Abstract
Background: Adolescent bullying is a prevalent issue that may contribute to long-term health risks, including obesity. This study aimed to examine how school bullying relates to adolescent BMI percentile and to identify the psychological and behavioral pathways that mediate this association.
Methods: We used a representative sample of Florida high school students from the Youth Risk Behavior Surveillance System (YRBS). A multi-step analytic framework was applied, including LASSO regression with survey weights to identify candidate mediators, followed by a total effect model to assess significant predictors of body mass index percentile (BMI%). Confirmatory factor analysis (CFA) was used to validate latent constructs, and structural equation modeling (SEM) estimated direct and indirect effects within a causal mediation framework.
Results: Structural equation modeling revealed that bullying was significantly associated with mental distress (β = 0.23), risk behaviors (β = 0.49), and body dissatisfaction (β = 0.66). The final model demonstrated acceptable fit (CFI = 0.814, RMSEA = 0.066) and explained 34.2% of the variance in adolescent BMI percentile. These findings support a multi-pathway framework linking school bullying to obesity through psychological and behavioral mechanisms. Conclusions: Bullying contributes to adolescent obesity through distinct psychological and behavioral mechanisms. Prevention efforts should target not only bullying behaviors but also the underlying mental health and body image concerns that link victimization to physical health outcomes. Policy reforms, including weight-based protections and school-based mental health services, are needed to address these interconnected risks.