© 2018 Elsevier Inc. Purpose: The purpose of this study was to examine the influence of psychological stress and depressive symptoms on body mass and central adiposity in 10-to-12-year-old children and to determine the mediating role of cortisol in the relationships among psychological stress, depressive symptoms, body mass, or central adiposity. Design and Methods: The convenience sample included 147 children (84 females; 63 males) who were recruited from one middle school and three elementary schools in a rural area of a southeastern state. Height, weight, waist circumference (WC), and salivary cortisol were measured. Children completed the Rating Scale for Pubertal Development for screening, Children's Depression Inventory, and the Feel Bad Scale. Bivariate correlation, multiple regression analyses, and univariate regression techniques were used in data analyses. Results: A positive relationship between psychological stress and depressive symptoms (r = 0.559, p <.001) was found. Depressive symptoms explained a significant amount of the variance in body mass index (BMI) (β = 0.37, p ≤.001) and central adiposity (β = 0.40, p ≤.001) when sex, race/ethnicity, puberty, and socioeconomic status were controlled. No statistically significant relationships were found between psychological stress and cortisol or between depressive symptoms and cortisol. Conclusions: Depressive symptoms were reported by normoweight, overweight, and obese children. Depressive symptoms accounted for variance in body mass and central adiposity. Practice Implications In addition to regular screening of BMI and WC, nurses and other health care professionals need to consider psychological factors that contribute to childhood obesity.