Purpose: Children who are overweight or obese are at increased risk for psychosocial challenges. The 2016 National Survey of Children’s Health (NSCH) provides an opportunity to evaluate the impact of weight status on two newly added measures of psychosocial functioning. “Flourishing” (otherwise known as “thriving”) was introduced in the 2011/12 NSCH and then substantially revised in the 2016 NSCH. It is a composite measure to reflect resilience, self-regulation, and curiosity and discovery about learning. In terms of peer relations, the 2016 NSCH not only continues to ask if a child “bullies, picks on, or excludes others” but now also asks if a child is bullied, picked on, or excluded by others. The objective of this study is to assess, in a large nationally representative sample, to what extent overweight or obese school-age children in the United States are likely to “flourish” and to what extent they experience difficulties in peer relations. Methods: In the 2016 NSCH, school-age children were identified as “flourishing” if the parent responded “Definitely True” to questions about whether the child shows interest and curiosity in learning new things, works to finish tasks he or she starts, and stays calm and in control when faced with a challenge. Logistic regression was performed for children 10-17 years of age to examine the association between weight status (underweight, healthy weight, overweight and obese) and the psychosocial measures described above, with adjustment for age, sex, race/ethnicity, child’s overall health status, household structure, highest caregiver educational achievement, and household income. Results: The 2016 NSCH included 26,094 children 10-17 years of age, and survey results were adjusted and weighted by the CDC to reflect the demographic composition of the US. The weighted national prevalences for overweight and obese children in 2016 were 15.0% and 16.1 % respectively. The weighted prevalence of flourishing for different demographic groups is reported in Table 1. Even after adjusting for demographic variables and overall health status, overweight and obese children were 8% and 24% less likely to be classified as flourishing. Adjusted odds ratios for flourishing and for difficulties with peer relations as a function of weight status are shown in Table 2. Overweight and obese children were 23% and 27% more likely to be bully-victims. Obese children were 67% more likely to be just bullied, picked on, or excluded by others. Conclusion: Overweight and obese children aged 10-17 years are less likely to be perceived as flourishing and more likely to experience difficulties with peer relations. The 2016 NSCH results highlight the psychological challenges that overweight/ obese children face and stresses the need for both mental health counseling and weight loss programs.

Figure 1

PSMF Protocol