Moderating Effects of Components of Resilience on Obesity Across Income Strata in the National Survey of Children's Health

Objective: This study examined whether components of resilience at the family or child level are associated with a decreased risk of obesity in children after accounting for community-, family-, and individual-level stressors associated with an increased risk of obesity. Methods: Data are from the 2016 National Survey of Children's Health, using the subset of children 10 to 17 years of age with weight data. We examined whether or not components of family- or child-level resilience were associated with weight status. Community-, family-, and individual-level risk factors for obesity were examined within each income stratum. We used multinomial logistic regression to evaluate if components of resilience are associated with lower overweight or obesity. Results: The sample included 24,405 10- to 17-year-old children. Child-level but not family-level resilience components were associated with a decreased risk of child obesity across income strata. Food security and adverse childhood experiences (ACEs) were only associated with obesity within higher income strata; bullying was consistently associated across strata. Physical activity was strongly associated with increased emotional resilience. The association between higher emotional resilience and lower obesity remained after adjusting for community-level factors (parks), family-level factors (ACEs), and individual-level factors (bullying). Better maternal health was associated with increased emotional resilience and lower risk of obesity. Conclusions: Resilience, specifically emotional resilience, may be a protective factor against obesity in children regardless of income stratum. Physical activity of the child is associated with greater emotional resilience, and better maternal health may mediate the association between this component of resilience and weight.