[Research on the association between overweight and obesity mediated by Chinese children and adolescent aged 13-18 years physical exercise and psychological distress].

Objective: To analyze the association between overweight and obesity, psychological distress, and the influence of physical exercise among Chinese children and adolescents. Methods: The study used data from the 2019 Chinese National Survey on Students' Constitution and Health. A total of 95 280 Han Chinese children and adolescents aged 13 to 18 years were included in the study based on complete information on overweight and obesity, psychological distress assessment, and physical exercise variables. The Kessler Psychological Distress Scale was used to measure their psychological distress, with scores above 25 indicating high psychological distress. The BMI group of the adolescents was evaluated according to the Chinese standard "WS/T 586-2018 Screening for Overweight and Obesity in School-age Children and Adolescents", including underweight, normal weight, overweight, and obesity. The individual's BMI Z-score (BMIZ) was evaluated using the WHO standard and divided into ten groups based on the population percentile distribution. The survey collected the subjects' average daily physical exercise time and divided them into two groups: less than 1 hour and greater than or equal to 1 hour. Logistic regression analysis was used to analyze the relationship between overweight and obesity and high psychological distress among children and adolescents and the differences in association between different physical exercise groups. Results: The detection rates of overweight and obesity among Han Chinese children and adolescents aged 13 to 18 years in 2019 were 14.5%, and 7.6%, respectively. The rate of high psychological distress was 37.6%, and the rate of average daily physical exercise time exceeding 1 hour was 17.1%. Using the population with a BMIZ P10 below as a reference, the association strength between high psychological distress and the population gradually increased, with an OR (95%CI) value of 1.08 (1.02-1.14), 1.09 (1.02-1.14), 1.10 (1.03-1.16), and 1.16 (1.09-1.23) for BMIZ in the P60-, P70-, P80-, >P90 groups. Compared to normal weight, both overweight and obesity were positively associated with high psychological distress in children and adolescents, with obesity showing a more significant correlation, while underweight was negatively associated with high psychological distress. The detection rates of high psychological distress in normal weight, underweight, overweight, and obese groups were 37.6%, 37.0%, 38.2%, and 38.7%, respectively, with an OR (95%CI) value of 0.93 (0.88-0.98) for the underweight group and 1.05 (1.01-1.10) and 1.13 (1.07-1.19) for the overweight and obese groups, respectively. The positive correlation between BMIZ, overweight, and obesity with high psychological distress was significant only in adolescents who exercised less than 1 hour per day on average. Conclusions: Chinese children and adolescents face the problem of obesity and high psychological distress, with a positive correlation between these two problems. Physical activity may moderate the association between obesity and psychological distress in children and adolescents. Adequate physical exercise may offset the potential high psychological distress caused by obesity in children and adolescents. Thus, strengthening physical exercise among children and adolescents reduces the risks of both obesity and psychological health problems effectively.目的： 分析我国儿童青少年超重/肥胖与心理困扰的关联及体育锻炼的修饰作用。 方法： 利用2019年全国学生体质与健康调研数据中汉族儿童青少年，基于超重/肥胖、心理困扰评估和体育锻炼变量信息完全者，最终纳入95 280名13~18岁儿童青少年，使用凯斯勒心理困扰量表测量其心理困扰，以评分≥25判定为高心理困扰，根据中国《WS/T 586-2018学龄儿童青少年超重与肥胖筛查》标准进行BMI分组，包括消瘦、正常、超重和肥胖，采用WHO标准评价个体的BMI Z评分（BMIZ），并依据人群百分位数分布平均划分为10组，通过问卷收集调查对象平均每日体育锻炼时间，并划分为<1 h组和≥1 h组。采用logistic回归模型分析儿童青少年超重/肥胖与高心理困扰之间的关联，以及在不同体育锻炼时间组中的关联差异。 结果： 2019年13~18岁汉族儿童青少年超重、肥胖检出率分别为14.5%和7.6%，高心理困扰率为37.6%，平均每日体育锻炼的时间≥1 h的比例为17.1%。以BMIZP90组人群高心理困扰概率增加，其OR值（95%CI）分别为1.08（1.02~1.14）、1.09（1.02~1.14）、1.10（1.03~1.16）和1.16（1.09~1.23）。以BMI正常为参照，超重和肥胖均与儿童青少年高心理困扰呈正相关，肥胖更为明显，而消瘦与其呈负相关。BMI正常组儿童青少年的高心理困扰率为37.6%，而消瘦组为37.0%，超重和肥胖组分别为38.2%和38.7%。以BMI正常组为参照，消瘦、超重和肥胖组高心理困扰的OR值（95%CI）分别为0.93（0.88~0.98）、1.05（1.01~1.10）和1.13（1.07~1.19）。BMIZ和超重/肥胖与高心理困扰的正相关关系仅存在于平均每日体育锻炼时间<1 h的儿童青少年中。 结论： 我国儿童青少年同时面临着肥胖和高心理困扰的问题，且两者存在正相关，体育锻炼可能对儿童青少年肥胖和心理困扰的关联起调节作用，充足的体育锻炼可能抵消儿童青少年肥胖潜在的高心理困扰的影响，因此，加强儿童青少年体育锻炼是同时降低肥胖和心理健康问题风险的有效手段之一。.