Factors associated with depression and anxiety symptoms among children seeking treatment for obesity: A social-ecological approach

A Cross-Sectional Retrospective Review of Neuropsychiatric Comorbidities in Children With Non-Alcoholic Fatty Liver Disease

This single-center cross-sectional retrospective chart review sought to define the prevalence of neuropsychiatric (NP) disorders among children with non-alcoholic fatty liver disease (NAFLD) compared to the general population. The prevalence rate of NP disorders was determined at diagnosis among children evaluated from 2006 to 2016. The NP disorder prevalence rates were compared to those reported in the 2016 National Survey of Children's Health (NSCH). 24.3% of 254 children with NAFLD reported to have at least 1 NP disorder compared to 16.9% of those in NSCH (relative risk [RR] = 1.44; P < .0001). More children had intellectual disability (ID) (4.5% vs 0.8%; RR = 5.43, P < .0001), depression (3.9% vs 2.2%; RR = 1.82, P = .0009), or autism spectrum disorder (ASD) (3.3% vs 2.0%; RR = 1.67, P = .047) in the Boston Children's Hospital (BCH) NAFLD cohort. The prevalence of 1 NP disorder was 29.4% in our cohort compared to 22.3% in NSCH (RR = 1.32; P = .007). Children with NAFLD have a higher rate of NP disorders compared to the general population.

Contributions of subjective status to eating behaviors, obesity, and metabolic health across development

Subjective status is the evaluation of one's social or socioeconomic status relative to others. Lower subjective status has been associated with risk of overweight/obesity, poorer metabolic health, and obesogenic food preferences and eating behaviors. However, these findings are predominantly based on studies of adolescents and young adults. This indicates major gaps in knowledge and application of this social determinant of obesity and metabolic health, given that perceived status develops throughout the life course along with food environments and eating habits. Here, we review the relationships that subjective status shares with the outcomes of eating behaviors, obesity, and metabolic health across milestones and periods of development: during the prenatal period, as caregivers who feed children, during childhood (prior to age 10) and from adolescence into emerging adulthood (until mid-20's). For each developmental period, we explore why the period critically contributes to these outcomes and how subjective status may affect eating behaviors and metabolic health. We propose that subjective status contributes to eating/feeding behaviors and metabolic health both within and across developmental periods, such that the effect of low subjective status at an earlier period may contribute to obesogenic eating behaviors and metabolic health in later developmental periods and intergenerationally. The influence of low subjective status on higher body weight may also threaten subjective status later in development through heightened vulnerability to social stressors, such as weight-based stigma. Overall, subjective status may be a broadly influential factor to consider when examining social determinants of obesity and metabolic health across development.

Overview of Pediatric Obesity as a Disease

The authors highlight well-known and hypothesized pathophysiologic mechanistic links underlying obesity and the various pediatric disorders across multiple organ systems with which it is associated. Obesity is attributed to an imbalance in energy intake versus expenditure; there is growing knowledge regarding its multifactorial origins, dysfunctional physiologic processes, and adverse health consequences. Individuals with obesity exhibit variations in metabolic rate, genetic predisposition, and hormonal regulation, influencing diverse responses in regulating energy balance. Understanding the complex mechanistic relationships surrounding the pathophysiology of obesity assists in its consideration as a disease process, allowing pediatric health practitioners to manage its sequelae more effectively.

Prevalence of overweight/obesity, and associated factors among adolescents aged 12 ∼ 15 in Shandong Province, China: A cross-sectional study

Overweight/obesity among adolescents in Shandong Province, China, has been rising, posing significant public health challenge. Comprehensive investigation is needed to develop effective interventions. Following the Strengthening the Reporting of Observational Studies in Epidemiology guidelines, a stratified random cluster sampling approach was used from September to October 2023 across 17 cities in Shandong Province. The study included 165 middle schools, surveying 99,638 students aged 12 ∼ 15. After applying exclusion criteria, 97,356 students (97.71% effective rate) completed anthropometric measurements and questionnaires. Overweight/obesity were assessed based on national and international standards. Univariable chi-square test and multivariable logistic regression were used to analyze factors influencing overweight/obesity. In 2023, the overweight/obesity rate among 12 ∼ 15-year-olds in Shandong was 19.75%. Significant factors included sex, age, residence, family income, parental weight status and activity, mother's gestational diabetes history, birth weight, physical activity, sleep, screen time, homework, and diet. Girls, older adolescents, and those with physically active parents or who themselves engaged in over 1.5 h of daily physical activity had lower odds of being overweight/obese. Adequate sleep and frequent consumption of vegetable and fruit were also protective. Higher odds were associated with urban residence, high family income, overweight/obese parents, maternal gestational diabetes, high birth weight, excessive screen time, extensive homework, and frequent fast food consumption. Overweight/obesity in Shandong adolescents is influenced by multiple determinants. Holistic interventions addressing genetic, behavioral, and environmental factors are essential for promoting healthier lifestyles and reducing the prevalence in this demographic.

Depression and emotional eating in children and adolescents: A systematic review and meta-analysis

Major Depressive Disorder in youth is associated with obesity and adult cardiovascular disease (CVD) risk. Eating in response to emotions (emotional eating) is a potential contributing factor to this association. Although emotional eating is associated with Major Depressive Disorder in adults, findings in children and adolescents are mixed. This systematic review and meta-analysis aims to determine the association between depression and emotional eating in children and adolescents. Systematic searches were conducted in seven databases. Studies were included if the study population had a mean age of ≤18 years and assessed both depression and emotional eating using validated measures. The search generated 12,241 unique studies, of which 37 met inclusion criteria. Random-effects meta-analyses of study outcomes were performed. Thirty-seven studies (26,026 participants; mean age = 12.4 years, SD = 3.1) were included. The mean effect size was significant for both cross-sectional and longitudinal data (Hedges' g = 0.48, p < 0.0001; g = 0.37, p = 0.002, respectively), revealing a positive moderately strong association between depressive symptoms and emotional eating in youth. Among longitudinal studies, the association was stronger when depressive symptoms and emotional eating were assessed using child and adolescent self-report versus parent-report. No studies examined youth with a clinical diagnosis of depression. Meta-analyses revealed that depressive symptoms and emotional eating are positively associated in children and adolescents. However, further research in clinical samples is needed. Results raise the possibility for the importance of emotional eating in the link between depression and early CVD risk, though further examination is required to determine whether emotional eating is a potential treatment target to decrease CVD risk among adolescents with increased depression symptoms.

Not Only Metabolic Complications of Childhood Obesity

The increasing incidence of obesity in the pediatric population requires attention to its serious complications. It turns out that in addition to typical, well-known metabolic complications, obesity as a systemic disease carries the risk of equally serious, although less obvious, non-metabolic complications, such as cardiovascular diseases, polycystic ovary syndrome, chronic kidney disease, asthma, thyroid dysfunction, immunologic and dermatologic conditions, and mental health problems. They can affect almost all systems of the young body and also leave their mark in adulthood. In addition, obesity also contributes to the exacerbation of existing childhood diseases. As a result, children suffering from obesity may have a reduced quality of life, both physically and mentally, and their life expectancy may be shortened. It also turns out that, in the case of obese pregnant girls, the complications of obesity may also affect their unborn children. Therefore, it is extremely important to take all necessary actions to prevent the growing epidemic of obesity in the pediatric population, as well as to treat existing complications of obesity and detect them at an early stage. In summary, physicians treating a child with a systemic disease such as obesity must adopt a holistic approach to treatment.

Change in parent and child psychopathology following obesity treatment and maintenance: A secondary data analysis

BACKGROUND

General and eating disorder (ED) psychopathology are common among children and adults with overweight/obesity; few studies have examined their course of change throughout family-based behavioural obesity treatment (FBT) and maintenance.

OBJECTIVES

Examine: (1) the changes in the parent and child general and ED psychopathology during FBT and maintenance interventions; (2) the associations between change in psychopathology and change in weight among children or parents; (3) the associations between change in psychopathology within parent-child dyads.

METHODS

172 parent-child dyads participated in 4-month FBT and were subsequently randomized to one of three 8-month maintenance interventions. General psychopathology (child anxiety/depressive symptoms, parent severity of global psychological distress), ED psychopathology (shape/weight concern), and percent overweight were assessed at baseline, post-FBT, and post-maintenance. Separate linear mixed-effects models evaluated change in general and ED psychopathology, including an interaction between maintenance condition and time. Partial correlations examined associations between change in psychopathology and percent overweight among children or parents, and associations between change in psychopathology within parent-child dyads.

RESULTS

Among children, significant reductions were observed from baseline to post-FBT in all forms of psychopathology and from post-FBT to post-maintenance in general psychopathology. Among parents, significant reductions were observed from baseline to post-FBT in all forms of psychopathology; reductions were maintained from post-FBT to post-maintenance. There was no significant interaction between maintenance condition and time. Correlations between change in most forms of parent or child psychopathology and percent overweight were observed.

CONCLUSIONS

Participation in FBT and maintenance was associated with improvements in general and ED psychopathology in both parents and children.

Effect of exposure to endocrine disrupting chemicals in obesity and neurodevelopment: The genetic and microbiota link

Current evidence highlights the importance of the genetic component in obesity and neurodevelopmental disorders (attention-deficit hyperactivity disorder (ADHD), autism spectrum disorder (ASD) and intellectual disability (ID)), given that these diseases have reported an elevated heritability. Additionally, environmental stressors, such as endocrine disrupting chemicals (EDCs) have been classified as obesogens, neuroendocrine disruptors, and microbiota disrupting chemicals (MDCs). For this reason, the importance of this work lies in examining two possible biological mechanistic pathways linking obesity and neurodevelopmental/behavioural disorders: EDCs - gene and EDCs - microbiota interactions. First, we summarise the shared mechanisms of action of EDCs and the common genetic profile in the bidirectional link between obesity and neurodevelopment. In relation to interaction models, evidence from the reviewed studies reveals significant interactions between pesticides/heavy metals and gene polymorphisms of detoxifying and neurotransmission systems and metal homeostasis on cognitive development, ASD and ADHD symptomatology. Nonetheless, available literature about obesity is quite limited. Importantly, EDCs have been found to induce gut microbiota changes through gut-brain-microbiota axis conferring susceptibility to obesity and neurodevelopmental disorders. In view of the lack of studies assessing the impact of EDCs - gene interactions and EDCs - mediated dysbiosis jointly in obesity and neurodevelopment, we support considering genetics, EDCs exposure, and microbiota as interactive factors rather than individual contributors to the risk for developing obesity and neurodevelopmental disabilities at the same time.

General and Eating Disorder Psychopathology in Relation to Short- and Long-Term Weight Change in Treatment-Seeking Children: A Latent Profile Analysis

BACKGROUND

Concurrent general psychopathology (GP) and eating disorder psychopathology (EDP) are commonly reported among youth with overweight/obesity and may impact weight change.

PURPOSE

We identified patterns of GP and EDP in children with overweight/obesity and examined the impact on weight change following family-based behavioral obesity treatment (FBT) and maintenance interventions.

METHODS

Children (N = 172) participated in 4 month FBT and subsequent 8 month weight maintenance interventions. GP and EDP were assessed prior to FBT (baseline). Child percentage overweight was assessed at baseline, post-FBT (4 months), and post-maintenance (12 months). Latent profile analysis identified patterns of baseline GP and EDP. Linear mixed-effects models examined if profiles predicted 4- and 12-month change in percentage overweight and if there were two-way and three-way interactions among these variables, adjusting for relevant covariates.

RESULTS

Results indicated a three-profile structure: lower GP and EDP (LOWER); subclinically elevated GP and EDP without loss of control (LOC; HIGHER); and subclinically elevated GP and EDP with LOC (HIGHER + LOC). Across profiles, children on average achieved clinically meaningful weight loss (i.e., ≥9 unit change in percentage overweight) from baseline to 4 month FBT and sustained these improvements at 12 month maintenance. There was no evidence that latent profiles were related to percentage overweight change from baseline to FBT (p > .05) or baseline to maintenance (p > .05). There was no evidence for two-way or three-way interactions (p > .05).

CONCLUSION

Concurrent GP and EDP do not portend differential short- or long-term weight change following FBT and maintenance. Future research is warranted on the durability of weight change among youth with GP and EDP.

TRIAL REGISTRATION

NCT00759746.

A brief session-by-session measure of eating disorder psychopathology for children and adolescents: Development and psychometric properties of the Eating Disorder-15 for Youth (ED-15-Y)

OBJECTIVE

Despite evidence supporting the use of measures to track ongoing progress and outcome in treatment, there is a relative absence of measures that are appropriate for this purpose in youth with eating disorders. This study examined the psychometric properties of the Eating Disorder-15 for Youth (ED-15-Y) scale, including its ability to detect short-term change in symptomatology.

METHOD

Youth (N = 203) ages 8-18 years completed self-report questionnaires and semi-structured diagnostic interviews upon initial presentation for an outpatient eating disorders assessment at an academic medical center.

RESULTS

The ED-15-Y demonstrated excellent reliability (internal consistency, split-half reliability) and high sensitivity to change early in treatment (change from sessions 1 to 8, adjusting for baseline score). Further, these data demonstrate that the ED-15-Y has excellent convergent validity, being highly correlated with a well-tested, longer measure of eating disorders psychopathology-the Eating Disorders Examination-Questionnaire (EDE-Q). These data also support good discriminant and concurrent validity, differentiating between youth without an eating disorder or with ARFID and youth with eating disorders involving weight and shape concerns (e.g., anorexia nervosa, bulimia nervosa).

DISCUSSION

The ED-15-Y may be a useful tool to briefly assess eating disorder psychopathology in youth as young as 8 years old. Its sensitivity to change very early in treatment suggests that it has the potential to be used as a routine outcome measure in the context of treatment.

Body mass index and peer victimization: A transactional model

Past research has shown concurrent associations between adolescent's body mass index (BMI) and classroom bullying victimization experiences. The goal of this three‐wave longitudinal study is to examine a transactional model of associations between BMI and bullying victimization among adolescents in India. We investigate concurrent unidirectional and bidirectional relations between BMI and victimization. In a sample of 1238 students from nine schools (Grades 7–9; M‐age_T1 = 13.15, SD = 1.16) in Indore, India, we used self‐ and peer‐reports to measure bullying victimization in the classroom, and objective measurement of students' height and weight to collect data on adolescents' BMI, across three waves in one school year. Structural equational modeling was used to test transactional relations between BMI and bullying victimization. For self‐reported victimization, there was no concurrent or over time association between BMI and victimization for boys or girls in the present study. For peer‐reported victimization, we observed concurrent associations between BMI and victimization for boys and girls and a prospective relation where higher BMI corresponded to less victimization over time for boys. The study yielded mainly concurrent relations between BMI and victimization among adolescents in India. Results from western countries may not generalize to India.

Associations between objective physical activity and emotional eating among adiposity-discordant siblings using ecological momentary assessment and accelerometers

BACKGROUND

Emotional eating is associated with obesity, though less is known regarding factors that predict emotional eating episodes in children and adolescents.

OBJECTIVES

To investigate whether moderate to vigorous physical activity (MVPA) or total activity counts 60 minutes prior to psychological stress predicted stress-related eating and positive emotional eating (ie, eating while happy), and whether adiposity (z-BMI) moderated these associations.

METHODS

Participants were drawn from a prior study of siblings (N = 77; mean age = 15.4 ± 1.4 years) discordant for weight status (39 non-overweight siblings, 38 siblings with overweight/obesity) who completed an ecological momentary assessment protocol with accelerometer-based assessment of physical activity.

RESULTS

Greater MVPA was associated with lower stress-related eating across the sample. Lower total activity (between-person effects) and lower MVPA (within-person effects) were associated with greater stress-related eating for siblings with greater z-BMI. Greater total activity was associated with lower positive emotional eating for siblings with lower z-BMI (between- and within-person).

CONCLUSIONS

Findings demonstrate potential regulating effects of prior physical activity on emotional eating at the individual and momentary level, though there are nuances depending on z-BMI. Future work is needed to examine underlying mechanisms and timescale of effects, and particularly the extent to which enhancing MVPA time among youth with z-BMI may mitigate momentary risk of stress-related eating episodes.

The Co-occurrence of Pediatric Obesity and ADHD: an Understanding of Shared Pathophysiology and Implications for Collaborative Management

PURPOSE OF REVIEW

To describe what is known about the association between obesity and attention-deficit hyperactivity disorder (ADHD) in children along with the co-occurring conditions of sleep dysfunction, loss of control/binge eating disorder (LOC-ED/BED), and anxiety.

RECENT FINDINGS

Obesity and ADHD share common brain pathways (hypothalamic, executive, and reward centers) with pathophysiology in these areas manifesting in partial or complete expression of these diseases. Sleep dysfunction, LOC-ED/BED, and anxiety share similar pathways and are associated with this disease dyad. The association of obesity and ADHD with sleep dysfunction, LOC-ED/BED, and anxiety is discussed. An algorithm outlining decision pathways for patients with obesity and with and without ADHD is presented. Future research exploring the complex pathophysiology of both obesity and ADHD as well as co-occurring conditions is needed to develop clinical guidelines and ultimately assist in providing the best evidence-based care.

Development of RisObIn.Com, a Screening Tool for Risk of Childhood Obesity in the Community

The prevalence of childhood overweight has increased considerably in the past three decades and there is evidence that childhood obesity can persist into adulthood. A simple tool to identify relevant risk factors may alert families and prevent overweight and obesity. This study aims to develop a pre-school screening tool to assess the risk of childhood obesity. Child anthropometric measurements and several risk factors for childhood obesity factors were obtained. The effect of the variables on the outcome of obesity (defined as increased anthropometry-estimated adiposity) was assessed by binary logistic regression analyses. The identified variables were submitted for expert panel validation and combined for the tool development. A total of 304 children were included. Eight items were included in the tool. A higher score of the tool indicates a greater risk for obesity in childhood with the cutoff point set at 0. The tool sensitivity for obesity was 95%, specificity was 74.4%, the positive predictive value was 37.3%, and negative predictive value was 98.9%. The Risk of childhood Obesity In the Community (RisObIn.Com) tool is proposed to be a comprehensive tool to identify children at high risk for late childhood obesity at admission to primary school. Further studies are needed to assess the performance of the tool.

Prevention and Management of Childhood Obesity and Its Psychological and Health Comorbidities

Childhood obesity has become a global pandemic in developed countries, leading to a host of medical conditions that contribute to increased morbidity and premature death. The causes of obesity in childhood and adolescence are complex and multifaceted, presenting researchers and clinicians with myriad challenges in preventing and managing the problem. This article reviews the state of the science for understanding the etiology of childhood obesity, the preventive interventions and treatment options for overweight and obesity, and the medical complications and co-occurring psychological conditions that result from excess adiposity, such as hypertension, nonalcoholic fatty liver disease, and depression. Interventions across the developmental span, varying risk levels, and service contexts (e.g.,community, school, home, health care systems) are reviewed. Future directions for research are offered with an emphasis on translational issues for taking evidence-based interventions to scale in a manner that will reduce the public health burden of the childhood obesity pandemic.

An Update on Mental Health Problems and Cognitive Behavioral Therapy in Pediatric Obesity

Prevalence of pediatric obesity has increased worldwide in the last 20 years. Obese children suffer not only physical complications but also mental health problems such as depression, attention deficit hyperactivity disorder (ADHD), and eating disorders, as well as psychosocial impairments, such as school adjustment problems, bullying, and low self-esteem. Recently, there have been some studies on the association of mental health problems and pediatric obesity. In the treatment of pediatric obesity, many previous studies suggest multidisciplinary treatment. However, cognitive behavioral therapy (CBT) has attracted attention because obese children are accompanied by body image distortion, emotion dysregulation, and difficulties in stimulus control. This review is a narrative summary of the recent studies on mental health problems and CBT in pediatric obesity. The relationship between depression/anxiety and pediatric obesity is still inconsistent but recent studies have revealed a bidirectional relation between depression and obesity. Additionally, some studies suggest that obese children may have eating disorder symptoms, like loss of control eating, and require therapeutic intervention for pediatric obesity treatment. Furthermore, impulsivity and inattention of ADHD symptom is thought to increase the risk of obesity. It has also been suggested that CBT can be very effective for mental health problems such as depression, impulsivity, and body image distortion, that may coexist with pediatric obesity, and use of multimedia and application can be useful in CBT.