The indirect effect of family cohesion on children’s weight status through maternal quality of life and children’s internalizing and externalizing symptoms

Background Obesity has serious psychosocial consequences for youth and family members and has reached epidemic levels in Portugal. Objective This study had two goals: (1) to investigate differences in family cohesion, mothers’ quality of life (QoL), and externalizing/internalizing symptoms between children/adolescents with healthy-weight and overweight/obesity; (2) to assess the mediating role of maternal QoL and children/adolescents’ externalizing/internalizing symptoms in the association between family cohesion and weight. Methods Children/adolescents with healthy-weight (n = 134) and with overweight/obesity (n = 163) and their mothers participated in the study. Mothers completed measures of family cohesion (FC) and QoL and children/adolescents completed measures of externalizing and internalizing symptoms. This study used a cross-sectional design. Results Children/adolescents with overweight/obesity reported higher levels of externalizing and internalizing symptoms than children/adolescents with healthy-weight. Mothers of children/adolescents with overweight/obesity reported lower levels of FC and QoL than mothers of children/adolescents with healthy-weight. Mothers’ QoL and children/adolescents’ externalizing symptoms sequentially mediated the relationship between FC and weight status. Specifically, an increase in FC and QoL resulted in a decreased likelihood of the child/adolescent reporting overweight or obesity, whereas an increase in externalizing symptoms resulted in a higher likelihood of the child/adolescent reporting overweight or obesity. Conclusions This study identifies mechanisms that might account for the link between FC and weight, suggesting the importance of mothers’ QoL and children’s externalizing symptoms. Moreover, it provides a better understanding of the psychosocial outcomes related to pediatric obesity, highlighting the relevance of working with the parents to promote weight reduction in youths.