Perceptions, attitudes, and behaviors among adolescents living with obesity, caregivers, and healthcare professionals in Italy: the ACTION Teens study.

PURPOSE: ACTION Teens (NCT05013359) was conducted in 10 countries to identify perceptions, attitudes, behaviors, and barriers to effective obesity care among adolescents living with obesity (ALwO), caregivers of ALwO, and healthcare professionals (HCPs). Here, we report data from participants in Italy. METHODS: The ACTION Teens cross-sectional online survey was completed by 649 ALwO (aged 12- < 18 years), 455 caregivers, and 252 HCPs in Italy in 2021. RESULTS: Most ALwO thought their weight was above normal (69%), worried about weight affecting their future health (87%), and reported making a weight-loss attempt in the past year (60%); fewer caregivers responded similarly regarding their child (46%, 72%, and 33%, respectively). In addition, 49% of caregivers believed their child would lose excess weight with age. ALwO (38%) and caregivers (30%) most often selected wanting to be more fit/in better shape as a weight-loss motivator for ALwO; HCPs most often selected improved social life/popularity (73%). ALwO (25%) and caregivers (22%) most frequently selected lack of hunger control and not liking exercise, respectively, as weight-loss barriers, while HCPs most often agreed that unhealthy eating habits were a barrier (93%). ALwO most often obtained weight-management information from family/friends (25%) and search engines (24%); caregivers most often obtained information from doctors (29%). CONCLUSION: In Italy, the impact of obesity on ALwO was underestimated by caregivers, and ALwO and HCPs had different perceptions of key weight-loss motivators and barriers. Additionally, the internet was a key information source for ALwO, which suggests new education/communication strategies are needed. LEVEL OF EVIDENCE: IV; Evidence obtained from multiple time series with/without intervention, e.g. TRIAL REGISTRATION: ClinicalTrials.gov, NCT05013359.

Utilisation of the health belief model to study the behavioural intentions relating to obesity management among university students: a cross-sectional study.

BACKGROUND: Overweight and obesity are excessive fat accumulations linked with many health problems, including heart diseases, type 2 diabetes and cancer. Multiple studies have demonstrated that beliefs about overweight, obesity and self-efficacy play essential roles in the success of interventions for obesity management. OBJECTIVES: This study aimed to identify the perceptions of university students of overweight and obesity using the health belief model (HBM) and to analyse their association with the body mass index (BMI) categories of the students. DESIGN: A cross-sectional questionnaire-based study and a multistage sampling technique were used to ensure the recruitment of students from selected colleges of Jazan University-Saudi Arabia. SETTING: Six colleges of Jazan University were randomly selected to ensure equal representation of health sciences, sciences and humanities colleges. PARTICIPANTS: A total of 579 students completed an online survey between January and April 2023. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome measures were demographic characteristics and HBM constructs. Secondary outcome measures were behavioural intentions relating to obesity management. RESULTS: This study demonstrated that gender and self-reported family history of obesity were significantly correlated with the BMI categories of the students (p <0.001). Students in the underweight category showed the highest mean score for perceived severity (3.62 ±0.08). Perceived self-efficacy in exercise and diet was significantly associated with BMI categories, with adjusted ORs of 2.82 (2.10 to 3.79) and 1.51 (1.09 to 2.09), respectively. Perceived barriers to healthy eating and regular physical activity were significantly related to the behavioural intentions of obesity management. Multivariate logistic regression showed that perceived severity, perceived cues to action, perceived barriers and self-efficacy in dieting and exercise were significant predictors of behavioural intentions for the management of obesity. CONCLUSION: This study underscores the need for tailored health promotion strategies that consider the perceptions and beliefs of people about the management of obesity.

Experiences of living with overweight/obesity and early type 2 diabetes in Singapore-a qualitative interview study.

OBJECTIVES: To understand the lived experience of adults with overweight/obesity and early type 2 diabetes in a modern urban environment, and the interrelations among the various aspects of these experiences and participants' attitudes to weight management. DESIGN: Qualitative inductive approach to analysing data thematically from semistructured interviews and interpreted from a socioecological perspective. SETTING: Primary care clinics located in northern and central Singapore. PARTICIPANTS: 21 patients between 29 and 59 years old who are living with overweight/obese (Body Mass Index of 25.3-44.0kg/m2) and type 2 diabetes for 6 years or less. RESULTS: The main themes - everyday life, people around me and within me - pointed to a combination of barriers to weight and health management for participants. These included environmental factors such as easy physical and digital access to unhealthy food, and high-stress work environments; social factors such as ambiguous family support and dietary practices of peers; and individual factors such as challenges with self-regulation, prioritising work, dealing with co-existing medical conditions and the emotional significance of food. While lack of motivation and cultural dietary practices are hard to change, a problem-solving attitude, and presence of role models, may enable behaviour change. CONCLUSION: An exploration of the lifeworld of patients with overweight/obese and early type 2 diabetes revealed that work demands, dietary practices in the workplace and at home, and the easy availability of calorie-dense foods afforded by a technology-infused environment hindered the individual's efforts at maintaining a healthy weight and lifestyle. Policy and initiatives promoting work-life balance as well as individualised interventions can support participants' stress management, and problem-solving capability for behaviour change. These barriers stemmed from the various domains of the environmental, interpersonal and intrapersonal but were interrelated. They underscored the need for an integrated approach to weight and diabetes management.

A qualitative exploration of the experiences of pregnant women living with obesity and accessing antenatal care.

Women are advised to optimise weight before pregnancy. However, many are either already living with overweight or obesity prior to becoming pregnant, increasing the risks for adverse outcomes. Health care professionals (HCP) are responsible for advising women of risks throughout and following pregnancy. However, midwives often find broaching the conversation around maternal obesity difficult. This study explored the experiences of pregnant women living with obesity in accessing antenatal care. Seventeen women completed a semi-structured interview. Transcripts were analysed thematically. Four themes were developed: 1) antenatal care is inconsistent, 2) additional support is needed, 3) women feel judged about their weight, and 4) weight cycling is highly prevalent. Findings suggest that pregnant women living with obesity often experience weight bias from HCPs, feel judged because of their weight and are left feeling confused and overlooked. Women reported inconsistencies in advice and care offered and acknowledged a lack of continuity of care throughout pregnancy. We call for an urgent need for further multidisciplinary training to address the concerns, experiences and needs of pregnant women living with obesity.

Validation and assessment of psychometric properties of the Greek Eating Behaviors Assessment for Obesity (GR-EBA-O).

INTRODUCTION: With increasing morbidity and risk of death, obesity has become a serious health problem largely attributable to difficulties in finding proper treatments for related diseases. Many studies show how detecting abnormal eating behaviors could be useful in developing effective clinical treatments. This study aims at validating the Greek version of the Eating Behaviors Assessment for Obesity (EBA-O). METHOD: After a double English/Greek forward/backward translation of the EBA-O, 294 participants completed the Greek version (GR-EBA-O), the Eating Disorder Examination Questionnaire, the Binge Eating Scale, and the Yale Food Addiction Scale. Confirmatory factor analysis (CFA) and construct validity were calculated, and Two-way MANOVA was computed with the factors of GR-EBA-O controlling for sex and BMI categories. RESULTS: CFA confirmed the second-order five factors (i.e., food addiction, night eating, binge eating, sweet eating, and prandial hyperphagia) structure of the original EBA-O with excellent fit indices. GR-EBA-O factors were highly correlated. The GR-EBA-O subscales were also significantly correlated with the remaining measures, demonstrating good concurrent validity. CONCLUSION: The Greek version of the EBA-O has demonstrated sound psychometric properties and appears a reliable and user-friendly tool to identify pathological eating behaviors in obesity. LEVEL OF EVIDENCE: V, descriptive research.

Effectiveness of an Artificial Intelligence-Assisted App for Improving Eating Behaviors: Mixed Methods Evaluation.

BACKGROUND: A plethora of weight management apps are available, but many individuals, especially those living with overweight and obesity, still struggle to achieve adequate weight loss. An emerging area in weight management is the support for one's self-regulation over momentary eating impulses. OBJECTIVE: This study aims to examine the feasibility and effectiveness of a novel artificial intelligence-assisted weight management app in improving eating behaviors in a Southeast Asian cohort. METHODS: A single-group pretest-posttest study was conducted. Participants completed the 1-week run-in period of a 12-week app-based weight management program called the Eating Trigger-Response Inhibition Program (eTRIP). This self-monitoring system was built upon 3 main components, namely, (1) chatbot-based check-ins on eating lapse triggers, (2) food-based computer vision image recognition (system built based on local food items), and (3) automated time-based nudges and meal stopwatch. At every mealtime, participants were prompted to take a picture of their food items, which were identified by a computer vision image recognition technology, thereby triggering a set of chatbot-initiated questions on eating triggers such as who the users were eating with. Paired 2-sided t tests were used to compare the differences in the psychobehavioral constructs before and after the 7-day program, including overeating habits, snacking habits, consideration of future consequences, self-regulation of eating behaviors, anxiety, depression, and physical activity. Qualitative feedback were analyzed by content analysis according to 4 steps, namely, decontextualization, recontextualization, categorization, and compilation. RESULTS: The mean age, self-reported BMI, and waist circumference of the participants were 31.25 (SD 9.98) years, 28.86 (SD 7.02) kg/m2, and 92.60 (SD 18.24) cm, respectively. There were significant improvements in all the 7 psychobehavioral constructs, except for anxiety. After adjusting for multiple comparisons, statistically significant improvements were found for overeating habits (mean -0.32, SD 1.16; P<.001), snacking habits (mean -0.22, SD 1.12; P<.002), self-regulation of eating behavior (mean 0.08, SD 0.49; P=.007), depression (mean -0.12, SD 0.74; P=.007), and physical activity (mean 1288.60, SD 3055.20 metabolic equivalent task-min/day; P<.001). Forty-one participants reported skipping at least 1 meal (ie, breakfast, lunch, or dinner), summing to 578 (67.1%) of the 862 meals skipped. Of the 230 participants, 80 (34.8%) provided textual feedback that indicated satisfactory user experience with eTRIP. Four themes emerged, namely, (1) becoming more mindful of self-monitoring, (2) personalized reminders with prompts and chatbot, (3) food logging with image recognition, and (4) engaging with a simple, easy, and appealing user interface. The attrition rate was 8.4% (21/251). CONCLUSIONS: eTRIP is a feasible and effective weight management program to be tested in a larger population for its effectiveness and sustainability as a personalized weight management program for people with overweight and obesity. TRIAL REGISTRATION: ClinicalTrials.gov NCT04833803; https://classic.clinicaltrials.gov/ct2/show/NCT04833803.

Understanding family functioning in mothers and daughters with obesity.

PURPOSE: This study sought to understand family functioning surrounding weight in Mexican American women with obesity. METHODS: Semi-structured in-depth interviews were conducted with mothers and adult daughters (N = 116). RESULTS: Thematic analysis identified five themes. 1) The communication process drives perception of supportive messages. Messages perceived as non-supportive consist of directives as interventions, confirmation of faults, and critical compliments whereas supportive consist of compliments, encouragement, empathetic listening, and disclosure. 2) Acculturation differences interfere with intergenerational alliance. Differences involve dissonance in communication, behavioural expectations, and weight-related practices. 3) Maladaptive conflict responses contribute to relational strain. These responses include avoidance, withdrawal, and defensiveness. 4) Role transformations alter the generational hierarchical relationship. Daughters serve as role models, caregivers, or collaborators. 5) Low communal coping heightens psychological distress. It does so by challenging family roles, increasing social isolation, and compromising social support. CONCLUSION: Obesity interventions for Mexican American women may benefit from targeting relational skills to improve family functioning.

Beyond individual responsibility: Exploring lay understandings of the contribution of environments on personal trajectories of obesity.

INTRODUCTION: Reversing the upward trajectory of obesity requires responding by including the multiple influences on weight control. Research has focused on individual behaviours, overlooking the environments where individuals spend their lives and shape lifestyles. Thus, there is a need for lay understandings of the impact of environments as a cause and solution to obesity. This research aimed to understand the influence of environments on the adoption of health practices in adults with obesity and to identify lay strategies with which to address environmental barriers to behaviour change. METHODS: Nineteen adults with a history of obesity living in the United Kingdom were interviewed through video conferencing between May 2020 and March 2021. Semi-structured interviews and socio-demographic questionnaires were used, and data analysed through hermeneutic phenomenology informed reflexive thematic analysis. RESULTS: Three main themes were created: living with convenience and normalcy: the increased accessibility of unhealthy food, people interacting with digital media for positive practice change, and the need to prioritise prevention in schools, the National Health Service and the food industry. CONCLUSIONS: The food environment was the major barrier, while interactions with social media was the most important opportunity to adopt healthy practices. The National Health Service was considered an obesogenic environment, something relevant since it has been traditionally recognised as an obesity management system. The perceptions from individuals with a history of obesity provide new suggestions on the influence of previously overlooked environments to design more adequate and effective interventions and policies that consider, more than in the past, the environments where people spend their lives.

High-fat diet, microbiome-gut-brain axis signaling, and anxiety-like behavior in male rats.

Obesity, associated with the intake of a high-fat diet (HFD), and anxiety are common among those living in modern urban societies. Recent studies suggest a role of microbiome-gut-brain axis signaling, including a role for brain serotonergic systems in the relationship between HFD and anxiety. Evidence suggests the gut microbiome and the serotonergic brain system together may play an important role in this response. Here we conducted a nine-week HFD protocol in male rats, followed by an analysis of the gut microbiome diversity and community composition, brainstem serotonergic gene expression (tph2, htr1a, and slc6a4), and anxiety-related defensive behavioral responses. We show that HFD intake decreased alpha diversity and altered the community composition of the gut microbiome in association with obesity, increased brainstem tph2, htr1a and slc6a4 mRNA expression, including in the caudal part of the dorsomedial dorsal raphe nucleus (cDRD), a subregion previously associated with stress- and anxiety-related behavioral responses, and, finally, increased anxiety-related defensive behavioral responses. The HFD increased the Firmicutes/Bacteroidetes ratio relative to control diet, as well as higher relative abundances of Blautia, and decreases in Prevotella. We found that tph2, htr1a and slc6a4 mRNA expression were increased in subregions of the dorsal raphe nucleus in the HFD, relative to control diet. Specific bacterial taxa were associated with increased serotonergic gene expression in the cDRD. Thus, we propose that HFD-induced obesity is associated with altered microbiome-gut-serotonergic brain axis signaling, leading to increased anxiety-related defensive behavioral responses in rats.

Electrophysiological Characteristics of Inhibitive Control for Adults with Different Physiological or Psychological Obesity.

Individuals exhibiting high scores on the fatness subscale of the negative-physical-self scale (NPSS-F) are characterized by heightened preoccupation with body fat accompanied by negative body image perceptions, often leading to excessive dieting behaviors. This demographic constitutes a considerable segment of the populace in China, even among those who are not obese. Nonetheless, scant empirical inquiries have delved into the behavioral and neurophysiological profiles of individuals possessing a healthy body mass index (BMI) alongside elevated NPSS-F scores. This study employed an experimental paradigm integrating go/no-go and one-back tasks to assess inhibitory control and working memory capacities concerning food-related stimuli across three adult cohorts: those with normal weight and low NPSS-F scores, those with normal weight and high NPSS-F scores, and individuals classified as obese. Experimental stimuli comprised high- and low-caloric-food pictures with concurrent electroencephalogram (EEG) and photoplethysmogram (PPG) recordings. Individuals characterized by high NPSS-F scores and normal weight exhibited distinctive electrophysiological responses compared to the other two cohorts, evident in event-related potential (ERP) components, theta and alpha band oscillations, and heart rate variability (HRV) patterns. In essence, the findings underscore alterations in electrophysiological reactivity among individuals possessing high NPSS-F scores and a healthy BMI in the context of food-related stimuli, underscoring the necessity for increased attention to this demographic alongside individuals affected by obesity.

Conditioned overconsumption is dependent on reinforcer type in lean, but not obese, mice.

Associative learning can drive many different types of behaviors, including food consumption. Previous studies have shown that cues paired with food delivery while mice are hungry will lead to increased consumption in the presence of those cues at later times. We previously showed that overconsumption can be driven in male mice by contextual cues, using chow pellets. Here we extended our findings by examining other parameters that may influence the outcome of context-conditioned overconsumption training. We found that the task worked equally well in males and females, and that palatable substances such as high-fat diet and Ensure chocolate milkshake supported learning and induced overconsumption. Surprisingly, mice did not overconsume when sucrose was used as the reinforcer during training, suggesting that nutritional content is a critical factor. Interestingly, we also observed that diet-induced obese mice did not learn the task. Overall, we find that context-conditioned overconsumption can be studied in lean male and female mice, and with multiple reinforcer types.

Association between body mass index and mental health among nurses: a cross-sectional study in China.

PURPOSE: To examine the correlation between body mass index (BMI) and mental well-being in Chinese nurses during the COVID-19 epidemic. METHOD: This study was conducted in a tertiary hospital using a cross-sectional design. A total of 2,811 nurses were enlisted at Shengjing Hospital in China during the period from March to April, 2022. Information was gathered through a questionnaire that individuals completed themselves. The mental health of the participants was assessed using the Patient Health Questionnaire-9 and the Generalized Anxiety Disorder Assessment-7. Binary logistic regression was used to calculate adjusted odds ratios (ORs) and their corresponding 95% confidence intervals. RESULTS: The prevalence of nurses experiencing depression and anxiety was 7.8% (219) and 6.7% (189), respectively. Regarding depression after adjustment, the odds ratios (ORs) for each quartile, compared to the lowest quartile, were as follows: 0.91 (95% confidence interval [CI]: 0.53, 1.56), 2.28 (95% CI: 0.98, 3.77), and 2.32 (95% CI: 1.41, 3.83). The p-value for trend was found to be 0.001. The odds ratios (ORs) for anxiety after adjustment were 2.39 (0.83, 4.36), 4.46 (0.51, 7.93), and 2.81 (1.56, 5.08) when comparing the highest quartiles to the lowest quartile. The p-value for trend was 0.009. CONCLUSION: This study found a positive association between BMI and poor mental health among nurses during the COVID-19 pandemic, particularly in those who were overweight or obesity. The findings could assist in developing interventions and help policy-makers establish appropriate strategies to support the mental health of frontline nurses, especially those who are overweight or obesity.

Effect of obesity on mood regulation and eating attitudes in mental disorders.

OBJECTIVE: The precise relationship between obesity and eating habits, attitudes, and emotion regulation is still ambiguous. The purpose of this study was to investigate possible correlations among body mass index, challenges related to managing emotions, and attitudes toward eating among adult participants with known psychiatric diagnoses. METHODS: The body mass indices of participants were calculated, and data on eating styles were collected using the Dutch Eating Behavior Questionnaire. The level of difficulty in managing emotions was evaluated using the Difficulties in Emotion Regulation Scale. RESULTS: The research findings indicated a meaningful positive association. An observation was made between body mass index and results from the Eating Attitude Test-40, as well as the restrained eating subdimension of the Dutch Eating Behavior Questionnaire. Conversely, a meaningful reverse relationship was identified between the scores of the "strategies" subdimension of the Difficulties in Emotion Regulation Scale. No meaningful differences in eating attitudes and emotion regulation were found between non-obese and obese patients. CONCLUSION: While a partial and meaningful correlation was observed among body mass index, eating attitudes, and emotion regulation difficulties, it is suggested that factors such as patients' age, disease duration, current body mass index, and the simultaneous presence of depression and anxiety should be considered.

Perceptions and Experiences of People with Obesity and Type 2 Diabetes Around Appetite and Eating Behaviors: A Qualitative Study.

INTRODUCTION: Chronic weight management and treatments for type 2 diabetes (T2D) involve a combination of lifestyle-based (diet, exercise) and pharmaceutical interventions. In people with obesity or T2D, understanding the impact of drivers/triggers on appetite and eating behaviors can be crucial to successful medical management. This study aimed to characterize perceptions and experiences regarding appetite and eating behaviors among people with obesity or T2D and identify drivers/triggers of food choices. METHODS: This non-interventional, cross-sectional, qualitative study utilized semi-structured concept elicitation interviews to explore the perceptions of people with obesity and/or T2D around appetite, eating behaviors and drivers/triggers of food choices. Adult US residents (≥ 18 years) with stable body weight (± 5 kg) in the 3 months preceding participation were included in the study. RESULTS: Forty-five participants (obesity: n = 15; overweight: n = 10; T2D: n = 20) were interviewed. Interviews were audio-recorded and transcribed verbatim for analysis. A subset of participants described eating behaviors on smartphone-based app tasks over 5 days. Most (> 96%) discussed the influence of hunger, cravings and satiety on food choices. Participants identified 22 drivers/triggers (including health, 95.6%; culture/heritage, 93.3%; location, 91.1%; stress, 88.8%). Participants also discussed associations between drivers/triggers and eating behavior concepts (appetite, hunger, cravings, satiety, motivation/determination). A conceptual model illustrating eating behavior concepts and related drivers/triggers was developed. The concept elicitation interviews identified a multitude of drivers and triggers and characterized the association of such drivers/triggers with seven core patient-reported concepts encompassing eating behaviors. CONCLUSION: The findings build upon existing models of factors influencing food choices. Findings confirm prior research regarding impact of drivers/triggers on food choice in people with obesity and T2D and indicate underlying disease state does not appear to influence eating behaviors in people with stable body weight.

"Treated as second class citizens" - the lived experience of obesity-related stigma: an IMI2 SOPHIA study.

PURPOSE: Obesity-related stigma impacts on and shapes the physical and psychosocial wellbeing of individuals living with obesity. Often absent from the literature in the field is the voice(s) of those living with obesity capturing the nuances of the lived experiences of obesity-related stigma. METHODS: This study adopted a qualitative approach encompassing individual (n = 15) and photovoice method (n = 12), with a purposeful sample of patients accessing treatment for obesity within the healthcare setting during 2021. Analysis was undertaken using thematic analysis. RESULTS: Key themes developed from the analysis related to experiencing obesity-related stigma as exposure to external judgement, societal exclusion and felt environmental stigmatization. Exposure to external judgement was described as judgemental comments resulting in hypervigilance to societal judgement. Participants reported how being overlooked and ignored by others had various negative effects and compounded obesity-related stigma through societal exclusion. Public spaces lacking suitable equipment further made obesity-related stigma visible through felt environmental stigmatization when pursuing hobbies and in everyday life. CONCLUSIONS: Obesity-related stigma had a profoundly negative impact on participants in this study, particularly in shaping social interaction, limiting life experiences and impacting psychosocial wellbeing.

Obesity in U.S. low-income veterans:Prevalence, clinical characteristics, and homelessness.

OBJECTIVE: Obesity is associated with lower socioeconomic status. To date, however, scarce research has examined the prevalence, comorbidity, and incremental burden of obesity in relation to medical, psychiatric, functional, and homelessness measures among low-income veterans. METHODS: A nationally representative sample of 1004 low-income U.S. veterans was examined. Bivariate and multivariable analyses were conducted to assess relationships between obesity and medical and psychiatric comorbidities, functioning, and homelessness measures. RESULTS: The prevalence estimate of obesity among low-income U.S. veterans was 38.2% (confidence interval (CI): 34.2; 42.2), which is higher than previously reported for the general U.S. veteran population. It was particularly high among young, females with children. Obesity was associated with co-occurring medical (chronic pain, diabetes, sleep disorders, high blood pressure, heart disease) and psychiatric (trauma- and anxiety-related) conditions, poor functioning, and current psychiatric medication use. Veterans with obesity were less likely to have current savings and more likely to have current debt. They also were more likely to have experienced evictions and foreclosures and less likely to use active coping or positive reframing as a means of dealing with stressful situations. CONCLUSION: The prevalence of obesity among U.S. veterans is high. Specific demographic groups particularly vulnerable to developing obesity warrant targeted interventions. Modifying weight management programs, understanding coping styles, and assessing, monitoring, and treating obesity in low-income veterans may help improve overall health and quality of life in multiple domains.

The Associations of Physical Activity and Health-Risk Behaviors toward Depressive Symptoms among College Students: Gender and Obesity Disparities.

Engaging in health-risk behaviors (HRBs) may be correlated with depressive symptoms among college students, but these relationships require more research. The purpose of this study was to examine the associations of physical activity levels (i.e., light [LPA] and moderate-vigorous [MVPA]) and HRBs (i.e., sedentary behavior [screen-based and non-screen-based behavior] and cigarette and e-cigarette tobacco use) with depressive symptoms in a sample of college students. Physical activity levels and HRBs were assessed through validated questionnaires. In total, 366 students participated (Mage = 22.59 ± 3.54; 60.1% female; 52.9% normal weight). E-cigarette use in males (ß = 0.23, p < 0.05) and screen-based sedentary behavior in females (ß = 0.14, p < 0.05) showed significant predictive utility toward depressive symptoms. In the overweight/obese group, screen-based sedentary behaviors (ß = 0.19, p < 0.05) and e-cigarette use (ß = 0.23, p < 0.01) showed significant predictive utility toward depressive symptoms. Females reported higher levels of depressive symptoms (Mfemale = 18.23 vs. Mmale = 14.81; η2 = 0.03) and less MVPA (Mmale = 52.83 vs. Mfemale = 41.09; η2 = 0.06) than males. Enhancing mental health by improving physical activity and eliminating HRBs should be tailored toward at-risk demographics.