Parent reported inattention and hyperactivity/impulsivity as predictor of long-term weight loss after inpatient treatment in obese adolescents

Predictors of Effectiveness and Adherence in a Multimodal Obesity Treatment Program for Children and Adolescents in Routine Care

Multimodal obesity treatments for children and adolescents generally showed only small to modest treatment effects and high dropout rates. Potential variations by patients' clinical and sociodemographic factors remain, however, largely unclear. For this reason, our study analyzed psychological, physical, and sociodemographic predictors of treatment success and adherence in a multimodal obesity treatment over 12 months. The intent-to-treat sample included n = 361 children and adolescents (ages 3-17 years), of which n = 214 or 59.28% of patients completed treatment. A younger age and, in the sensitivity analysis, additionally a greater eating disorder psychopathology and treatment initiation before COVID-19 pandemic predicted greater BMI-SDS reductions (Body Mass Index-Standard Deviation Score). In contrast, predictors of treatment adherence were not found. The results underline the importance of early treatment of juvenile obesity. Additionally, eating disorder psychopathology includes restrained eating, which implies the ability to self-regulate eating behavior and therefore may have a positive effect on the treatment goal of controlled food intake. Challenges from altered treatment procedures due to the COVID-19 pandemic nonetheless remain.

The association between obesity and hyperactivity/anxiety among elementary school students in Japan

BACKGROUND

We aimed to evaluate the association between hyperactivity/anxiety and obesity among elementary school students in Matsuyama City, Japan.

METHODS

We conducted a cross-sectional study of all 46 elementary school students (24, 296 students) in Matsuyama City. The questionnaire included question items from the Strengths and Difficulties Questionnaire (SDQ), as well as questions about height and weight. The students were classified into two groups according to Rohrer index. After separating the data by gender, we examined the association between (1) obesity and hyperactivity, (2) obesity and anxiety, and (3) obesity and combination of hyperactivity and anxiety, by estimating relative risk using Poisson regression model. We also conducted stratified analyses to examine the effect modification by age groups and unbalance of diet on those associations. Moreover, we calculated relative excess risk due to the interaction (RERI) to examine whether there was an additive interaction between hyperactivity and anxiety.

RESULTS

Sixteen thousand forty-eight students were included in the present analysis. The prevalence ratio (PR) of being obese in girls who had both hyperactivity and anxiety was higher compared to girls without those symptoms (PR = 1.80; 95% CI 1.04-3.13). There was no significant difference in the prevalence ratio for obesity in boys, whether they were hyperactive, anxious, or neither. RERI was 0.00 for boys and 0.18 for girls.

CONCLUSION

We found a significant association between obesity and co-existence of hyperactivity and anxiety among elementary school girls. Our findings strengthen the need to further explore the association between childhood obesity, hyperactivity, and anxiety.

Emotion regulation strategies predict weight loss during an inpatient obesity treatment for adolescents

OBJECTIVE

Weight loss during an inpatient obesity treatment is an important predictor of subsequent weight maintenance. However, psychological factors influencing weight loss are not well established. Psychological models suggest some importance of executive functioning and emotion regulation strategies. Therefore, this study investigated whether these factors predict weight loss during an inpatient obesity treatment and whether this effect holds after controlling for general personal and treatment characteristics.

METHOD

A total of 158 adolescents with diagnosed obesity underwent inpatient obesity treatment at a German rehabilitation clinic. Psychological factors (executive functioning and emotion regulation) were measured at admission and used to predict BMI reduction after treatment completion.

RESULTS

More frequent use of reappraisal as an emotion regulation strategy, but not suppression or executive functioning, predicted weight loss at the end of the obesity treatment, even after controlling for age, gender, treatment duration, and BMI at admission.

CONCLUSION

Functional emotion regulation strategies, like reappraisal, might offer an additional target for obesity treatment programmes, complementary to the more traditional components of psychoeducation, physical activity, and caloric restriction.

Role of Motor Competence and Executive Functioning in Weight Loss: A Study in Children with Obesity

OBJECTIVE

This study aimed to compare motor competence and executive functioning (EF) between children with obesity and peers with healthy weight. Additionally, the predictive value of motor competence and EF in weight loss after a 5-month multidisciplinary residential treatment program was examined.

METHODS

Thirty-two children with obesity (7-11 years, 14 boys) and 32 age-matched controls (18 boys) performed 8 motor skill tasks and 4 tasks of EF (only at baseline). In the group of children with obesity, anthropometric measurements were performed at baseline and 5 months after the start of their treatment program. Also in control children, there was a time span of 5 months in between anthropometric measurements.

RESULTS

Lower levels of motor competence and reduced updating abilities, inhibition control, and planning skills were observed in children with obesity compared with healthy-weight controls. Within the total group, better general motor competence and balance skills were significantly associated with better updating, inhibition control, and planning. Finally, hierarchical regression analyses revealed that ball skills, balance skills, and inhibition/updating at baseline predicted 14% to 17% of the variance in weight loss after a 5-month treatment program in children with obesity.

CONCLUSION

These results suggest that motor competence and EF are both relevant factors associated with childhood obesity. Moreover, these factors seem to be significant predictors of weight loss. Future (intervention) studies are needed to understand the impact of the difficulties in motor and EF on obesity-related behaviors as well as on short-term and, especially, long-term weight loss and maintenance.

Psychosocial measures and weight change in a clinical paediatric population with obesity

PURPOSE

Poor quality of life has been shown to occur in youth with obesity. This study aimed to assess associations between health-related quality of life, general mental health and general psychological distress measures, collectively termed psychosocial health questionnaires (PSH), with weight outcomes in a busy paediatric weight management service.

METHODS

A cross-sectional longitudinal clinical cohort, 'Childhood Overweight BioRepository of Australia (COBRA)', was used (n = 250, median age 11, range 2-18 year, mean BMI z-score 2.5 ± 0.2). Clinical data were collected and HRQOL questionnaires; Pediatric Quality of Life 4.0 (PedsQL), 'Sizing Me/Them Up' (SMU/STU), and psychological well-being questionnaires; strengths and difficulties questionnaire (SDQ) and Kessler 10 (K10) were completed by the child and primary caregiver. PSH results were compared to age- and sex-adjusted BMI z-score at baseline and follow-up. Direct logistic regression modelling was performed to assess the impact of PSH factors on the likelihood of successful weight reduction over a period of ≥ 12 months.

RESULTS

Mean self-report PSH scores were: 68.0 ± 15.28 (PedsQL, range 0-100), 64.8 ± 15.8, (SMU, range 0-100), 17.3 ± 4.4 (SDQ, range 0-40) and 20.0 ± 7.7 (K10, range 0-50). A significant negative correlation was observed between PSH scores and childhood obesity (baseline BMI z-scores (p < 0.01)). No correlations were observed between psychological well-being measures and BMI z-scores. Higher subscale scores of the PedsQL and SDQ, which measure impaired psychosocial health and more difficulties with hyperactivity and inattention, significantly predict weight loss in children with obesity after 12 months.

CONCLUSION

PSH questionnaires may be useful in identifying individuals who require additional support to achieve weight loss goals in a tertiary weight management service.

[Not Available]

Zusammenfassung. Adipositas im Kindes- und Jugendalter ist eine komplexe Herausforderung. Die Früherfassung durch den Grundversorger ist dabei wichtig. In der Schweiz können seit dem 01.01.2014 die umfassenden Betreuungsformen (individuell oder in der Gruppe) kostenpflichtig und leistungsberechtigt erbracht werden. Um der globalen Übergewichtsepidemie Einhalt zu gebieten, bedarf es weltweit aber bereits präkonzeptionell umfassender gesundheitsfördernder und primär präventiver Massnahmen.

The Impact of Self-Reported Impulsivity on the Course of Weight Is Mediated by Disinhibited Eating

This study investigates the impact of impulsivity and the mediating role of disinhibited eating behaviour (DEB) on weight and weight trajectories in a large data set including obese non-treatment seeking individuals (obese control, n = 138) and obese individuals who were either receiving a conventional treatment program (n = 227) or bariatric surgery (n = 123). Data was assessed one, 4 and 9 years after baseline including self-reports for impulsivity and DEB. Results suggest a significant association between impulsivity and body mass index, which is partially mediated by DEB. Longitudinally, the influence of impulsivity on the course of weight after 9 years was fully mediated by DEB in obese control but not in the treatment groups. The results indicate an interplay between impulsivity and DEB with respect to obesity. Further research is needed to clarify how the mediation works and when it exerts its effect, in order to identify those that might profit from a specific (impulsivity-reducing) training. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.

The association of self-regulation with weight loss maintenance after an intensive combined lifestyle intervention for children and adolescents with severe obesity

BACKGROUND

Knowledge is limited on the role the ability to self-regulate plays in the long-term outcome of obesity treatment in children and adolescents with severe obesity. The purpose of this study was to determine whether the ability to self-regulate after an one year intensive, partly inpatient, combined lifestyle intervention is associated with weight loss maintenance in children and adolescents with severe obesity.

METHODS

One hundred twenty participants (8-19 years) with an average SDS-BMI of 3.41 and their parents/caregivers were included in an intervention study. As primary determinant of weight loss maintenance, general self-regulation ability was evaluated using two behavioral computer tasks assessing inhibitory control and sensitivity to reward.

RESULTS

There was no association between inhibitory control at T12 and ∆SDS-BMI between T12 and T24 (β = 0.0002; CI 95% = -0.0010-0.0014; P = 0.761). There was also no relation between sensitivity to reward at T12 and ∆SDS-BMI between T12 and T24 (β = -0.0028; CI 95% = -0.0075-0.0019; P = 0.244). None of the psychosocial factors that were examined as moderators, showed a statistically significant interaction, except for parental feeding style (P = 0.023).

CONCLUSIONS

The ability to self-regulate after an intensive, partly inpatient, multidisciplinary one year intervention for severe obesity in children and adolescents was not associated with the ability to maintain the achieved weight loss during the following year. Factors that explain the large range of long term outcomes need to be elucidated.

TRIAL REGISTRATION

Netherlands Trial Register (NTR1678, registered 20-Feb-2009).

Neurocognitive correlates of obesity and obesity-related behaviors in children and adolescents

Childhood obesity rates have risen dramatically over the past few decades. Although obesity has been linked to poorer neurocognitive functioning in adults, much less is known about this relationship in children and adolescents. Therefore, we conducted a systematic review to examine the relationship between obesity and obesity-related behaviors with neurocognitive functioning in youth. We reviewed articles from 1976 to 2013 using PsycInfo, PubMed, Medline and Google Scholar. Search terms included cognitive function, neurocognitive function/performance, executive function, impulsivity, self-regulation, effortful control, cognitive control, inhibition, delayed gratification, memory, attention, language, motor, visuo-spatial, academic achievement, obesity, overweight, body mass index, waist-hip ratio, adiposity and body fat. Articles were excluded if participants had health problems known to affect cognitive functioning, the study used imaging as the only outcome measure, they were non-peer-reviewed dissertations, theses, review papers, commentaries, or they were non-English articles. Sixty-seven studies met inclusion criteria for this review. Overall, we found data that support a negative relationship between obesity and various aspects of neurocognitive functioning, such as executive functioning, attention, visuo-spatial performance, and motor skill. The existing literature is mixed on the effects among obesity, general cognitive functioning, language, learning, memory, and academic achievement. Executive dysfunction is associated with obesity-related behaviors, such as increased intake, disinhibited eating, and less physical activity. Physical activity is positively linked with motor skill. More longitudinal research is needed to determine the directionality of such relationships, to point towards crucial intervention time periods in the development of children, and to inform effective treatment programs.

Association of symptoms of attention-deficit/hyperactivity disorder with physical activity, media time, and food intake in children and adolescents

Introduction

The aim of the study was to assess the association between attention deficit/hyperactivity disorder (ADHD) symptoms and potentially obesogenic behaviors.

Methods

Data of 11,676 German children and adolescents (6–17 years) were analyzed. Television/video exposure, physical activity, food frequency and portion size were assessed using questionnaires. A dietary quality index, energy density and volumes of consumed food, and total energy intake were calculated. The parent-rated hyperactivity/inattention subscale of the Strengths and Difficulties Questionnaire (SDQ-HI) was used as a continuous measure of ADHD symptoms. Associations were analyzed with general linear models adjusting for sex, age, socioeconomic status, migrant status, parental BMI, and parental smoking.

Results

SDQ-HI scores correlated positively with physical activity, average energy density of food, volume of beverages, total energy intake, and television exposure and negatively with the nutritional quality score (HuSKY) even after adjustment for parental variables (BMI, smoking, socioeconomic status, migrant status), age, sex, as well as the other SDQ subscales. The adjusted association of the SDQ-HI scores with the nutritional quality score was stronger in girls and the associations with food volume, food energy, and total energy intake was significant only in girls.

Conclusions

Poor nutritional quality, high energy intake and television exposure appear to be independently associated with ADHD symptoms. The relationship between food energy intake and ADHD symptoms was especially pronounced in girls and this may help to explain the reported association of ADHD symptoms with overweight in adolescent girls.

Association of symptoms of attention-deficit/hyperactivity disorder with childhood overweight adjusted for confounding parental variables

OBJECTIVE

There have been numerous reports on association between attention-deficit/hyperactivity disorder (ADHD) and overweight/obesity in children and adolescents; however, most studies adjusted only for a limited number of possible confounders.

METHODS

We analyzed the data of 11,159 six through seventeen-year-old participants in the German Health Interview and Examination Survey for Children and Adolescents. We determined weight status based on measured anthropometry and national reference data by International Obesity Task Force criteria. The parent-rated hyperactivity/inattention subscale of the Strengths and Difficulties Questionnaire (SDQ-HI) was used as a continuous measure of ADHD symptoms. We examined whether the putative confounders socioeconomic status, migrant status, parental body mass index (BMI) and parental smoking were associated with both SDQ-HI and overweight/obesity. Associations between SDQ-HI and overweight/obesity vs normal weight were analyzed by binary logistic regression analyses. In the first model, we adjusted for age and sex only and in the second model also for the parental confounders.

RESULTS

SDQ-HI was associated with an increased risk for overweight/obesity in both sexes adjusting for age and sex. However, after adjusting for all confounders SDQ-HI was associated with an increased risk for overweight/obesity only in adolescent females. Socioeconomic status, parental BMI and parental smoking each were relevant confounders. Migrant status was also significantly associated with both SDQ-HI and overweight/obesity, thus qualifying as a confounder but contributed only weakly to the association.

CONCLUSIONS

The association between ADHD symptoms and overweight/obesity is due to confounding by family background variables in all but adolescent girls. Possible reasons for the increased risk for overweight/obesity in this subgroup are discussed. We also propose possible mechanisms for confounding by parental socioeconomic status, BMI and smoking.