Parental Mental Health, Feeding Practices and Sociodemographic Factors as Determinants of Childhood Obesity in Greece

Background/Objectives: Childhood obesity remains a major public health issue, particularly in Mediterranean countries such as Greece. Although parental influences on children’s weight have been extensively studied, fewer studies have jointly examined parental mental health, feeding practices, sociodemographic factors and biological stress markers. This study aimed to investigate associations between psychological status, educational level, feeding behaviors and children’s Body Mass Index (BMI) in a Greek sample. A pilot assessment of salivary cortisol was included in evaluating its feasibility as an objective biomarker of parental stress. Subjects and Methods: A total of 103 parent-child dyads participated in this cross-sectional study. Children’s BMI was classified using World Health Organization (WHO) Growth Standards. Parental stress, anxiety and depressive symptoms were assessed using the Perceived Stress Scale-14 (PSS-14) and the Depression Anxiety Stress Scale-21 (DASS-21) questionnaires. Feeding practices were evaluated with the Comprehensive Feeding Practices Questionnaire (CFPQ). Statistical analyses included Pearson correlations, independent samples t-tests, one-way ANOVA, Mann-Whitney U and Kruskal Wallis tests. A subsample provided saliva samples for cortisol analysis to assess feasibility and explore potential associations with parental stress indicators. Results: Parental BMI showed a strong positive association with child BMI (p = 0.002). Higher parental anxiety (p = 0.002) and depression (p = 0.009) were also associated with increased child BMI. Restrictive (p < 0.001) and emotion-driven (p < 0.001) feeding practices were associated to higher child BMI, whereas monitoring (p = 0.013) and health-promoting feeding practices (p = 0.001) appeared protective. Lower parental education was related to higher BMI in both parents (p = 0.001) and children (p = 0.002) and to more frequent use of restrictive feeding strategies (p = 0.001). WHO charts identified a greater proportion of children as overweight or obese compared with the Centers for Disease Control and Prevention (CDC) criteria. The analysis showed statistically significant differences between the two classification systems (χ² (4) = 159.704, p < 0.001), indicating that BMI categorization varies considerably depending on the reference system used. No significant associations were observed with residential environment or salivary cortisol, likely due to the limited size of the pilot biomarker subsample. Conclusions: The findings highlight the combined effect of parental mental health status, educational level and feeding practices on child BMI within the Greek context. The preliminary inclusion of a biological stress marker provides added value to existing research in this area. These results underscore the importance of prevention strategies that promote parental psychological wellbeing, and responsive feeding practices while addressing socioeconomic disparities to reduce childhood obesity risk.