Parental Mental Health Associated With Child Overweight and Obesity, Examined Within Rural and Urban Settings, Stratified by Income

Purpose: Rural areas experience greater childhood obesity compared with urban areas. Differences in reported physical activity and dietary intake do not fully explain the disparity. The purpose of this study was to examine the association between parental mental health and childhood obesity within urban and rural areas. Methods: We used data from the National Survey of Children's Health, 2016, subset to children age 10-17 with available weight data. We stratified the sample by rural and urban settings and examined whether maternal or paternal mental health was associated with child overweight or obesity, accounting for income stratum (low-income: ≤200% federal poverty line; high-income: >200% federal poverty line). We used multivariable analyses to test if associations remained after including covariates of food security, physical activity, and screen time. Findings: For the 14,733 children 10-17 years of age in our sample, family income but not rurality was associated with overweight or obesity. Among high-income families, positive mental health of either the mother or the father was associated with lower odds of overweight or obesity. In multivariable models, the association between positive maternal mental health and lower odds of child overweight/obesity persisted after adjustment for family food security, child physical activity, and child screen time. For paternal mental health, the association was not significant after adjusting for these covariates. Conclusions: After stratification by income, there were no differences in childhood overweight/obesity by rurality. Both maternal and paternal mental health are associated with children's weight, though only the maternal association remains after adjusting for covariates.