Do depression, self-esteem, body-esteem, and eating attitudes vary by BMI among African American adolescents?

Structure of family health and its association with obesity-related eating behavior and depressive symptoms: Insights from network analysis

The health of families is inextricably linked to the health of individuals and communities, providing the foundation for their development. Family health is a multifaceted concept and has been suggested to impact individuals' obesity-related eating behavior and the alleviation of depressive symptoms. However, existing studies have not comprehensively examined the structure of family health and its' potential associations with obesity-related eating behavior and depressive symptoms. The present study employed network analysis to ascertain the most pivotal characteristics within the interdisciplinary and holistic concept of family health. In addition, this study investigated the moderating effect of family health on the association between obesity-related eating behavior and depressive symptoms, and identified the characteristics of family health that were the most strongly linked to the association. A total of 9091 adults participated in this nationally representative study between 10 July and September 15, 2021. The participants completed self-report assessments of family health, obesity-related eating behavior, and depressive symptoms. The results of network analysis indicated that helping each other in seeking health care services when needed (such as making physician's appointments) had the highest node expected influence (1.154) within the network. The results of moderation analysis showed that family health significantly buffered the association between obesity-related eating behavior and depressive symptoms (B = -0.06, 95 % CI = -0.077, -0.042). Further investigation demonstrated that not trusting doctors and other health professionals in the family presented the strongest negative correlation (-0.125) with obesity-related eating behavior, and not having adequate housing in the family showed the strongest negative correlation (-0.069) with depressive symptoms. These findings provide further insight into the critical aspects of family health and its significant correlations with obesity-related eating behavior and depressive symptoms.

Differences in severity of depression symptoms in overweight, obese and normal weight Palestinian children and adolescents

Obesity is related to a wide variety of medical and psychological comorbidities which has short- and long-term effects on children's mental health. One of the most significant ones is depression. Thus, the current study utilized a descriptive methodology to explore the differences in depressive symptoms among overweight, obese, and normal-weight Palestinian children and adolescents. Data was collected from 270 Palestinian children and adolescents, aged (9-16) years: 85 with normal weight, 95 with over-weight and 90 obese. Findings showed that participants who are over-weight or obese exhibited more depressive symptoms than those with a normal weight. These findings showed that Palestinian children and adolescents who are over-weight or obese do experience depression and thus interventions should take this into account. In particular, it seems that over-weight boys or adolescents need more direct help in losing weight while obese children and adolescents who feel more helpless about their weight need serious psychological interventions. it is critical to offer psychological treatment as part of any weight loss intervention program for children and adolescents. Especially as these adolescents' families might encourage them to avoid seeking professional help and deal with the problem in the family.

The association between depressive symptoms and overweight or obesity in prepubertal children: Findings from the QUALITY cohort

BACKGROUND

Youth obesity and depression are public health concerns. Although meta-analyses suggest a positive association between those conditions in adults and adolescents, evidence remains unclear in prepubertal children. We examined the bidirectional associations between levels of depressive symptoms and weight status in 8-10-year-old children with a parental history of obesity, over two years, and whether they differ by sex.

METHODS

Data were drawn from the QUebec Adipose and Lifestyle InvesTigation in Youth Cohort Study's baseline and first follow-up evaluations (n = 558). Depressive symptoms were assessed using the 12-item Center for Epidemiological Studies Depression scale and weight status using body mass index z-scores based on World Health Organization standards. Linear and logistic regression models were used to test the directionality and magnitude of the associations, adjusting for age, sex, physical activity, screen time, parental education, alcohol and cigarette use, and baseline outcome measure.

RESULTS

Children with higher levels of depressive symptoms at baseline were not more likely to have overweight/obesity at follow-up (odds ratio [95 % Coefficient Interval] = 0.95[0.88;1.02]). Baseline overweight/obesity was not associated with subsequent higher levels of depressive symptoms (beta coefficient [95 % Coefficient Interval] = 0.20 [-0.47;0.87]). No sex differences emerged.

LIMITATIONS

Selection bias may have occurred due to loss at follow-up (10 % attrition) and exclusion of 6 participants taking mood disorder medication.

CONCLUSIONS

Unlike in adults and adolescents, no association between weight status and depressive symptoms was observed in childhood over two years. Underlying mechanisms linking both conditions later in life may not apply as early as prepubertal childhood.

Self-Esteem Among U.S. African American and Latinx Adolescents With Depressive Symptoms and Overweight and/or Obesity

PURPOSE

To examine the concept of self-esteem among African American and Latinx adolescents with overweight and/or obesity and depressive symptoms in the United States.

METHOD

Using key terms in CINAHL, PubMed, and PsycINFO databases, an initial search yielded 371 articles; after examining title, abstract, and full text, 33 articles remained. The concept of adolescent self-esteem was analyzed using Rodger's evolutionary method.

RESULTS

Several antecedents of self-esteem in this context were identified, including bullying, negative portrayal in the media, stressors and hassles, low socioeconomic status, dieting, and family dietary influences. Attributes identified were body image and misperception, body image dissatisfaction, diminished social status, and isolation. Consequences included stigma, somatic complaints, decreased earnings over a lifetime, decreased quality of life, lower educational attainment over a lifetime, and increased substance use. Increased self-esteem, increased number of friends, and in-depth friendships were associated with a lower risk of being overweight or obese.

CONCLUSION

Adolescent self-esteem varied based on gender, racial and ethnic group, and changed over time in the African American population but remained static in the Latinx population. [Journal of Psychosocial Nursing and Mental Health Services, 62(12), 17-25.].

Black adolescents' appearance concerns, depressive symptoms, and self-objectification: Exploring the roles of gender and ethnic-racial identity commitment

There is a dearth of research examining Black adolescents' body image, with even less work examining gender differences or the influence of ethnic-racial identity (ERI) commitment. It is critical to understand how culturally relevant aspects of appearance-beyond commonly measured ideals such as thinness and muscularity-are particularly relevant to Black adolescents. The present study of Black youth (n = 252; 55% girls, 45% boys, ages 13-18, M_age = 15.5) explored the roles of gender and ERI commitment in the associations between skin tone, hair, and facial satisfaction and appearance esteem, depressive symptomatology, and self-objectification. With a few exceptions, satisfaction with skin tone, hair, and face were significantly associated with higher appearance esteem and lower self-objectification and depressive symptoms, even when controlling for weight and muscle tone satisfaction. Findings were similar across genders, with some associations stronger among Black girls relative to boys. Among youth with higher ERI commitment, associations were stronger between skin tone, hair, and facial satisfaction and some indicators of wellbeing. Findings elucidate the role of culturally relevant appearance concerns of Black adolescents and the potential benefits of ERI commitment. This work can inform culturally sensitive research practices and therapeutic interventions related to Black youth's body image experiences.

How a 7-Week Food Literacy Cooking Program Affects Cooking Confidence and Mental Health: Findings of a Quasi-Experimental Controlled Intervention Trial

Obesity and mental health disorders are rising simultaneously with shifting dietary behavior away from home cooking, toward typically nutrition-poor and energy-dense convenience meals. Food literacy strongly influences nutrition choices. Community-based cooking interventions target barriers to healthy eating and facilitate development of food literacy skills, thereby potentially increasing preparation of home-cooked meals and positively influencing health. This study of 657 healthy Australian adults explored the efficacy of a 7-week cooking program in improving cooking confidence, whether this transferred to behavior surrounding food, and/or affected mental health. Significant post-program improvements in cooking confidence and satisfaction (all p < 0.001, ηp2 1.12 large), ability to change eating habits (p < 0.001) and overcome lifestyle barriers (p = 0.005) were observed for the intervention group but not control. Participation also improved mental and general health (all p < 0.05, ηp2 0.02 small). No changes were observed for acquisition and consumption of food, or nutrition knowledge in either group. This 7-week cooking program built cooking confidence and improved general and mental health but did not change dietary behavior. To further improve nutrition related behaviors associated with better mental health, more effort is needed to recruit those with below-average nutrition knowledge and interest in cooking.

The relationship between body shape perception and health behaviors among Korean normal-weight adolescents using Korea Youth Risk Behavior Web-Based Survey

Inappropriate adolescent health behavior can be influenced by the negative impact of physical and mental health promotion. Obesity influences subjective improper weight perception. This study aimed to verify Korean normal-weight adolescents' subjective experience of weight control, mental health, physical activity, and subjective status based on their body mass index (BMI). As a result, efforts to control weight appeared less in normal-weight boys. Thin girls were less likely to carry out 60 min of physical activity 7 or 5 days per a week. Obese boys were less likely to carry out vigorous physical activity 3 days per a week. Normal-weight girls were less likely to practice muscular strength training 3 days per a week. Thin boys and thing girls were less likely to practice regular physical activity, and less likely to practice at the rate stipulated in the sedentary behavior guideline. In conclusion, boys and girls with inappropriate weight perception reported feeling stressed and depressed, and reported subjective sleep fulfillment, perceived subjective happiness, and perceived subjective health.

Associations of self-esteem with body mass index and body image among Saudi college-age females

PURPOSE

To examine the association of self-esteem with the body mass index (BMI), perceived body image (BI), and desired BI of college-age Saudi females.

METHODS

A cross-sectional study was conducted with 907 randomly selected females using a multistage stratified cluster sampling technique. Self-esteem and BI were assessed using the Rosenberg Self-Esteem Scale and Stunkard Figure Rating Scale, respectively.

RESULTS

The prevalence of low self-esteem was only 6.1% among college females; however, this percentage was higher (9.8%) among overweight or obese participants. The total self-esteem scores showed significant negative correlations with actual BMI and perceived BI, but not with desired BI. Meanwhile, multivariate analyses revealed significant differences in total self-esteem scores according to obesity/overweight status and perceived BI group, but not desired BI group.

CONCLUSION

Despite the high prevalence of overweight and obesity in Saudi Arabia, few Saudi college females have low self-esteem. In addition, body weight, BMI, perceived BI, and the BMI corresponding to the perceived BI all significantly differed between females with low self-esteem and those with normal self-esteem.

LEVEL OF EVIDENCE

Level V, cross-sectional descriptive study.

Nocturnal enuresis in obese children: a nation-wide epidemiological study from China

Childhood obesity increases the risk of obstructive sleep apnea syndrome, type 2 diabetes mellitus, cardiovascular abnormalities, and psychological and behavioral disorders. But it is unclear whether obesity is associated with childhood nocturnal enuresis (NE). This study aimed to assess the relationship between childhood obesity and NE in a nationally representative large sample in China. Subjects were enrolled from Urumqi, Chengdu, Xi'an, Hohhot, Wuhan, Canton, Shanghai, and Harbin cities in China in November and December 2005. The survey included 20,987 children aged 5-12 years and they and their caregivers completed questionnaires. Height and weight were measured by school teachers trained in healthcare. According to the WHO child growth standards, obesity was defined as a body mass index >95th percentile of peers with the same age and gender. NE was defined as bed wetting for more than twice a week for 3 consecutive months. Demographic variables were compared among different groups. The prevalence of obesity, asthma, attention-deficit/hyperactivity disorder (ADHD), depressive moods, and snoring were different between the NE and without-NE groups (P < 0.05). The raw odds ratio (OR) for NE and obesity was 1.36 (95%CI = 1.07-1.74; P = 0.013) and the adjusted OR was 1.42 (95%CI = 1.11-1.82; P = 0.005) in the multivariable analysis. When adjusting for co-occurring conditions, the results showed that asthma did not affect the risk of NE (OR = 1.42, 95%CI = 1.11-1.82; P = 0.005), but ADHD (OR = 1.41; 95%CI = 1.10-1.81; P = 0.006) and depressive moods (OR = 1.34; 95%CI = 1.07-1.76; P = 0.012) slightly weakens the association between NE in children and obesity, while snoring weakens the association between obesity and NE and the risk became non-significant (OR = 1.21; 95%CI = 0.94-1.56; P = 0.138). In conclusion, obese children were at a higher risk of incurring NE compared to non-obese children. This association was weaker in children who either snored, had ADHD, or had depressive mood.

The Impact of School Bullying on Physical Activity in Overweight Youth: Exploring Race and Ethnic Differences

BACKGROUND

About one third of youth in the United States are overweight or obese and African American youth are at an increased risk for pediatric overweight and obesity as well as their complications. Physical activity has been identified as one determinant of overweight and obesity, and school bullying has been found to be associated with decreased physical activity. Guided by the Transactional Stress and Coping Model, this study examines how school bullying might impact the physical activity of white and African American healthy weight and overweight youth.

METHODS

Existing, nationally representative, and complex survey data (N = 4509) from the 2005-2006 United States Health Behavior in School-Aged Children (HBSC) were analyzed using multiple group structural equation modeling to evaluate study questions.

RESULTS

Support for the hypothesized model was found such that bullying negatively impacted physical activity by way of increasing internalizing symptoms. Possible evidence for parental support, but not peer support, as a protective factor was also found. Results were generally similar for all groups, though some differences are discussed.

CONCLUSION

School bullying is a risk factor for reduced physical activity, regardless of race-ethnicity and weight. Implications for school health professionals are discussed.

Relating shape/weight based self-esteem, depression, and anxiety with weight and perceived physical health among young adults

Simultaneous contributions of self-esteem, depression, and anxiety to weight and perceived physical health in young adults is understudied. A diverse sample of 424 young adults completed measures of shape/weight based self-esteem, depression, anxiety, and perceived physical health. Height and weight were measured to calculate body mass index (BMI). Latent profile analysis was conducted to derive patterns of depression, anxiety, and shape/weight based self-esteem. Then, we examined the association of the profiles with weight status and perceived physical health. Three profiles emerged: (1) High Shape/Weight Influence (HSWI); (2) Low Shape/Weight, Depression, & Anxiety Influence (LSWDAI); and (3) High Depression & Anxiety Influence (HDAI). The HSWI profile had significantly higher BMI than the LSWDAI and HDAI profiles, and significantly lower perceived physical health than the LSWDAI profile. Over emphasis on shape/weight, regardless of depression and anxiety, is associated with elevated weight and negative internalized health views.

BMI and disordered eating in urban, African American, adolescent girls: The mediating role of body dissatisfaction

OBJECTIVE

This study examined the mediating role of body dissatisfaction between Body Mass Index (BMI) and subsequent disordered eating (e.g. dieting and restricting/purging) among early adolescent African American girls.

STUDY DESIGN

Participants included 701 African American girls in 6th and 7th grades in urban schools serving low-income communities, mean age 12.15 (SD = 0.72) years. Participants were assessed at baseline and approximately 6 months later. Objectively measured height and weight were used to calculate BMI z-score. Participants completed questionnaires on body size dissatisfaction and recent dieting and restricting/purging behaviors.

RESULTS

At baseline, 51.5% of participants were overweight/obese, and 60.4% expressed body dissatisfaction and a desire to be smaller. Path analytic analyses revealed change in body dissatisfaction significantly mediates the relation between initial BMI z-score and increases in dieting behaviors (B = 0.924, SE = 0.280, p = 0.001) but not restricting/purging behaviors (p = 0.05).

CONCLUSIONS

Body dissatisfaction explains some associations between excess body weight and subsequent disordered eating symptoms among early adolescent, African American girls. Body dissatisfaction, identified by screening, may be an indicator of further negative consequences, including disordered eating behaviors.

Engaging African American Adolescents and Stakeholders to Adapt Interpersonal Psychotherapy for Weight Gain Prevention

Developing culturally appropriate obesity prevention programs for African American (AA) adolescent girls that account for psychological risk factors is paramount to addressing health disparities. The current study was part of an investigation utilizing a community-based participatory research framework to gather qualitative data from urban AA girls, their caregivers, and community health liaisons to develop a novel obesity prevention program based on interpersonal psychotherapy for the prevention of excessive weight gain (IPT-WG). In the current study with urban AAs, data from seven focus groups (total sample size, N = 40) were analyzed using thematic analysis. Participants identified problematic eating behaviors, including binge or loss of control eating; highlighted the importance of interpersonal relationships, mood functioning, and eating; and supported the tenets of IPT-WG. While features of IPT-WG generally resonated with participants, culturally based modifications were suggested. These data will be used to inform the development of a culturally relevant IPT-WG program.

Integrated Immunomodulatory Mechanisms through which Long-Chain n-3 Polyunsaturated Fatty Acids Attenuate Obese Adipose Tissue Dysfunction

Obesity is a global health concern with rising prevalence that increases the risk of developing other chronic diseases. A causal link connecting overnutrition, the development of obesity and obesity-associated co-morbidities is visceral adipose tissue (AT) dysfunction, characterized by changes in the cellularity of various immune cell populations, altered production of inflammatory adipokines that sustain a chronic state of low-grade inflammation and, ultimately, dysregulated AT metabolic function. Therefore, dietary intervention strategies aimed to halt the progression of obese AT dysfunction through any of the aforementioned processes represent an important active area of research. In this connection, fish oil-derived dietary long-chain n-3 polyunsaturated fatty acids (PUFA) in the form of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) have been demonstrated to attenuate obese AT dysfunction through multiple mechanisms, ultimately affecting AT immune cellularity and function, adipokine production, and metabolic signaling pathways, all of which will be discussed herein.

Assessing the causal role of adiposity on disordered eating in childhood, adolescence, and adulthood: a Mendelian randomization analysis

Background: Observational studies have shown that higher body mass index (BMI) is associated with increased risk of developing disordered eating patterns. However, the causal direction of this relation remains ambiguous.Objective: We used Mendelian randomization (MR) to infer the direction of causality between BMI and disordered eating in childhood, adolescence, and adulthood.Design: MR analyses were conducted with a genetic score as an instrumental variable for BMI to assess the causal effect of BMI at age 7 y on disordered eating patterns at age 13 y with the use of data from the Avon Longitudinal Study of Parents and Children (ALSPAC) (n = 4473). To examine causality in the reverse direction, MR analyses were used to estimate the effect of the same disordered eating patterns at age 13 y on BMI at age 17 y via a split-sample approach in the ALSPAC. We also investigated the causal direction of the association between BMI and eating disorders (EDs) in adults via a two-sample MR approach and publically available genome-wide association study data.Results: MR results indicated that higher BMI at age 7 y likely causes higher levels of binge eating and overeating, weight and shape concerns, and weight-control behavior patterns in both males and females and food restriction in males at age 13 y. Furthermore, results suggested that higher levels of binge eating and overeating in males at age 13 y likely cause higher BMI at age 17 y. We showed no evidence of causality between BMI and EDs in adulthood in either direction.Conclusions: This study provides evidence to suggest a causal effect of higher BMI in childhood and increased risk of disordered eating at age 13 y. Furthermore, higher levels of binge eating and overeating may cause higher BMI in later life. These results encourage an exploration of the ways to break the causal chain between these complex phenotypes, which could inform and prevent disordered eating problems in adolescence.

Subjective evaluation of psychosocial well-being in children and youths with overweight or obesity: the impact of multidisciplinary obesity treatment

PURPOSE

To investigate the effects of a multidisciplinary childhood obesity treatment programme on subjective evaluations of psychosocial well-being and quality of life.

METHODS

This longitudinal observational study included 1291 children, adolescents and young adults, 6-22 years of age, with overweight or obesity. At entry and after 2-82 months of obesity treatment, the patients evaluated the following domains of psychosocial well-being on a visual analogue scale: quality of life, mood, appetite, bullying, motivation for weight loss and body image satisfaction. The degree of overweight was calculated using a body mass index (BMI) standard deviation score (SDS) at each visit.

RESULTS

At entry, the mean BMI SDS was 2.81 (range: 1.35-6.65, 95% confidence interval (95% CI): 2.44-3.18). After a median of 14 months of treatment, the median reduction in BMI SDS was 0.29 (95% CI: 0.26-0.31, p < 0.0001). Improvements were observed in the domains of quality of life, mood, appetite, bullying and body image satisfaction (p < 0.0001). Larger reductions in BMI SDS were associated with greater improvements in the domains of quality of life (p = 0.001), mood (p = 0.04) and body image satisfaction (p < 0.0001), independent of BMI SDS at entry. However, improvements in psychosocial well-being were also observed in those increasing their BMI SDS (n = 315).

CONCLUSIONS

In a large group of children and youths, psychosocial well-being improved during a multidisciplinary childhood obesity treatment programme, irrespective of the degree of obesity at treatment entry. Greater reductions in BMI SDS were associated with greater improvements in psychosocial well-being, but even in the group increasing their BMI SDS improvements were observed.

Obesity in Children and the 'Myth of Psychological Maladjustment': Self-Esteem in the Spotlight

PURPOSE OF REVIEW

There are contrasting views regarding the psychological well-being of children with obesity. Responding to limitations of existing evidence, Jane Wardle in 2005 argued for a 'myth of psychological maladjustment'. This review looks again at self-esteem.

RECENT FINDINGS

The different characterisations of self-esteem each offer value. Global self-esteem is reduced in nearly all studies of youth with obesity. Dimensional self-esteem reveals physical appearance, athletic and social competence as the most affected areas, confirmed by research that has operationalised low self-competence. Children with obesity are also more likely to be victimised by their peers, generally and for their fatness. Victims who bully others appear to preserve some aspects of self-esteem. A relatively small proportion of youth with obesity has low self-esteem, but those with severe and persistent obesity are especially compromised. Weight loss is only weakly associated with improved self-competence suggesting the value of resilience and asset approaches to improving well-being.

Maternal mental health symptoms are positively related to emotional and restrained eating attitudes in a statewide sample of mothers participating in a supplemental nutrition program for women, infants and young children

Postpartum, low-income mothers are at risk for mental health symptoms and obesity, and disordered eating attitudes may be associated with both mental health and obesity in this vulnerable population. The study objective is to determine whether higher levels of mental health symptoms are associated with increased odds of emotional and restrained eating attitudes in this sample of Special Supplemental Nutrition Program for Women, Infants and Children (WIC) participants. Data on 711 mothers of infants <13 months from a statewide sample of Maryland WIC participants were collected via telephone survey. Maternal mental health symptoms were measured on continuous scales for depression (PRIME-MD), stress (Perceived Stress Scale) and anxiety (Spielberger State-Trait Anxiety Inventory). Emotional and restrained eating attitudes were measured with questions adapted from the Dutch Eating Behavior Questionnaire. Multivariate logistic regression analysis was used. Obesity [body mass index (BMI) ≥ 30] was explored as a moderating variable. Mothers reporting higher levels of depression symptoms [odds ratio (OR) = 3.93, 95%CI: 2.71-5.69], anxiety symptoms (OR = 1.96, 95%CI: 1.47-2.65), stress symptoms (OR = 2.09, 95%CI: 1.67-2.61) and high overall mental health symptomatology (OR = 3.51, 95%CI: 2.43-5.3) had increased odds of emotional eating attitudes. There were significant associations between symptoms of depression (OR = 1.59, 95% CI: 1.12-2.25) and increased odds of restrained eating attitudes. Obesity did not moderate the association. Mothers with mental health symptoms are at risk for disordered eating attitudes, which may increase risk of poor diet. These findings underscore the need for greater focus on addressing maternal mental health status and eating attitudes in the postpartum period.

"It's not like a fat camp" - A focus group study of adolescents' experiences on group-based obesity treatment

Background

The health burden related to obesity is rising among children and adolescents along with the general population worldwide. For the individual as well as the society this trend is alarming. Several factors are driving the trend, and the solution seems to be multifaceted because long-lasting treatment alternatives are lacking. This study aims to explore adolescents’ and young adults’ motivation for attending group-based obesity treatment and social and environmental factors that can facilitate or hinder lifestyle change.

Methods

In this study, we arranged three focus groups with 17 participants from different obesity treatment programs in the west and south of Norway. The content in these programs differed, but they all used Motivational Interviewing as a teaching method. We conducted a data-driven analysis using systematic text condensation. Self-determination theory has been used as an explanatory framework.

Results

We identified four major themes: 1) motivation, 2) body experience and self-image, 3) relationships and sense of belonging, and 4) the road ahead. Many of the participants expressed external motivation to participate but experienced increasing inner motivation and enjoyment during the treatment. Several participants reported negative experiences related to being obese and appreciated group affiliation and sharing experiences with other participants.

Conclusion

Motivation may shift during a lifestyle course. Facilitating factors include achieving and experiencing positive outcomes as well as gaining autonomy support from other course participants and friends. Obstacles to change were a widespread obesogenic environment as well as feelings of guilt, little trust in personal achievements and non-supporting friends.

Cognitive-Behavioral Therapy Plus Healthy Lifestyle Enhancement for Depressed, Overweight/Obese Adolescents: Results of a Pilot Trial

The objective of this article was to conduct a treatment development study to examine the feasibility, acceptability, and preliminary efficacy of treating depressed, overweight/obese adolescents using both an exercise regimen and a Cognitive Behavioral Therapy (CBT) protocol modified to address aspects of healthy living and nutrition (CBT plus healthy lifestyle; CBT-HL). A randomized controlled repeated measures design was used to test the hypothesis that CBT-HL would lead to greater reductions in depressed mood and weight compared to CBT for Depression Only (CBT). Participants (n=33; 24 in CBT-HL condition) included 33 adolescents (median age 15, 73% female, 61% white, 36% Hispanic) who met DSM-IV criteria for Current Major Depressive Episode (MDE) and had BMI ≥ 85th percentile. CBT-HL was found to be feasible to implement with most adolescents. Both conditions resulted in improvement in depressed mood. The CBT-HL protocol was more effective in stabilizing weight status as assessed by BMI. Percent time spent in MVPA was increased at 12 weeks for adolescents in CBT-HL compared to those in CBT. The CBT-HL protocol was acceptable to most, but not all, adolescents, and resulted in an improvement in depressed mood as well as stabilization of weight status. A larger study to test efficacy and moderators of treatment outcome is necessary to better understand which adolescents would benefit most from the increased demands of exercise and adhering to nutrition recommendations in addition to standard CBT for depression. Revisions to the treatment protocol to support weight loss, not just stabilization, are also suggested.

Prospective Associations between Depression and Obesity for Adolescent Males and Females- A Systematic Review and Meta-Analysis of Longitudinal Studies

Adolescent obesity and depression are increasingly prevalent and are currently recognised as major public health concerns worldwide. The aim of this study is to evaluate the bi-directional associations between obesity and depression in adolescents using longitudinal studies. A systematic literature search was conducted using Pubmed (including Medline), PsycINFO, Embase, CINAHL, BIOSIS Preview and the Cochrane Library databases. According to the inclusion criteria, 13 studies were found where seven studies evaluated depression leading to obesity and six other studies examined obesity leading to depression. Using a bias-adjusted quality effects model for the meta-analysis, we found that adolescents who were depressed had a 70% (RR 1.70, 95% CI: 1.40, 2.07) increased risk of being obese, conversely obese adolescents had an increased risk of 40% (RR 1.40, 95% CI: 1.16, 1.70) of being depressed. The risk difference (RD) of early adolescent depression leading to obesity is 3% higher risk than it is for obesity leading to depression. In sensitivity analysis, the association between depression leading to obesity was greater than that of obesity leading to depression for females in early adulthood compared with females in late adolescence. Overall, the findings of this study suggest a bi-directional association between depression and obesity that was stronger for female adolescents. However, this finding also underscores the importance of early detection and treatment strategies to inhibit the development of reciprocal disorders.

Weight patterns of youth entering an urban juvenile justice facility

Adolescents with a history of incarceration face a disproportionate number of health issues compared with their peers in virtually all areas, including perceived well-being; self-esteem; acute, chronic, and psychosocial disorders; and physical activity. Some studies have shown correlates of weight status and incarceration; however, the literature is conflicting. The current study sought to assess weight patterns of primarily minority urban youth (N = 548) entering a juvenile justice facility as well as associations between medications and weight status. Results indicate incarcerated adolescents have higher rates of overweight and obesity (40%) in comparison with nonincarcerated adolescents in the state (20 to 30%) or surrounding community (30 to 34%). Of interest, incarcerated adolescents taking asthma medications have significantly higher rates of overweight and obesity when compared with those not taking asthma medications. The clinical implications of these findings are discussed and implications for future research explored.

BMI, Body Image, Emotional Well-Being and Weight-Control Behaviors in Urban African American Adolescents

IMPORTANCE

While urban African American adolescents face significant health disparities associated with overweight and obesity that follow them into adulthood; there is limited data on body image, emotional well-being, and weight control behaviors in this population to design effective public health interventions.

OBJECTIVE

This study was designed to understand the association of weight status to adolescent weight control, body image, and emotional well-being responses, in African American high school students.

DESIGN/SETTING/PARTICIPANTS

The study cohort consisted of 776 students, mean age 15.8 years (±1.2). Data from Guidelines for Adolescent Preventive Services (GAPS) student surveys and anthropometric studies were collected at School-Based Health Centers.

MAIN OUTCOME MEASURES

Associations between adolescent responses on the GAPS and body mass index (BMI) status (healthy weight: 5th to less than 85th percentile, overweight: 85th to less than 95th percentile, obese: 95th percentile or greater) were estimated using logistic regression and dose- response plots.

RESULTS

There were statistically significant associations between BMI category and weight control (ranging from a mean 5.18 to 7.68 odds of obesity) and body image (3.40 to 13.26 odds of obesity) responses. Responses to weight control and body image questions exhibited a dose-response for odds of overweight and obesity. Feelings of depressed mood were associated with obesity (1.47 times the odds of obesity compared to students who did not endorse depressed mood; 95% CI, 1.01 to 2.13) but not overweight status.

CONCLUSION AND RELEVANCE

Overweight and obese urban African American adolescents are more likely to screen positively on weight control risk behaviors and negative body image questions than their normal weight peers. The weight control and body image measures on the GAPS may provide information to identify youth in need of services and those motivated for brief school-based weight control interventions.

Parents' perception of health-related quality of life in children and adolescents with excess weight

OBJECTIVE

To evaluate the perception of parents or caregivers on the health-related quality of life (HRQOL) of children/adolescents with overweight/obesity and possible factors associated with this perception.

METHODS

This was a cross-sectional study involving 297 caregivers of children and adolescents with normal weight (n=170) and with overweight/obesity (n=127), from public and private schools in the study municipality. HRQOL scores obtained through the Child Health Questionnaire - Parent Form 50 (CHQ-PF50) were compared according to the nutritional status and gender of the children/adolescents. Multiple regression analysis was used to determine the predictive value of studied variables for the variation in HRQOL scores.

RESULTS

Parents of children/adolescents with overweight/obesity attributed lower HRQOL scores to their children in the following domains: physical functioning (p<0.01; d=0.49), self-esteem (p<0.01; d=0.38), parental impact-emotional (p<0.05; d=0.29), family cohesion (p<0.05; d=0.26), physical summary score (p<0.05; d=0.29), and psychosocial summary score (p<0.05; d=0.25). In the multiple regression models, the variables with the highest contribution to the variation in HRQOL scores were: in the physical functioning domain, parental impact-time (β=0.23; p<0.05); self-esteem, nutritional status (β=-0.18; p≤0.01); emotional impact on parents, impact on parents' time (β=0.31; p<0.05); and in family cohesion, global behavior (β=0.30; p<0.05).

CONCLUSIONS

A negative impact on HRQOL of children/adolescents with overweight/obesity was observed in the physical and psychosocial aspects. The nutritional status was the variable with the greatest contribution for the assessment the self-esteem of children and adolescents in this study.

Recruitment and retention in obesity prevention and treatment trials targeting minority or low-income children: a review of the clinical trials registration database

Background

Efforts to recruit and retain participants in clinical trials are challenging, especially in studies that include minority or low-income children. To date, no studies have systematically examined recruitment and retention strategies and their effectiveness in working successfully with this population. We examined strategies employed to recruit or retain minority or low-income children in trials that included an obesity-related behavior modification component.

Methods

First, completed home-, community-, and school-based trials involving minority or low-income children aged 2–17 years were identified in a search of the ClinicalTrials.gov registry. Second, a PubMed search of identified trials was conducted to locate publications pertinent to identified trials. Recruitment and retention rates were calculated for studies that included relevant information.

Results

Our final analytic sample included 43 studies. Of these, 25 studies reported recruitment or retention strategies, with the amount of information varying from a single comment to several pages; 4 published no specific information on recruitment or retention; and 14 had no publications listed in PubMed. The vast majority (92 %) of the 25 studies reported retention rates of, on average, 86 %. Retention rates were lower in studies that: targeted solely Hispanics or African Americans (vs. mixed races of African Americans, whites, and others); involved children and parents (vs. children only); focused on overweight or obese children (vs. general children), lasted ≥1 year (vs. <1 year), were home or community-based (vs. school-based), included nutrition and physical activity intervention (vs. either intervention alone), had body mass index or other anthropometrics as primary outcome measures (vs. obesity-related behavior, insulin sensitivity, etc.). Retention rates did not vary based on child age, number of intervention sessions, or sample size.

Conclusions

Variable amounts of information were provided on recruitment and retention strategies in obesity-related trials involving minority or low-income children. Although reported retention rates were fairly high, a lack of reporting limited the available information. More and consistent reporting and systematic cataloging of recruitment and retention methods are needed. In addition, qualitative and quantitative studies to inform evidence-based decisions in the selection of effective recruitment and retention strategies for trials including minority or low-income children are warranted.

A qualitative analysis of parents' perceptions of weight talk and weight teasing in the home environments of diverse low-income children

Research has shown that family weight talk and teasing are associated with child overweight status and unhealthy weight control behaviors. However, little is known about how weight talk and teasing are experienced in the home, how parents respond, and what factors influence whether weight talk and teasing occur. The main objective of this study is to qualitatively examine weight talk and teasing in the home environments of diverse low-income children. Parents (N=118) from a mixed-methods cross-sectional study were interviewed in their home. The majority of parents (90% female; mean age=35 years.) were from minority (65% African American) and low income (<$25,000/year) households. A grounded theory analysis found the following themes: weight talk contradictions, overt and covert weight talk/teasing, reciprocal teasing, and cultural factors related to weight talk/teasing. These themes should be addressed when developing family-based interventions to reduce weight talk and teasing in the home environment.

Overweight and Obesity: Prevalence, Consequences, and Causes of a Growing Public Health Problem

This review considers a variety of perspectives on overweight and obesity (OW/obesity), including measurement and classification; prevalence and changes in prevalence in recent years; genetic, biological, medical, individual, and social correlates of OW/obesity; and treatment approaches. Despite increased attention, OW/obesity is escalating in prevalence worldwide, and the causes are exceedingly complex. A range of innovative studies, including basic research on gut microflora, dietary composition, pharmacologic interventions, and surgical procedures, is generating findings with potential for future prevention and treatment of OW/obesity. Social system changes such as school programs and the awareness of the roles of personal, family, health provider, and cultural experiences related to OW/obesity have also gained traction for vital prevention and treatment efforts over the past decade.

Weight management-related assessment and counseling by primary care providers in an area of high childhood obesity prevalence: current practices and areas of opportunity

BACKGROUND

Childhood obesity in Georgia exceeds the national rate. The state's pediatric primary care providers (PCPs) are well positioned to support behavior change, but little is known about provider perceptions and practices regarding this role.

PURPOSE

The aim of this study was to assess and compare weight-management-related counseling perceptions and practices among Georgia's PCPs.

METHODS

In 2012-2013, 656 PCPs (265 pediatricians, 143 family practice physicians [FPs], and 248 nurse practitioners/physician assistants [NP/PAs]) completed a survey regarding weight-management-related practices at well-child visits before their voluntary participation in a free training on patient-centered counseling and child weight management. Data were analyzed in 2014. Likert scales were used to quantify responses from 1 (strongly disagree or never) to 5 (strongly agree or always). Responses of 4 and 5 responses were combined to denote agreement or usual practice. Chi-squared analyses tested for independent associations between pediatricians and others. Statistical significance was determined using two-sided tests and p value <0.05.

RESULTS

The majority of PCPs assessed fruit and vegetable intake (83%) and physical activity (78%), but pediatricians were more likely than FPs and NP/PAs to assess beverage intake (96% vs. 82-87%; p≤0.002) and screen time (86% vs. 74-75%; p≤0.003). Pediatricians were also more likely to counsel patients on lifestyle changes (88% vs. 71%; p<0.001) and to track progress (50% vs. 35-39%; p<0.05). Though all PCPs agreed that goal setting is an effective motivator (88%) and that behavior change increases with provider encouragement (85%), fewer were confident in their ability to counsel (72%).

CONCLUSIONS

Our results show that many PCPS in Georgia, particularly pediatricians, have incorporated weight management counseling into their practice; however, important opportunities to strengthen these efforts by targeting known high-risk behaviors remain.

Weight stigma "gets under the skin"-evidence for an adapted psychological mediation framework: a systematic review

OBJECTIVE

Research consistently shows a negative view of individuals with obesity in the general public and in various other settings. Stigma and discrimination can be considered chronic stressors, as these factors have a profound impact on the psychological well-being of the affected individuals. This article proposes a framework that entails a mediation of the adverse effects of discrimination and stigmatization on mental well-being through elevated psychological risk factors that are not unique to weight but that could affect overweight and normal-weight individuals alike.

METHODS

A systematic review was conducted to assess the prevalence of psychological risk factors, such as self-esteem and coping, in individuals with obesity.

RESULTS

Forty-six articles were assessed and included for detailed analysis. The number of studies on these topics is limited to certain dimensions of psychological processes. The best evaluated association of obesity and psychosocial aspects is seen for self-esteem. Most studies establish a negative association of weight and self-esteem in children and adults. All studies with mediation analysis find a positive mediation through psychological risk factors on mental health outcomes.

CONCLUSIONS

This review shows that elevated psychological risk factors are existent in individuals with obesity and that they may be a mediator between weight discrimination and pathopsychological outcomes.

Pioneers in pediatric psychology: integrating nutrition and child development interventions

As part of the Pioneers in Pediatric Psychology series, this article provides a brief personal account of Maureen Black's career as a pediatric psychologist. It traces the transition of the Society of Pediatric Psychology (SPP) from a section of the Division of Clinical Psychology of the American Psychological Association (APA) to an independent division of APA, which occurred during my presidency of SPP. The article addresses three aspects of pediatric psychology that have been central to my career: pediatric nutritional problems, global child development, and the advancement of children's health and development through policy-related strategies. The article concludes with Lessons Learned and Recommendations for the future of pediatric psychology.

Depressive symptoms are associated with excess weight and unhealthier lifestyle behaviors in urban adolescents

BACKGROUND

Adolescence is a critical period for the development of depressive symptoms and obesity. This study examined the association of depressive symptoms with standardized BMI (BMI z-score), lifestyle behaviors, and self-efficacy measures in a sample of urban adolescents.

METHODS

A school-based study was conducted among adolescents (N=1508) enrolled from 11 public schools. Depressive symptoms were assessed with Kandel's depressive symptoms scale for adolescents. Fruit and vegetable intake and intake of energy-dense foods were assessed by a short food frequency questionnaire. Sedentary behavior and physical activity (PA) were obtained by self-report. Height and weight were measured directly and BMI z-scores were calculated. Mixed-effects models were used to examine the association of depressive symptoms with BMI z-score and lifestyle behaviors, accounting for clustering at school level and adjusting for confounders. Self-efficacy measures were evaluated as potential mediators.

RESULTS

The sample was 53% female, 75% Hispanic, and 82% US born, with a mean age of 13.9 years. Higher depressive symptoms were associated with higher BMI z-score (β=0.02; p=0.02), intake of energy-dense foods (β=0.42; p<0.001), and sedentary behavior (β=0.48; p<0.001), but lower PA (β=-0.03; p=0.01). There was an interaction by gender in the association of depressive symptoms and PA. Self-efficacy mediated the association of depressive symptoms and PA.

CONCLUSIONS

Obesity prevention and treatment programs should consider addressing the role of negative emotions as part of their preventive strategies.

Quantification of wear-time adherence of removable appliances in young orthodontic patients in relation to their BMI: a preliminary study

PURPOSE

The relationship between unhealthy body mass index (BMI) and adherence to orthodontic treatment with removable appliances has not previously been evaluated.

OBJECTIVE

The aim of this study was to quantify the association between BMI and wear time of removable orthodontic appliances and to evaluate BMI changes during orthodontic treatment.

PATIENTS AND METHODS

Fifty-three normal-weight and 39 overweight/obese children and adolescents (7-15 years old) undergoing orthodontic treatment with removable appliances were enrolled into the study. BMI categories were determined using standardized age-specific and sex-specific BMI criteria, using data measured at the beginning of therapy and once during orthodontic treatment. Wear times of removable appliances were measured at 15-minute intervals over a period of 5 months using implanted microelectronic sensors. Median wear-time values were used in the analysis with the Mann-Whitney U-test used to test statistical differences between groups.

RESULTS

The median wear time of removable orthodontic appliances was 9.3 hours for normal-weight patients and 9.2 hours for overweight/obese patients. No statistically significant (P>0.05) or clinically relevant differences in usage or adherence were detected between normal-weight and overweight/obese patients. BMI did not influence wear time or behavior of removable orthodontic appliances by young patients. The majority of patients showed qualitative decreases in BMI during therapy.

CONCLUSION

The orthodontic treatment of young patients with removable devices does not require BMI-dependent changes in the treatment strategy. However, the use of removable appliances during meal times raises the possibility of reducing food intake, and in this way the orthodontist may have an active role to play in weight reduction.