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Background : The aim of this study was to analyze the inhibitory and promotive factors of psychosocial health in the context of childhood obesity, incorporating physical fitness as an additional, potentially relevant predictor.  Methods : The sample comprised cross-sectional data of 241 children and adolescents with obesity and overweight from the German Children’s Health InterventionaL TriaL III program (12.5 ± 2.1 years; 51.9% girls). Demographics and lifestyle patterns were assessed via parent reports. Anthropometric data and physical fitness in relation to body weight (W/kg) were measured. Children and adolescents completed standardized questionnaires (GW-LQ-KJ, FSK-K) to assess health-related quality of life (HRQOL) and five dimensions of self-concept (scholastic, social, physical, behavioral, and self-worth).  Results : Multiple linear regression analysis showed that HRQOL was significantly related to relative physical fitness (W/kg;  β  = 0.216,  p  = 0.011) as were scholastic ( β  = 0.228,  p  = 0.008) and social self-concept ( β  = 0.197,  p  = 0.023). Increasing body mass index (BMI)  Z -scores, age, physical activity (hours/day), low parental educational levels, and/or migration background were negatively associated with three subdomains of self-concept (physical, behavioral, self-worth; all  p  < 0.05).  Conclusion : The results emphasize BMI  Z -scores, age, physical activity, migration background, and parents’ educational level as relevant predictors of psychosocial health in the context of childhood obesity. Additionally, this study adds physical fitness as a key determinant of HRQOL and self-concept. To enable the development of more effective weight management, therapeutic strategies should therefore consider addressing these aspects and improving physical fitness in particular not only for weight loss but also to strengthen psychosocial health.

Predicting Psychosocial Health of Children and Adolescents with Obesity in Germany: The Underappreciated Role of Physical Fitness