{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,5]],"date-time":"2026-09-05T00:07:52Z","timestamp":1788566872642,"version":"build-2803163510"},"reference-count":60,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2025,3,7]],"date-time":"2025-03-07T00:00:00Z","timestamp":1741305600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"National Cheng Kung University Hospital","award":["NCKUH-10602007"],"award-info":[{"award-number":["NCKUH-10602007"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Obesity in youth is a growing public health concern, placing them at higher risk for adverse physical and psychological outcomes. Understanding the predictors that affect weight management, particularly the role of internalized weight stigma, psychosocial factors, and eating behaviors, is essential for developing an effective intervention at longitudinal follow-up. Materials and Methods: We enrolled 102 youths with obesity aged 10 to 18 years old from clinical settings. Baseline demographic data, psychosocial measures, including the Weight Self-Stigma Questionnaire (WSSQ) and Hospital Anxiety and Depression Scale (HADS), and eating behavior scales, such as the Three-Factor Eating Questionnaire (TFEQ-R21) and eating disorder as Sick, Control, One, Fat, Food questionnaire (SCOFF), were collected in the first visit. We conducted a study with both cross-sectional and longitudinal components. Correlational bivariate analysis was conducted to explore relationships between key variables. The factors affecting BMI changes were investigated using generalized estimating equations (GEEs) as part of a longitudinal analysis. Results: The mean age of participants was 13.22 years and 63.7% were male. Bivariate correlation analysis revealed positive relationships between initial BMI Z-scores and WSSQ scores (r = 0.196, p &lt; 0.05). In bivariate analysis, a negative correlation was found between the difference in BMI Z-scores and visit number (r = \u22120.428, p &lt; 0.01). GEE analysis demonstrated that initial BMI Z-scores (coefficient = 1.342, p &lt; 0.001) and anxiety (coefficient = 0.050, p &lt; 0.001) were significant positive predictors of BMI Z-scores, while depression was negatively associated (coefficient = \u22120.081, p &lt; 0.001). Excluding the TFEQ subscales, SCOFF improved the model\u2019s QIC and highlighted WSSQ as a significant, albeit weak, predictor (p = 0.615 in the full model versus p &lt; 0.05 in the reduced model). Conclusions: Psychosocial factors, particularly anxiety and weight stigma, are associated with elevated BMI Z-scores in youth affected by obesity in this study. The baseline age, BMI Z-score, internalized weight stigma, and psychological stress influenced the body weight trajectory over time. Frequent clinical follow-ups contribute to improved BMI outcomes. Future research may examine the efficacy of weight management by reducing weight stigma and psychological distress along with the outpatient care of obesity.<\/jats:p>","DOI":"10.3390\/medicina61030466","type":"journal-article","created":{"date-parts":[[2025,3,7]],"date-time":"2025-03-07T04:29:59Z","timestamp":1741321799000},"page":"466","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Cross-Sectional and Longitudinal Associations Among Weight Stigma, Psychological Distress, and Eating Behaviors in Youth with Obesity: A Clinical Sample"],"prefix":"10.3390","volume":"61","author":[{"given":"Wee Shen","family":"Khoo","sequence":"first","affiliation":[{"name":"Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704302, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ying-Chu","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Nursing, National Cheng Kung University Hospital, Collage of Medicine, National Cheng Kung University, Tainan 704302, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yen-Yin","family":"Chou","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704302, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5469-0364","authenticated-orcid":false,"given":"Yu-Wen","family":"Pan","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704302, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yun-Han","family":"Weng","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704302, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1057-3315","authenticated-orcid":false,"given":"Meng-Che","family":"Tsai","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704302, Taiwan"},{"name":"Department of Genomic Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704302, Taiwan"},{"name":"Department of Medical Humanities and Social Medicine, School of Medicine, National Cheng Kung University, Tainan 704302, Taiwan"},{"name":"Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, No. 1 University Road, Tainan 70101, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,3,7]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Ni, Y.-L., Chang, J.-H., and Chen, L.H. (2019). Investigating the relationship between district-level socioeconomic status and individual obesity in Taiwanese adolescents: A large-scale cross-sectional analysis. Sci. Rep., 9.","DOI":"10.1038\/s41598-019-39167-5"},{"key":"ref_2","first-page":"599","article-title":"Weight-for-height reference and the prevalence of obesity for school children and adolescents in Taiwan and Fuchien areas","volume":"66","author":"Huang","year":"2003","journal-title":"J. Chin. Med. Assoc."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Yang, Y., Zhang, M., Yu, J., Pei, Z., Sun, C., He, J., Qian, T., Luo, F., Zhang, S., and Xu, Z. (2022). Nationwide Trends of Pediatric Obesity and BMI z-Score From 2017\u20132021 in China: Comparable Findings from Real-World Mobile- and Hospital-Based Data. Front. Endocrinol., 13.","DOI":"10.3389\/fendo.2022.859245"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"800","DOI":"10.1001\/jamapediatrics.2024.1576","article-title":"Global Prevalence of Overweight and Obesity in Children and Adolescents: A Systematic Review and Meta-Analysis","volume":"178","author":"Zhang","year":"2024","journal-title":"JAMA Pediatr."},{"key":"ref_5","first-page":"e18577","article-title":"Internalized Weight Stigma: Prevalence and Association with Psychiatric Disorder Among Overweight and Obese Individuals","volume":"13","author":"Almutairi","year":"2021","journal-title":"Cureus"},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Lindberg, L., Hagman, E., Danielsson, P., Marcus, C., and Persson, M. (2020). Anxiety and depression in children and adolescents with obesity: A nationwide study in Sweden. BMC Med., 18.","DOI":"10.1186\/s12916-020-1498-z"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"738","DOI":"10.1001\/jama.2024.11809","article-title":"Obesity in Adolescents: A Review","volume":"332","author":"Kelly","year":"2024","journal-title":"JAMA"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"e12538","DOI":"10.1111\/ijpo.12538","article-title":"Weight-based teasing is associated with gain in BMI and fat mass among children and adolescents at-risk for obesity: A longitudinal study","volume":"14","author":"Schvey","year":"2019","journal-title":"Pediatr. Obes."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1016\/j.pedneo.2020.08.006","article-title":"Psychological correlates of eating behavior in overweight\/obese adolescents in Taiwan: Psychometric and correlation analysis of the Three-Factor Eating Questionnaire (TFEQ)-R21","volume":"62","author":"Lin","year":"2021","journal-title":"Pediatr. Neonatol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"e20173034","DOI":"10.1542\/peds.2017-3034","article-title":"Stigma Experienced by Children and Adolescents with Obesity","volume":"140","author":"Pont","year":"2017","journal-title":"Pediatrics"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"402","DOI":"10.1007\/s13679-020-00408-8","article-title":"Weight Stigma in Youth: Prevalence, Consequences, and Considerations for Clinical Practice","volume":"9","author":"Puhl","year":"2020","journal-title":"Curr. Obes. Rep."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1186\/s40337-024-01132-7","article-title":"psychological interventions for internalized weight stigma: A systematic scoping review of feasibility, acceptability, and preliminary efficacy","volume":"12","author":"Shonrock","year":"2024","journal-title":"J. Eat. Disord."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1016\/j.appet.2014.06.108","article-title":"Weight stigma is stressful. A review of evidence for the Cyclic Obesity\/Weight-Based Stigma model","volume":"82","author":"Tomiyama","year":"2014","journal-title":"Appetite"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"575","DOI":"10.1007\/s40519-017-0382-0","article-title":"Psychometric properties of the Weight Self-Stigma Questionnaire (WSSQ) among a sample of overweight\/obese French-speaking adolescents","volume":"24","author":"Lepage","year":"2019","journal-title":"Eat. Weight Disord."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Chaves, E., Jeffrey, D.T., and Williams, D.R. (2023). Disordered Eating and Eating Disorders in Pediatric Obesity: Assessment and Next Steps. Int. J. Environ. Res. Public Health, 20.","DOI":"10.3390\/ijerph20176638"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"403","DOI":"10.1016\/j.jaac.2015.01.020","article-title":"Weight Status and DSM-5 Diagnoses of Eating Disorders in Adolescents from the Community","volume":"54","author":"Flament","year":"2015","journal-title":"J. Am. Acad. Child Adolesc. Psychiatry"},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Stabouli, S., Erdine, S., Suurorg, L., Jankauskien\u0117, A., and Lurbe, E. (2021). Obesity and Eating Disorders in Children and Adolescents: The Bidirectional Link. Nutrients, 13.","DOI":"10.3390\/nu13124321"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"226","DOI":"10.3961\/jpmph.2011.44.5.226","article-title":"The effect of eating behavior on being overweight or obese during preadolescence","volume":"44","author":"Lee","year":"2011","journal-title":"J. Prev. Med. Public Health"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1016\/j.jadohealth.2023.01.024","article-title":"Can Family and Parenting Factors Modify the Impact of Weight Stigma on Disordered Eating in Young People? A Population-Based Longitudinal Study","volume":"73","author":"Hooper","year":"2023","journal-title":"J. Adolesc. Health"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"182","DOI":"10.1007\/s13679-015-0153-z","article-title":"Health Consequences of Weight Stigma: Implications for Obesity Prevention and Treatment","volume":"4","author":"Puhl","year":"2015","journal-title":"Curr. Obes. Rep."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"554","DOI":"10.1111\/j.1745-7599.2002.tb00089.x","article-title":"Exploring the association between body weight, stigma of obesity, and health care avoidance","volume":"14","author":"Drury","year":"2002","journal-title":"J. Am. Assoc. Nurse Pract."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1241","DOI":"10.1038\/s41366-022-01087-2","article-title":"Experienced weight stigma, internalized weight bias, and clinical attrition in a medical weight loss patient sample","volume":"46","author":"Verhaak","year":"2022","journal-title":"Int. J. Obes."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"611","DOI":"10.1038\/ijo.2009.74","article-title":"Psychometric analysis of the Three-Factor Eating Questionnaire-R21: Results from a large diverse sample of obese and non-obese participants","volume":"33","author":"Cappelleri","year":"2009","journal-title":"Int. J. Obes."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1016\/j.jpsychores.2014.05.006","article-title":"Comparing weight gain in the year prior to treatment for overweight and obese patients with and without binge eating disorder in primary care","volume":"77","author":"Ivezaj","year":"2014","journal-title":"J. Psychosom. Res."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"576","DOI":"10.1002\/smi.3208","article-title":"Body mass index trajectories from childhood concerning emotional states in young adulthood: Tehran Lipid and Glucose Study","volume":"39","author":"Mahani","year":"2023","journal-title":"Stress Health"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"967","DOI":"10.1037\/0022-006X.67.6.967","article-title":"Naturalistic weight-reduction efforts prospectively predict growth in relative weight and onset of obesity among female adolescents","volume":"67","author":"Stice","year":"1999","journal-title":"J. Consult. Clin. Psychol."},{"key":"ref_27","unstructured":"Taiwan Pediatric Association (2025, March 01). Evidences-Based Guideline on Children Obesity Prevention and Management, Available online: https:\/\/www.hpa.gov.tw\/Pages\/EBook.aspx?nodeid=3792."},{"key":"ref_28","first-page":"221","article-title":"Body Mass Index Reference for Taiwanese Children and Adolescents","volume":"22","author":"Huang","year":"2002","journal-title":"J. Med. Sci."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"971","DOI":"10.1038\/oby.2009.353","article-title":"Measuring Weight Self-stigma: The Weight Self-Stigma Questionnaire","volume":"18","author":"Lillis","year":"2010","journal-title":"Obesity"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1071","DOI":"10.12740\/PP\/38139","article-title":"The factorial structure and validity of the Hospital Anxiety and Depression Scale (HADS) in Polish adolescents","volume":"49","author":"Mihalca","year":"2015","journal-title":"Psychiatr. Pol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"865","DOI":"10.1007\/s11136-010-9645-1","article-title":"Psychometric evaluation of the Hospital Anxiety and Depression Scale in a large community sample of adolescents in Hong Kong","volume":"19","author":"Chan","year":"2010","journal-title":"Qual. Life Res."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"540","DOI":"10.1192\/bjp.179.6.540","article-title":"Hospital Anxiety and Depression (HAD) scale: Factor structure, item analyses and internal consistency in a large population","volume":"179","author":"Mykletun","year":"2001","journal-title":"Br. J. Psychiatry"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"361","DOI":"10.1111\/j.1600-0447.1983.tb09716.x","article-title":"The hospital anxiety and depression scale","volume":"67","author":"Zigmond","year":"1983","journal-title":"Acta Psychiatr. Scand."},{"key":"ref_34","unstructured":"Maggino, F. (2023). Hospital Anxiety and Depression Scale for Use Among Adolescents. Encyclopedia of Quality of Life and Well-Being Research, Springer International Publishing."},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Lin, C.-Y., Tsai, M.-C., Liu, C.-H., Lin, Y.-C., Hsieh, Y.-P., and Strong, C. (2019). Psychological Pathway from Obesity-Related Stigma to Anxiety via Internalized Stigma and Self-Esteem among Adolescents in Taiwan. Int. J. Environ. Res. Public Health, 16.","DOI":"10.3390\/ijerph16224410"},{"key":"ref_36","unstructured":"Lin, W., and Lin, Y.-C. (2004). The restrained eating behavior of Taiwanese adolescents- a preliminary study. J. Home Econ. Educ., 1\u201321."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"164","DOI":"10.1136\/ewjm.172.3.164","article-title":"The SCOFF questionnaire: A new screening tool for eating disorders","volume":"172","author":"Morgan","year":"2000","journal-title":"West. J. Med."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"239","DOI":"10.1016\/j.ijnurstu.2008.09.004","article-title":"Psychometric properties of the SCOFF questionnaire (Chinese version) for screening eating disorders in Hong Kong secondary school students: A cross-sectional study","volume":"46","author":"Leung","year":"2009","journal-title":"Int. J. Nurs. Stud."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"160","DOI":"10.1016\/j.comppsych.2014.11.014","article-title":"Sex difference in using the SCOFF questionnaire to identify eating disorder patients at a psychiatric outpatient clinic","volume":"57","author":"Liu","year":"2015","journal-title":"Compr. Psychiatry"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1177\/1094428104263672","article-title":"Using Generalized Estimating Equations for Longitudinal Data Analysis","volume":"7","author":"Ballinger","year":"2004","journal-title":"Organ. Res. Methods"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"2567","DOI":"10.1007\/s11695-021-05285-1","article-title":"Impact of Baseline BMI and Adherence to Follow-Up on the Outcome of Sleeve Gastrectomy in Treatment of Adolescent Obesity","volume":"31","author":"Mohammed","year":"2021","journal-title":"Obes. Surg."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"466","DOI":"10.1016\/j.jpeds.2003.12.031","article-title":"Predictors of attrition from a pediatric weight management program","volume":"144","author":"Zeller","year":"2004","journal-title":"J. Pediatr."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"5417","DOI":"10.1007\/s00431-023-05218-3","article-title":"The younger the better: Importance of age in treatment of childhood obesity","volume":"182","author":"Bruun","year":"2023","journal-title":"Eur. J. Pediatr."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"e2022060640","DOI":"10.1542\/peds.2022-060640","article-title":"Clinical Practice Guideline for the Evaluation and Treatment of Children and Adolescents with Obesity","volume":"151","author":"Hampl","year":"2023","journal-title":"Pediatrics"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"e2022060642","DOI":"10.1542\/peds.2022-060642","article-title":"Appraisal of Clinical Care Practices for Child Obesity Treatment. Part I: Interventions","volume":"151","author":"Skinner","year":"2023","journal-title":"Pediatrics"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1037\/0278-6133.10.2.133","article-title":"Gender differences in eating behavior and body weight regulation","volume":"10","author":"Rolls","year":"1991","journal-title":"Health Psychol."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"289","DOI":"10.1127\/0003-5548\/2012\/0212","article-title":"Gender differences in nutritional behavior and weight status during early and late adolescence","volume":"69","author":"Askovic","year":"2012","journal-title":"Anthropol. Anz."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1016\/j.jad.2024.09.153","article-title":"Association of adolescent obesity with Anxiety, Depression and Attention-Deficit\/Hyperactivity disorder in the Arab population in Israel\u2014A nationwide study","volume":"369","author":"Menashe","year":"2025","journal-title":"J. Affect. Disord."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"639","DOI":"10.1016\/j.appet.2016.09.011","article-title":"Relationship among obesity, depression, and emotional eating in young adults","volume":"107","author":"Lazarevich","year":"2016","journal-title":"Appetite"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"111867","DOI":"10.1016\/j.jpsychores.2024.111867","article-title":"Depression, anxiety, and development of obesity from childhood to young adulthood in China","volume":"185","author":"Fan","year":"2024","journal-title":"J. Psychosom. Res."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"517","DOI":"10.1007\/s10578-009-0141-1","article-title":"A longitudinal study of childhood depression and anxiety in relation to weight gain","volume":"40","author":"Rofey","year":"2009","journal-title":"Child Psychiatry Hum. Dev."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1016\/j.apnu.2022.12.016","article-title":"A predictor of emotional eating in adolescents: Social anxiety","volume":"43","author":"Erdem","year":"2023","journal-title":"Arch. Psychiatr. Nurs."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"701","DOI":"10.1016\/j.appet.2010.10.006","article-title":"Trait anxiety, but not trait anger, predisposes obese individuals to emotional eating","volume":"55","author":"Schneider","year":"2010","journal-title":"Appetite"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"186","DOI":"10.1111\/j.1746-1561.2009.00485.x","article-title":"Body Dissatisfaction, Dietary Restraint, Depression, and Weight Status in Adolescents","volume":"80","author":"Goldfield","year":"2010","journal-title":"J. Sch. Health"},{"key":"ref_55","first-page":"457","article-title":"Body shape dissatisfaction and obesity among Taiwanese adolescents","volume":"17","author":"Chen","year":"2008","journal-title":"Asia Pac. J. Clin. Nutr."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"e13840","DOI":"10.1111\/obr.13840","article-title":"Potential pathways to the onset and development of eating disorders in people with overweight and obesity: A scoping review","volume":"26","author":"Khalid","year":"2025","journal-title":"Obes. Rev."},{"key":"ref_57","doi-asserted-by":"crossref","unstructured":"Obeid, N., Flament, M.F., Buchholz, A., Henderson, K.A., Schubert, N., Tasca, G., Thai, H., and Goldfield, G. (2022). Examining Shared Pathways for Eating Disorders and Obesity in a Community Sample of Adolescents: The REAL Study. Front. Psychol., 13.","DOI":"10.3389\/fpsyg.2022.805596"},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"558","DOI":"10.4097\/kja.19087","article-title":"Multicollinearity and misleading statistical results","volume":"72","author":"Kim","year":"2019","journal-title":"Korean J. Anesthesiol."},{"key":"ref_59","doi-asserted-by":"crossref","unstructured":"Ramsamy, G., Mosbah, H., Faure, J.P., Plault, V., Albouy, M., and Esnard, C. (2024). How to reduce the adverse effects of weight stigma on the quality of life: A preferred reported items for systematic reviews and meta-analyses (PRISMA). Front. Psychol., 15.","DOI":"10.3389\/fpsyg.2024.1421609"},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"88","DOI":"10.1159\/000519284","article-title":"Stress, Stress Reduction and Obesity in Childhood and Adolescence","volume":"96","author":"Kappes","year":"2023","journal-title":"Horm. Res. Paediatr."}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/61\/3\/466\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T16:48:50Z","timestamp":1760028530000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/61\/3\/466"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,3,7]]},"references-count":60,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2025,3]]}},"alternative-id":["medicina61030466"],"URL":"https:\/\/doi.org\/10.3390\/medicina61030466","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,3,7]]}}}