Intersectionality of Obesity, Socioeconomic Conditions, and Mental Well-Being in Children: A Systematic Review

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This systematic review aims to examine the impact of childhood obesity on psychological outcomes and to identify effective therapies and prevention strategies. Methods: Studies were included if they investigated the link between childhood obesity and psychological effects. A comprehensive literature search was conducted using electronic databases, including Google Scholar, PubMed, and CINAHL, in accordance with specific inclusion and exclusion criteria. Selected studies were analyzed using a thematic approach to gather and synthesize data. Results: The review encompassed ten studies. Childhood obesity has been associated with various adverse psychological effects, including depression, anxiety, conduct issues, behavioral problems, and low self-esteem. Strategies such as promoting healthy behaviors, addressing socioeconomic disparities, early detection and intervention, personalized treatments, and timely intervention have proven effective in improving psychological outcomes. Conclusion: Since childhood obesity significantly affects psychological well-being, effective treatments and prevention measures are essential to address this growing public health challenge. Experts recommend early detection and intervention, personalized therapies, promotion of healthy lifestyles, and tackling social and economic inequalities to improve psychological health in children with obesity. childhood obesity psychological well-being melancholy anxiety conduct problems behavioral problems reduced self-esteem socioeconomic determinants Figures Figure 1 Introduction Globally, there exists a significant public health concern regarding childhood obesity. The Centers for Disease Control and Prevention (CDC) characterizes obesity as having a body mass index (BMI) of 30 kg/m² or higher [ 1 ]. Obesity and mental health may be linked, especially in adolescent females, influenced by stigma, body image, nutrition, and physical restrictions [ 2 ]. Lifestyle modifications can elevate the risk of obesity and emotional eating, whereas grief may exert an opposing influence [ 3 ]. Reproductive hormones in adolescent females can contribute to the development of obesity and inflammatory processes [ 4 ]. Parental influences have a significant impact on the mental health and obesity of children, affecting their eating behaviors, activity levels, and emotional well-being. Environmental factors such as access to nutritious food, safe recreational areas, and supportive social environments are of critical importance. Environments conducive to health reduce the prevalence of obesity and enhance mental health, whereas resource scarcity increases associated risks [ 5 , 6 ]. Sociocultural variables, including societal norms, social support systems, and peer influences, also shape health outcomes. Positive social environments foster healthy habits, while cultural norms that favor sedentary behaviors heighten the risks [ 7 , 8 ]. Socioeconomic status exerts an impact on obesity and mental health, with lower income and educational attainment associated with increased risks due to limited resources, elevated stress levels, and reduced health literacy [ 9 , 10 ]. The prevalence of childhood obesity has increased significantly. It is anticipated that this trend will persist in the years to come. Childhood obesity has been linked to various physical health problems, such as diabetes, heart disease, and stroke [ 11 ]. Over the past few decades, the rate of pediatric obesity has steadily risen, along with several adverse psychological effects like anxiety, depression, and low self-esteem [ 12 ]. The WHO estimates that in 2019, 38 million children under five were overweight or obese [ 13 ]. Projections suggest that by 2025, 70 million children will be overweight or obese, posing a significant public health concern. Children often gain excessive weight due to a lack of physical activity and unhealthy eating habits [ 14 ]. Many health professionals are concerned about the rapidly increasing rate of childhood obesity. This condition affects approximately 5–10% of children in developed countries and is linked to various health risks [ 14 ]. The psychological effects of childhood obesity can be profound and widespread, affecting both a person's overall quality of life and mental well-being [ 15 ]. Children who are overweight or obese may face negative stereotypes and attitudes from peers and adults, which can lead to social exclusion, prejudice, and low self-esteem [ 16 ]. The stigma linked to obesity can also result in body dissatisfaction and poor self-image, which can harm mental well-being. The connection between childhood obesity and mental health outcomes is complex and intricate [ 17 ]. The impact of childhood obesity extends beyond physical health to encompass mental well-being and overall quality of life. Despite the growing concern about the psychological effects of childhood obesity, research in this area is lacking [ 18 ]. Most studies have focused on the physical health consequences of obesity, and there is a need to investigate the psychological effects of this health problem. Understanding the impact of childhood obesity on psychological well-being is essential for developing effective interventions that address both physical and mental health issues. Studies have indicated that obese children are more likely than nonobese children to experience sadness and anxiety [ 19 ]. The association between pediatric obesity and mental health outcomes is impacted by several factors, including sex, age, and socioeconomic position, which is one explanation for the contradictory results [ 20 ]. Studies have also revealed that, compared with boys, females are more strongly linked with obesity and mental health outcomes. Another study showed that children of poorer socioeconomic origin had a greater correlation between obesity and mental health outcomes [ 21 ]. Although childhood obesity may have psychological effects, few studies have been conducted in this area. There is a need to look at the psychological repercussions of this health issue because the majority of studies have concentrated on the physical health effects of obesity. To create successful therapies that address both physical and mental health concerns, comprehending how childhood obesity affects psychological wellness is crucial [ 18 ]. The changing mental health of children and adolescents is not sufficiently reflected in this concept of mental health in adulthood [ 22 ]. Children are learning and developing the psychosocial skills necessary to navigate life [ 23 ]. They also lack the verbal and cognitive abilities to recognize and express their feelings [ 21 ]. Nevertheless, the optimal therapies to mitigate the adverse effects of childhood obesity on both physical and mental health remain somewhat unclear. To evaluate the existing body of research on the impact of childhood obesity on psychological well-being, this systematic review focuses on the fundamental processes that link childhood obesity to psychological health. Additionally, it examines the efficacy of therapeutic interventions designed to mitigate these adverse effects. The purpose of this review is to identify existing knowledge gaps and highlight areas requiring further investigation, thereby informing the development of effective strategies to enhance the health and well-being of children and adolescents. This objective is achieved through a comprehensive review of the pertinent literature. Methods and Materials As previously indicated, this systematic review emphasizes the various significant effects of childhood obesity on the psychological well-being of children. Accordingly, a systematic review methodology was employed, which involves comprehensive data analysis on a specified topic, adhering to an analytical process that includes locating, classifying, and evaluating pertinent research [ 24 ]. Unlike primary researchers, systematic reviewers do not seek access to confidential, sensitive, or classified information. Furthermore, systematic reviewers rarely seek institutional ethical approval before commencing their work and frequently use publicly accessible records as evidence. Registered with PROSPERO under the registration number CRD42024513690, this review addresses a critical question: how does exposure to childhood obesity influence the psychological well-being of children? To derive a scientific response, we adhered to the PEO framework, which facilitates demonstrating the causal relationship between exposure and outcomes [ 25 ]. P (Population) Children (Below 13 years) E (Exposure) Obesity O (Outcome) The effects of childhood obesity on psychological well-being Researchers can investigate potential causative relationships by analyzing the impact of childhood obesity (exposure) on psychological well-being (outcome) within a specific community. This information is crucial for understanding the impact of obesity on mental health and for informing therapeutic interventions and preventive measures. Researchers can concentrate their efforts on examining the particular issues faced by this age group by identifying the population of interest (children) through the Population, Exposure, and Outcome (PEO) framework. Such information can facilitate the development of targeted treatments, regulations, and programs that effectively address the psychological consequences of childhood obesity. The PEO framework promotes a comprehensive analysis of the subject by considering multiple factors [ 6 ]. Juvenile obesity is a complex issue with varied effects. The framework recognizes the significance of both physical and mental health in understanding how obesity impacts society by incorporating psychological well-being as a key outcome. Search strategy We conducted searches in academic databases, including Google Scholar, PubMed, and CINAHL, to find relevant literature. To find reliable material on the study topic, a variety of keywords were used. The specifications for this dissertation's enclosure were contrasted with those for summaries of longer works. The criteria and viewpoint approaches were used to analyze the lengthy articles. The published references were also used in the manual search process. Keywords associated with the subject were used to obtain the data. To provide a more focused and efficient search that eliminates duplicate and irrelevant information while reducing the number of publications, Boolean operators (AND, NOT, and OR) were used. Keywords such as “Childhood obesity” OR “Overweight children” AND “Body mass index” AND “Psychological well-being” OR “Mental health” AND “Quality of life” AND “Self-esteem” were used to ensure dependable and accurate data collection. Inclusion and Exclusion Criteria The methodology of this study involved meticulous adherence to predetermined inclusion and exclusion criteria to guarantee the robustness and pertinence of the data analyzed. The inclusion criteria were specified as follows: firstly, studies considered for inclusion were those published within the timeframe from 2013 to 2023. This period was selected to encompass the most recent research findings while providing a substantial body of literature for review. Secondly, only studies that had been translated and made accessible in English were included, aiming to mitigate language barriers and ensure broader accessibility. Lastly, the study incorporated research published in journals with an established impact factor, serving as a quality assurance measure, as such journals are typically recognized for their rigorous peer-review processes and scholarly contributions. Conversely, exclusion criteria were established to omit studies that did not meet specific standards considered essential for the study's objectives. Studies published before 2013 were excluded to focus on recent developments and advancements within the relevant field. Additionally, studies not available in English were excluded to facilitate comprehension and analysis by the research team and potential readers. Finally, research published in journals lacking a peer-review process was excluded, given that such publications may not adhere to the same standards of academic rigor and quality control as peer-reviewed journals. By rigorously applying these inclusion and exclusion criteria, the study aimed to ensure the selection of high-quality, relevant literature for analysis. This methodological approach enhances the validity and reliability of the findings, enabling the derivation of meaningful conclusions and contributing to the advancement of knowledge within the research domain. Screening of Studies A systematic review screening procedure is instrumental in evaluating the quality and relevance of the included research. Initially, duplicates were removed after importing all search results into a reference management system. Subsequently, the titles and abstracts of all articles were meticulously examined to ascertain their eligibility for inclusion in the review. Each study underwent a comprehensive assessment to determine whether it met predetermined inclusion criteria, which encompassed factors such as participant age range, methods for assessing psychological health and childhood obesity, and research design. Studies that failed to meet these criteria were excluded at this stage. Following this initial screening, the full texts of the remaining articles were obtained for further evaluation to confirm their suitability for inclusion. This process involved a detailed examination of study design, sample size, participant characteristics, outcome measures, and potential biases or conflicts of interest. To ensure accuracy and consistency, two or more impartial reviewers collaboratively conducted the screening. Any disagreements were resolved through discussion or consultation with a third reviewer. Employing a rigorous screening methodology in a systematic review ensures that only studies meeting established criteria are included, thereby facilitating a high-quality synthesis of data concerning the impacts of childhood obesity on psychological well-being. Each study that fulfilled the inclusion and exclusion criteria was carefully scrutinized. The importance and influence of abstracts were critically analyzed for identifying pertinent research, with abstracts serving as indicators of original research publications. The initial search yielded 10,320 studies. After removing duplicates, 5,481 studies remained. A total of 2,569 studies were excluded due to the presence of primary and secondary outcomes. The review of study designs resulted in the exclusion of 188 publications. Additionally, 129 articles were excluded owing to irrelevance, including conference papers, commentary articles, and publications with insufficient data. Consequently, ten studies remained for comprehensive examination (see PRISMA Fig. 1 ). The Critical Appraisal Skills Programme (CASP) confirmed that all selected studies were of high quality (see Table 2 ). Table 1 Summary of the outcomes of all included studies Author (s) and Year of publishing Aim Methods Sample Key findings Conclusion (Newson et al., 2013) The purpose of this study is to determine whether or not maltreatment in childhood is associated with obesity or body mass index at various ages. Cross-sectional study 16,527 participants Children who are overweight have an increased risk of developing mood disorders such despair, anxiety, and paranoia. Suicidal ideation and behavior are more common among overweight children and adolescents than among their physically healthy peers. Children and adolescents are more vulnerable to mood disorders like bipolar disorder and depression than adults. (Robinson and Sutin, 2017) The purpose of this study was to gain insight into families' perspectives on a program designed to reduce juvenile obesity and to identify the factors that influence participation and long-term behavior change. Interpretative analysis 46 children Children with disruptive disorders had higher body mass indices than children without these disorders, suggesting that behavioral issues in childhood and early adolescence are linked to an increased risk of obesity in young adulthood. Preadolescent overweight children are more likely to have behavioral problems than their classmates who are a healthy weight. (Adab et al., 2018) The purpose of this study is to investigate the connection between children's food access, economic disadvantage, and obesity. Cross-sectional study 345 children School-aged overweight children showed higher incidence of full-blown hyperactivity disorder compared to children of the same age having normal weight. Children with ADHD are more likely to be overweight, more likely to be obese, and more likely to become overweight if they are not taking medication to treat their ADHD (Johnson et al., 2015) To evaluate parents’ opinions of their children as overweight Longitudinal study 311 children Child body dissatisfaction, feelings of worthlessness, and confidence are all found to be higher in obese children. Children who are overweight often experience a deterioration in self-esteem over time, with adolescents reporting a greater loss of physical self-worth than younger children. (Cetateanu and Jones, 2014) Examine a healthy lifestyle programme aimed at reducing childhood obesity and implementing it in schools and homes. Cluster randomized controlled trial 980 children There is a substantial relation between eating disorders and obesity in several areas of psychosocial dysfunction, and girls were especially susceptible to having both mood and eating issues at once. A family-based intervention with sustained follow-up significantly enhanced the subjects' emotional and physical health. Children who were overweight saw improvements in their grades after participating in treatment programs that stressed the importance of exercise and healthy eating. (Fraser et al., 2012) The purpose of this study was to examine the associations between children's obesity and several possible correlates, including intensity-specific physical activity. Cross sectional study 245 children To promote healthy lifestyle changes within families, interventions focused on parenting and attachment concerns, behavioral variables, and self-management. The ability to recognize one's own underlying motivations and barriers to change improved significantly as a result of family interventions. (Karhunen et al., 2021) The goal of this study was to see if the results of mental health issues in children had altered over the past four decades. Millennium cohort study 35924 participants Children who were overweight were more likely to have behavioral issues and abusive ethics. Eating disorders and ineffective weight-control methods are all linked to obesity-related teasing. (Wilkie et al., 2018) To examine the correlation between eating at fast food restaurants and being overweight among teens. Cohort study 4827 participants Overweight children were more likely to experience psychosocial discomfort and to have worse socioeconomic status and psychological well-being than their leaner peers. Overall health-related quality of life and depression symptoms were significantly reduced in clinically obese children. (Power, Pinto Pereira and Li, 2015) The purpose of this study was to analyze how the prevalence of overweight and obesity in children and adults has changed later. Longitudinal study 56,632 participants Overweight children and teens were more likely to be isolated from social networks and less regarded as friends. Characteristics of children who were overweight were selfishness, laziness, isolation, dysfunctional social relationships, and poor academic performance. (Sellers et al., 2019) To investigate whether or whether symptoms of hyperactivity disorder are correlated with obesity. Longitudinal study 3834 samples Early behavior difficulties including disobedience, aggression, property damage, and cruelty are linked to overweight young people. Self-reported ADHD was more common among overweight adolescents than among obese ones. Table 2 CASP tool scores of the included studies Authors Was there a clear statement of aims of research? Is a qualitative methodology appropriate? Was the research design appropriate to address the aims of research? Was the recruitment strategy appropriate to the aims of research? Was the data collected in a way to address the research issue? Has the relationship between researcher and participants adequately considered Have the ethical issues been taken into consideration? Was the data analysis sufficiently rigorous? Is there a deer statement of finding? How valuable is the research? Score (Newson et al., 2013) + + + + + + + + + + 10/10 (Robinson and Sutin, 2017) + + + - + + + + + + 9/10 (Adab et al., 2018) + + + + + + + + + + 10/10 (Johnson et al., 2015) + + + + + + + + + + 10/10 (Cetateanu and Jones, 2014) - + + + - + + + - + 7/10 (Fraser et al., 2012) + + + - + + + + + + 9/10 (Karhunen et al., 2021) + + + + + + + + + - 10/10 (Wilkie et al., 2018) + + + + + + - + + + 9/10 (Power, Pinto Pereira and Li, 2015) + + + + - + + + + + 9/10 (Sellers et al., 2019) - + + + - + + + - + 7/10 Literature Review Analysis Reading the complete articles and abstracts allowed us to filter any extraneous information. An analysis of the quantity of published research was conducted utilizing a standardized data gathering method. The names of the authors, publication dates, primary research phases, types, and patient counts for each study were included, along with details about them. The findings were compiled into a table that contains a list of clearly stated implications, along with an explanation for each one. The results were analyzed thematically. By employing proven methods for identifying and generating analytical themes in original research data, thematic analysis aims to synthesize secondary data [ 26 ]. For numerous reasons, this review opted for theme synthesis [ 27 ]. It is, first and foremost, ideally suited to the current goal of combining accessible information and identifying data patterns. The results of quantitative investigations are summarized thematically, especially when there are varying outcomes. Finally, the topic synthesis process is open, and outcomes are easily accessible [ 28 ]. The thematic analysis technique enables researchers to explore and interpret the data in great depth and nuance. For various reasons, the thematic analysis stage of the data analysis process is crucial. This analysis can be used to highlight the complexity of the data and the diversity of participant experiences. Significant amounts of qualitative data may be organized and interpreted with the help of thematic analysis. By identifying themes within the data, researchers can organize and categorize the information in a way that is both meaningful and easy for others to understand. This could help in providing a concise and understandable summary of the study's primary findings. Additionally, a thorough and meticulous approach to data analysis is facilitated through thematic analysis. By employing a structured and transparent methodology, researchers can ensure that a comprehensive and methodical analysis of the data supports their findings. This can enhance the reliability and validity of the study's results. Ethical considerations Since a systematic review constitutes a secondary analysis of previously published research, the collection of new data from human participants is not required. Consequently, there was no necessity for an ethical review of this study. To uphold the confidentiality and privacy of the research participants whose data were analyzed in the included studies, ethical considerations remained integral to the investigation. To safeguard participant anonymity and privacy, only de-identified data were provided in the subsequent research. This approach ensured that only studies with ethical approval and adherence to recognized ethical standards were included. Studies that did not meet established ethical criteria or lacked ethical support were excluded from the analysis. The study was conducted transparently and objectively, with any potential conflicts of interest or biases identified and appropriately addressed. Results Childhood Obesity Induced Depression and Behavioral Issues According to Newson et al. (2013), obese children are more prone to depression and internalizing conditions like anxiety and paranoia, with higher body weight linked to increased psychological distress [ 29 ]. Obesity prevalence is higher among children under stress. Overweight children show more psychological problems than their non-obese peers. Mood disorders related to obesity are more common in children and adolescents, especially depression and bipolar disorder [ 29 ]. Psychological issues in children increase their risk of suicidal thoughts and attempts. It's crucial to consider social and family factors when assessing the risk of weight gain. Robinson and Sutin (2017) found that prepubescent children with behavioral disorders also tend to have higher BMIs. These children, especially those with disruptive disorders, are more likely to be overweight, possibly linking childhood behavioral issues to overweight in early adulthood [ 30 ]. These associations remain even after accounting for parental and lifestyle factors. Most behavioral problems in overweight children don't develop into full disorders, but they do show higher ADHD symptoms like impulsiveness and inattentiveness compared to normal-weight children. Sellers et al. (2019) analyzed adolescent outcomes in children with early mental health problems by comparing data from two major UK birth cohorts [ 31 ]. Their findings demonstrated that adolescents in the more recent cohort experienced significantly worse outcomes in areas such as education, peer relationships, and behavioral functioning compared to those in the earlier cohort. These differences suggest a compounding effect of modern stressors on existing psychological vulnerabilities [ 31 ]. The study reinforces the notion that children with pre-existing mental health challenges, including those with obesity, may face amplified difficulties over time due to shifts in societal pressures and environments. Similarly, Adab and colleagues (2018) reported that obese children exhibited higher incidences of hyperactivity disorder compared to children of the same age with normal weight. There appears to be an association between clinical diagnoses of childhood obesity and ADHD symptoms in comparison to the general population [ 32 ]. Additionally, they noted that early behavioral issues such as resistance, disobedience, aggression, property damage, and cruelty to others have been linked to overweight young individuals and children with ADHD [ 32 ]. The atypical increase in BMI during early adulthood or adolescence has also been associated with these early childhood behaviors. Overweight adolescents reported a higher prevalence of ADHD. Furthermore, children with ADHD are more likely to be of normal weight rather than obese. Self-esteem, Bullying, and Obesity Johnson and colleagues (2015) found that obese or overweight children have lower self-esteem, experience more body dissatisfaction, and have poorer self-evaluations than normal-weight children. Gender differences are inconsistent; overweight women rate their attractiveness and self-worth more negatively than men, but both genders show a link between obesity and low self-esteem [ 33 ]. As children age, especially if overweight, their self-esteem drops, notably regarding physical appearance. Parental sensitivity to obesity correlates with a child's self-esteem, but parenting does not affect body dissatisfaction [ 33 ]. Karhunen and colleagues (2021) found that overweight or obese children face more psychosocial issues like peer concerns, attentional and emotional problems compared to healthy-weight children [ 34 ]. These issues are linked to early obesity, worsening with age. Bullying and teasing, driven by stigma, harm their psychological health, leading to lower self-esteem and mental health issues, especially in adolescents. Such children also tend to perform worse academically, have poorer social lives, and are more affected by peer rejection, social stigma, eating disorders, and weight-control problems. Power and colleagues (2015) studied children with obesity, finding they often show traits like agitation, inactivity, social isolation, low academic achievement, and limited social engagement [ 35 ]. Overweight children tend to be less healthy, eat poorly, and exercise less than their healthy peers. Their belief that they can control their weight may exacerbate stigma. Adolescents, particularly girls, are subjected to increased insults, and overweight women are less likely to engage in dating and experience higher levels of victimization. Overweight children and teens are more socially isolated, excluded, and less likely to be appreciated or chosen as friends. Preschoolers with weak social ties are more prone to overweight and obesity. Eating Disorders and Obesity Obesity and eating disorders are also interconnected. Cetateanu and Jones (2014) indicated that females are more vulnerable to concurrent eating and mood disturbances [ 36 ]. In numerous cases of psychological dysfunction, obesity and eating disorders exhibit considerable similarities. Furthermore, overweight women often engage in severe weight-control practices, such as inducing vomiting, using laxatives, fasting, smoking, and consuming diet pills. The study also found that individuals with obesity are more likely to develop restrictive eating disorders. A notable proportion of individuals with a history of childhood obesity who are attempting weight loss show an increased incidence of mood disorders and a higher prevalence of bulimia nervosa. Compared to their healthy-weight peers, overweight children and adolescents exhibit greater dissatisfaction with their bodies, psychosocial difficulties, and engage in excessive dieting behaviors [ 36 ]. Academic Outcomes and Obesity Johnson and colleagues (2015) reported that obese children were more likely to experience psychosocial discomfort than their nonobese classmates were and that they often had lower average living standards and mental health [ 33 ]. Additionally, poor academic achievement in adolescence and childhood is a strong predictor of obesity later in life. Psychosocial variables such as body dissatisfaction and bullying based on weight may attenuate the impact of obesity on children's well-being. It has also been demonstrated that young people who follow a healthy diet and engage in regular exercise frequently perform better on cognitive and academic examinations. The addition of gender, family structure, parental education, depressed mood, absenteeism, self-esteem, BMI, diet, and physical activity may account for the variation in academic success. Wilkie et al. (2018) investigated the relationship between physical activity levels and weight status and psychological well-being in children aged 9–11 years [ 37 ]. The study found that children who engaged in more moderate-to-vigorous physical activity had lower BMIs and better mental health, while those from socioeconomically disadvantaged backgrounds were less active overall. This inactivity may contribute to both elevated obesity risk and emotional difficulties, especially in vulnerable populations [ 37 ]. Their results emphasize the importance of targeted interventions that increase physical activity as a dual strategy to improve both physical and psychological health outcomes. Interventions to reduce obesity Fraser and colleagues (2012) reported that comprehensive interventions that prioritize physical exercise and a healthy diet for overall academic attainment were beneficial for overweight children [ 38 ]. The emotional and physical health of the participants also improved with a family-based intervention and maintenance follow-up. Individual variations in setting appealing weight loss objectives were incorporated into interventions. To prevent veering from the short-term results gained, follow-up treatment was given. To promote the adoption of a healthy lifestyle, family interventions focus on attachment difficulties and self-management treatments. When attitudes around obesity began to change, steps were taken to reduce stigma. It was also claimed that motivational interviewing is a guided approach to treating obesity, assisting people in examining and understanding their intrinsic motivations and barriers to change [ 38 ]. Discussion This review highlights research results on the psychological impacts of childhood obesity. Obesity-related problems have been found to have a significant and enduring impact on individuals' overall well-being, including their physical health, as well as their psychological, psychosocial, and psychiatric functioning. The potential for enduring and persisting health issues into adulthood is a significant concern, as it increases the likelihood of long-term health complications [ 39 ]. The results of the current study show that childhood obesity is linked to children's low self-esteem, emotional and behavioral issues, reported poor health-related quality of life, sadness, and other comorbid psychological conditions. These findings confirm the findings of other studies from this age, which revealed that psychological problems are more prevalent in overweight children and adolescents than in their peers, who are healthy in weight [ 40 ]. These findings indicate that adult obesity and depression have mutually reinforcing relationships, with melancholy also predicting the onset of obesity. Owing to various study findings, the evidence for the mental condition of ADHD patients is still debatable. Many studies have revealed a link between overweight or obesity and ADHD [ 41 ]. Children with early-onset, persistent ADHD in infancy and adolescence are more likely to become obese than adults are. There is a potential correlation between ADHD and weight gain in children, as well as between obesity and the likelihood of being diagnosed with ADHD [ 42 ]. According to recent research findings, children who are obese are at greater risk of developing a variety of mental conditions than their healthy peers. Similarly, bullying, obesity stigma, and adolescent treatment use may influence how closely mental diseases, psychosocial issues, and obesity are related in a recent study [ 43 ]. Stigmatization typically manifests as harmful stereotypes, victimization, and social exclusion. The findings of Järvholm and colleagues (2020) suggest that negative attitudes toward overweight and obese adults are reflected by children, irrespective of their gender or weight status, as a result of societal and parental influences. The present study investigated the relationship between preadolescent girls' weight status and their perceived beauty while controlling for popularity level. Specifically, the study examines whether overweight girls are less likely to be viewed as beautiful than their nonoverweight peers are, even when their popularity levels are similar. The present study investigated the relationships between weight teasing and actual weight among different age groups. The results indicate a strong positive correlation between weight teasing and real weight in younger adolescents, which gradually decreases as they age [ 44 ]. Bullying and teasing connected to obesity are widespread and can have adverse emotional and physical effects. Several public health efforts to address obesity aim to induce weight loss in young, overweight children and teens, sometimes by employing harsh methods [ 45 ]. This implies that social stigmas against fat may contribute to illnesses or psychological issues. Among those who are predisposed to developing obesity, psychological conditions may play a substantial role in their personality development. Fighting childhood and teenage obesity requires action and intervention [ 46 ]. During this critical growth stage, children are more prone to obesity and psychological problems. Childhood obesity is more likely to develop and persist until adulthood [ 47 ]. In contrast to their nonobese counterparts, obese children and adolescents have greater rates of depression, anxiety, and low self-esteem, according to another comprehensive study [ 48 ]. Similarly, Bradwisch and colleagues (2020) discovered a link between childhood obesity and a greater risk of emotional and behavioral issues [ 49 ]. This evaluation, which is consistent with other studies, also revealed efficient therapies and preventative approaches for enhancing psychological outcomes in obese children. For example, a comprehensive review showed that behavioral, nutritional, and physical activity treatments can help improve the psychological outcomes of children with obesity [ 49 ]. Similarly, Dalsgaard, McGrath, et al. (2020) reported that school-based programs that support healthy habits can increase the self-esteem of children with obesity and decrease their depressive symptoms [ 50 ]. The results of this systematic review are generally in line with those of other studies and emphasize the need for efficient treatments and prevention strategies to address the detrimental psychological effects of childhood obesity. Even after controlling for confounding variables such as parental characteristics, sports participation, physical activity, and psychosocial development, the finding of suboptimal functioning in obese children remains significant [ 51 ]. The potential negative impact of lower skill attainment during childhood and adolescence on the academic performance of adults and obese teenagers is a matter of concern [ 52 ]. The etiology of elevated psychopathology in obese children and adolescents compared with their normal-weight counterparts remains unclear, despite varying findings across studies [ 49 ]. In examining the impact of family dynamics on the life of an obese child, it is reasonable to hypothesize that the family's attitudes toward the child's eating habits and weight may play a crucial role in shaping the child's susceptibility to obesity and overall health outcomes [ 32 ]. Consequently, the social well-being of overweight children is significantly impacted by bullying, weight teasing, and other behaviors with comparable characteristics. Preschool and early childhood are crucial years for managing and treating obesity. Therapies should place a significant emphasis on children's mental health, advance knowledge, and offer fat children top-notch treatment [ 53 ]. Families must provide advice on modifying one's lifestyle as well as social and psychological support. Secondary prevention and therapeutic approaches for children with disruptive behavior problems should emphasize the need for a healthy diet and regular physical activity to reduce the risk of obesity later in life. One of the most important steps in reducing obesity is treating depression and anxiety, especially in children and women. Doctors, teachers, and parents must be aware of specific comorbidities associated with childhood obesity so that they can take targeted measures to improve their health [ 54 ]. Implications for Practice The effects of childhood obesity on psychological well-being have substantial practical implications. This study suggests that educators, parents, and healthcare professionals should be aware of the potential harm that young obese individuals may do to their mental health and should take proactive measures to avoid and manage these problems. The results indicate that early identification and management of childhood obesity are essential for preventing or minimizing the related detrimental impacts on the psychological well-being of healthcare providers. Children with obesity should have regular mental health screenings and access mental health services as part of their treatment regimen [ 55 ]. Likewise, parents can critically contribute to reducing childhood obesity and promoting children's mental health. Encouraging healthy eating practices, supporting physical exercise, and promoting a positive body image can all help reduce the risk of obesity and improve the mental health of children [ 56 ]. Teachers need to be aware of how childhood obesity may impact students' academic performance and attitudes. Academic performance and general well-being can be enhanced by addressing obesity through school-based interventions that promote physical exercise and healthy nutrition, as well as foster a positive body image [ 22 ]. Politicians and public health experts share crucial responsibilities in addressing the broader social and environmental factors that contribute to childhood obesity. Adopting measures to encourage healthy eating and physical activity, expanding the availability of affordable, wholesome food options, and developing environments that are safe and supportive of physical activity can contribute to the prevention of childhood obesity and improve mental health outcomes [ 55 ]. The documented impacts of childhood obesity on psychological well-being have apparent practical repercussions. Positive results for children's mental health depend heavily on proactive prevention, early identification, and focused treatments that address the physical, social, and environmental causes of childhood obesity [ 22 ]. Strengths and Limitations This systematic review has several strengths and weaknesses. A comprehensive search, using multiple databases and relevant keywords, is one of its key strengths. This approach enhances the overall rigor of the review and increases the likelihood of identifying relevant studies. Additionally, by focusing the review on a specific area and using the PEO framework to develop a research question, the results were more targeted and relevant. The review's application of inclusion criteria is another strength, as it is clearly and consistently applied. This reduces the risk of bias and improves the validity of the findings, since only studies meeting the set criteria are included. Another benefit is the use of two independent reviewers to screen and select research, which minimizes selection bias and ensures consistent application of the inclusion criteria. However, this study also has limitations. Including only research written in English is a constraint, potentially missing relevant studies published in other languages. The quality of the included studies varied, with some possibly having methodological flaws that could influence their results. Additionally, the search was limited to studies published up to a specific date, excluding more recent research that could offer valuable insights. Lastly, like any systematic review, the findings are limited by the quality and number of included papers and the methods used. Despite these limitations, this review provides important implications for practice and offers valuable insights into the impact of pediatric obesity on psychological well-being. Conclusions This systematic review conducts a comprehensive examination of the impact of childhood obesity on mental health. Childhood obesity is associated with several adverse psychological effects, such as depression, conduct issues, behavioral problems, diminished self-esteem, eating disorders, negative attitudes, and academic challenges. The study further highlights that preventative strategies and effective treatments can be employed to mitigate the detrimental effects of childhood obesity. According to the research, parental, environmental, social, and economic factors play a significant role in the onset and persistence of childhood obesity. Therefore, a comprehensive approach to addressing childhood obesity and its psychological ramifications must take these variables into account. Collaboration among healthcare professionals, policymakers, and families is crucial in addressing this complex issue. The review concludes that early intervention and preventative initiatives, along with personalized treatments tailored to the specific needs of individuals and families, are vital. These interventions should promote healthy nutrition, regular physical activity, and psychological well-being. Additionally, the review underscores the importance of promoting equity and reducing health disparities linked to childhood obesity, as children from disadvantaged backgrounds are more susceptible to obesity and its adverse psychological consequences. Addressing this issue requires an interdisciplinary and holistic approach. The findings of this study can inform practices and policies aimed at combating childhood obesity, thereby supporting global efforts to enhance the health and well-being of children. Recommendations Numerous recommendations can be proposed to improve the prevention and management of childhood obesity and its related psychiatric effects, based on the findings of this extensive study. Children at risk of becoming obese should be identified early and given appropriate support, as advised by healthcare professionals and legislators. This may involve implementing screening programs within healthcare and educational settings, as well as providing information and support to families. Interventions must be customized to meet the specific needs of individuals and their families, using evidence-based techniques such as cognitive-behavioral therapy and family-based treatments. Initiatives should be introduced to encourage regular physical activity and healthy eating among children and their families. Such measures could include community- and school-based programs, as well as other strategies aimed at improving access to nutritious food and opportunities for physical activity. It is also crucial to address the social and economic disparities that contribute to childhood obesity and related psychological issues. This could involve enacting laws and programs focused on reducing poverty, increasing access to nutritious food, and creating more opportunities for physical activity. Further research is necessary to fully understand the complex mechanisms underlying childhood obesity and its psychological impacts. Longitudinal studies, randomized controlled trials, and other research methods may be required to evaluate the effectiveness of various treatments and preventive strategies. Ultimately, the health and well-being of children worldwide can be greatly improved through the adoption of evidence-based interventions, preventive measures, and efforts to reduce social and economic inequalities. Declarations Funding details No funding was received for this research. Disclosure statement The authors declare that they have no known conflicts of interest that could have affected this manuscript. Ethical consideration The review is registered with Prosper under the registration number CRD42024513690. Data availability statement The data that support the findings of this study, including any relevant details needed to reproduce the published results, are available from the corresponding author upon reasonable request. Clinical Trial Number Not applicable. Consent to participate and Consent to publish We obtained written consent from each participant to participate in this study, and they gave their consent to publish these results. 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Sutin, Parents’ perceptions of their children as overweight and children’s weight concerns and weight gain. Psychological science, 2017. 28 (3): p. 320-329. Sellers, R., et al., Cross‐cohort change in adolescent outcomes for children with mental health problems. Journal of Child Psychology and Psychiatry, 2019. 60 (7): p. 813-821. Adab, P., et al., Effectiveness of a childhood obesity prevention programme delivered through schools, targeting 6 and 7 year olds: cluster randomised controlled trial (WAVES study). bmj, 2018. 360 . Johnson, W., et al., How has the age-related process of overweight or obesity development changed over time? Co-ordinated analyses of individual participant data from five United Kingdom birth cohorts. PLoS medicine, 2015. 12 (5): p. e1001828. Karhunen, V., et al., The link between attention deficit hyperactivity disorder (ADHD) symptoms and obesity-related traits: genetic and prenatal explanations. Translational Psychiatry, 2021. 11 (1): p. 455. Power, C., S.M. Pinto Pereira, and L. Li, Childhood maltreatment and BMI trajectories to mid-adult life: Follow-up to age 50y in a British birth cohort. PloS one, 2015. 10 (3): p. e0119985. Cetateanu, A. and A. Jones, Understanding the relationship between food environments, deprivation and childhood overweight and obesity: evidence from a cross sectional England-wide study. Health & place, 2014. 27 : p. 68-76. Wilkie, H.J., et al., Correlates of intensity-specific physical activity in children aged 9–11 years: A multilevel analysis of UK data from the International Study of Childhood Obesity, Lifestyle and the Environment. BMJ open, 2018. 8 (2): p. e018373. Fraser, L.K., et al., Fast food and obesity: a spatial analysis in a large United Kingdom population of children aged 13–15. American journal of preventive medicine, 2012. 42 (5): p. e77-e85. Pierce, M., et al., Effects of parental mental illness on children's physical health: systematic review and meta-analysis. The British Journal of Psychiatry, 2020. 217 (1): p. 354-363. Hadjiyannakis, S., et al., Obesity class versus the Edmonton Obesity Staging System for Pediatrics to define health risk in childhood obesity: results from the CANPWR cross-sectional study. The Lancet Child & Adolescent Health, 2019. 3 (6): p. 398-407. Moonajilin, M.S., M.E. Rahman, and M.S. Islam, Relationship between overweight/obesity and mental health disorders among Bangladeshi adolescents: a cross-sectional survey. Obesity Medicine, 2020. 18 : p. 100216. Arango, C., et al., Risk and protective factors for mental disorders beyond genetics: an evidence‐based atlas. World Psychiatry, 2021. 20 (3): p. 417-436. Mazur, A., et al., Childhood obesity: position statement of polish society of pediatrics, polish society for pediatric obesity, polish society of pediatric endocrinology and diabetes, the college of family physicians in Poland and polish association for study on obesity. Nutrients, 2022. 14 (18): p. 3806. Järvholm, K., et al., 5-year mental health and eating pattern outcomes following bariatric surgery in adolescents: a prospective cohort study. The Lancet Child & Adolescent Health, 2020. 4 (3): p. 210-219. Blanco, M., et al., Psychological well-being and weight-related teasing in childhood obesity: a case–control study. Eating and Weight Disorders-Studies on Anorexia, Bulimia and Obesity, 2020. 25 (3): p. 751-759. Cortese, S., et al., Association between mental disorders and somatic conditions: protocol for an umbrella review. BMJ Ment Health, 2020. 23 (4): p. 135-139. Gibson-Smith, D., et al., Childhood overweight and obesity and the risk of depression across the lifespan. BMC pediatrics, 2020. 20 (1): p. 25. Bohnert, A.M., D.M. Loren, and A.L. Miller, Examining childhood obesity through the lens of developmental psychopathology: Framing the issues to guide best practices in research and intervention. American Psychologist, 2020. 75 (2): p. 163. Bradwisch, S.A., et al., Obesity in children and adolescents: An overview. Nursing2025, 2020. 50 (11): p. 60-66. Dalsgaard, S., et al., Association of mental disorder in childhood and adolescence with subsequent educational achievement. JAMA psychiatry, 2020. 77 (8): p. 797-805. McLaren, L., et al., Child care: implications for overweight/obesity in Canadian children? Health Promotion and Chronic Disease Prevention in Canada, 2012. 33 (1). Hayes, J.F., et al., Disordered eating attitudes and behaviors in youth with overweight and obesity: implications for treatment. Current obesity reports, 2018. 7 (3): p. 235-246. Stadtlander, L., Maternal Obesity and the Development of Child Obesity. International Journal of Childbirth Education, 2014. 29 (2). Kendrick, J.G., R.R. Carr, and M.H. Ensom, Pediatric obesity: pharmacokinetics and implications for drug dosing. Clinical therapeutics, 2015. 37 (9): p. 1897-1923. Jastreboff, A.M., et al., Preventing childhood obesity through a mindfulness-based parent stress intervention: A randomized pilot study. The Journal of Pediatrics, 2018. 202 : p. 136-142. e1. Dereń, K., et al., Consumption of sugar-sweetened beverages in paediatric age: a position paper of the European Academy of Paediatrics and the European Childhood Obesity Group. Annals of Nutrition and Metabolism, 2019. 74 (4): p. 296-302. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7190451","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":492536851,"identity":"051cd30f-0162-41d7-a527-d222f91d094d","order_by":0,"name":"Rabail Fatima","email":"","orcid":"","institution":"Riphah International University","correspondingAuthor":false,"prefix":"","firstName":"Rabail","middleName":"","lastName":"Fatima","suffix":""},{"id":492536852,"identity":"9b439bb0-c50f-4267-9e2a-731474e876b1","order_by":1,"name":"Inayat Ali","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA20lEQVRIiWNgGAWjYBAC+QY4k/kAA2MDToUIwAYmE8DMBJK18BgQqUW6+ZnEzx8Msv0zcr5J/NxhI8fAfvjoBrxaZI6ZSfYkMBjPuJG7TbL3TJoxA09a2g28WiQSzCR4EhgSG4BaJHjbDic2SPCYEdCS/k3yD1DL/Bs5zyT/Eqclx0waZMuGGzls0kTaklNsLZPGYLzxzDNja9m2NGM2Qn6Rn5G+8eYbGwbZeceTH95822Yjx89++BheLUDAIsHA8B8UIyAGLKbwA+YPQAKkBcwYBaNgFIyCUYABAM2NSGITxVubAAAAAElFTkSuQmCC","orcid":"","institution":"Fatima Jinnah Women University","correspondingAuthor":true,"prefix":"","firstName":"Inayat","middleName":"","lastName":"Ali","suffix":""}],"badges":[],"createdAt":"2025-07-22 21:38:09","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7190451/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7190451/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":88037530,"identity":"5cbdfac7-bd77-4ab8-b2ae-103f489d714f","added_by":"auto","created_at":"2025-07-31 16:30:21","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":272648,"visible":true,"origin":"","legend":"\u003cp\u003ePRISMA flowchart for the screening process of studies\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7190451/v1/58cf5f9e4e10bd0e5a7b69bf.jpeg"},{"id":103395879,"identity":"4ee79f9e-1ae1-499d-b30e-f451fece085c","added_by":"auto","created_at":"2026-02-25 08:42:53","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1244460,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7190451/v1/f84080bc-725a-4f44-bd98-2f1a408e47b8.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Intersectionality of Obesity, Socioeconomic Conditions, and Mental Well-Being in Children: A Systematic Review","fulltext":[{"header":"Introduction","content":"\u003cp\u003eGlobally, there exists a significant public health concern regarding childhood obesity. The Centers for Disease Control and Prevention (CDC) characterizes obesity as having a body mass index (BMI) of 30 kg/m² or higher [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Obesity and mental health may be linked, especially in adolescent females, influenced by stigma, body image, nutrition, and physical restrictions [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Lifestyle modifications can elevate the risk of obesity and emotional eating, whereas grief may exert an opposing influence [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Reproductive hormones in adolescent females can contribute to the development of obesity and inflammatory processes [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eParental influences have a significant impact on the mental health and obesity of children, affecting their eating behaviors, activity levels, and emotional well-being. Environmental factors such as access to nutritious food, safe recreational areas, and supportive social environments are of critical importance. Environments conducive to health reduce the prevalence of obesity and enhance mental health, whereas resource scarcity increases associated risks [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Sociocultural variables, including societal norms, social support systems, and peer influences, also shape health outcomes. Positive social environments foster healthy habits, while cultural norms that favor sedentary behaviors heighten the risks [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Socioeconomic status exerts an impact on obesity and mental health, with lower income and educational attainment associated with increased risks due to limited resources, elevated stress levels, and reduced health literacy [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe prevalence of childhood obesity has increased significantly. It is anticipated that this trend will persist in the years to come. Childhood obesity has been linked to various physical health problems, such as diabetes, heart disease, and stroke [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Over the past few decades, the rate of pediatric obesity has steadily risen, along with several adverse psychological effects like anxiety, depression, and low self-esteem [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. The WHO estimates that in 2019, 38\u0026nbsp;million children under five were overweight or obese [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Projections suggest that by 2025, 70\u0026nbsp;million children will be overweight or obese, posing a significant public health concern. Children often gain excessive weight due to a lack of physical activity and unhealthy eating habits [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Many health professionals are concerned about the rapidly increasing rate of childhood obesity. This condition affects approximately 5–10% of children in developed countries and is linked to various health risks [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe psychological effects of childhood obesity can be profound and widespread, affecting both a person's overall quality of life and mental well-being [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Children who are overweight or obese may face negative stereotypes and attitudes from peers and adults, which can lead to social exclusion, prejudice, and low self-esteem [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. The stigma linked to obesity can also result in body dissatisfaction and poor self-image, which can harm mental well-being. The connection between childhood obesity and mental health outcomes is complex and intricate [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. The impact of childhood obesity extends beyond physical health to encompass mental well-being and overall quality of life. Despite the growing concern about the psychological effects of childhood obesity, research in this area is lacking [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Most studies have focused on the physical health consequences of obesity, and there is a need to investigate the psychological effects of this health problem. Understanding the impact of childhood obesity on psychological well-being is essential for developing effective interventions that address both physical and mental health issues.\u003c/p\u003e\u003cp\u003eStudies have indicated that obese children are more likely than nonobese children to experience sadness and anxiety [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. The association between pediatric obesity and mental health outcomes is impacted by several factors, including sex, age, and socioeconomic position, which is one explanation for the contradictory results [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Studies have also revealed that, compared with boys, females are more strongly linked with obesity and mental health outcomes. Another study showed that children of poorer socioeconomic origin had a greater correlation between obesity and mental health outcomes [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Although childhood obesity may have psychological effects, few studies have been conducted in this area. There is a need to look at the psychological repercussions of this health issue because the majority of studies have concentrated on the physical health effects of obesity.\u003c/p\u003e\u003cp\u003eTo create successful therapies that address both physical and mental health concerns, comprehending how childhood obesity affects psychological wellness is crucial [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. The changing mental health of children and adolescents is not sufficiently reflected in this concept of mental health in adulthood [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Children are learning and developing the psychosocial skills necessary to navigate life [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. They also lack the verbal and cognitive abilities to recognize and express their feelings [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eNevertheless, the optimal therapies to mitigate the adverse effects of childhood obesity on both physical and mental health remain somewhat unclear. To evaluate the existing body of research on the impact of childhood obesity on psychological well-being, this systematic review focuses on the fundamental processes that link childhood obesity to psychological health. Additionally, it examines the efficacy of therapeutic interventions designed to mitigate these adverse effects. The purpose of this review is to identify existing knowledge gaps and highlight areas requiring further investigation, thereby informing the development of effective strategies to enhance the health and well-being of children and adolescents. This objective is achieved through a comprehensive review of the pertinent literature.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e"},{"header":"Methods and Materials","content":"\u003cp\u003eAs previously indicated, this systematic review emphasizes the various significant effects of childhood obesity on the psychological well-being of children. Accordingly, a systematic review methodology was employed, which involves comprehensive data analysis on a specified topic, adhering to an analytical process that includes locating, classifying, and evaluating pertinent research [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Unlike primary researchers, systematic reviewers do not seek access to confidential, sensitive, or classified information. Furthermore, systematic reviewers rarely seek institutional ethical approval before commencing their work and frequently use publicly accessible records as evidence. Registered with PROSPERO under the registration number CRD42024513690, this review addresses a critical question: how does exposure to childhood obesity influence the psychological well-being of children? To derive a scientific response, we adhered to the PEO framework, which facilitates demonstrating the causal relationship between exposure and outcomes [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e].\u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003ctable float=\"No\" id=\"Taba\" border=\"1\"\u003e\u003ccolgroup cols=\"2\"\u003e\u003c/colgroup\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eP (Population)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eChildren (Below 13 years)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eE (Exposure)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eObesity\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eO (Outcome)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eThe effects of childhood obesity on psychological well-being\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\u003c/div\u003e\u003cp\u003eResearchers can investigate potential causative relationships by analyzing the impact of childhood obesity (exposure) on psychological well-being (outcome) within a specific community. This information is crucial for understanding the impact of obesity on mental health and for informing therapeutic interventions and preventive measures. Researchers can concentrate their efforts on examining the particular issues faced by this age group by identifying the population of interest (children) through the Population, Exposure, and Outcome (PEO) framework. Such information can facilitate the development of targeted treatments, regulations, and programs that effectively address the psychological consequences of childhood obesity. The PEO framework promotes a comprehensive analysis of the subject by considering multiple factors [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Juvenile obesity is a complex issue with varied effects. The framework recognizes the significance of both physical and mental health in understanding how obesity impacts society by incorporating psychological well-being as a key outcome.\u003c/p\u003e\u003cp\u003e\u003cem\u003eSearch strategy\u003c/em\u003e\u003c/p\u003e\u003cp\u003eWe conducted searches in academic databases, including Google Scholar, PubMed, and CINAHL, to find relevant literature. To find reliable material on the study topic, a variety of keywords were used. The specifications for this dissertation's enclosure were contrasted with those for summaries of longer works. The criteria and viewpoint approaches were used to analyze the lengthy articles. The published references were also used in the manual search process. Keywords associated with the subject were used to obtain the data. To provide a more focused and efficient search that eliminates duplicate and irrelevant information while reducing the number of publications, Boolean operators (AND, NOT, and OR) were used. Keywords such as “Childhood obesity” OR “Overweight children” AND “Body mass index” AND “Psychological well-being” OR “Mental health” AND “Quality of life” AND “Self-esteem” were used to ensure dependable and accurate data collection.\u003c/p\u003e\u003cp\u003e\u003cem\u003eInclusion and Exclusion Criteria\u003c/em\u003e\u003c/p\u003e\u003cp\u003eThe methodology of this study involved meticulous adherence to predetermined inclusion and exclusion criteria to guarantee the robustness and pertinence of the data analyzed. The inclusion criteria were specified as follows: firstly, studies considered for inclusion were those published within the timeframe from 2013 to 2023. This period was selected to encompass the most recent research findings while providing a substantial body of literature for review. Secondly, only studies that had been translated and made accessible in English were included, aiming to mitigate language barriers and ensure broader accessibility. Lastly, the study incorporated research published in journals with an established impact factor, serving as a quality assurance measure, as such journals are typically recognized for their rigorous peer-review processes and scholarly contributions. Conversely, exclusion criteria were established to omit studies that did not meet specific standards considered essential for the study's objectives. Studies published before 2013 were excluded to focus on recent developments and advancements within the relevant field. Additionally, studies not available in English were excluded to facilitate comprehension and analysis by the research team and potential readers. Finally, research published in journals lacking a peer-review process was excluded, given that such publications may not adhere to the same standards of academic rigor and quality control as peer-reviewed journals. By rigorously applying these inclusion and exclusion criteria, the study aimed to ensure the selection of high-quality, relevant literature for analysis. This methodological approach enhances the validity and reliability of the findings, enabling the derivation of meaningful conclusions and contributing to the advancement of knowledge within the research domain.\u003c/p\u003e\u003cp\u003e\u003cem\u003eScreening of Studies\u003c/em\u003e\u003c/p\u003e\u003cp\u003eA systematic review screening procedure is instrumental in evaluating the quality and relevance of the included research. Initially, duplicates were removed after importing all search results into a reference management system. Subsequently, the titles and abstracts of all articles were meticulously examined to ascertain their eligibility for inclusion in the review. Each study underwent a comprehensive assessment to determine whether it met predetermined inclusion criteria, which encompassed factors such as participant age range, methods for assessing psychological health and childhood obesity, and research design. Studies that failed to meet these criteria were excluded at this stage. Following this initial screening, the full texts of the remaining articles were obtained for further evaluation to confirm their suitability for inclusion. This process involved a detailed examination of study design, sample size, participant characteristics, outcome measures, and potential biases or conflicts of interest. To ensure accuracy and consistency, two or more impartial reviewers collaboratively conducted the screening. Any disagreements were resolved through discussion or consultation with a third reviewer. Employing a rigorous screening methodology in a systematic review ensures that only studies meeting established criteria are included, thereby facilitating a high-quality synthesis of data concerning the impacts of childhood obesity on psychological well-being.\u003c/p\u003e\u003cp\u003eEach study that fulfilled the inclusion and exclusion criteria was carefully scrutinized. The importance and influence of abstracts were critically analyzed for identifying pertinent research, with abstracts serving as indicators of original research publications. The initial search yielded 10,320 studies. After removing duplicates, 5,481 studies remained. A total of 2,569 studies were excluded due to the presence of primary and secondary outcomes. The review of study designs resulted in the exclusion of 188 publications. Additionally, 129 articles were excluded owing to irrelevance, including conference papers, commentary articles, and publications with insufficient data. Consequently, ten studies remained for comprehensive examination (see PRISMA Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). The Critical Appraisal Skills Programme (CASP) confirmed that all selected studies were of high quality (see Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eSummary of the outcomes of all included studies\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003c/colgroup\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAuthor (s) and Year of publishing\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAim\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMethods\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eSample\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eKey findings\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eConclusion\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e(Newson et al., 2013)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eThe purpose of this study is to determine whether or not maltreatment in childhood is associated with obesity or body mass index at various ages.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eCross-sectional study\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e16,527 participants\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eChildren who are overweight have an increased risk of developing mood disorders such despair, anxiety, and paranoia. Suicidal ideation and behavior are more common among overweight children and adolescents than among their physically healthy peers.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eChildren and adolescents are more vulnerable to mood disorders like bipolar disorder and depression than adults.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e(Robinson and Sutin, 2017)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eThe purpose of this study was to gain insight into families' perspectives on a program designed to reduce juvenile obesity and to identify the factors that influence participation and long-term behavior change.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eInterpretative analysis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e46 children\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eChildren with disruptive disorders had higher body mass indices than children without these disorders, suggesting that behavioral issues in childhood and early adolescence are linked to an increased risk of obesity in young adulthood.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003ePreadolescent overweight children are more likely to have behavioral problems than their classmates who are a healthy weight.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e(Adab et al., 2018)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eThe purpose of this study is to investigate the connection between children's food access, economic disadvantage, and obesity.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eCross-sectional study\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e345 children\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eSchool-aged overweight children showed higher incidence of full-blown hyperactivity disorder compared to children of the same age having normal weight.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eChildren with ADHD are more likely to be overweight, more likely to be obese, and more likely to become overweight if they are not taking medication to treat their ADHD\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e(Johnson et al., 2015)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTo evaluate parents’ opinions of their children as overweight\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eLongitudinal study\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e311 children\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eChild body dissatisfaction, feelings of worthlessness, and confidence are all found to be higher in obese children.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eChildren who are overweight often experience a deterioration in self-esteem over time, with adolescents reporting a greater loss of physical self-worth than younger children.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e(Cetateanu and Jones, 2014)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eExamine a healthy lifestyle programme aimed at reducing childhood obesity and implementing it in schools and homes.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eCluster randomized controlled trial\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e980 children\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eThere is a substantial relation between eating disorders and obesity in several areas of psychosocial dysfunction, and girls were especially susceptible to having both mood and eating issues at once. A family-based intervention with sustained follow-up significantly enhanced the subjects' emotional and physical health.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eChildren who were overweight saw improvements in their grades after participating in treatment programs that stressed the importance of exercise and healthy eating.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e(Fraser et al., 2012)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eThe purpose of this study was to examine the associations between children's obesity and several possible correlates, including intensity-specific physical activity.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eCross sectional study\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e245 children\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eTo promote healthy lifestyle changes within families, interventions focused on parenting and attachment concerns, behavioral variables, and self-management.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eThe ability to recognize one's own underlying motivations and barriers to change improved significantly as a result of family interventions.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e(Karhunen et al., 2021)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eThe goal of this study was to see if the results of mental health issues in children had altered over the past four decades.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMillennium cohort study\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e35924 participants\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eChildren who were overweight were more likely to have behavioral issues and abusive ethics.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eEating disorders and ineffective weight-control methods are all linked to obesity-related teasing.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e(Wilkie et al., 2018)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTo examine the correlation between eating at fast food restaurants and being overweight among teens.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eCohort study\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4827 participants\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eOverweight children were more likely to experience psychosocial discomfort and to have worse socioeconomic status and psychological well-being than their leaner peers.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eOverall health-related quality of life and depression symptoms were significantly reduced in clinically obese children.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e(Power, Pinto Pereira and Li, 2015)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eThe purpose of this study was to analyze how the prevalence of overweight and obesity in children and adults has changed later.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eLongitudinal study\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e56,632 participants\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eOverweight children and teens were more likely to be isolated from social networks and less regarded as friends.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eCharacteristics of children who were overweight were selfishness, laziness, isolation, dysfunctional social relationships, and poor academic performance.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e(Sellers et al., 2019)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTo investigate whether or whether symptoms of hyperactivity disorder are correlated with obesity.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eLongitudinal study\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3834 samples\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eEarly behavior difficulties including disobedience, aggression, property damage, and cruelty are linked to overweight young people.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eSelf-reported ADHD was more common among overweight adolescents than among obese ones.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\u003c/div\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c12\" colnum=\"12\"\u003e\u003c/div\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eCASP tool scores of the included studies\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"12\"\u003e\u003c/colgroup\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAuthors\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eWas there a clear statement of aims of research?\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eIs a qualitative methodology appropriate?\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eWas the research design appropriate to address the aims of research?\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eWas the recruitment strategy appropriate to the aims of research?\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eWas the data collected in a way to address the research issue?\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eHas the relationship between researcher and participants adequately considered\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003eHave the ethical issues been taken into consideration?\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c9\"\u003e\u003cp\u003eWas the data analysis sufficiently rigorous?\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c10\"\u003e\u003cp\u003eIs there a deer statement of finding?\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c11\"\u003e\u003cp\u003eHow valuable is the research?\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c12\"\u003e\u003cp\u003eScore\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e(Newson et al., 2013)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e+\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e+\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e+\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e+\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e+\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e+\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cb\u003e+\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u003cb\u003e+\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e\u003cb\u003e+\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e\u003cb\u003e+\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e10/10\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e(Robinson and Sutin, 2017)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e+\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e+\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e+\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e-\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e+\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e+\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cb\u003e+\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u003cb\u003e+\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e\u003cb\u003e+\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e\u003cb\u003e+\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e9/10\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e(Adab et al., 2018)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e+\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e+\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e+\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e+\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e+\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e+\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cb\u003e+\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u003cb\u003e+\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e\u003cb\u003e+\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e\u003cb\u003e+\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e10/10\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e(Johnson et al., 2015)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e+\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e+\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e+\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e+\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e+\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e+\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cb\u003e+\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u003cb\u003e+\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e\u003cb\u003e+\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e\u003cb\u003e+\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e10/10\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e(Cetateanu and Jones, 2014)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e-\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e+\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e+\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e+\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e-\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e+\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cb\u003e+\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u003cb\u003e+\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e\u003cb\u003e-\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e\u003cb\u003e+\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e7/10\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e(Fraser et al., 2012)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e+\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e+\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e+\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e-\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e+\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e+\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cb\u003e+\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u003cb\u003e+\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e\u003cb\u003e+\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e\u003cb\u003e+\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e9/10\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e(Karhunen et al., 2021)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e+\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e+\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e+\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e+\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e+\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e+\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cb\u003e+\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u003cb\u003e+\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e\u003cb\u003e+\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e\u003cb\u003e-\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e10/10\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e(Wilkie et al., 2018)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e+\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e+\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e+\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e+\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e+\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e+\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cb\u003e-\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u003cb\u003e+\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e\u003cb\u003e+\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e\u003cb\u003e+\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e9/10\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e(Power, Pinto Pereira and Li, 2015)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e+\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e+\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e+\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e+\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e-\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e+\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cb\u003e+\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u003cb\u003e+\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e\u003cb\u003e+\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e\u003cb\u003e+\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e9/10\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e(Sellers et al., 2019)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e-\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e+\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e+\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e+\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e-\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e+\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cb\u003e+\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u003cb\u003e+\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e\u003cb\u003e-\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e\u003cb\u003e+\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e7/10\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\u003c/div\u003e\u003cp\u003e\u003cem\u003eLiterature Review Analysis\u003c/em\u003e\u003c/p\u003e\u003cp\u003eReading the complete articles and abstracts allowed us to filter any extraneous information. An analysis of the quantity of published research was conducted utilizing a standardized data gathering method. The names of the authors, publication dates, primary research phases, types, and patient counts for each study were included, along with details about them. The findings were compiled into a table that contains a list of clearly stated implications, along with an explanation for each one. The results were analyzed thematically. By employing proven methods for identifying and generating analytical themes in original research data, thematic analysis aims to synthesize secondary data [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. For numerous reasons, this review opted for theme synthesis [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. It is, first and foremost, ideally suited to the current goal of combining accessible information and identifying data patterns. The results of quantitative investigations are summarized thematically, especially when there are varying outcomes. Finally, the topic synthesis process is open, and outcomes are easily accessible [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe thematic analysis technique enables researchers to explore and interpret the data in great depth and nuance. For various reasons, the thematic analysis stage of the data analysis process is crucial. This analysis can be used to highlight the complexity of the data and the diversity of participant experiences. Significant amounts of qualitative data may be organized and interpreted with the help of thematic analysis. By identifying themes within the data, researchers can organize and categorize the information in a way that is both meaningful and easy for others to understand. This could help in providing a concise and understandable summary of the study's primary findings. Additionally, a thorough and meticulous approach to data analysis is facilitated through thematic analysis. By employing a structured and transparent methodology, researchers can ensure that a comprehensive and methodical analysis of the data supports their findings. This can enhance the reliability and validity of the study's results.\u003c/p\u003e\u003cp\u003e\u003cb\u003eEthical considerations\u003c/b\u003e\u003c/p\u003e\u003cp\u003eSince a systematic review constitutes a secondary analysis of previously published research, the collection of new data from human participants is not required. Consequently, there was no necessity for an ethical review of this study. To uphold the confidentiality and privacy of the research participants whose data were analyzed in the included studies, ethical considerations remained integral to the investigation. To safeguard participant anonymity and privacy, only de-identified data were provided in the subsequent research. This approach ensured that only studies with ethical approval and adherence to recognized ethical standards were included. Studies that did not meet established ethical criteria or lacked ethical support were excluded from the analysis. The study was conducted transparently and objectively, with any potential conflicts of interest or biases identified and appropriately addressed.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cem\u003eChildhood Obesity Induced Depression and Behavioral Issues\u003c/em\u003e\u003c/p\u003e\u003cp\u003eAccording to Newson et al. (2013), obese children are more prone to depression and internalizing conditions like anxiety and paranoia, with higher body weight linked to increased psychological distress [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. Obesity prevalence is higher among children under stress. Overweight children show more psychological problems than their non-obese peers. Mood disorders related to obesity are more common in children and adolescents, especially depression and bipolar disorder [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. Psychological issues in children increase their risk of suicidal thoughts and attempts. It's crucial to consider social and family factors when assessing the risk of weight gain.\u003c/p\u003e\u003cp\u003eRobinson and Sutin (2017) found that prepubescent children with behavioral disorders also tend to have higher BMIs. These children, especially those with disruptive disorders, are more likely to be overweight, possibly linking childhood behavioral issues to overweight in early adulthood [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. These associations remain even after accounting for parental and lifestyle factors. Most behavioral problems in overweight children don't develop into full disorders, but they do show higher ADHD symptoms like impulsiveness and inattentiveness compared to normal-weight children.\u003c/p\u003e\u003cp\u003eSellers et al. (2019) analyzed adolescent outcomes in children with early mental health problems by comparing data from two major UK birth cohorts [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. Their findings demonstrated that adolescents in the more recent cohort experienced significantly worse outcomes in areas such as education, peer relationships, and behavioral functioning compared to those in the earlier cohort. These differences suggest a compounding effect of modern stressors on existing psychological vulnerabilities [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. The study reinforces the notion that children with pre-existing mental health challenges, including those with obesity, may face amplified difficulties over time due to shifts in societal pressures and environments.\u003c/p\u003e\u003cp\u003eSimilarly, Adab and colleagues (2018) reported that obese children exhibited higher incidences of hyperactivity disorder compared to children of the same age with normal weight. There appears to be an association between clinical diagnoses of childhood obesity and ADHD symptoms in comparison to the general population [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. Additionally, they noted that early behavioral issues such as resistance, disobedience, aggression, property damage, and cruelty to others have been linked to overweight young individuals and children with ADHD [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. The atypical increase in BMI during early adulthood or adolescence has also been associated with these early childhood behaviors. Overweight adolescents reported a higher prevalence of ADHD. Furthermore, children with ADHD are more likely to be of normal weight rather than obese.\u003c/p\u003e\u003cp\u003e\u003cem\u003eSelf-esteem, Bullying, and Obesity\u003c/em\u003e\u003c/p\u003e\u003cp\u003eJohnson and colleagues (2015) found that obese or overweight children have lower self-esteem, experience more body dissatisfaction, and have poorer self-evaluations than normal-weight children. Gender differences are inconsistent; overweight women rate their attractiveness and self-worth more negatively than men, but both genders show a link between obesity and low self-esteem [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. As children age, especially if overweight, their self-esteem drops, notably regarding physical appearance. Parental sensitivity to obesity correlates with a child's self-esteem, but parenting does not affect body dissatisfaction [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eKarhunen and colleagues (2021) found that overweight or obese children face more psychosocial issues like peer concerns, attentional and emotional problems compared to healthy-weight children [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. These issues are linked to early obesity, worsening with age. Bullying and teasing, driven by stigma, harm their psychological health, leading to lower self-esteem and mental health issues, especially in adolescents. Such children also tend to perform worse academically, have poorer social lives, and are more affected by peer rejection, social stigma, eating disorders, and weight-control problems.\u003c/p\u003e\u003cp\u003ePower and colleagues (2015) studied children with obesity, finding they often show traits like agitation, inactivity, social isolation, low academic achievement, and limited social engagement [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. Overweight children tend to be less healthy, eat poorly, and exercise less than their healthy peers. Their belief that they can control their weight may exacerbate stigma. Adolescents, particularly girls, are subjected to increased insults, and overweight women are less likely to engage in dating and experience higher levels of victimization. Overweight children and teens are more socially isolated, excluded, and less likely to be appreciated or chosen as friends. Preschoolers with weak social ties are more prone to overweight and obesity.\u003c/p\u003e\u003cp\u003e\u003cem\u003eEating Disorders and Obesity\u003c/em\u003e\u003c/p\u003e\u003cp\u003eObesity and eating disorders are also interconnected. Cetateanu and Jones (2014) indicated that females are more vulnerable to concurrent eating and mood disturbances [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. In numerous cases of psychological dysfunction, obesity and eating disorders exhibit considerable similarities. Furthermore, overweight women often engage in severe weight-control practices, such as inducing vomiting, using laxatives, fasting, smoking, and consuming diet pills. The study also found that individuals with obesity are more likely to develop restrictive eating disorders. A notable proportion of individuals with a history of childhood obesity who are attempting weight loss show an increased incidence of mood disorders and a higher prevalence of bulimia nervosa. Compared to their healthy-weight peers, overweight children and adolescents exhibit greater dissatisfaction with their bodies, psychosocial difficulties, and engage in excessive dieting behaviors [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e].\u003c/p\u003e\u003cp\u003e\u003cem\u003eAcademic Outcomes and Obesity\u003c/em\u003e\u003c/p\u003e\u003cp\u003eJohnson and colleagues (2015) reported that obese children were more likely to experience psychosocial discomfort than their nonobese classmates were and that they often had lower average living standards and mental health [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. Additionally, poor academic achievement in adolescence and childhood is a strong predictor of obesity later in life. Psychosocial variables such as body dissatisfaction and bullying based on weight may attenuate the impact of obesity on children's well-being. It has also been demonstrated that young people who follow a healthy diet and engage in regular exercise frequently perform better on cognitive and academic examinations. The addition of gender, family structure, parental education, depressed mood, absenteeism, self-esteem, BMI, diet, and physical activity may account for the variation in academic success.\u003c/p\u003e\u003cp\u003eWilkie et al. (2018) investigated the relationship between physical activity levels and weight status and psychological well-being in children aged 9\u0026ndash;11 years [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. The study found that children who engaged in more moderate-to-vigorous physical activity had lower BMIs and better mental health, while those from socioeconomically disadvantaged backgrounds were less active overall. This inactivity may contribute to both elevated obesity risk and emotional difficulties, especially in vulnerable populations [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. Their results emphasize the importance of targeted interventions that increase physical activity as a dual strategy to improve both physical and psychological health outcomes.\u003c/p\u003e\u003cp\u003e\u003cem\u003eInterventions to reduce obesity\u003c/em\u003e\u003c/p\u003e\u003cp\u003eFraser and colleagues (2012) reported that comprehensive interventions that prioritize physical exercise and a healthy diet for overall academic attainment were beneficial for overweight children [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. The emotional and physical health of the participants also improved with a family-based intervention and maintenance follow-up. Individual variations in setting appealing weight loss objectives were incorporated into interventions. To prevent veering from the short-term results gained, follow-up treatment was given. To promote the adoption of a healthy lifestyle, family interventions focus on attachment difficulties and self-management treatments. When attitudes around obesity began to change, steps were taken to reduce stigma. It was also claimed that motivational interviewing is a guided approach to treating obesity, assisting people in examining and understanding their intrinsic motivations and barriers to change [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e].\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis review highlights research results on the psychological impacts of childhood obesity. Obesity-related problems have been found to have a significant and enduring impact on individuals' overall well-being, including their physical health, as well as their psychological, psychosocial, and psychiatric functioning. The potential for enduring and persisting health issues into adulthood is a significant concern, as it increases the likelihood of long-term health complications [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe results of the current study show that childhood obesity is linked to children's low self-esteem, emotional and behavioral issues, reported poor health-related quality of life, sadness, and other comorbid psychological conditions. These findings confirm the findings of other studies from this age, which revealed that psychological problems are more prevalent in overweight children and adolescents than in their peers, who are healthy in weight [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]. These findings indicate that adult obesity and depression have mutually reinforcing relationships, with melancholy also predicting the onset of obesity. Owing to various study findings, the evidence for the mental condition of ADHD patients is still debatable. Many studies have revealed a link between overweight or obesity and ADHD [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e]. Children with early-onset, persistent ADHD in infancy and adolescence are more likely to become obese than adults are. There is a potential correlation between ADHD and weight gain in children, as well as between obesity and the likelihood of being diagnosed with ADHD [\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eAccording to recent research findings, children who are obese are at greater risk of developing a variety of mental conditions than their healthy peers. Similarly, bullying, obesity stigma, and adolescent treatment use may influence how closely mental diseases, psychosocial issues, and obesity are related in a recent study [\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e]. Stigmatization typically manifests as harmful stereotypes, victimization, and social exclusion. The findings of J\u0026auml;rvholm and colleagues (2020) suggest that negative attitudes toward overweight and obese adults are reflected by children, irrespective of their gender or weight status, as a result of societal and parental influences. The present study investigated the relationship between preadolescent girls' weight status and their perceived beauty while controlling for popularity level. Specifically, the study examines whether overweight girls are less likely to be viewed as beautiful than their nonoverweight peers are, even when their popularity levels are similar. The present study investigated the relationships between weight teasing and actual weight among different age groups. The results indicate a strong positive correlation between weight teasing and real weight in younger adolescents, which gradually decreases as they age [\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eBullying and teasing connected to obesity are widespread and can have adverse emotional and physical effects. Several public health efforts to address obesity aim to induce weight loss in young, overweight children and teens, sometimes by employing harsh methods [\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e]. This implies that social stigmas against fat may contribute to illnesses or psychological issues. Among those who are predisposed to developing obesity, psychological conditions may play a substantial role in their personality development. Fighting childhood and teenage obesity requires action and intervention [\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e]. During this critical growth stage, children are more prone to obesity and psychological problems. Childhood obesity is more likely to develop and persist until adulthood [\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIn contrast to their nonobese counterparts, obese children and adolescents have greater rates of depression, anxiety, and low self-esteem, according to another comprehensive study [\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e]. Similarly, Bradwisch and colleagues (2020) discovered a link between childhood obesity and a greater risk of emotional and behavioral issues [\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e]. This evaluation, which is consistent with other studies, also revealed efficient therapies and preventative approaches for enhancing psychological outcomes in obese children. For example, a comprehensive review showed that behavioral, nutritional, and physical activity treatments can help improve the psychological outcomes of children with obesity [\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e]. Similarly, Dalsgaard, McGrath, et al. (2020) reported that school-based programs that support healthy habits can increase the self-esteem of children with obesity and decrease their depressive symptoms [\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e]. The results of this systematic review are generally in line with those of other studies and emphasize the need for efficient treatments and prevention strategies to address the detrimental psychological effects of childhood obesity.\u003c/p\u003e\u003cp\u003eEven after controlling for confounding variables such as parental characteristics, sports participation, physical activity, and psychosocial development, the finding of suboptimal functioning in obese children remains significant [\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e]. The potential negative impact of lower skill attainment during childhood and adolescence on the academic performance of adults and obese teenagers is a matter of concern [\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e]. The etiology of elevated psychopathology in obese children and adolescents compared with their normal-weight counterparts remains unclear, despite varying findings across studies [\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIn examining the impact of family dynamics on the life of an obese child, it is reasonable to hypothesize that the family's attitudes toward the child's eating habits and weight may play a crucial role in shaping the child's susceptibility to obesity and overall health outcomes [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. Consequently, the social well-being of overweight children is significantly impacted by bullying, weight teasing, and other behaviors with comparable characteristics. Preschool and early childhood are crucial years for managing and treating obesity. Therapies should place a significant emphasis on children's mental health, advance knowledge, and offer fat children top-notch treatment [\u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e]. Families must provide advice on modifying one's lifestyle as well as social and psychological support. Secondary prevention and therapeutic approaches for children with disruptive behavior problems should emphasize the need for a healthy diet and regular physical activity to reduce the risk of obesity later in life. One of the most important steps in reducing obesity is treating depression and anxiety, especially in children and women. Doctors, teachers, and parents must be aware of specific comorbidities associated with childhood obesity so that they can take targeted measures to improve their health [\u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e].\u003c/p\u003e\u003cp\u003e\u003cb\u003eImplications for Practice\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe effects of childhood obesity on psychological well-being have substantial practical implications. This study suggests that educators, parents, and healthcare professionals should be aware of the potential harm that young obese individuals may do to their mental health and should take proactive measures to avoid and manage these problems. The results indicate that early identification and management of childhood obesity are essential for preventing or minimizing the related detrimental impacts on the psychological well-being of healthcare providers. Children with obesity should have regular mental health screenings and access mental health services as part of their treatment regimen [\u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e]. Likewise, parents can critically contribute to reducing childhood obesity and promoting children's mental health. Encouraging healthy eating practices, supporting physical exercise, and promoting a positive body image can all help reduce the risk of obesity and improve the mental health of children [\u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eTeachers need to be aware of how childhood obesity may impact students' academic performance and attitudes. Academic performance and general well-being can be enhanced by addressing obesity through school-based interventions that promote physical exercise and healthy nutrition, as well as foster a positive body image [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Politicians and public health experts share crucial responsibilities in addressing the broader social and environmental factors that contribute to childhood obesity. Adopting measures to encourage healthy eating and physical activity, expanding the availability of affordable, wholesome food options, and developing environments that are safe and supportive of physical activity can contribute to the prevention of childhood obesity and improve mental health outcomes [\u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e]. The documented impacts of childhood obesity on psychological well-being have apparent practical repercussions. Positive results for children's mental health depend heavily on proactive prevention, early identification, and focused treatments that address the physical, social, and environmental causes of childhood obesity [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e].\u003c/p\u003e\u003cp\u003e\u003cb\u003eStrengths and Limitations\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThis systematic review has several strengths and weaknesses. A comprehensive search, using multiple databases and relevant keywords, is one of its key strengths. This approach enhances the overall rigor of the review and increases the likelihood of identifying relevant studies. Additionally, by focusing the review on a specific area and using the PEO framework to develop a research question, the results were more targeted and relevant. The review's application of inclusion criteria is another strength, as it is clearly and consistently applied. This reduces the risk of bias and improves the validity of the findings, since only studies meeting the set criteria are included. Another benefit is the use of two independent reviewers to screen and select research, which minimizes selection bias and ensures consistent application of the inclusion criteria. However, this study also has limitations. Including only research written in English is a constraint, potentially missing relevant studies published in other languages. The quality of the included studies varied, with some possibly having methodological flaws that could influence their results. Additionally, the search was limited to studies published up to a specific date, excluding more recent research that could offer valuable insights. Lastly, like any systematic review, the findings are limited by the quality and number of included papers and the methods used. Despite these limitations, this review provides important implications for practice and offers valuable insights into the impact of pediatric obesity on psychological well-being.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThis systematic review conducts a comprehensive examination of the impact of childhood obesity on mental health. Childhood obesity is associated with several adverse psychological effects, such as depression, conduct issues, behavioral problems, diminished self-esteem, eating disorders, negative attitudes, and academic challenges. The study further highlights that preventative strategies and effective treatments can be employed to mitigate the detrimental effects of childhood obesity. According to the research, parental, environmental, social, and economic factors play a significant role in the onset and persistence of childhood obesity. Therefore, a comprehensive approach to addressing childhood obesity and its psychological ramifications must take these variables into account. Collaboration among healthcare professionals, policymakers, and families is crucial in addressing this complex issue. The review concludes that early intervention and preventative initiatives, along with personalized treatments tailored to the specific needs of individuals and families, are vital. These interventions should promote healthy nutrition, regular physical activity, and psychological well-being. Additionally, the review underscores the importance of promoting equity and reducing health disparities linked to childhood obesity, as children from disadvantaged backgrounds are more susceptible to obesity and its adverse psychological consequences. Addressing this issue requires an interdisciplinary and holistic approach. The findings of this study can inform practices and policies aimed at combating childhood obesity, thereby supporting global efforts to enhance the health and well-being of children.\u003c/p\u003e\u003cp\u003e\u003cb\u003eRecommendations\u003c/b\u003e\u003c/p\u003e\u003cp\u003eNumerous recommendations can be proposed to improve the prevention and management of childhood obesity and its related psychiatric effects, based on the findings of this extensive study. Children at risk of becoming obese should be identified early and given appropriate support, as advised by healthcare professionals and legislators. This may involve implementing screening programs within healthcare and educational settings, as well as providing information and support to families. Interventions must be customized to meet the specific needs of individuals and their families, using evidence-based techniques such as cognitive-behavioral therapy and family-based treatments. Initiatives should be introduced to encourage regular physical activity and healthy eating among children and their families. Such measures could include community- and school-based programs, as well as other strategies aimed at improving access to nutritious food and opportunities for physical activity. It is also crucial to address the social and economic disparities that contribute to childhood obesity and related psychological issues. This could involve enacting laws and programs focused on reducing poverty, increasing access to nutritious food, and creating more opportunities for physical activity. Further research is necessary to fully understand the complex mechanisms underlying childhood obesity and its psychological impacts. Longitudinal studies, randomized controlled trials, and other research methods may be required to evaluate the effectiveness of various treatments and preventive strategies. Ultimately, the health and well-being of children worldwide can be greatly improved through the adoption of evidence-based interventions, preventive measures, and efforts to reduce social and economic inequalities.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eFunding details\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo funding was received for this research.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDisclosure statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors\u0026nbsp;declare that they have no known conflicts of interest that could have affected this manuscript.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical consideration\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe review is registered with Prosper under the registration number CRD42024513690.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eData availability statement\u003c/p\u003e\n\u003cp\u003eThe data that support the findings of this study, including any relevant details needed to reproduce the published results, are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical Trial Number\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to participate and Consent to publish\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe obtained written consent from each participant to participate in this study, and they gave their consent to publish these results.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors Contribution\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBoth authors contributed equally.\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eBlack, N., R. 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Ensom, \u003cem\u003ePediatric obesity: pharmacokinetics and implications for drug dosing.\u003c/em\u003e Clinical therapeutics, 2015. \u003cstrong\u003e37\u003c/strong\u003e(9): p. 1897-1923.\u003c/li\u003e\n\u003cli\u003eJastreboff, A.M., et al., \u003cem\u003ePreventing childhood obesity through a mindfulness-based parent stress intervention: A randomized pilot study.\u003c/em\u003e The Journal of Pediatrics, 2018. \u003cstrong\u003e202\u003c/strong\u003e: p. 136-142. e1.\u003c/li\u003e\n\u003cli\u003eDereń, K., et al., \u003cem\u003eConsumption of sugar-sweetened beverages in paediatric age: a position paper of the European Academy of Paediatrics and the European Childhood Obesity Group.\u003c/em\u003e Annals of Nutrition and Metabolism, 2019. \u003cstrong\u003e74\u003c/strong\u003e(4): p. 296-302.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"childhood obesity, psychological well-being, melancholy, anxiety, conduct problems, behavioral problems, reduced self-esteem, socioeconomic determinants","lastPublishedDoi":"10.21203/rs.3.rs-7190451/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7190451/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eIntroduction: Childhood obesity is a global public health concern with significant adverse effects on physical and mental well-being. This systematic review aims to examine the impact of childhood obesity on psychological outcomes and to identify effective therapies and prevention strategies.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMethods: Studies were included if they investigated the link between childhood obesity and psychological effects. A comprehensive literature search was conducted using electronic databases, including Google Scholar, PubMed, and CINAHL, in accordance with specific inclusion and exclusion criteria. Selected studies were analyzed using a thematic approach to gather and synthesize data.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eResults: The review encompassed ten studies. Childhood obesity has been associated with various adverse psychological effects, including depression, anxiety, conduct issues, behavioral problems, and low self-esteem. Strategies such as promoting healthy behaviors, addressing socioeconomic disparities, early detection and intervention, personalized treatments, and timely intervention have proven effective in improving psychological outcomes.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eConclusion: Since childhood obesity significantly affects psychological well-being, effective treatments and prevention measures are essential to address this growing public health challenge. Experts recommend early detection and intervention, personalized therapies, promotion of healthy lifestyles, and tackling social and economic inequalities to improve psychological health in children with obesity.\u003c/p\u003e","manuscriptTitle":"Intersectionality of Obesity, Socioeconomic Conditions, and Mental Well-Being in Children: A Systematic Review","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-07-31 16:22:17","doi":"10.21203/rs.3.rs-7190451/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"f6138dc7-8919-458e-af90-17639bf4d398","owner":[],"postedDate":"July 31st, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-02-25T08:42:25+00:00","versionOfRecord":[],"versionCreatedAt":"2025-07-31 16:22:17","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7190451","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7190451","identity":"rs-7190451","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}