mass index (BMI) or the psychosocial role of weight perception. Therefore, our study aims to assess the association between BMI and mental health, and the role of weight perception and demographic factors.

Methods: Using data from the 2021 Youth Risk Behavior Surveillance System, we determined population estimates, demographics, and rates of BMI, weight perception, and mental health groups. We constructed logistic regression models to assess associations between BMI and mental health, weight perception and mental health, and the effects of sex, age, and ethnicity/race.

Results: Adolescents with BMI’s classified as overweight or obese had higher rates of poor mental health (34.4% and 32.89%, respectively). The odds ratios also found that they were 1.43 (95% CI: 1.24-1.66) and 1.53 (95% CI: 1.31-1.79) times more likely to experience poor mental health, compared to those with a healthy weight. Adolescents who perceived themselves as obese, regardless of actual BMI, were significantly more likely to experience poor mental health (BMI <95th percentile AOR: 1.95, 95% CI: 1.74-2.18 and BMI >95th percentile AOR: 1.82, 95% CI: 1.47-2.27) while those with obesity who perceived themselves as healthy weight were significantly less likely to experience poor mental health (AOR: 0.65, 95% CI: 0.45-0.93), compared to those who had healthy weight and their perception was congruent.

Conclusions: The association between BMI and poor mental health was significant, however, the association between weight perception and mental health was even stronger. Additionally, the additive effects of ethnicity/race, sex, and age highlight the need for personalized interventions in addressing adolescent mental health.