Related Experiment Video
Updated: Jul 18, 2026

Multidisciplinary Approach to Obesity Management: A Case Report
Published on: May 30, 2025
Parent-rated behavior problems associated with overweight before and after controlling for sleep disordered breathing
Shelagh A Mulvaney1, Kristine L Kaemingk, James L Goodwin
1School of Nursing and Department of Pediatrics, Vanderbilt University, Nashville, Tennessee, USA. shelagh.mulvaney@vanderbilt.edu
Insights
Overweight children often exhibit withdrawal and social problems, even after accounting for sleep issues. These behavioral factors are crucial for designing effective interventions for childhood obesity.
Area of Science:
- Pediatric Health
- Behavioral Science
- Sleep Medicine
Background:
- Behavioral interventions for overweight children are needed, but behavioral correlates are understudied in community samples.
- This study investigated behavior problems in overweight versus normal-weight children, considering sleep disordered breathing.
Purpose of the Study:
- To determine the nature and prevalence of behavior problems in overweight school-aged children compared to normal-weight peers.
- To assess the influence of sleep disordered breathing on these behavioral differences.
Main Methods:
- 402 children (6-11 years) underwent anthropometric evaluation and behavioral ratings.
- Overweight status was defined by CDC guidelines (≥95th percentile).
- Behavior problems were assessed using Conners' Parent Rating Scales-Revised and Child Behavior Checklist; sleep disordered breathing was evaluated via polysomnography.
Main Results:
- 15% of children were classified as overweight.
- Overweight children showed higher rates of internalizing symptoms, psychosomatic complaints, withdrawal, and social problems.
- Withdrawal and social problems remained significantly higher in overweight children after adjusting for sleep disordered breathing.
Conclusions:
- Withdrawal and social problems are common in overweight children, independent of sleep disordered breathing.
- These behavioral factors may moderate the effectiveness of behavioral treatments for childhood overweight.
- Intervention and service design must account for these prevalent behavioral issues.
Background:
Researchers and clinicians are seeking to develop efficacious behavioral interventions to treat overweight children; however, few studies have documented the behavioral correlates of overweight children in community samples. The goal of this study was to determine the nature and prevalence of behavior problems for overweight school-aged children versus normal weight peers before and after controlling for the effect of sleep disordered breathing.
Methods:
Hispanic and Caucasian children were invited to participate in a study of sleep through public elementary school classrooms. Anthropometric evaluation and behavioral ratings were collected for 402 children aged 6-11 years. Overweight was calculated using the Centers for Disease Control age- and gender-specific guidelines. Children were classified as overweight if they were at or above the 95th percentile for their age and gender group. Behavior problems were measured using the Conners' Parent Rating Scales-Revised and the Child Behavior Checklist. Sleep disordered breathing was assessed using in-home overnight polysomnography.
Results:
Approximately 15% (59/402) of the sample was classified as overweight. Simple odds ratios indicated that overweight children were more likely to have clinically relevant levels of internalizing symptoms (OR 2.23, CI 1.05-4.72), psychosomatic complaints (OR 2.15, CI 1.02-4.54), withdrawal (OR 4.69, CI 2.05-10.73), and social problems (3.18, 1.53-6.60). When odds ratios were adjusted for level of sleep disordered breathing, withdrawal (OR 3.83 CI 1.59-9.22) and social problems (OR 2.49 CI 1.14-5.44) remained significantly higher for overweight subjects.
Conclusion:
After controlling for the effect of sleep disordered breathing, behaviors such as withdrawal and social problems, are common in overweight children and need to be taken into account in the design of interventions and services as they may act to moderate the efficacy of behavioral treatments.
Related Concept Videos
Sleep Apnea
The condition is more prevalent among...
REM Sleep Behavior Disorder
RBD is significantly associated with...
Substance Use Disorders Affecting Sleep
Understanding the concepts of physical dependence,...
Binge Eating Disorders
Cause and Effect
Bulimia Nervosa