A meta-analysis of weight status and anxiety in children and adolescents

Although some posit that youth who are overweight/obese experience greater amounts of anxiety than their peers who are normal weight, extant literature shows that the association between weight status and anxiety in youth is equivocal. Therefore, the purpose of this study was to elucidate the association between weight status and anxiety in children and adolescents through meta-analytic methods.

Electronic databases and review articles were searched for studies including quantitative data on weight status and anxiety in youth aged ≤18 years. Data were analyzed using a random effects model. Putative moderators were selected a priori.

A total of 61 studies yielded 78 effect sizes (N = 180,136) and a small but significant overall summary effect (r = .08; 95% confidence interval, 0.06-0.11; z = 6.41; p < .001). Gender, age group, and type of weight status measure significantly moderated the association. Specifically, studies with girls, children aged 12 years and under, or norm-referenced measures of weight status (e.g., body mass index [BMI] z-score) evidenced significantly higher effect sizes between weight status and anxiety than studies with boys, adolescents aged 13 years and over, or non-norm-referenced measures of weight status (e.g., BMI), respectively. Sample type, publication type, anxiety type, anxiety informant, and race/ethnicity were not significant moderators.

Overall, the association between weight status and anxiety is small; however, study or methodological characteristics may modestly influence the effect. Longitudinal studies are needed to determine the directionality of the association, and consequently, the intended target of intervention.