. 2022 Sep 26;81(6):658–669. doi: 10.1093/nutrit/nuac083

Table 2.

General characteristics of included studies

Reference and study design	Setting^a	Participants: total (% female); age (mean [SD], y	Prevalence of OW or OB; reference used	Outcome measurement	Overall result
Álvarez-Villaseñor 2020²⁵ Cross-sectional	La Paz, Baja California Sur Clinical setting	406 (50.7); age: 10.4 (1.2)	OW: 24.6, OB: 18.7, OW+OB: 43.3; CDC	Anxiety measured through a validated test toward anxiety in the presence of food (validated in Latin population)	Significative association between nutritional status with anxiety (P = 0.01). Also, there was a significant association between anxiety with socioeconomic level (P = 0.01), remaining unclear in this relationship.
Angulo-Valenzuela 2016²⁶ Cross-sectional	Zapopan, Jalisco Clinical setting	74 (52.7); age: 13 (NR)	OW: NA, OB: 100, OW+OB: NA; WHO	Depression measured with Birleson Scale	40.5% of the sample had depression. The level of depression increased when the BMI was higher, but this trend was not significant (P = 0.393)
Caetano-Anolles 2013²⁷ Cross-sectional	NR, San Luis Potosí School setting	102 (52.94); age: 18 (1.5)	OW: 15.7, OB: 11.8, OW+OB: 27.5; WHO	Depression measured with CESD-10 (validated)	No significant association between BMI and depression (P > 0.05) was found. However, when related to sex, there was a marginally significant association between BMI and depression among female participants (P < 0.05). There was also a significant negative association between family support and depression (P < 0.05) that was more significantly pronounced among female participants (P < 0.05).
Contreras-Valdez 2015²⁸ Cross-sectional	Mexico City School setting	231 (100%); age: 11.3 (0.72)	OW: 24.7, OB: 16.9, OW+OB: 41.6; WHO	Depression measured with CESD (validated)	No significant differences among the level of depression and BMI groups (P = 0.68). However, girls with overweight and obesity and with body dissatisfaction had lower self-esteem levels (P < 0.01) compared with other BMI groups. Overall, participants with obesity and overweight showed a greater body dissatisfaction level than normal-weight participants (P < 0.01, P = 0.04, respectively).
Escalante-Izeta 2016²⁹ Cross-sectional	Toluca, Estado de Mexico School setting	585 (49.23%); age: 9 (1.32)	OW: 29.7, OB: 26.0, OW+OB: 55.7; WHO	Anxiety measured with CMAS-R (validated)	No significant association between anxiety and BMI status (P > 0.05). However, there was a positive and significant association between waist size and anxiety (P = 0.015).
Flores 2015³⁰ Cross-sectional	Cuernavaca, Morelos Clinical setting	164 (49); age: 14.7 (2.3)	OW: 38.4, OB: 40.2, OW+OB: 78.5; WHO	Depressive symptoms were assessed was with Children's Depression Inventory: Short Version	Overall, participants with obesity were significantly (P < 0.05) more likely to have depressive symptoms, and as BMI increased, more depressive symptoms were reported (P = 0.04). The adjusted odds for those participants with overweight and obesity were 1.9 (95%CI 0.6–6.4) and 2.7 (95%CI 0.9–9.2) to be more likely to have depression; however, these were not significant. Nevertheless, those participants with a greater waist circumference (>90th percentile) were significantly more likely to have depression OR 4.4 (95%CI 1.4–19.5).
Garcia-Falconi 2016³¹ Cross-sectional	Cárdenas, Centro, Macuspana, Emiliano Zapata and Tacotalpa, Tabasco School setting	332 (46.1); age: NR	OW: NR, OB: NR, OW+OB: 100.0; NR	Anxiety measured with CMAS-R (validated) Depression measured with CDS (validated)	No association between anxiety and BMI was found. However, authors reported that children with overweight and obesity with low anxiety levels consumed fewer fruits than those with moderate anxiety (P < 0.05). No results were presented for depression, but when related to food consumption, authors reported that children with overweight and obesity with higher levels of depression had a higher consumption of fats (P < 0.05).
Gonzalez-Toche 2017³² Cross-sectional	Morelia, Michoacan Clinical Setting	165 (55.2); age: NR	OW: 38.4, OB: 40.2, OW+OB: 78.5; CDC	Depression measured with CDI (validated)	20.6% of the participants had depression, and a significantly higher proportion of these had obesity (64.7; P = 0.001); 35.3% had average weight. Also, the prevalence of depression was significantly (P < 0.001) higher among females (70.5%) than males (26.5%). Those participants with obesity were more likely to report depression (OR,2.4; 95%CI, 1.1–5.3; P = 0.025), and that likelihood was higher among females (r = 2.5; 95%CI, 1.1–5.6; P = 0.021)
Hernández Nava 2020³³ Cross-sectional	Acapulco de Juárez, Guerrero Clinical setting	238 (50%); age: 10.8 (NR)	OW: NR, OB: NR, OW+OB: 37.8; WHO	Depression measured with CDI (validated)	5.9% of the sample had depression. The prevalence was higher among females (7.5%) than males (4.2%). Having overweight or obesity was associated with a higher likelihood of depression (OR, 4.5; 95%CI, 1.3-14.8; P > 0.008)
Lopez-Morales 2014³⁴ Cross-sectional	Villa Juárez, Sonora Clinical setting	101 (60.4); age: 9.89 (NR)	OW: 21.8, OB: 23.8, OW+OB: 45.5; CDC	Depression measured with CDI (validated)	28.7% of the sample had depression; of these, 65.5% of children had overweight or obesity (P value not reported).
Merino-Zeferino 2018³⁵ Cross-sectional	NR, Estado de México School setting	616 (50.33); age: 14 (NR)	OW: NR, OB: NR, OW+OB: 37.8; WHO	Depression measured with Zung Scale (validated)	BMI, self perception of body image, and waist size were higher in adolescents with higher depressive symptoms (P < 0.05). Frequency of depressive symptoms was greater in girls but unclearly related to BMI (P value not reported). There was a positive association between BMI and self perception of body image (P = 0.0001).
Moreno-Martínez 2018³⁶ Cross-sectional	Matamoros, Tamaulipas School setting	60 (65%); age: NR. School children	OW: NA, OB : 100, OW+OB: NA; WHO	Depression measured with Beck's tool (validated)	A nonsignificant relationship between depression and obesity was found (P = 0.572). However, female participants reported depression more frequently than males, but a relationship to BMI was unclear (P value not reported).
Pompa-Guajardo 2017³⁷ (Linked to Pena 2017)³⁸ Cross-sectional	Monterrey, Nuevo León School setting	849 (53.7); age: 13.17 (NR)	OW: 29.7, OB: 28.6, OW+OB: 58.3; WHO	Anxiety measured with CMAS-R (validated) Depression measured with CDS (validated)	A person with overweight or obesity has an OR of 1.8 of presenting with high stress and anxiety levels (P value and CIs not reported). Females had a higher likelihood of manifesting anxiety than males, but this was not related to BMI (OR, 1.4; 95%CI, 0.955–2.032; P > 0.001). The prevalence of depression in participants with overweight or obesity was 57.9% compared with 42.1% of participants with normal weight. There was no statistically significant association between variables (OR, 0.976, 95%CI, 0.733–1.298; P > 0.005). The percentage of depressive symptoms was higher among female adolescents and even higher among those with overweight or obesity compared with boys and those with normal weight (P > 0.005).
Radilla 2013³⁹^,⁴⁰ (abstracts) Cross-sectional	Mexico City School setting	142 (50.7); age: NR School children	OW: 27.5, OB: 13.4, OW+OB: 40.9; WHO	Anxiety and depression measured with HAD (validated)	No significant association was found between anxiety and nutritional status (P > 0.05), as well as between depression and nutritional status (P > 0.05).
Radilla-Vazquez 2015⁴¹ Cross-sectional	Mexico City School setting	2368 (49.75); age: 12.1 (0.5)	OW: NR, OB: NR, OW+OB: NR; WHO	Anxiety and measured with HAD (validated)	No significant association was found between anxiety and nutritional status (P > 0.05). Girls had higher anxiety levels (P < 0.01) than boys. However, it is unclear if there was a relation with their BMI. Children attending school in the evening had higher anxiety than in those attending during the morning (P < 0.05).
Shamah-Levy 2020⁴² Cross-sectional (ENSANUT 2018-19)	National Sample Home setting	5670 adolescents (49.8); age: 15.3 (NR)	OW: 23.8, OB: 14.7, OW+OB: 38.5; WHO	Depression symptoms were measured with CESD-7 (validated)	3.5% of the sample had depression. The likelihood of depression increased with obesity (OR, 1.46; P = 0.035) and was reported to be greater in females (OR, 2.07; P < 0.001) and to increase with age (OR, 1.21; P < 0.001). In addition, the probability of having depression was reported to be greater than the medium wellness index (based on household conditions) (OR, 1.59; P = 0.006), although it seemed to be greater in the high wellness index, but not significantly so (OR, 1.39; P = 0.071) (both compared with the lower wellness index).

City or municipality, state in Mexico.

Abbreviations: BMI, body mass index; CDC, Centers for Disease Control and Prevention; CDI, Depression Inventory for Children; CDS, Depression Scale for Children; CES-D, Center for Epidemiologic Studies Depression Scale (CESD-7 is the short version); CMAS-R, Child Manifest Anxiety Scale-Revised; ENSANUT, Mexican National Health and Nutrition Survey; HAD, Hamilton Anxiety Questionnaire; NA, not applicable; NR, not reported; OB, obesity; OW, overweight; WHO, World Health Organization.