Body composition and fitness linked to anxiety and depression in preadolescent children

Body composition and fitness linked to anxiety and depression in preadolescent children | Image Credit: © Tom Wang - stock.adobe.com.

A cross-sectional study published in JAMA Network Open examined associations between body composition, cardiorespiratory fitness, and mental health outcomes in preadolescent children. The findings indicate that higher lean mass and fitness levels are linked to fewer anxiety and depression symptoms, while greater visceral adipose tissue (VAT) is associated with increased symptoms.¹

The investigation included 207 children aged 8 to 11 years without prior mental health diagnoses, recruited from the Greater Boston area between 2019 and 2023. Researchers assessed body composition using dual-energy x-ray absorptiometry (DXA), which provided measures of body fat percentage (BF%), VAT, and lean mass. Cardiorespiratory fitness was evaluated by peak oxygen uptake (VO₂peak) relative to body weight. Mental health outcomes were measured using the State-Trait Anxiety Inventory for Children (trait subscale) and the Children’s Depression Inventory short form.²

Key results

Analysis showed distinct associations between different tissue types and mental health. Anxiety symptoms were positively associated with BF% and VAT, and negatively associated with lean mass and VO₂peak. Specifically, “higher BF% was associated with higher STAIC-T (β = 0.15; 95% CI, 0.23 to 6.33; P = .04). Higher VAT was associated with higher STAIC-T (β = 0.15; 95% CI, 0.04 to 1.82; P = .04). Higher lean mass was associated with lower STAIC-T (β = −0.16; 95% CI, −14.77 to −1.21; P = .02). Significant associations were also found for VO₂peak, with higher VO₂peak associated with lower STAIC-T (β = −0.19; 95% CI, −0.28 to −0.04; P = .01)”.

Depressive symptoms showed a different pattern. BF% was not significantly associated, but VAT was positively correlated, while lean mass and VO₂peak were inversely correlated. The authors reported, “higher VAT was significantly associated with higher CDI (β = 0.27; 95% CI, 0.34 to 1.11; P < .001) and higher lean mass was associated with lower CDI (β = −0.16; 95% CI, −6.39 to −0.43; P = .03). Lastly, significant associations were found for VO₂peak, with higher VO₂peak associated with lower CDI (β = −0.16; 95 % CI, −0.11 to −0.01; P = .03)”.

BMI, commonly used in pediatric assessments, was not significantly related to either anxiety or depression in this cohort, though results trended in the expected direction. This finding underscores the importance of tissue-specific assessments beyond BMI when considering mental health implications.

Interpretation and implications

The authors noted that “greater lean mass and higher fitness were associated with fewer anxiety and depression symptoms, while higher VAT was associated with increased symptoms of both”. The findings highlight VAT’s potential role in mood regulation, possibly through inflammatory processes and effects on brain regions involved in stress response. Conversely, lean mass and physical fitness may exert protective effects by promoting anti-inflammatory states, enhancing neuroplasticity, and supporting more adaptive stress responses.

Although causality cannot be inferred due to the cross-sectional design, the results suggest that monitoring body composition and fitness could support early identification of children at risk for adverse mental health outcomes. The study authors emphasized the need for further longitudinal research to clarify mechanisms and developmental trajectories.

The authors concluded, “These distinctions, detectable even in preadolescence, could support early identification of children at greater risk for mental health symptoms. Integrating modifiable factors like fitness and body composition into routine pediatric assessments may help guide preventative care and early intervention to improve children’s mental health outcomes.”

References:

1. Braun B, Khan NA, Hillman CH, Raine LB. Body Composition, Fitness, and Mental Health in Preadolescent Children. JAMA Network Open. 2025;8(8):e2528868-e2528868. doi:https://doi.org/10.1001/jamanetworkopen.2025.28868
2. Spielberger CD, Edwards CD, Montouri J, Lushene R. State-Trait Anxiety Inventory for Children (STAI-CH). APA PsycNet. Accessed July 23, 2025. https://psycnet.apa.org/doiLanding?doi=10.1037%2Ft06497-000