Associations between sleep, obesity, and mental health in adolescents: Understanding sex-specific vulnerabilities

Sleep disturbances and mental health challenges often arise during adolescence, with a greater prevalence among females and individuals experiencing obesity. In this study, we examined the intricate relationships between sleep problems, obesity, and biological sex, and their combined relationship with well-being in a large, diverse cohort of US adolescents.

We analyzed data from 7261 adolescents (Year 2: Mean age = 11.94 years, range: 10-14 years, 47.3 % female) participating in the ongoing Adolescent Brain Cognitive Development (ABCD) Study®. Sleep duration and sleep quality were determined from self-reported questionnaires. Internalizing and externalizing problems were assessed using the Child Behavior Checklist (caregiver-report) and the Brief Problem Monitor (youth-report). Positive affect was measured with the NIH Toolbox (youth-report). Regression models were used to investigate the associations between obesity (body mass index >95th percentile), sleep patterns, and mental health, while accounting for sex, age and socio-demographic variables.

Shorter sleep duration, poorer sleep quality, and experiencing obesity were associated with higher internalizing and externalizing problems. Longer sleep duration was associated with lower internalizing scores, but only among adolescents who were not experiencing obesity. Additionally, shorter sleep and poorer sleep quality were associated with lower positive affect, with stronger effects observed among adolescent females compared to males.

This study reveals complex interactions between sleep, obesity, and mental health in adolescents, with notable sex differences. The findings emphasize the need for adolescent mental health interventions to address both sleep and obesity, while considering the distinct vulnerabilities associated with sex and obesity.