Social Withdrawal, Eating Behaviors, and Daytime Sleepiness in Adolescents with Obesity: A Biopsychosocial Case-Control Study.

BACKGROUND/

OBJECTIVES

Adolescent obesity is increasingly recognized as a multidimensional condition involving psychosocial and behavioral vulnerabilities beyond metabolic risk. Although social withdrawal, dysregulated eating behaviors, and sleep disturbances have each been associated with obesity, integrative studies examining these domains concurrently remain limited. This study aimed to comparatively evaluate social withdrawal characteristics, eating behavior patterns, and daytime sleepiness in adolescents with obesity and normal-weight peers.

METHODS

This cross-sectional case-control study included 209 adolescents aged 14-18 years (100 with obesity; 109 normal-weight controls). Social withdrawal was assessed using the Hikikomori Risk Inventory (HRI-24), eating behaviors with the Children's Three-Factor Eating Questionnaire (CTFEQ-17), and daytime sleepiness with the Pediatric Daytime Sleepiness Scale (PDSS). The BMI z-scores were calculated according to the CDC growth charts. Group comparisons and correlation analyses were performed.

RESULTS

Adolescents with obesity demonstrated significantly higher total social withdrawal scores and higher anthropophobia, agoraphobia, lethargy, and depressive mood subscale scores compared with the controls (all p < 0.01). Uncontrolled eating and emotional eating were also significantly higher in the obesity group (both p < 0.001), whereas cognitive restraint did not differ between groups (p > 0.05). Daytime sleepiness scores were higher in adolescents with obesity (p < 0.01). The BMI z-scores were positively correlated with social withdrawal dimensions and dysregulated eating behaviors (r = 0.15-0.30, p < 0.05) but not with daytime sleepiness. In contrast, daytime sleepiness was moderately associated with social withdrawal and uncontrolled/emotional eating (all p < 0.001).

CONCLUSIONS

Adolescent obesity is associated not only with maladaptive eating behaviors but also with broader psychosocial vulnerabilities, including social withdrawal tendencies and sleep-related difficulties. These findings support a biopsychosocial conceptualization of adolescent obesity and underscore the importance of multidimensional intervention approaches targeting emotional regulation, sleep hygiene, and social functioning alongside weight management strategies.