Social Withdrawal, Eating Behaviors, and Daytime Sleepiness in Adolescents with Obesity: A Biopsychosocial Case–Control Study

BACKGROUND/OBJECTIVES: Adolescent obesity is increasingly recognized as a multidimensional condition involving psychosocial and behavioral vulnerabilities beyond metabolic risk. Although social withdrawal, dysregulated eating behaviors, and sleep disturbances have each been associated with obesity, integrative studies examining these domains concurrently remain limited. This study aimed to comparatively evaluate social withdrawal characteristics, eating behavior patterns, and daytime sleepiness in adolescents with obesity and normal-weight peers. METHODS: This cross-sectional case-control study included 209 adolescents aged 14-18 years (100 with obesity; 109 normal-weight controls). Social withdrawal was assessed using the Hikikomori Risk Inventory (HRI-24), eating behaviors with the Children's Three-Factor Eating Questionnaire (CTFEQ-17), and daytime sleepiness with the Pediatric Daytime Sleepiness Scale (PDSS). The BMI z-scores were calculated according to the CDC growth charts. Group comparisons and correlation analyses were performed. RESULTS: < 0.001). CONCLUSIONS: Adolescent obesity is associated not only with maladaptive eating behaviors but also with broader psychosocial vulnerabilities, including social withdrawal tendencies and sleep-related difficulties. These findings support a biopsychosocial conceptualization of adolescent obesity and underscore the importance of multidimensional intervention approaches targeting emotional regulation, sleep hygiene, and social functioning alongside weight management strategies.