*4.1. Anthropometric and Demographic Determinants of Psychosocial Health of Children and Adolescents with Obesity*

Consistently with the literature, we identified the physical self-concept to be most affected by high BMI *Z*-scores [9]. The higher the *Z*-score, the more dissatisfied participants were with their physical appearance in our sample. Many studies have concluded that girls with overweight or obesity are especially susceptible to body dissatisfaction [5]; however, other studies have not yielded results containing differences between the sexes [2]. While we did not find differences related to sex between any dimension of self-concept or HRQOL, we did find age to be a significant predictor in our study. These results are not surprising when considered in the context of the effects of puberty. Pubescent individuals are particularly vulnerable to low self-esteem and negative body image [5,37]. Our findings thus support those of earlier research, which suggested that addressing body image should be included as a highly relevant issue in obesity-treatment agendas to improve patients' self-esteem, particularly in adolescence [10].

Migration background and low socioeconomic status have been identified as key determinants of obesity and are also associated with determinants of psychosocial health [12,32]. Several researchers have recommended interventions at an early stage in childhood to address children who—due to their familial background—are particularly at risk of developing obesity and psychosocial impairments [4]. In line with this, our findings indicate that children and adolescents with obesity and overweight who have a migration background or whose parents had comparatively low education assessed their behavioral conduct and global self-worth as worse than their German counterparts. Considering the observed age effect in our study, the need for early action becomes especially evident. Besides

this, the strong influence of familial background and behavior-specific family variables (e.g., lifestyle patterns and nutrition) in the context of both obesity and the subdomains of self-concept underpin the need for parental involvement in intervention strategies [13].
