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Understanding the relationship between obesity and mental disorders in children and adolescents will help develop effective prevention and intervention strategies. Objectives The main aim is to examine the relationship between anxiety-related emotional disorders, self-esteem, and BMI (obesity) among children, as well as determined the role of anxiety-related emotional disorders and self-esteem in predicting childhood obesity in China. Methods Utilizing a non-experimental, cross-sectional study design, data were from 136 participants collected through standardized instrument measures from Chinese children: the “Chinese screening for overweight and obesity among school-age children and adolescents” in the “Health Industry Standards of the People’s Republic of China” as the standard for identifying obesity, the Screen for Anxiety-Related Emotional Disorders (SCARED) for assessing anxiety disorder, and the Children’s Self-Esteem Scale (CSES) for evaluating self-esteem. Statistical analysis, including descriptive statistics, Pearson correlation analysis, and multiple regression analyses was performed using SPSS version 26 to determine the predictive relationships between the variables. Results Specific anxiety-related emotional disorders—particularly panic disorder and separation anxiety disorder—significantly predicted higher BMI in Chinese children, while generalized anxiety disorder and school avoidance were associated with lower BMI. Self-esteem, contrary to expectations, did not significantly predict obesity. Conclusion This study emphasises the necessity of including early psychological screen in childhood obesity prevention, particularly for anxiety symptoms. The findings have practical consequences for schools, doctors, and public health officials. Further research is needed to better understand the mental-physical health relationship in children. 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F1000Research 2026, 14 :84 ( https://doi.org/10.12688/f1000research.156811.3 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. Close Copy Citation Details Export Export Citation Sciwheel EndNote Ref. Manager Bibtex ProCite Sente EXPORT Select a format first Track Share ▬ ✚ Research Article Revised The influence of anxiety-related emotional disorders and self-esteem on obesity among Chinese children [version 3; peer review: 1 approved, 1 approved with reservations] Xin Shi 1 , Saeid Motevalli https://orcid.org/0000-0002-7131-1207 1 , Elaine Jing Ying Chang 1 , Yifei Pan 1 , Jing Sun https://orcid.org/0009-0002-5850-0828 2 Xin Shi 1 , Saeid Motevalli https://orcid.org/0000-0002-7131-1207 1 , [...] Elaine Jing Ying Chang 1 , Yifei Pan 1 , Jing Sun https://orcid.org/0009-0002-5850-0828 2 PUBLISHED 05 May 2026 Author details Author details 1 Psychology, UCSI University, Kuala Lumpur, Federal Territory of Kuala Lumpur, 56000, Malaysia 2 Education Department, Faculty of Social Sciences and Liberal Arts, UCSI University, Kuala Lumpur, Federal Territory of Kuala Lumpur, 56000, Malaysia Xin Shi Roles: Conceptualization, Data Curation, Formal Analysis, Investigation, Writing – Original Draft Preparation, Writing – Review & Editing Saeid Motevalli Roles: Conceptualization, Methodology, Supervision, Validation Elaine Jing Ying Chang Roles: Data Curation, Formal Analysis, Investigation Yifei Pan Roles: Writing – Review & Editing Jing Sun Roles: Writing – Review & Editing OPEN PEER REVIEW DETAILS REVIEWER STATUS Abstract Background Anxiety and obesity can have negative impacts on the health of children. Understanding the relationship between obesity and mental disorders in children and adolescents will help develop effective prevention and intervention strategies. Objectives The main aim is to examine the relationship between anxiety-related emotional disorders, self-esteem, and BMI (obesity) among children, as well as determined the role of anxiety-related emotional disorders and self-esteem in predicting childhood obesity in China. Methods Utilizing a non-experimental, cross-sectional study design, data were from 136 participants collected through standardized instrument measures from Chinese children: the “Chinese screening for overweight and obesity among school-age children and adolescents” in the “Health Industry Standards of the People’s Republic of China” as the standard for identifying obesity, the Screen for Anxiety-Related Emotional Disorders (SCARED) for assessing anxiety disorder, and the Children’s Self-Esteem Scale (CSES) for evaluating self-esteem. Statistical analysis, including descriptive statistics, Pearson correlation analysis, and multiple regression analyses was performed using SPSS version 26 to determine the predictive relationships between the variables. Results Specific anxiety-related emotional disorders—particularly panic disorder and separation anxiety disorder—significantly predicted higher BMI in Chinese children, while generalized anxiety disorder and school avoidance were associated with lower BMI. Self-esteem, contrary to expectations, did not significantly predict obesity. Conclusion This study emphasises the necessity of including early psychological screen in childhood obesity prevention, particularly for anxiety symptoms. The findings have practical consequences for schools, doctors, and public health officials. Further research is needed to better understand the mental-physical health relationship in children. READ ALL READ LESS Keywords Self-esteem, Obesity, Panic Disorder, Generalized Anxiety Disorder, Separation Anxiety Disorder, Social Anxiety Disorder, School Avoidance, Good health and Wellbeing Corresponding Author(s) Saeid Motevalli ( [email protected] ) Close Corresponding author: Saeid Motevalli Competing interests: No competing interests were disclosed. Grant information: The author(s) declared that no grants were involved in supporting this work. Copyright: © 2026 Shi X et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. How to cite: Shi X, Motevalli S, Chang EJY et al. The influence of anxiety-related emotional disorders and self-esteem on obesity among Chinese children [version 3; peer review: 1 approved, 1 approved with reservations] . F1000Research 2026, 14 :84 ( https://doi.org/10.12688/f1000research.156811.3 ) First published: 15 Jan 2025, 14 :84 ( https://doi.org/10.12688/f1000research.156811.1 ) Latest published: 05 May 2026, 14 :84 ( https://doi.org/10.12688/f1000research.156811.3 ) Revised Amendments from Version 2 The revised version of this article includes several methodological improvements in response to reviewer feedback. The sampling procedure has been clarified by providing a detailed explanation of simple random sampling in the Methodology. The sample size calculation using G*Power has been expanded with clearer specification of the statistical assumptions and parameters. Information on instrument validity and reliability has been strengthened through the inclusion of a pilot study. In addition, checks for key regression assumptions (normality, linearity, homoscedasticity, and multicollinearity) have been reported, and the role of demographic variables such as age and gender has been clarified. Overall, these revisions improve the clarity, transparency, and rigor of the study. The revised version of this article includes several methodological improvements in response to reviewer feedback. The sampling procedure has been clarified by providing a detailed explanation of simple random sampling in the Methodology. The sample size calculation using G*Power has been expanded with clearer specification of the statistical assumptions and parameters. Information on instrument validity and reliability has been strengthened through the inclusion of a pilot study. In addition, checks for key regression assumptions (normality, linearity, homoscedasticity, and multicollinearity) have been reported, and the role of demographic variables such as age and gender has been clarified. Overall, these revisions improve the clarity, transparency, and rigor of the study. See the authors' detailed response to the review by Mohtaram Rabbani See the authors' detailed response to the review by Mahmoud Danaee READ REVIEWER RESPONSES Introduction Childhood obesity has emerged as a critical public health issue worldwide, with profound implications for both physical and mental health. In China, the prevalence of obesity among children has been increasing at an alarming rate. 1 Psychological factors, including anxiety-related emotional disorders and self-esteem, have been identified as important contributors to obesity. 2 Anxiety-related disorders in children can manifest as excessive worry, fear, or nervousness, often leading to unhealthy eating behaviors such as emotional eating, where food is used as a coping mechanism for stress and anxiety. 3 Therefore, children with higher levels of anxiety are more likely to have higher body mass index (BMI) scores. 4 , 5 Similarly, self-esteem, which reflects a child’s overall sense of self-worth, has been shown to influence eating habits and physical activity levels. Children with low self-esteem may resort to overeating as a coping mechanism, further exacerbating weight gain. 6 Overweight and obese children tend to have lower self-esteem than their non-overweight peers, and higher BMI predicts worse self-esteem over time. 7 Understanding how anxiety-related emotional disorders and self-esteem affect childhood obesity is essential for developing comprehensive interventions that address both the physical and mental health aspects of obesity. By exploring the intricate links between these constructs, researchers and practitioners can gain valuable insights into both psychological factors that may be more effective in reducing childhood obesity rates. This study aims to contribute to this understanding by exploring the psychological dimensions of obesity, specifically the roles of anxiety-related emotional disorders and self-esteem. The objective of the study is to examine the relationship between anxiety-related emotional disorders, self-esteem, and BMI (obesity) among children, as well as determined the role of anxiety-related emotional disorders and self-esteem in predicting childhood obesity in China. By addressing these factors, the research seeks to inform the development of holistic interventions promoting physical and mental health among Chinese children. Methods Study design and participants This study used a non-experimental, cross-sectional research design to examine the relationship between anxiety-related emotional disorders, self-esteem, and obesity among children, as well as to determine the role of anxiety-related emotional disorders and self-esteem in predicting childhood obesity in China. In this study, a random sampling technique was used. Children between the ages of 6 and 12 who attend counselling facilities in Hefei City, Anhui Province, served as the basis for the sampling frame. To guarantee that every eligible child had an equal chance of being included, participants were chosen using a straightforward random sampling technique. The representativeness of the larger population should be interpreted cautiously, though, as there may be selection bias because the sample was taken from particular counselling centers. G*Power software was used to calculate the sample size based on a multiple linear regression model. A medium effect size (f2 = 0.15), a statistical power of 0.80, and an alpha level of 0.05 were used in an a priori power analysis. Six predictors were chosen, matching the independent variables in the regression model (i.e., self-esteem and five dimensions related to anxiety). According to the analysis, a minimum sample size of 98 participants was needed. In order to guarantee adequate statistical power for identifying significant effects, the final sample size of 136 participants was deemed sufficient. Children who met the set criterias were recruited as participants, inclusion criteria are (a) China citizen, (b) 6-12 years old, (c) currently residing in Anhui, Hefei Province, (d) the absence of any diagnosed psychiatric or neurological disorders, (e) willing to participate in this study, (f) signing the consent form by parents. To make sure that participants are truly informed, the information letter lists the research title, research purpose, benefits and risks of participating in this research, along with the consent form, which was used to protect the rights of participants. Participants were able to give informed consent from their parents. A total of 25 minutes was allotted for the questionnaires regarding obesity, anxiety and self-esteem. Participants were informed that they would remain anonymous while answering the questionnaires and the responses were confidential as well. No incentives were offered, avoiding undue influence. The researchers declare no conflicts of interest related to this study. No external funding was received; the research was self-funded by the authors, ensuring independence in study design, data analysis, and reporting. Measures Obesity The study used the “Chinese screening for overweight and obesity among school-age children and adolescents” from the “Health Industry Standards of the People’s Republic of China” to identify obesity. This standard is recommended by Dang et al. 8 for its prioritization in diagnosing obesity in Chinese children. It has been widely adopted in research on obesity screening for children and adolescents in China, proving its effectiveness and reliability. 9 According to China’s National Health Council’s standards for children aged 6-18, BMI is evaluated against age- and gender-specific thresholds: Overweight: BMI ≥ P85 threshold but < P95 threshold. Obesity: BMI ≥ P95 threshold. Screen for Child Anxiety Related Disorders (SCARED) The SCARED tool, closely related to the DSM, consists of 41 items. It effectively distinguishes between the five types of anxiety: Panic disorder, generalized anxiety disorder, separation anxiety disorder, social anxiety disorder, and school avoidance. 10 The Chinese version, revised in 2008, is suitable for assessing anxiety symptoms in Chinese children and adolescents aged 6-18 years in China. 11 Its strong psychometric properties, including significant validity and reliability across various populations, have been well-documented in scholarly research. 12 The Children’s Self-esteem Scale The CSES, developed by Wei Yunhua, was administered to primary and secondary school students in China and has an internal consistency coefficient of 0.69, indicating high reliability. 13 , 14 It consists of 26 items scored on a 5-point Likert scale, with higher scores indicating higher self-esteem. The CSES includes reverse-scoring items and measures appearance, sports, ability, sense of achievement, discipline, and public morality/helping others. Scores are categorized into three groups: high self-esteem, middle group, and low self-esteem. The instruments used in this study have shown satisfactory psychometric properties and have previously been validated in the Chinese context. The Children’s Self-Esteem Scale (CSES) has been reported to have acceptable internal consistency, and the Chinese version of the SCARED has demonstrated good validity and reliability in previous studies. To make sure the questionnaire items were appropriate and clear, a pilot study was also carried out with participants before the main data collection. Good internal consistency was further confirmed by reliability analysis from the current study; Cronbach’s alpha coefficients are presented in the following result section. Data analysis Preliminary analyses included descriptive statistics to summarize the sample characteristics and the main study variables. Pearson correlation analysis was used to explore the relationships between anxiety-related emotional disorders, self-esteem, and obesity. This analysis helped to identify the strength and direction of the associations between these variables, providing insight into how anxiety and self-esteem are related to obesity in children. Important presumptions were examined before the regression analysis was performed. Skewness and kurtosis values were used to determine the dependent variable’s normality, and scatterplots of standardised residuals were used to determine its linearity and homoscedasticity. Variance inflation factor (VIF) and tolerance values were used to evaluate multicollinearity among predictors. The findings suggested that the regression analysis was suitable for the data since all presumptions were satisfied. Multiple linear regression analysis was used to examine the extent to which anxiety-related emotional disorders and self-esteem predicted obesity. Panic disorder, generalized anxiety disorder, separation anxiety disorder, social anxiety disorder, and school avoidance were entered as independent variables and BMI score was the dependent variable. Beta coefficients, significance levels, and R-squared statistics were reported to describe the relationships between variables. Significance levels were set at p < .05 for all statistical tests. The regression analysis primary focus on examining the predictive effects of anxiety-related emotional disorders and self-esteem on BMI. As a result, the final regression model contained only the main predictor variables. Results Descriptive statistics The study was conducted in counseling centers in Hefei City, Anhui Province. A total of 136 questionnaires were distributed. After removing invalid and incomplete responses, 121 valid questionnaires were collected. Table 1 shows the demographic information of participants. The students had a mean age of 9.68 years (SD = 1.59), with 55.4% boys and 44.6% girls participants. Table 1. Socio-demographic features of the participants (n=136). Variable n % Mean SD Children age 9.68 1.59 7 12 8.8 8 20 14.7 9 35 25.7 10 28 20.6 11 19 14.0 12 17 12.5 13 5 3.7 Gender Male 67 55.4 Female 54 44.6 Fathers age group 39.6 4.853 30 and below 5 4.1 31-40 62 51.2 41-50 52 43.0 51 and above 2 1.7 Mothers age group 38.2 4.464 30 and below 6 5 31-40 68 56.2 41-50 47 38.8 Fathers’ high education level SPM 13 10.7 STPM 21 17.4 Diploma 25 20.7 Bachelor degree 40 33.1 Master degree 18 14.9 PhD 1 0.8 Mothers high education level SPM 20 16.5 STPM 19 15.7 Diploma 32 26.4 Bachelor degree 34 28.1 Master degree 12 9.9 PhD 1 0.8 Family monthly income (RMB) 11601.65 8677.19 5000 and below 7 5.8 5001-10000 69 57.0 10001-20000 41 33.9 20000 and above 4 3.3 The distribution of BMI weight status and anxiety symptoms in the sample is presented in Table 2 . Among the sample, there were 60 non-overweight and non-obese children (49.6%), comprising 28 boys and 32 girls. There were 25 overweight children (20.7%), with 17 boys and 8 girls. The sample included 36 obese children (29.8%), consisting of 22 boys and 14 girls. The distribution of anxiety disorders among the children was as follows: 25 children (20.7%) had panic disorder, including 12 boys and 13 girls. Generalized anxiety disorder was present in 14 children (11.6%), with 7 boys and 7 girls. Separation anxiety disorder affected 41 children (33.9%), consisting of 22 boys and 19 girls. Social anxiety disorder was found in 20 children (16.5%), including 6 boys and 14 girls. School avoidance was observed in 20 children (14.0%), with 9 boys and 8 girls. In terms of self-esteem, 20 children (16.5%) had low self-esteem, including 11 boys and 9 girls. A moderate level of self-esteem was reported in 88 children (72.7%), comprising 50 boys and 38 girls. High self-esteem was noted in 13 children (10.7%), with 6 boys and 7 girls. Table 2. BMI weight status, anxiety disorder symptom dimensions, and Self-esteem dimensions of Chinese children. Male Female Total n % n % n % BMI weight status Non-overweight and non-obesity 28 41.8 32 59.3 60 49.6 Overweight 17 25.4 8 14.8 25 20.7 Obesity 22 32.8 14 25.9 36 29.8 Anxiety disorder symptom dimension Panic Disorder 12 17.9 13 24.1 25 20.7 Generalized Anxiety Disorder 7 10.4 7 13.0 14 11.6 Separation Anxiety Disorder 22 32.8 19 35.2 41 33.9 Social Anxiety Disorder 6 9.0 14 25.9 20 16.5 School Avoidance 9 13.4 8 14.8 20 14.0 Self-esteem dimension Low self-esteem 11 16.4 9 16.7 20 16.5 Middle group 50 74.6 38 70.4 88 72.7 High self-esteem 6 9.0 7 13.0 13 10.7 Reliability analysis Reliability analysis of the anxiety and self-esteem scales yielded the following results: The anxiety scale, comprising 41 items, had a Cronbach’s α of 0.915, with a mean of 17.56 (SD = 12.520) which indicated very good reliability. The self-esteem scale, comprising 26 items, had a Cronbach’s α of 0.835, with a mean of 71.68 (SD = 14.312) which indicated good reliability ( Table 3 ). Table 3. Reliability analysis of Anxiety, Self-Esteem Scale. Scale No. of item Cronbach’s alpha Mean SD Anxiety 41 0.915 17.56 12.520 Self-Esteem 26 0.835 71.68 14.312 Correlation analysis Pearson correlation coefficient analysis is conducted to examine the relationship between variables. The research objective is to examine the relationship between anxiety-related emotional disorders, self-esteem, and BMI (obesity) among children. Correspondingly, the hypothesis 1 is: there are significant relationships between anxiety-related emotional disorders, self-esteem, and BMI (obesity). Table 4 shows the correlation analysis results of each variable. Correlation analysis reveals significant relationships between several variables. BMI shows a significant positive correlation with Panic Disorder (r=0.214*) and Separation Anxiety Disorder (r=0.223*), indicating that higher levels of these disorders are associated with higher BMI. Panic Disorder exhibits strong significant positive correlations with Generalized Anxiety Disorder (r=0.692**), Separation Anxiety Disorder (r=0.557**), Social Anxiety Disorder (r=0.399**), School Avoidance (r=0.520**), and Self-esteem (r=0.407**). These findings suggest that higher levels of one anxiety-related disorder are often accompanied by higher levels of other disorders and lower self-esteem. These correlations support Hypothesis 1 by demonstrating significant relationships between anxiety-related emotional disorders, self-esteem, and BMI scores. Table 4. The correlation analysis results of each variable (N=121). Variables 1 2 3 4 5 6 7 1 BMI 1.000 2 Panic disorder 0.214 * 1.000 3 Generalized Anxiety Disorder 0.055 0.692 ** 1.000 4 Separation Anxiety Disorder 0.223 * 0.557 ** 0.623 ** 1.000 5 Social Anxiety Disorder 0.053 0.399 ** 0.530 ** 0.448 ** 1.000 6 School Avoidance -0.028 0.520 ** 0.473 ** 0.443 ** 0.298 ** 1.000 7 Self-esteem 0.096 0.407 ** 0.553 ** 0.431 ** 0.396 ** 0.437 ** 1.00 * Correlation is significant at the 0.05 level (2-tailed). ** Correlation is significant at the 0.01 level (2-tailed). Regression analysis Table 5 presents the multiple linear regression analysis results, examining whether anxiety-related emotional disorders and self-esteem can significantly predict children’s obesity (BMI). The research objective is to determined the role of anxiety-related emotional disorders and self-esteem in predicting childhood obesity in China. Correspondingly, hypothesis 2 of the study is: Anxiety-related emotional disorders and self-esteem can significantly predict obesity among children. The analysis, with BMI as the dependent variable, provides valuable insights into the predictors of BMI among children. Panic Disorder emerged as a significant predictor of higher BMI (B=0.597, p<0.01), indicating that increased levels of panic disorder are associated with higher BMI scores. Similarly, Separation Anxiety Disorder significantly predicts higher BMI (B=0.463, p<0.05), implying that higher levels of separation anxiety disorder are linked to increased BMI. Table 5. Multiple linear regression for emotional anxiety-related emotional disorders and self-esteem as the predictor variable of BMI. B SE Beta t p Panic Disorder 0.597 0.218 0.351 2.733 <.01 ** Generalized Anxiety Disorder -0.460 0.223 -0.298 -2.061 <.05 * Separation Anxiety Disorder 0.463 0.193 0.282 2.402 <.05 * Social Anxiety Disorder -0.051 0.177 -0.030 -0.286 0.776 School Avoidance -0.947 0.436 -0.234 -2.172 <.05 * Self-esteem 0.046 0.045 0.111 1.015 0.312 R Square = .137, Adjusted R Square = .091 * p < .05. ** p < .01. Conversely, Generalized Anxiety Disorder significantly predicts a lower BMI (B=-0.460, p<0.05), suggesting that higher levels of generalized anxiety disorder are associated with lower BMI scores. Additionally, School Avoidance is a significant predictor of lower BMI (B=-0.947, p<0.05), indicating that higher levels of school avoidance are associated with lower BMI scores. However, Social Anxiety Disorder and Self-esteem do not significantly predict BMI in this model. Hypothesis 2 is partially supported. Despite various anxiety-related emotional disorders significantly predicted childhood obesity, social anxiety disorder and self-esteem did not exhibit significant predictive effects. This suggests that although psychological factors influence obesity, their impact may vary in strength and direction. The overall regression model explains 13.7% of the variance in BMI (R Square = 0.137, Adjusted R Square = 0.091), indicating that while these emotional disorders contribute to variations in BMI, a large proportion of the variance remains unexplained. Conclusion and Discussion Discussion The first aim of the current study is to examine the relationship between anxiety-related emotional disorders, self-esteem, and BMI (obesity) among children in Hefei, China. The results of the current study showed a significant relationship between anxiety-related emotional disorders, self-esteem, and BMI (obesity). This finding is consistent with most previous studies, such as Rofey et al., 15 who found that anxiety disorders are common among obese children and that both childhood depression and anxiety are associated with increasing BMI percentiles over time. Similarly, Patalay and Hardman 16 observed that the association and interrelationship between BMI and internalized symptoms strengthen as children age. Research suggests a significant association between obesity and low self-esteem in Chinese children, with obese primary school children in China having lower self-esteem scores than their normal-weight peers. 17 This association is particularly pronounced in girls, with overweight girls showing higher scores for depression symptoms. Body dissatisfaction partially explains the association between obesity and low self-esteem in both sexes. 18 The relationship between obesity and self-esteem appears to strengthen as children progress through primary school. 19 While some studies suggest that low self-esteem may precede the development of obesity, 20 others suggest that obesity is more likely to lead to low self-esteem, 21 highlighting the need for early intervention in the management of childhood obesity. The current study also examined the role of anxiety-related emotional disorders and self-esteem in predicting childhood obesity in Hefei, China. Multiple regression analysis revealed that panic disorder and separation anxiety disorder significantly predicted higher BMI, indicating that children with these conditions were more likely to be obese. This is consistent with the findings of Haghighi et al., 22 who reported that children and adolescents with Panic Disorder had the highest mean BMI. Similarly, pre-adolescent Separation Anxiety symptoms are associated with increased BMI in adolescent boys, with the relationship mediated by emotional eating, hunger sensitivity, and difficulty regulating emotions. 23 In addition, early separation anxiety and a focused attachment style are significant predictors of body dissatisfaction in women with eating disorders, which may increase the risk of developing eating disorders. In contrast, generalized anxiety disorder and school avoidance significantly predict lower BMI, meaning that children may be underweight, probably due to reduced appetite or avoidance behaviors that affect eating patterns. One study shows that Generalized Anxiety Disorder is the most common among school-aged children in China. 24 Notably, social anxiety disorder and self-esteem did not significantly predict BMI in this study, which is inconsistent from certain prior findings, possibly due to their complex or indirect effects not captured by the analysis. Despite the extensive argument in the prior literature that low self-esteem and increased social anxiety are risk factors for obesity, 25 results of the current study challenge this assumption. It is important to note that similar findings have been reported elsewhere, suggesting that social anxiety and self-esteem may not consistently predict BMI or obesity among children. For instance, Wang et al. 26 found that childhood obesity predicts lower self-esteem, whereas self-esteem does not predict obesity. Besides, Wang et al. 27 argued that obesity was negatively impact children’s self-esteem; however, self-esteem does not influence obesity or academic performance among children. In terms of social anxiety disorder, Ozkan et al. 28 discovered that there is no correlation between BMI and depression/social anxiety scores in obese children suggesting that the influence of social anxiety on obesity may be contingent upon contextual factors or moderated by additional variables, including peer relationships or social support systems. Besides, Anderson et al. 29 indicated that adolescent obesity in males did not show a significant correlation with a higher likelihood of developing major depressive disorder or anxiety disorder. Hence, findings of the study indicated that social anxiety and self-esteem were not significant predictors of obesity, contradicting the widely held belief that higher anxiety and lower self-esteem contributes to weight gain through emotional eating and decreased physical activity. Other literature suggesting that social appearance anxiety is negatively correlated with self-esteem, with BMI acting as a mediating factor. 30 Kornapalli et al. 25 found that body image concerns were negatively correlated with self-esteem and positively correlated with social anxiety, with significant BMI-related differences. Furthermore, Horenstein et al. 31 argued that Social Anxiety moderates the relationship between BMI and exercise avoidance motivation, particularly for those with higher BMIs. Interestingly, Ternouth et al. 32 found that childhood emotional difficulties were predictive of weight gain in women but did not have the same effect in men, while low childhood self-esteem predicted weight gain in both men and women, with a stronger effect in women. In contrast, Roberts and Duong 33 found that anxiety disorders may increase risk of obesity in adolescent males, but not females. While these studies demonstrate associations between social anxiety, self-esteem, and BMI, they do not definitively establish the specific predictive value of social anxiety and self-esteem for BMI. Furthermore, Sheinbein et al. 34 mention in their study that the pathology of eating disorders in children is significantly correlated with anxiety symptoms in children. Children with obesity or eating disorders often have difficulty controlling their eating behavior, which leads to weight gain and associated negative emotions such as shame, guilt, and anxiety. In addition, T. Wang et al. 35 emphasized the importance of healthy weight status for the development of young children, particularly in terms of cognitive function. Moss et al. 36 mentioned that obesity may impair the activation of neurophysiological components that are essential for cognitive function, thus affecting children’s cognitive function. These studies again highlight the link between cognitive development in obese children and emotional problems such as anxiety and low self-esteem. For this matter, numerous studies have demonstrated that physical activity interventions have the potential to enhance psychological outcomes in obese youth, including improved body image, increased self-esteem, and reduced depression. 37 , 38 In addition, early intervention is critical, with overweight/obese youth receiving targeted mental health screening in early adolescence for depressive and adjustment disorders, and in early childhood for anxiety disorders. 39 Consequently, it is imperative to incorporate psychological interventions that address mental health issues into obesity prevention and treatment programs for children and adolescents, focusing on both physical and psychological well-being to effectively improve health outcomes. Limitation However, some limitations of the study should be noted. First of all, the cross-sectional, non-experimental design of the study makes it difficult to establish causal relationships between self-esteem, anxiety-related emotional disorders, and obesity. The observed associations may have been influenced by other factors, such as parental influence, lifestyle habits, and environmental conditions, as the data were collected at a single point in time. In order to gain a more comprehensive understanding of the direction of these relationships, future research should consider experimental designs that enable controlled interventions as well as longitudinal studies that monitor changes over time. Secondly, the study depended exclusively on self-reported measures, which may be influenced by biases such as social desirability and inaccurate recall. Participants’ symptoms may have been underreported or overestimated, compromising the reliability of the findings. For this matter, future studies should use more objective assessment tools, such as clinical evaluations, behavioural observations, or physiological markers, alongside self-report questionnaires, to gain a more comprehensive and in-depth understanding of psychological and physical health outcomes. Thirdly, the sample size is relatively small, and the focus on a single province limits the findings’ generalisability. Psychological health and obesity-related factors can vary by region in China, particularly between urban and rural areas with different socioeconomic and educational resources. Hence, expanding the sample to include multiple provinces or a nationally representative cohort would result in more robust and generalisable findings. Lastly, although this study identifies significant correlations between anxiety-related disorders, self-esteem, and obesity, it does not thoroughly investigate the mechanisms underlying these associations. In order to better understand how these variables interact, future research should look into potential mediators and moderators, such as coping strategies, family dynamics, and peer influences. Furthermore, studies of interventions that assess the efficacy of behavioural or psychological programs may offer useful information about methods for enhancing children’s mental health and weight-related outcomes. Implication The study’s findings have important implications for school and community, public health policymakers, mental health and healthcare professionals, as well as future researchers. Schools and community organisations should provide structured psychological support and health education to assist children in developing better coping mechanisms and healthier habits. Specifically, early intervention programs for children should be designed to boost self-esteem, reduce anxiety, and promote healthy lifestyle habits. Besides, workshops and parental guidance sessions can provide families with the resources to tackle both emotional well-being and physical health in their children. For public health policymakers, it should be a priority to integrate mental health initiatives with obesity prevention strategies. The resources necessary for children to maintain both their physical health and emotional resilience can be provided by policies that support school-based mental health services, accessible counselling programs, and community-based health promotion campaigns. Moreover, policymakers should strive to reduce the barriers to mental health care by increasing the availability of affordable psychological services. Mental health and healthcare professionals should adopt a multidisciplinary approach that integrates mental health counselling with lifestyle interventions. In this regard, educational institutions, paediatricians, and mental health practitioners have to cooperate to develop intervention programs that tackle psychological issues and maladaptive behaviours, thereby ensuring an effective treatment strategy. Lastly, this study has provided future researchers with scientific information regarding the impact of anxiety-related emotional disorders and self-esteem on obesity in children. This information will enable them to conduct further longitudinal studies and experimental designs in order to elucidate the causal pathways between anxiety, self-esteem, and obesity. In addition, future research should investigate mediators including familial influence, peer relationships, and socioeconomic variables to formulate targeted interventions that more effectively address the psychological and physical health needs of children. Summary This study highlights significant relationships between anxiety-related emotional disorders, self-esteem, and obesity among children in Hefei City, Anhui Province. Findings indicates that specific anxiety-related emotional disorders—particularly panic disorder and separation anxiety disorder—significantly predicted higher BMI in Chinese children, while generalized anxiety disorder and school avoidance were associated with lower BMI. Self-esteem, contrary to expectations, did not significantly predict obesity. The results highlight the need for early psychological screening and intervention as part of obesity prevention programs, particularly targeting anxiety symptoms in school-aged children. Despite the study’s limitations, it provides a valuable foundation for future research and offers insights for clinical practice, educational settings, and public health policies. Continued efforts to understand and address the interplay between mental health and obesity are crucial for promoting children’s overall well-being. Ethical considerations The study adhered to ethical guidelines, securing approval from the institutional review board (IRB), Department of Psychology, UCSI University, Ethical Clearance Application, DEC/PSY/2022/09/24/03 on 28/03/2024 and because of the age of children (minors under 16 years) the written informed consent from all participants’ parents or guardians was collected. Confidentiality and anonymity were assured, and participation was voluntary. Data were used solely for research purposes, maintaining participants’ anonymity. Participants were informed of their right to withdraw from the study at any time, ensuring their autonomy and comfort throughout the research process. Author contributions All of the authors greatly aided the manuscript’s development. Contributor role Authors Conceptualization Dr. Saeid Motevalli Data Curation Xin Shi Formal Analysis Xin Shi Funding Acquisition Xin Shi Investigation Xin Shi Methodology Dr. Saeid Motevalli Project Administration Xin Shi Resources Xin Shi Software Elaine Jing Ying Chang Supervision Dr. Saeid Motevalli Validation Elaine Jing Ying Chang Visualization Xin Shi Writing – Original Draft Preparation Xin Shi Writing – Review & Editing Dr. Saeid Motevalli Writing – Review & Editing Yifei Pan Writing – Review & Editing Jing Sun Data availability Underlying data Figshare: The Influence of Anxiety-Related Emotional Disorders and Self-esteem on Obesity Among Chinese Children. https://doi.org/10.6084/m9.figshare.27968115.v1 . 40 The project contains the following underlying data: • Datasets.xlsx. (Anonymised answers to the questionnaire) Data are available under the terms of the Creative Commons Attribution 4.0 International license (CC-BY 4.0). Extended data Figshare: The Influence of Anxiety-Related Emotional Disorders and Self-esteem on Obesity Among Chinese Children. https://figshare.com/articles/figure/Extended_data/27036154.v1 . 41 • English-Demographic Information (Blank English version of the questionnaire) Data are available under the terms of the Creative Commons Attribution 4.0 International license (CC-BY 4.0). • English-Screen for Child Anxiety-Related Disorders (SCARED) (Blank English version of the questionnaire) Data are available under the terms of the Creative Commons Attribution 4.0 International license (CC-BY 4.0). • English- The children’s self-esteem scale (Blank English version of the questionnaire) Data are available under the terms of the Creative Commons Attribution 4.0 International license (CC-BY 4.0). • Chinese-Demographic Information (Blank Chinese version of the questionnaire) Data are available under the terms of the Creative Commons Attribution 4.0 International license (CC-BY 4.0). • Chinese-Screen for Child Anxiety-Related Disorders (SCARED) (Blank Chinese version of the questionnaire) Data are available under the terms of the Creative Commons Attribution 4.0 International license (CC-BY 4.0). • Chinese- The children’s self-esteem scale (Blank Chinese version of the questionnaire) Data are available under the terms of the Creative Commons Attribution 4.0 International license (CC-BY 4.0). 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Publisher Full Text Comments on this article Comments (0) Version 3 VERSION 3 PUBLISHED 15 Jan 2025 ADD YOUR COMMENT Comment Author details Author details 1 Psychology, UCSI University, Kuala Lumpur, Federal Territory of Kuala Lumpur, 56000, Malaysia 2 Education Department, Faculty of Social Sciences and Liberal Arts, UCSI University, Kuala Lumpur, Federal Territory of Kuala Lumpur, 56000, Malaysia Xin Shi Roles: Conceptualization, Data Curation, Formal Analysis, Investigation, Writing – Original Draft Preparation, Writing – Review & Editing Saeid Motevalli Roles: Conceptualization, Methodology, Supervision, Validation Elaine Jing Ying Chang Roles: Data Curation, Formal Analysis, Investigation Yifei Pan Roles: Writing – Review & Editing Jing Sun Roles: Writing – Review & Editing Competing interests No competing interests were disclosed. Grant information The author(s) declared that no grants were involved in supporting this work. Article Versions (3) version 3 Revised Published: 05 May 2026, 14:84 https://doi.org/10.12688/f1000research.156811.3 version 2 Revised Published: 30 Jul 2025, 14:84 https://doi.org/10.12688/f1000research.156811.2 version 1 Published: 15 Jan 2025, 14:84 https://doi.org/10.12688/f1000research.156811.1 Copyright © 2026 Shi X et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Download Export To Sciwheel Bibtex EndNote ProCite Ref. Manager (RIS) Sente metrics Views Downloads F1000Research - - PubMed Central info_outline Data from PMC are received and updated monthly. - - Citations open_in_new 0 open_in_new 0 open_in_new SEE MORE DETAILS CITE how to cite this article Shi X, Motevalli S, Chang EJY et al. The influence of anxiety-related emotional disorders and self-esteem on obesity among Chinese children [version 3; peer review: 1 approved, 1 approved with reservations] . F1000Research 2026, 14 :84 ( https://doi.org/10.12688/f1000research.156811.3 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS track receive updates on this article Track an article to receive email alerts on any updates to this article. TRACK THIS ARTICLE Share Open Peer Review Current Reviewer Status: ? Key to Reviewer Statuses VIEW HIDE Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Version 3 VERSION 3 PUBLISHED 05 May 2026 Revised Views 0 Cite How to cite this report: Danaee M. Reviewer Report For: The influence of anxiety-related emotional disorders and self-esteem on obesity among Chinese children [version 3; peer review: 1 approved, 1 approved with reservations] . F1000Research 2026, 14 :84 ( https://doi.org/10.5256/f1000research.200432.r481764 ) The direct URL for this report is: https://f1000research.com/articles/14-84/v3#referee-response-481764 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 13 May 2026 Mahmoud Danaee , University of Malaya, Kuala Lumpur, Malaysia Approved VIEWS 0 https://doi.org/10.5256/f1000research.200432.r481764 Authors addressed ... Continue reading READ ALL Authors addressed all my comments. Competing Interests: No competing interests were disclosed. Reviewer Expertise: Research methodology and statistical analysis I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Danaee M. Reviewer Report For: The influence of anxiety-related emotional disorders and self-esteem on obesity among Chinese children [version 3; peer review: 1 approved, 1 approved with reservations] . F1000Research 2026, 14 :84 ( https://doi.org/10.5256/f1000research.200432.r481764 ) The direct URL for this report is: https://f1000research.com/articles/14-84/v3#referee-response-481764 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Respond or Comment COMMENT ON THIS REPORT Version 2 VERSION 2 PUBLISHED 30 Jul 2025 Revised Views 0 Cite How to cite this report: Danaee M. Reviewer Report For: The influence of anxiety-related emotional disorders and self-esteem on obesity among Chinese children [version 3; peer review: 1 approved, 1 approved with reservations] . F1000Research 2026, 14 :84 ( https://doi.org/10.5256/f1000research.184521.r405305 ) The direct URL for this report is: https://f1000research.com/articles/14-84/v2#referee-response-405305 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 03 Sep 2025 Mahmoud Danaee , University of Malaya, Kuala Lumpur, Malaysia Approved with Reservations VIEWS 0 https://doi.org/10.5256/f1000research.184521.r405305 The manuscript mentions “random sampling” only in Results. Sampling procedures should be reported in Methodology. It is recommended to provide more details on how random sampling was conducted (e.g., sampling frame, sampling process and discuss them in more detail ... Continue reading READ ALL The manuscript mentions “random sampling” only in Results. Sampling procedures should be reported in Methodology. It is recommended to provide more details on how random sampling was conducted (e.g., sampling frame, sampling process and discuss them in more detail to allow the reader to understand the representativeness of the sample and potential sources of bias. Description of sample size calculation is not clear enough. The study states that GPower was used to calculate a sample size of 136 but does not mention the specific statistical test or method used within GPower. Since the study conducted a multivariate linear regression analysis, the assumptions made (e.g., type of test, number of predictors, effect size) should have been specified. Without this information, it is unclear if the reported sample size was appropriate for the planned analyses. It is not reported whether the instruments used in the study were validated or tested for reliability through a pilot study. Validity and reliability should be reported to ensure that the instruments used accurately measure the intended constructs and provide consistent results. Since a multivariate linear regression analysis was conducted, it would be important to report whether the key assumptions of regression (normality of the dependent variable, linearity, homoscedasticity, multicollinearity among predictors) were checked. Checks for normality, linearity, homoscedasticity, and multicollinearity should have been conducted and reported, as violations of these assumptions could impact the validity of the findings. It is unclear whether the final regression model included gender, age, or other potential confounding variables. it should be made clear whether these factors were controlled for in the analysis to rule out biased or misleading results. Is the work clearly and accurately presented and does it cite the current literature? Yes Is the study design appropriate and is the work technically sound? Yes Are sufficient details of methods and analysis provided to allow replication by others? Partly If applicable, is the statistical analysis and its interpretation appropriate? Partly Are all the source data underlying the results available to ensure full reproducibility? Partly Are the conclusions drawn adequately supported by the results? Yes Competing Interests: No competing interests were disclosed. Reviewer Expertise: Research methodology and statistical analysis I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Danaee M. Reviewer Report For: The influence of anxiety-related emotional disorders and self-esteem on obesity among Chinese children [version 3; peer review: 1 approved, 1 approved with reservations] . F1000Research 2026, 14 :84 ( https://doi.org/10.5256/f1000research.184521.r405305 ) The direct URL for this report is: https://f1000research.com/articles/14-84/v2#referee-response-405305 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Author Response 29 Apr 2026 Saeid Motevalli , Psychology, UCSI University, Kuala Lumpur, 56000, Malaysia 29 Apr 2026 Author Response Thank you for your valuable comments. The sampling procedure has been moved to the Methods section and further elaborated to clarify the sampling frame, process, and potential sources of bias ... Continue reading Thank you for your valuable comments. The sampling procedure has been moved to the Methods section and further elaborated to clarify the sampling frame, process, and potential sources of bias . Additional details on the G*Power analysis, including the statistical test, effect size, number of predictors, and assumptions, have been clarified in the Methods section to justify the adequacy of the sample size. Modifications have been made to the Methods section to strengthen the methodological rigor of the study . Information regarding the assessment of regression assumptions, including normality, linearity, homoscedasticity, and multicollinearity, has been added to the data analysis part. The manuscript has been revised to clarify that demographic variables such as age and gender were considered but not included in the final regression model is now acknowledged. We hope that these revisions have adequately addressed the reviewer’s concerns and improved the clarity and rigor of the manuscript. Thank you again for your insightful feedback. Thank you for your valuable comments. The sampling procedure has been moved to the Methods section and further elaborated to clarify the sampling frame, process, and potential sources of bias . Additional details on the G*Power analysis, including the statistical test, effect size, number of predictors, and assumptions, have been clarified in the Methods section to justify the adequacy of the sample size. Modifications have been made to the Methods section to strengthen the methodological rigor of the study . Information regarding the assessment of regression assumptions, including normality, linearity, homoscedasticity, and multicollinearity, has been added to the data analysis part. The manuscript has been revised to clarify that demographic variables such as age and gender were considered but not included in the final regression model is now acknowledged. We hope that these revisions have adequately addressed the reviewer’s concerns and improved the clarity and rigor of the manuscript. Thank you again for your insightful feedback. Competing Interests: No competing interests were disclosed. Close Report a concern Respond or Comment COMMENTS ON THIS REPORT Author Response 29 Apr 2026 Saeid Motevalli , Psychology, UCSI University, Kuala Lumpur, 56000, Malaysia 29 Apr 2026 Author Response Thank you for your valuable comments. The sampling procedure has been moved to the Methods section and further elaborated to clarify the sampling frame, process, and potential sources of bias ... Continue reading Thank you for your valuable comments. The sampling procedure has been moved to the Methods section and further elaborated to clarify the sampling frame, process, and potential sources of bias . Additional details on the G*Power analysis, including the statistical test, effect size, number of predictors, and assumptions, have been clarified in the Methods section to justify the adequacy of the sample size. Modifications have been made to the Methods section to strengthen the methodological rigor of the study . Information regarding the assessment of regression assumptions, including normality, linearity, homoscedasticity, and multicollinearity, has been added to the data analysis part. The manuscript has been revised to clarify that demographic variables such as age and gender were considered but not included in the final regression model is now acknowledged. We hope that these revisions have adequately addressed the reviewer’s concerns and improved the clarity and rigor of the manuscript. Thank you again for your insightful feedback. Thank you for your valuable comments. The sampling procedure has been moved to the Methods section and further elaborated to clarify the sampling frame, process, and potential sources of bias . Additional details on the G*Power analysis, including the statistical test, effect size, number of predictors, and assumptions, have been clarified in the Methods section to justify the adequacy of the sample size. Modifications have been made to the Methods section to strengthen the methodological rigor of the study . Information regarding the assessment of regression assumptions, including normality, linearity, homoscedasticity, and multicollinearity, has been added to the data analysis part. The manuscript has been revised to clarify that demographic variables such as age and gender were considered but not included in the final regression model is now acknowledged. We hope that these revisions have adequately addressed the reviewer’s concerns and improved the clarity and rigor of the manuscript. Thank you again for your insightful feedback. Competing Interests: No competing interests were disclosed. Close Report a concern COMMENT ON THIS REPORT Version 1 VERSION 1 PUBLISHED 15 Jan 2025 Views 0 Cite How to cite this report: Rabbani M. Reviewer Report For: The influence of anxiety-related emotional disorders and self-esteem on obesity among Chinese children [version 3; peer review: 1 approved, 1 approved with reservations] . F1000Research 2026, 14 :84 ( https://doi.org/10.5256/f1000research.172179.r365605 ) The direct URL for this report is: https://f1000research.com/articles/14-84/v1#referee-response-365605 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 21 Feb 2025 Mohtaram Rabbani , Hong Kong University, Hong Kong, China Approved with Reservations VIEWS 0 https://doi.org/10.5256/f1000research.172179.r365605 Please add research objectives at the beginning to provide a clear roadmap for the study and guide the reader through the research aims. Please provide a rationale for the sample size of 136 participants and ... Continue reading READ ALL Please add research objectives at the beginning to provide a clear roadmap for the study and guide the reader through the research aims. Please provide a rationale for the sample size of 136 participants and discuss its representativeness for the broader population of Chinese children. Consideration of statistical power and sample adequacy could strengthen the study's findings. Address the limitations of the non-experimental, cross-sectional design by discussing potential confounding variables and alternative explanations for the observed relationships. Consider incorporating longitudinal or experimental designs for future studies. Given the reliability issues identified in the school avoidance scale, consider revising or validating the measurement tools to ensure their accuracy and reliability. Discuss the limitations of self-reported data and potential biases. Provide a more detailed explanation of the statistical analyses conducted, including assumptions, model fit statistics, and potential interactions among variables. Consider exploring additional statistical methods to strengthen the predictive models. Provide a more critical discussion of the study's findings by comparing them to existing literature, addressing inconsistencies, and explaining the implications of the results for theory and practice. Consider discussing the practical significance of the results in addition to statistical significance. While mentioning ethical considerations is important, provide more details on how confidentiality and anonymity were ensured, how participants were recruited, and how potential biases were mitigated. Consider discussing any potential conflicts of interest or funding sources. Offer concrete suggestions for future research directions based on the study's limitations and findings. Propose ways to address the identified issues and further explore the complex relationships between anxiety-related emotional disorders, self-esteem, and obesity. Strengthen the conclusion by summarizing key findings, discussing their implications for clinical practice and policy, and highlighting the significance of the study within the broader context of childhood obesity research. Consider addressing the practical implications for intervention programs. Is the work clearly and accurately presented and does it cite the current literature? Partly Is the study design appropriate and is the work technically sound? Partly Are sufficient details of methods and analysis provided to allow replication by others? Partly If applicable, is the statistical analysis and its interpretation appropriate? Partly Are all the source data underlying the results available to ensure full reproducibility? Partly Are the conclusions drawn adequately supported by the results? Partly Competing Interests: No competing interests were disclosed. Reviewer Expertise: NA I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Rabbani M. Reviewer Report For: The influence of anxiety-related emotional disorders and self-esteem on obesity among Chinese children [version 3; peer review: 1 approved, 1 approved with reservations] . F1000Research 2026, 14 :84 ( https://doi.org/10.5256/f1000research.172179.r365605 ) The direct URL for this report is: https://f1000research.com/articles/14-84/v1#referee-response-365605 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Author Response 09 Aug 2025 Saeid Motevalli , Psychology, UCSI University, Kuala Lumpur, 56000, Malaysia 09 Aug 2025 Author Response Thank you for your insightful feedback. We have made several revisions to address your concerns and improve the manuscript. To begin, we have included research objectives at abstract part ... Continue reading Thank you for your insightful feedback. We have made several revisions to address your concerns and improve the manuscript. To begin, we have included research objectives at abstract part and the end of introduction part, providing a clear roadmap for the study that was previously missing. Regarding the sample size, we have provided a detailed rationale for the 136 participants, explaining how the size was determined using G*Power analysis to ensure adequate statistical power and representativeness for children in Hefei, Anhui Province. We have expanded the discussion on the limitations of the cross-sectional design, addressing potential confounding variables and the need for longitudinal or experimental designs in future studies. Additionally, the reliability of the anxiety scale is acceptable mentioned in realiability part, and we acknowledge the limitations of self-reported data, suggesting more objective measures in future research. In response to your request, we have clarified the statistical analyses to improve transparency. The Discussion now includes a more critical comparison with existing literature, addressing inconsistencies and practical significance of the results. We have also provided more detailed ethical considerations, explaining how confidentiality, anonymity, and informed consent were ensured. Moreover, some content of limitations were changed, followed by recommendations accordingly added. Also, an implementation section was added to the article. Finally, the Conclusion has been revised to better summarize the study’s key findings and their practical implications for clinical practice and policy. These revisions strengthen the manuscript and we hope they address your concerns. Thank you again for your valuable feedback. Thank you for your insightful feedback. We have made several revisions to address your concerns and improve the manuscript. To begin, we have included research objectives at abstract part and the end of introduction part, providing a clear roadmap for the study that was previously missing. Regarding the sample size, we have provided a detailed rationale for the 136 participants, explaining how the size was determined using G*Power analysis to ensure adequate statistical power and representativeness for children in Hefei, Anhui Province. We have expanded the discussion on the limitations of the cross-sectional design, addressing potential confounding variables and the need for longitudinal or experimental designs in future studies. Additionally, the reliability of the anxiety scale is acceptable mentioned in realiability part, and we acknowledge the limitations of self-reported data, suggesting more objective measures in future research. In response to your request, we have clarified the statistical analyses to improve transparency. The Discussion now includes a more critical comparison with existing literature, addressing inconsistencies and practical significance of the results. We have also provided more detailed ethical considerations, explaining how confidentiality, anonymity, and informed consent were ensured. Moreover, some content of limitations were changed, followed by recommendations accordingly added. Also, an implementation section was added to the article. Finally, the Conclusion has been revised to better summarize the study’s key findings and their practical implications for clinical practice and policy. These revisions strengthen the manuscript and we hope they address your concerns. Thank you again for your valuable feedback. Competing Interests: No competing interests were disclosed. Close Report a concern Respond or Comment COMMENTS ON THIS REPORT Author Response 09 Aug 2025 Saeid Motevalli , Psychology, UCSI University, Kuala Lumpur, 56000, Malaysia 09 Aug 2025 Author Response Thank you for your insightful feedback. We have made several revisions to address your concerns and improve the manuscript. To begin, we have included research objectives at abstract part ... Continue reading Thank you for your insightful feedback. We have made several revisions to address your concerns and improve the manuscript. To begin, we have included research objectives at abstract part and the end of introduction part, providing a clear roadmap for the study that was previously missing. Regarding the sample size, we have provided a detailed rationale for the 136 participants, explaining how the size was determined using G*Power analysis to ensure adequate statistical power and representativeness for children in Hefei, Anhui Province. We have expanded the discussion on the limitations of the cross-sectional design, addressing potential confounding variables and the need for longitudinal or experimental designs in future studies. Additionally, the reliability of the anxiety scale is acceptable mentioned in realiability part, and we acknowledge the limitations of self-reported data, suggesting more objective measures in future research. In response to your request, we have clarified the statistical analyses to improve transparency. The Discussion now includes a more critical comparison with existing literature, addressing inconsistencies and practical significance of the results. We have also provided more detailed ethical considerations, explaining how confidentiality, anonymity, and informed consent were ensured. Moreover, some content of limitations were changed, followed by recommendations accordingly added. Also, an implementation section was added to the article. Finally, the Conclusion has been revised to better summarize the study’s key findings and their practical implications for clinical practice and policy. These revisions strengthen the manuscript and we hope they address your concerns. Thank you again for your valuable feedback. Thank you for your insightful feedback. We have made several revisions to address your concerns and improve the manuscript. To begin, we have included research objectives at abstract part and the end of introduction part, providing a clear roadmap for the study that was previously missing. Regarding the sample size, we have provided a detailed rationale for the 136 participants, explaining how the size was determined using G*Power analysis to ensure adequate statistical power and representativeness for children in Hefei, Anhui Province. We have expanded the discussion on the limitations of the cross-sectional design, addressing potential confounding variables and the need for longitudinal or experimental designs in future studies. Additionally, the reliability of the anxiety scale is acceptable mentioned in realiability part, and we acknowledge the limitations of self-reported data, suggesting more objective measures in future research. In response to your request, we have clarified the statistical analyses to improve transparency. The Discussion now includes a more critical comparison with existing literature, addressing inconsistencies and practical significance of the results. We have also provided more detailed ethical considerations, explaining how confidentiality, anonymity, and informed consent were ensured. Moreover, some content of limitations were changed, followed by recommendations accordingly added. Also, an implementation section was added to the article. Finally, the Conclusion has been revised to better summarize the study’s key findings and their practical implications for clinical practice and policy. These revisions strengthen the manuscript and we hope they address your concerns. Thank you again for your valuable feedback. Competing Interests: No competing interests were disclosed. Close Report a concern COMMENT ON THIS REPORT Comments on this article Comments (0) Version 3 VERSION 3 PUBLISHED 15 Jan 2025 ADD YOUR COMMENT Comment keyboard_arrow_left keyboard_arrow_right Open Peer Review Reviewer Status info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Reviewer Reports Invited Reviewers 1 2 Version 3 (revision) 05 May 26 read Version 2 (revision) 30 Jul 25 read Version 1 15 Jan 25 read Mohtaram Rabbani , Hong Kong University, Hong Kong, China Mahmoud Danaee , University of Malaya, Kuala Lumpur, Malaysia Comments on this article All Comments (0) Add a comment Sign up for content alerts Sign Up You are now signed up to receive this alert Browse by related subjects keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2026 Danaee M. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 13 May 2026 | for Version 3 Mahmoud Danaee , University of Malaya, Kuala Lumpur, Malaysia 0 Views copyright © 2026 Danaee M. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Authors addressed all my comments. Competing Interests No competing interests were disclosed. Reviewer Expertise Research methodology and statistical analysis I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. reply Respond to this report Responses (0) Danaee M. Peer Review Report For: The influence of anxiety-related emotional disorders and self-esteem on obesity among Chinese children [version 3; peer review: 1 approved, 1 approved with reservations] . F1000Research 2026, 14 :84 ( https://doi.org/10.5256/f1000research.200432.r481764) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/14-84/v3#referee-response-481764 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2025 Danaee M. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 03 Sep 2025 | for Version 2 Mahmoud Danaee , University of Malaya, Kuala Lumpur, Malaysia 0 Views copyright © 2025 Danaee M. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (1) Approved With Reservations info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions The manuscript mentions “random sampling” only in Results. Sampling procedures should be reported in Methodology. It is recommended to provide more details on how random sampling was conducted (e.g., sampling frame, sampling process and discuss them in more detail to allow the reader to understand the representativeness of the sample and potential sources of bias. Description of sample size calculation is not clear enough. The study states that GPower was used to calculate a sample size of 136 but does not mention the specific statistical test or method used within GPower. Since the study conducted a multivariate linear regression analysis, the assumptions made (e.g., type of test, number of predictors, effect size) should have been specified. Without this information, it is unclear if the reported sample size was appropriate for the planned analyses. It is not reported whether the instruments used in the study were validated or tested for reliability through a pilot study. Validity and reliability should be reported to ensure that the instruments used accurately measure the intended constructs and provide consistent results. Since a multivariate linear regression analysis was conducted, it would be important to report whether the key assumptions of regression (normality of the dependent variable, linearity, homoscedasticity, multicollinearity among predictors) were checked. Checks for normality, linearity, homoscedasticity, and multicollinearity should have been conducted and reported, as violations of these assumptions could impact the validity of the findings. It is unclear whether the final regression model included gender, age, or other potential confounding variables. it should be made clear whether these factors were controlled for in the analysis to rule out biased or misleading results. Is the work clearly and accurately presented and does it cite the current literature? Yes Is the study design appropriate and is the work technically sound? Yes Are sufficient details of methods and analysis provided to allow replication by others? Partly If applicable, is the statistical analysis and its interpretation appropriate? Partly Are all the source data underlying the results available to ensure full reproducibility? Partly Are the conclusions drawn adequately supported by the results? Yes Competing Interests No competing interests were disclosed. Reviewer Expertise Research methodology and statistical analysis I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. reply Respond to this report Responses (1) Author Response 29 Apr 2026 Saeid Motevalli, Psychology, UCSI University, Kuala Lumpur, 56000, Malaysia Thank you for your valuable comments. The sampling procedure has been moved to the Methods section and further elaborated to clarify the sampling frame, process, and potential sources of bias . Additional details on the G*Power analysis, including the statistical test, effect size, number of predictors, and assumptions, have been clarified in the Methods section to justify the adequacy of the sample size. Modifications have been made to the Methods section to strengthen the methodological rigor of the study . Information regarding the assessment of regression assumptions, including normality, linearity, homoscedasticity, and multicollinearity, has been added to the data analysis part. The manuscript has been revised to clarify that demographic variables such as age and gender were considered but not included in the final regression model is now acknowledged. We hope that these revisions have adequately addressed the reviewer’s concerns and improved the clarity and rigor of the manuscript. Thank you again for your insightful feedback. View more View less Competing Interests No competing interests were disclosed. reply Respond Report a concern Danaee M. Peer Review Report For: The influence of anxiety-related emotional disorders and self-esteem on obesity among Chinese children [version 3; peer review: 1 approved, 1 approved with reservations] . F1000Research 2026, 14 :84 ( https://doi.org/10.5256/f1000research.184521.r405305) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/14-84/v2#referee-response-405305 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2025 Rabbani M. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 21 Feb 2025 | for Version 1 Mohtaram Rabbani , Hong Kong University, Hong Kong, China 0 Views copyright © 2025 Rabbani M. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (1) Approved With Reservations info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Please add research objectives at the beginning to provide a clear roadmap for the study and guide the reader through the research aims. Please provide a rationale for the sample size of 136 participants and discuss its representativeness for the broader population of Chinese children. Consideration of statistical power and sample adequacy could strengthen the study's findings. Address the limitations of the non-experimental, cross-sectional design by discussing potential confounding variables and alternative explanations for the observed relationships. Consider incorporating longitudinal or experimental designs for future studies. Given the reliability issues identified in the school avoidance scale, consider revising or validating the measurement tools to ensure their accuracy and reliability. Discuss the limitations of self-reported data and potential biases. Provide a more detailed explanation of the statistical analyses conducted, including assumptions, model fit statistics, and potential interactions among variables. Consider exploring additional statistical methods to strengthen the predictive models. Provide a more critical discussion of the study's findings by comparing them to existing literature, addressing inconsistencies, and explaining the implications of the results for theory and practice. Consider discussing the practical significance of the results in addition to statistical significance. While mentioning ethical considerations is important, provide more details on how confidentiality and anonymity were ensured, how participants were recruited, and how potential biases were mitigated. Consider discussing any potential conflicts of interest or funding sources. Offer concrete suggestions for future research directions based on the study's limitations and findings. Propose ways to address the identified issues and further explore the complex relationships between anxiety-related emotional disorders, self-esteem, and obesity. Strengthen the conclusion by summarizing key findings, discussing their implications for clinical practice and policy, and highlighting the significance of the study within the broader context of childhood obesity research. Consider addressing the practical implications for intervention programs. Is the work clearly and accurately presented and does it cite the current literature? Partly Is the study design appropriate and is the work technically sound? Partly Are sufficient details of methods and analysis provided to allow replication by others? Partly If applicable, is the statistical analysis and its interpretation appropriate? Partly Are all the source data underlying the results available to ensure full reproducibility? Partly Are the conclusions drawn adequately supported by the results? Partly Competing Interests No competing interests were disclosed. Reviewer Expertise NA I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. reply Respond to this report Responses (1) Author Response 09 Aug 2025 Saeid Motevalli, Psychology, UCSI University, Kuala Lumpur, 56000, Malaysia Thank you for your insightful feedback. We have made several revisions to address your concerns and improve the manuscript. To begin, we have included research objectives at abstract part and the end of introduction part, providing a clear roadmap for the study that was previously missing. Regarding the sample size, we have provided a detailed rationale for the 136 participants, explaining how the size was determined using G*Power analysis to ensure adequate statistical power and representativeness for children in Hefei, Anhui Province. We have expanded the discussion on the limitations of the cross-sectional design, addressing potential confounding variables and the need for longitudinal or experimental designs in future studies. Additionally, the reliability of the anxiety scale is acceptable mentioned in realiability part, and we acknowledge the limitations of self-reported data, suggesting more objective measures in future research. In response to your request, we have clarified the statistical analyses to improve transparency. The Discussion now includes a more critical comparison with existing literature, addressing inconsistencies and practical significance of the results. We have also provided more detailed ethical considerations, explaining how confidentiality, anonymity, and informed consent were ensured. Moreover, some content of limitations were changed, followed by recommendations accordingly added. Also, an implementation section was added to the article. Finally, the Conclusion has been revised to better summarize the study’s key findings and their practical implications for clinical practice and policy. These revisions strengthen the manuscript and we hope they address your concerns. Thank you again for your valuable feedback. View more View less Competing Interests No competing interests were disclosed. reply Respond Report a concern Rabbani M. Peer Review Report For: The influence of anxiety-related emotional disorders and self-esteem on obesity among Chinese children [version 3; peer review: 1 approved, 1 approved with reservations] . F1000Research 2026, 14 :84 ( https://doi.org/10.5256/f1000research.172179.r365605) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. 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