The Association between Obesity and Depression among Children and the Role of Family: A Systematic Review

Food for Thought: The Impact of a Nutritional Toolkit on Well-being in Children

PURPOSE

This study investigated whether attendance by a cohort of pediatric patients at an educational/interventional nutritional program could impact dietary habits, physical health and mental well-being.

METHODS

A 16-week program was offered to 235 children with food insecurity which focused on fresh produce and nutritional education, recipes, as well as physical and mental wellness. Underlying diagnoses were obesity in 41.7 % (n = 98), cancer in 22.1 % (n = 52), mental health issues in 5.5 % (n = 12) or other in 30.7 % (n = 72). Health assessment surveys included changes in food choices, physical activity, mental wellness, memory, sleep, creativity, and BMI at enrollment, end of study, and at three-month follow-up. Results were compared by two-way student-t test and Pearson chi-square analysis.

RESULTS

The median age was 9.9 years (range 1-21 years). Significant improvements were found at the end of study in vegetable consumption (p = 0.002), physical activity (p = 0.001), mental wellness (p = 0.015), focus (p = 0.052), memory (p = 0.004), sleep (p = 0.003), creativity (p = 0.004) and BMI for obese patients (p = 0.025). Food choice improvements were seen in carbohydrates which decreased from 53.0 to 38.7 % (p = 0.013) and vegetable consumption which increased from 32.5 to 39.5 % (p = 0.014). Protein intake did not change significantly. At three-month follow-up there was no decline in interest, produce intake, physical activity, mental wellness, focus, sleep or creativity.

CONCLUSIONS

A diet intervention program where children and their parents are educated on healthy food choices had a significant influence on children's diet and well-being. For pediatric surgery patients with obesity and cancer, these changes could have a significant impact on long term outcomes and warrant further study.

LEVEL OF EVIDENCE

III.

Physical activity as a protective factor in the mood of children and adolescents: association with overweight and obesity

Introduction

Sedentary children and adolescents are more susceptible to developing diseases, obesity and psychological disorders, but little is known about the relationship between physical activity (PA), body mass index (BMI) and mood state in this population.

Methods

This is a cross-sectional study with the participation of 2,757 students, aged between 10 and 19 years. The Brunel Mood Scale-BRUMS was used to assess the dimensions of tension, depression, anger, vigor, fatigue and mental confusion, and the PA questionnaire for children and adolescents was used to assess the practice of PA.

Results

There was a significant difference between the eutrophic and overweight BMI groups for the mood states of depression (p = 0.004) and vigor (p = 0.047). On the other hand, the overweight (4.06 ± 4.3) and obese (3.85 ± 4.0) groups had the highest rates of depression. It was observed that a higher BMI was associated with depression, anger and fatigue in children and adolescents and that PA can explain 39% of vigor in this population (F = 103.062, p = 0.000; R 2 = 0.039). Active children and adolescents had twice as much vigor as inactive ones. There were differences between males and females, and between active and inactive individuals, in depression, anger, vigor, fatigue and confusion. There was a tendency for overweight and obese children and adolescents to have higher rates of depression when compared to underweight or normal-weight individuals.

Conclusion

The practice of physical activity (PA) was shown to have a positive effect on mood, with active children and adolescents reporting lower levels of depression, anger, fatigue, and confusion, and higher levels of vigor. These findings underscore the importance of PA as a protective factor against mood disturbances in this population, highlighting its potential role in improving emotional well-being.

Mental distress or psychiatric condition? Exploring the gray area of categorizing psychological suffering among adolescents with obesity: a mixed methods study

Introduction Obesity in adolescents is associated with increased mental distress and psychiatric disorders, both of which are under-diagnosed in clinical practice. Methods We designed a mixed methods study, to explore the practical challenges of this screening and its consequences. The qualitative part interviewed 20 physicians: non psychiatrist physicians and child and adolescent psychiatrists - practicing in various specialized settings. The quantitative part examined self-assessment questionnaires and psychiatric clinical diagnoses in 242 patients admitted for inpatient appraisal of obesity. Results 7.9% reported severe depressive symptoms and 71.9% severe anxiety symptoms. Among this cohort, 28.5% were diagnosed with anxiety disorder and 16.9% with depression disorder. Both qualitative and quantitative data show that a large share of adolescents with obesity experience mental health distress, often intense. However, in most of these adolescents, this distress is not diagnosed as a mental health condition, thus creating a discrepancy which we named a "gray area" of psychological suffering. Conclusions Screening adolescents with obesity for both mental health distress and disease should be systematic. Frontline professionals need improved training and referral pathways and resources.

Investigating the causal effects of childhood and adulthood adiposity on later life mental health outcome: a Mendelian randomization study

BACKGROUND

Obesity particularly during childhood is considered a global public health crisis and has been linked with later life health consequences including mental health. However, there is lack of causal understanding if childhood body size has a direct effect on mental health or has an indirect effect after accounting for adulthood body size.

METHODS

Two-sample Mendelian randomization (MR) was performed to estimate the total effect and direct effect (accounting for adulthood body size) of childhood body size on anxiety and depression. We used summary statistics from a genome-wide association study (GWAS) of UK Biobank (n = 453,169) and large-scale consortia of anxiety (Million Veteran Program) and depression (Psychiatric Genomics Consortium) (n = 175,163 and n = 173,005, respectively).

RESULTS

Univariable MR did not indicate genetically predicted effects of childhood body size with later life anxiety (beta = - 0.05, 95% CI = - 0.13, 0.02) and depression (OR = 1.06, 95% CI = 0.94, 1.20). However, using multivariable MR, we observed that the higher body size in childhood reduced the risk of later life anxiety (beta = - 0.19, 95% CI = - 0.29, - 0.08) and depression (OR = 0.83, 95% CI = 0.71, 0.97) upon accounting for the effect of adulthood body size. Both univariable and multivariable MR indicated that higher body size in adulthood increased the risk of later life anxiety and depression.

CONCLUSIONS

Higher body size in adulthood may increase the risk of anxiety and depression, independent of childhood higher body size. In contrast, higher childhood body size does not appear to be a risk factor for later life anxiety and depression.

Life-Threatening Respiratory Complications in Two Young Children with Extreme Obesity

BACKGROUND/OBJECTIVES

Obesity is a chronic disease characterized by pathological accumulation of adipose tissue. The exponentially increasing number of children with severe obesity draws attention to the tragic consequences of the lack of, or inadequate treatment of, obesity in this age group. This article aims to present ways of preventing obesity and ways of treating its complications in order to reduce the risk of the life-threatening problems caused by it.

CASE REPORT

The first patient was a 9-year-old boy with Prader-Willi syndrome, severe obesity, obstructive sleep apnea, hypertension, status post myocarditis, and recurring episodes of desaturation up to 70-80%. Respiratory support using continuous positive airway pressure (CPAP) and two-level positive airway pressure (BiPAP) were included in the treatment and the resolution of desaturation was observed. The second patient was a 5-year-old girl with simple obesity, obstructive sleep apnea, and subclinical hypothyroidism, hospitalized for sudden cardiac arrest, most likely caused by excessive fat tissue compressing the airway. Despite the introduced treatment, tracheostomy, and tonsillectomy, the girl remained unconscious during hospitalization and in the rehabilitation clinic, where she spent 7 months in a coma. Currently, her health is slowly improving as her weight significantly decreases. In both cases, serious consequences were observed due to non-adherence to dietary recommendations, lack of regular medical check-ups, and failure to implement appropriate treatment.

CONCLUSIONS

Obesity can lead to life-threatening consequences, including respiratory arrest and a need for respiratory support, if proper treatment is not administered and if medical recommendations are not followed.

Prevalence of Childhood Obesity Among Children and Adolescents in Saudi Arabia: A Systematic Review

Childhood obesity is a growing public health concern worldwide, with significant implications for long-term health outcomes. Thus, the aim of this study is to highlight the prevalence and trend of obesity among children and adolescents in Saudi Arabia over the last 24 years. This systematic review included participants aged 2 to 19 years without systemic disease, reporting the prevalence of obesity using the Centers for Disease Control and Prevention (CDC) classification and BMI calculation, from studies in English or Arabic published between January 2000 and April 2024. We conducted a comprehensive search across multiple databases including ProQuest, Google Scholar, ISI Web of Science, Embase via Ovid, and MEDLINE via Ovid, and reviewed references of included studies. Data were extracted and quality assessed independently by two authors, with any disagreements resolved through discussion with a third reviewer, using the Newcastle-Ottawa Scale modified for this study. This systematic review included 21 studies from Saudi Arabia, published between 2006 and 2023, with participants aged 2 to 19 years. The studies involved a total of 63,512 subjects. Among children, the prevalence of overweight ranged from 5% to 29%, while obesity ranged from 3.8% to 49.7%, classified using CDC criteria. Quality assessment rated 10 studies as Very Good, 10 as Good, and one as Unsatisfactory. The systematic review of childhood obesity prevalence in Saudi Arabia over the past 24 years highlights alarming trends and significant public health implications. Our analysis emphasizes an increase in obesity rates among children and adolescents, revealing a complex link of socioeconomic, cultural, and lifestyle factors contributing to this epidemic.

Childhood obesity and adolescent follow-up depressive symptoms: exploring a moderated mediation model of body esteem and gender

Obesity is a well-recognized risk factor for adolescent depressive symptoms, but mediating mechanisms of this association have scarcely been studied. This study is unique in examining an indirect pathway of this link via body esteem (BE) prospectively from childhood (8-12 years) to adolescence (13-18 years). In addition, potential gender moderation was examined. This study utilized data from a case-control study comparing 100 children with and without obesity matched on important confounders (age, gender, and socioeconomic status). Our findings provide support for the mediating role of BE in the link between childhood weight status and adolescent depressive symptoms at a 5-year follow-up. This mediation effect did not differ between boys and girls. The findings suggest the relevance of specifically targeting children's BE in preventive intervention programs among children with obesity to prevent future mental health problems.

Exploring the Link between Oxidative Stress, Selenium Levels, and Obesity in Youth

Obesity is a worldwide increasing concern. Although in adults this is easily estimated with the body mass index, in children, who are constantly growing and whose bodies are changing, the reference points to assess weight status are age and gender, and need corroboration with complementary data, making their quantification highly difficult. The present review explores the interaction spectrum of oxidative stress, selenium status, and obesity in children and adolescents. Any factor related to oxidative stress that triggers obesity and, conversely, obesity that induces oxidative stress are part of a vicious circle, a complex chain of mechanisms that derive from each other and reinforce each other with serious health consequences. Selenium and its compounds exhibit key antioxidant activity and also have a significant role in the nutritional evaluation of obese children. The balance of selenium intake, retention, and metabolism emerges as a vital aspect of health, reflecting the complex interactions between diet, oxidative stress, and obesity. Understanding whether selenium status is a contributor to or a consequence of obesity could inform nutritional interventions and public health strategies aimed at preventing and managing obesity from an early age.

Correlation between subcutaneous adipose tissue of the head and body mass index in children and young adults aged 8-19 years: implications for functional neuroimaging

High body mass index (BMI) is presumed to signify high amounts of fat (subcutaneous adipose tissue) distributed across the body. High amounts of fat co-occurring with increased BMI has been cited as a potential neuroimaging barrier. Presence of increased fat may result in high electrical impedance and increased light diffusion-resulting in low signal to noise ratios during electroencepholography (EEG), functional near-infrared spectroscopy (fNIRS), and transcranial direct current stimulation (tDCS) measurements. Examining if subcutaneous fat in the head increases with respect to total body fat percentage and BMI in school-aged children and adolescents is an essential next step in developing possible mathematical corrections for neuroimaging modalities. We hypothesized that percentage of subcutaneous adipose tissue in the head region would increase with respect to both total body fat percentage and BMI. Increased subcutaneous head fat percentage was associated with a positive linear relationship with BMI and a quadratic relationship with total body fat. The data indicate that participant age, sex, and adiposity should be considered in the development of model corrections for neuroimaging signal processing in school-aged children and adolescents. Strength of regression coefficients in our models differed from those in adults, indicating that age-specific models should be utilized.

Unveiling the links between physical activity, self-identity, social anxiety, and emotional eating among overweight and obese young adults

Introduction

Emotional eating not only contributes to physical obesity but also leads to the experience of guilt and shame, exacerbating emotional problems. Increasing physical activity, adopting a balanced diet, and seeking psychological support help improve emotional eating issues in overweight or obese young adults, enhancing overall mental and physical well-being.

Methods

This study investigates the correlation between physical activity, self-identity, social anxiety, and emotional eating among 373 overweight and obese college students aged 18-26 in central China. By utilizing AMOS v.26, a structural equation model was constructed to examine the hypotheses.

Results

The findings reveal that physical activity significantly influences self-identity and social anxiety, which, in turn, significantly impact emotional eating. Moreover, self-identity and social anxiety serve as mediators in the relationship between physical activity and emotional eating. These results emphasize the role of physical activity in mitigating emotional eating among young individuals struggling with overweight and obesity.

Discussion

Consequently, the government and relevant agencies are urged to address the issue of obesity among young adults and provide support for their engagement in physical activity.

Environmental factors of obesity before and after COVID-19 pandemic: a review

In past decades the prevalence of overweight and obesity had grown rapidly. There are numerous factors contributing to this unfavorable change in people's health. This review article investigates the environmental factors which may play a role in the prevalence of overweight and obesity and additionally the novel factors which appeared after the beginning of the COVID-19 pandemic, which caused the increase in BMI during the lockdown period. Most of the studies reveal that the COVID-19 pandemic and lockdown contributed to the growth of BMI in numerous countries and, eventually the prevalence of overweight and obesity increased. Studies suggest that the physical activity was decreased while sleep time and screen time were increased and the amount of food consumed increased, additionally more processed food with long shelf life was consumed. The diverse environmental factors may have an impact on obesity and overweight development taking into account policy and local school policy issues, socioeconomic status, lifestyle including physical activity, diet habits, and amongst others, more trivial causes such as uninteresting neighborhoods, lack of sense of security outside the place of residence or a long distance from shops. Still, this is the object of debate if air pollution is an environmental risk factor influencing the unfavorable trends towards increasing body weight.

The burden of low back pain in children and adolescents with overweight and obesity: from pathophysiology to prevention and treatment strategies

Nonspecific low back pain (LBP) is one of the most common causes of disability, affecting all individuals at least once in their lifetime. Such a condition is also becoming increasingly frequent in the pediatric population, especially in children and adolescents with overweight/obesity. Furthermore, new-onset LBP during adolescence has been demonstrated to be a strong predictor of developing LBP later in life, contributing to poorer outcomes and increasing social and medical costs. Several causes and different mechanisms have been considered for the development of LBP in pediatric individuals affected by obesity. For this reason, planning adequate prevention and treatment strategies, mainly through conservative lifestyle changes, would be crucial to anticipate the negative consequences of persisting LBP in adulthood. The aim of this narrative review was to characterize the relationship between LBP and overweight/obesity in the pediatric population, highlighting epidemiological and pathophysiological aspects. In addition, prevention and treatment approaches will be reviewed considering the need to reduce the burden of LBP on this population. According to our search, LBP was more frequent in children and adolescents with overweight and obesity and has been associated with several anthropometric and lifestyle factors, including lumbar hyperlordosis, sedentary habits, physical inactivity, carrying a heavy schoolbag, low vitamin D levels, psychosocial ill-being, and premature intervertebral disc degeneration. Most of these conditions may be addressed with conservative strategies mainly consisting of dietary adjustments, physical exercise, education programs, and physical therapy.

[The biopsychosocial understanding of health disorders and impairments in children with a focus on developmental neurological relationships]

The distinction between mental (spiritual and psychological) and physical health disorders is particularly difficult due to the special features of neurobiological development in children and adolescents. In this review article, the basics of developmental neurology are briefly described. On the basis of some congenital or early acquired neurological diseases, it is then shown to what extent mental processes can be impaired in interactions with the social context. Taking these aspects into account plays an important role in child and family-oriented counseling and support. The common occurrence of physical, mental, and psychological development disorders, which is also very variable between individuals and fluctuates over the course of a person's life, requires good interdisciplinary cooperation between conservative and surgical child and adolescent medicine and child and adolescent psychiatry.

Clinical review: Guide to pharmacological management in pediatric obesity medicine

Introduction

Newer pharmacotherapy agents (anti-obesity medication [AOM]) are revolutionizing the management of children and adolescents with obesity. Previously, treatment based on intensive behavioral therapy involved many patient and family contact hours and yielded improvements in obesity status of 1-3 percent of the 95th percentile of the body mass index (BMI). Newer AOMs are yielding more clinically significant improvement of 5-18 percent. This review provides guidance for practitioners in the care of children and adolescents with obesity who frequently have complex medical and behavioral health care needs. Specifically, we discuss the use of newer AOMs in these complex patients.

Methods

This review details an approach to the care of the child and adolescent with obesity using AOMs. A shared decision-making process is presented in which the provider and the patient and family collaborate on care. Management of medical and behavioral components of the disease of obesity in the child are discussed.

Results

Early aggressive treatment is recommended, starting with an assessment of associated medical and behavioral complications, weight promoting medications, use of AOMs and ongoing care. Intensive behavioral therapy is foundational to treatment, but not a specific treatment. Patients and families deserve education on expected outcomes with each therapeutic option.

Conclusions

The use of new AOMs in children and adolescents has changed expected clinical outcomes in the field of pediatric obesity management. Clinically significant improvement in obesity status occurs when AOMs are used early and aggressively. Ongoing, chronic care is the model for optimizing outcomes using a shared decision-making between provider and patient/family. Depending on the experience and comfort level of the primary care practitioner, referral to an obesity medicine specialist may be appropriate, particularly when obesity related co-morbidities are present and pharmacotherapy and metabolic and bariatric surgery are considerations.

Advances in Research on Nutrition and Childhood Obesity

Obesity is a complex, multifactorial problem affecting children and adolescents around the world [...].