Exploring the association between obesity and problems with peer relationships in children: a nationally representative cross-sectional study

Abstract

BackgroundThe number of children living with obesity in the UK is increasing, and the rise has been exacerbated by the lockdowns during the COVID-19 pandemic, when school attendance was suspended and leisure activities were curtailed. Whether an association exists between obesity and problems with peer relationships in children has not been definitively answered because few datasets collect these data simultaneously. This study was aimed at exploring the relationship between obesity and peer problems in children after adjustment for multiple confounding factors. MethodsChildren aged 4–15 years participating in the Welsh Health Survey for Children were included. The association between obesity (defined as body-mass index ≥95th centile) and peer relationship problems (as per the standard definitions in the internationally recognised Strengths and Difficulties Questionnaire) was assessed using multivariate logistic regression. Confounding factors included in the analysis were deprivation, meeting the UK Government's physical activity guidelines, and consumption of healthy foods (ie, daily fruit and vegetable consumption). Findings11 279 children were included (5470 [48·5%] girls and 5801 [51·5%] boys). A small but significant association between children living with obesity and peer problems was identified (odds ratio [OR] 1·06 [95% CI 1·04–1·08]; p=0·0001) after accounting for confounding factors. The association was strongest for girls aged 4–10 years (OR 1·12 [95% CI 1·07–1·16]; p=0·0001). InterpretationThis study contributes to the small evidence base on this topic by investigating the association between obesity and peer problems in a large nationally representative sample from Wales, UK, and identifies a small but significant association between obesity and peer problems in children, particularly in younger girls. Existing evidence has established this association in adolescents, but this study is the first nationally representative analysis to identify this association in children. Additional research, ideally using large community datasets, is needed to complement these findings. In the meantime, as a precautionary measure, solutions to reduce bodyweight-based stigma and enhance peer relationships in school-aged children should be developed. FundingNone.