Childhood obesity is generally caused by decreased physical activity and/or improper nutrition leading to excessive energy intake (1). Pharmacological interventions play a limited role in obesity treatment; the primary components of therapy include dietary modifications, exercise, and behavioral changes (1). Adolescence is a developmental stage marked by heightened stress reactivity, emotional sensitivity, and vulnerability (2). Obesity-related psychosocial stress may further intensify stress during adolescence (3, 4). Cumulative stress can negatively impact mental health (5). Many obese children experience lower academic performance, reduced quality of life, diminished self-esteem, and negative body image (6). Symptoms commonly observed in depressive disorders, such as impaired concentration and low energy, may interfere with participation in physical activity, potentially hindering obesity treatment and contributing to worsening severity (7). The relationship between depression and obesity is bidirectional, with each condition increasing the risk of the other (8).

Although it is generally accepted that childhood obesity has adverse effects on mental health, the literature presents conflicting results regarding the association. A study conducted in Iran reported no significant difference in the prevalence of depression among obese adolescents. It was suggested that in Iranian culture, being overweight is associated with health and happiness, possibly explaining the lack of increased depression (9). Zakeri et al. also found that obesity did not increase the incidence of emotional problems, highlighting the role of cultural factors (10).

Previous studies have explored the possibility that psychopathologies observed in obese individuals may be transmitted within families. One study reported a significant association between psychological problems in obese children and those in their mothers (6). A review of nine studies from the United States and Europe found that maternal chronic depression may be a risk factor for childhood obesity (11). However, there are also reports suggesting that childhood obesity is not necessarily linked to maternal depression, negative life events, poor overall family functioning, or ineffective parenting (12). A study conducted in Turkey found significantly increased anxiety but not depression in mothers of obese children, suggesting that impaired family functioning may negatively impact the treatment process (13). Emotional and physical support from parents plays a crucial role in adolescents' weight-loss efforts (14).

Burnout is an emotional state resulting from cumulative exposure to chronic occupational and life stress, characterized by emotional exhaustion, physical fatigue, and cognitive weariness. The Maslach Burnout Inventory (MBI) is the most widely used tool to assess burnout (15). To date, there is no study in the literature investigating burnout in families of obese children. Maternal depression may lead to emotional detachment from the child's weight problems, delays in seeking medical help, and poor adherence to treatment. We hypothesized that maternal burnout may be more prevalent among mothers of obese adolescents. Since obesity is a chronic condition, we also evaluated the “burden” of adolescent obesity on their caregivers.

This study was designed as a cross-sectional, relational screening model using convenience sampling. Between June 2021 and June 2022, adolescents aged 12–18 years who presented to the Pediatric Endocrinology outpatient clinic at Çukurova University Faculty of Medicine for obesity were randomly selected and evaluated through physical examination and structured interview forms. The control group consisted of adolescents of the same age range and their mothers who visited the general pediatrics outpatient clinic and had no obesity or chronic illnesses. All interviews were conducted face-to-face by a pediatrician. The diagnosis of obesity was based on a body mass index (BMI) greater than +2 standard deviations (SDS) for age (16). The study received ethical approval from the Non-Interventional Clinical Research Ethics Committee of Çukurova University (Approval Date: 11/06/2021; Approval No: 112). The study was conducted in accordance with the principles of the Declaration of Helsinki. Written informed consent for participation in the study and for the publication of the results was obtained from all legal guardians.

A total of 49 obese adolescents and 43 controls aged between 12 and 18 years were evaluated. The mean age of the obese group was 14.34 ± 1.66 years (min: 12, max: 18), while that of the control group was 15.00 ± 1.58 years (min: 12, max: 18) (p = 0.06). Among the obese participants, 33 were female and 16 were male; in the control group, 28 were female and 15 were male. There was no significant difference in sex distribution between the groups (p = 0.82) (Table 1).

The mean body mass index (BMI) of the obese group was 35.29 ± 4.77 kg/m² and the BMI-SDS was 2.44 ± 0.40, whereas the control group had a mean BMI of 22.45 ± 3.21 kg/m² and a BMI-SDS of 0.62 ± 0.67 (p < 0.01). The mean total depression score among obese adolescents was 16.36 ± 6.96 and the total anxiety score was 29.95 ± 14.09, while these values were 15.39 ± 9.69 and 27.04 ± 14.35, respectively, in the control group. No statistically significant difference was found between the groups (p = 0.57 and p = 0.32, respectively) (Table 1).

The mean maternal BMI in the study group was 31.07 ± 0.4, compared to 26.6 ± 4.3 in the control group (p = 0.01). The mean years of maternal education were 8.04 ± 3.69 years in the obese group and 7.9 ± 4.3 years in the control group, with no significant difference (p = 0.87). Among the mothers of the obese group, the depression score was 15.08 ± 10.5 (median: 14), anxiety score was 17.24 ± 13.13 (median: 16), and caregiver burden score was 24.81 ± 15.15. In the control group, these scores were 15.53 ± 11.38, 15.14 ± 11.48, and 20.62 ± 10.82, respectively. None of the differences were statistically significant (p = 0.84, p = 0.41, p = 0.13, respectively) (Table 1).

Among mothers of obese adolescents, the mean scores on the Maslach Burnout Inventory were as follows: emotional exhaustion: 9.14 ± 5.39, depersonalization: 3.14 ± 2.94. In the control group, these scores were 6.23 ± 4.65 and 1.74 ± 1.63, respectively (p = 0.007 for both). Emotional exhaustion and depersonalization scores were significantly higher among mothers in the obese group. The personal accomplishment subscale score was 7.87 ± 5.68 in the study group and 6.81 ± 5.75 in the control group, with no significant difference (p = 0.376) (Table 1).

Due to exclusion criteria, individuals or guardians with a diagnosed psychiatric disorder were not included. At the time of enrollment, none of the adolescents in the study group were receiving psychiatric or other medical treatment. All participants were within the age range of compulsory education, and none had dropped out of school.

Previous studies from Turkey have reported elevated depression and anxiety scores in obese adolescents (30, 31). However, our study did not identify significant differences in depression or anxiety scores between obese and non-obese adolescents. A report from Iran, a country geographically and culturally similar to Turkey, suggested that obesity may serve as a protective factor against psychosocial disorders (10). This has been attributed to cultural perceptions of overweight individuals as being healthier.

Studies conducted in Turkey have reported average childhood depression inventory (CDI) scores of 11.3 ± 6.02 and 13.3 ± 7.3 (32, 33). In our study, CDI scores were elevated in both obese and non-obese adolescents compared to those reported in the literature. These elevated depression scores may be related to the COVID-19 pandemic period during which the study was conducted. Supporting evidence from Turkey indicates that mental health outcomes worsened during this time (34). Similarly, previous studies using the Screen for Child Anxiety Related Emotional Disorders (SCARED) in Turkey reported a mean control group anxiety score of 26.7 ± 10.6, which is lower than our findings (35), suggesting a general elevation in anxiety possibly due to the pandemic.

We found no significant differences in maternal depression and anxiety scores between the groups. Some studies have reported higher maternal depression in obese groups, while others have found no difference (11, 12). Our findings align with previous research from Turkey indicating no significant difference in maternal depression scores (13). The significantly higher maternal BMI in the obese group is consistent with earlier literature (36). It is well established that both genetic and environmental components contribute to familial predisposition to obesity. Although our study did not focus specifically on “obesogenic” behavioral patterns within families—such as the nutritional content of snacks, portion sizes, chewing duration, or exposure to digital screens during meals—these factors may represent important areas for future research.

The mean caregiver burden score among mothers of obese adolescents was 24.81 ± 15.1, a value classified as “mild burden” (range: 22–46) according to the literature (37). While caregiver burden was elevated in mothers of obese adolescents, the difference was not statistically significant compared to controls. This scale has not previously been applied to non-syndromic obesity. Given the chronic nature of obesity and its treatment, emotional exhaustion in mothers of obese adolescents may mask symptoms of depression and anxiety. Furthermore, maternal depersonalization may result in underreporting or under-perception of psychological distress and caregiver burden.

One of the strengths of this study is the face-to-face, expert-conducted evaluations of both adolescents and their mothers. To our knowledge, the use of the Maslach Burnout Inventory among mothers of obese adolescents has not been previously reported. Emotional exhaustion and depersonalization scores were significantly higher in the mothers of obese adolescents. This burnout may be a cause or a consequence of adolescent obesity. Mothers who are also obese may feel powerless to change the situation, and a perceived lack of benefit from medical interventions may contribute to emotional exhaustion. Addressing maternal hopelessness may yield positive outcomes in adolescent obesity management.

Although depression and anxiety scores were elevated in all adolescents compared to national norms, no significant association with obesity was identified. Emotional exhaustion and depersonalization were significantly higher among mothers of obese adolescents. Assessing and supporting maternal burnout may contribute positively to adolescent obesity management. Due to the cross-sectional design, no causal inferences can be drawn. Future longitudinal research is needed to clarify the potential bidirectional relationship between childhood obesity, maternal obesity, and caregiver burnout.