The association between childhood depression and adulthood body mass index

Does Depression Cause Obesity?

To evaluate the causal effects of depression on obesity, longitudinal tests of the effect of depression on follow-up obesity status were meta-analyzed. Combining data from 16 studies the results confirmed that, after controlling for potential confounding variables, depressed compared to nondepressed people were at significantly higher risk for developing obesity. The risk among depressed people for later obesity was particularly high for adolescent females (odds ratio: 2.57, 95% CI: 2.27, 2.91). These findings highlight the importance of depression screening and treatment programs, especially among adolescents, to assist in the prevention of adult obesity.

Medical and substance-related comorbidity in bipolar disorder: translational research and treatment opportunities

It is well established that individuals with bipolar disorder are differentially affected by substance-related as well as medical disorders (ie, cardiometabolic disorders, respiratory disorders, neurological disorders, and infectious diseases). Emerging evidence indicates that some comorbid conditions (eg, diabetes mellitus) in bipolar individuals may be subserved by overlapping neurobiological networks. Disturbances in glucocorticoid/insulin signaling and immunoinflammatory effector systems are points of pathophysiological commonality between bipolar disorder and “stress-sensitive” medical disorders. Subphenotyping bipolar disorder as a function of comorbidity and temporality of onset may provide an opportunity for refining disease pathophysiological models and developing innovative disease-modifying therapies.

Co-occurring mental illness and health care utilization and expenditures in adults with obesity and chronic physical illness

The objectives of the study were to compare health care expenditures between adults with and without mental illness among individuals with obesity and chronic physical illness. We performed a cross-sectional analysis of 2440 adults (older than age 21) with obesity using a nationally representative survey of households, the Medical Expenditure Panel Survey. Chronic physical illness consisted of self-reported asthma, diabetes, heart disease, hypertension, or osteoarthritis. Mental illness included affective disorders; anxiety, somatoform, dissociative, personality disorders; and schizophrenia. Utilization and expenditures by type of service (total, inpatient, outpatient, emergency room, pharmacy, and other) were the dependent variables. Chi-square tests, logistic regression on likelihood of use, and ordinary least squares regression on logged expenditures among users were performed. All regressions controlled for gender, race/ethnicity, age, martial status, region, education, employment, poverty status, health insurance, smoking, and exercise. All analyses accounted for the complex design of the survey. We found that 25% of adults with obesity and physical illness had a mental illness. The average total expenditures for obese adults with physical illness and mental illness were $9897; average expenditures were $6584 for those with physical illness only. Mean pharmacy expenditures for obese adults with physical illness and mental illness and for those with physical illness only were $3343 and $1756, respectively. After controlling for all independent variables, among adults with obesity and physical illness, those with mental illness were more likely to use emergency services and had higher total, outpatient, and pharmaceutical expenditures than those without mental illness. Among individuals with obesity and chronic physical illness, expenditures increased when mental illness is added. Our study findings suggest cost-savings efforts should examine the reasons for high utilization and expenditures for those with obesity, chronic physical illness, and mental illness.

Overweight status and psychological well-being in adolescent boys and girls: a multilevel analysis

Background: Psychological distress and high body mass index (BMI) are linked in adults, especially in females. Effects of social position and behaviour, and whether obesogenic environments affect adolescents and adults equally are unresolved. The aim was to examine associations between psychological distress and being overweight in adolescents, by sex, accounting for social, lifestyle and contextual factors. Correlation of area-level variation in overweight status in adolescents and adults was investigated. Methods: Height, weight, General Health Questionnaire 12 (GHQ12) of psychological distress, physical activity, smoking, alcohol consumption, area deprivation and social class were available on 635 male and 618 female adolescents (13–15 years) from two cross-sectional population health surveys conducted in Scotland in 1998–99/2003–04. Multilevel logistic regression modelled overweight (including obese) status accounting for intraclass correlation of adolescents in households within postcode sector areas in health board regions. Univariable analysis examined effects of high (4 or more) GHQ12 score; multivariable analysis further allowed for covariates. Adult data were used to assess the importance of correlation between adolescent and adult area-level variation. Results: Univariably, there was significantly increased risk of being overweight associated with high GHQ12 score for girls but not boys; adolescent and adult area-level variation correlation did not impact. Results remained significant for girls in multivariable analyses (OR = 2.44, 95% confidence interval (CI): 1.33–4.50) and non-significant for boys (OR = 1.31, 95% CI: 0.56–3.05). Conclusions: Findings indicate being overweight is associated with psychological distress in adolescent girls, but not boys. Effects are not mediated by social, lifestyle or contextual factors.

Association of postpartum depression with weight retention 1 year after childbirth

OBJECTIVE

To examine the extent to which early postpartum depression is associated with weight retention 1 year after childbirth.

METHODS AND PROCEDURES

In a prospective cohort study of 850 women enrolled in Project Viva, mothers reported depressive symptoms on the Edinburgh Postnatal Depression Scale (EPDS) at midpregnancy and 6 months postpartum. A score >12 indicated probable depression. We assessed associations of antenatal and postpartum depression with risk of substantial weight retention (at least 5 kg) 1 year after childbirth.

RESULTS

Seven-hundred thirty-six women (87%) were not depressed during or after pregnancy, 55 (6%) experienced antenatal depression only, 22 (3%) experienced both antenatal and postpartum depression, and 37 (4%) experienced postpartum depression only. At 1 year, participants retained a mean of 0.6 kg (range -16.4 to 25.5), and 12% retained at least 5 kg. In multivariate logistic regression analyses, after adjustment for weight-related covariates, maternal sociodemographics, and parity, new-onset postpartum depression was associated with more than a doubling of risk of retaining at least 5 kg (odds ratio (OR): 2.54, 95% confidence interval (CI): 1.06, 6.09). Antenatal depression, either alone or in combination with postpartum depression, was not associated with substantial weight retention.

DISCUSSION

New-onset postpartum depression was associated with substantial weight retention in the first postpartum year. Interventions to manage depressive symptoms may help reduce excess weight retained postpartum and aid in the prevention of obesity among women.

Correlates of childhood obesity in Athens, Greece

OBJECTIVE

Childhood obesity is a growing public health problem. We have examined the association between sociodemographic profile and eating and physical activity patterns with overweight among primary-school students in Athens, Greece.

DESIGN

Cross-sectional study.

SETTING

Eleven primary schools in the greater Athens area, Greece.

SUBJECTS

A total of 633 children aged 10-12 years (50 % boys, 50 % girls) were interviewed in person during spring 2003. Multivariate logistic regression was used to investigate the association between eating and physical activity patterns and overweight (> or =85th sex- and age-specific BMI centile). Results are presented as odds ratios and 95 % confidence intervals.

RESULTS

Overweight was more common among girls than among boys (OR=1.73; 95% CI 1.11, 2.69) and substantially less common among children born outside Greece (OR=0.46; CI 0.22, 0.95). Reported physical activity (per 1.5 h per day) was unrelated to overweight (OR=0.97; CI 0.85, 1.12) but patent physical inactivity, operationalised as time spent watching television or working/playing with the computer (per 1.5 h per day) was a highly significant predictor of overweight (OR=1.20; CI 1.05, 1.36). Composition of diet was unrelated to overweight but the daily number of eating occasions, controlling for total energy intake, was significantly inversely associated with overweight (OR=0.61; CI 0.48, 0.76).

CONCLUSIONS

The principal factor underlying overweight among children in Athens appears to be the extended inactivity imposed by modern childhood lifestyles. An intriguing finding is that spreading a given energy intake over several eating occasions was inversely associated with the likelihood of childhood obesity.

Inflammation as an intermediate pathway in the association between psychosocial stress and obesity

Psychosocial stress is associated with risk of obesity although little is known about stress-induced biological mechanisms of obesity. We examined the potential mediating role of inflammatory processes. Data were collected from a nationally representative sample of 7540 individuals (54% women, mean age 46.8+/-15.4 years), from the Scottish Health Surveys. We calculated risk estimates of obesity for increasing numbers of psychosocial stressors (based on social position, education, psychological distress and marital/partner discord) using logistic regression analyses. Obesity was assessed using body mass index and central obesity using waist circumference. Potential mediators included inflammatory markers (C-reactive protein and fibrinogen) and health behaviours (physical activity, smoking, alcohol, and dietary intake). The unadjusted odds ratio of obesity for three or more psychosocial stressors was 1.81 (95% CI, 1.39-2.36, p<0.001). In multivariate analyses that adjusted for age, gender, health behaviours and inflammatory markers the association between psychosocial stress and obesity was attenuated but remained significant (1.49, 1.11-2.00, p<0.001). Inflammatory markers independently accounted for approximately 25% of the association between stress and obesity. We found similar associations in separate analyses of psychosocial stress and central obesity, although results were confounded by overall obesity. In summary, inflammatory processes appear to be an important intermediate pathway in the association between psychosocial stress and obesity.

The association of depression and anxiety with obesity and unhealthy behaviors among community-dwelling US adults

OBJECTIVE

The aim of this study was to examine the extent to which depression and anxiety are associated with smoking, obesity, physical inactivity and alcohol consumption in the US population using the Patient Health Questionnaire 8 (PHQ-8) and two questions on lifetime diagnosis of anxiety and depression.

METHODS

Data were analyzed in 38 states, the District of Columbia and two territories using the 2006 Behavioral Risk Factor Surveillance System (n=217,379), a large state-based telephone survey.

RESULTS

Overall, adults with current depression or a lifetime diagnosis of depression or anxiety were significantly more likely than those without each diagnosis to smoke, to be obese, to be physically inactive, to binge drink and drink heavily. There was a dose-response relationship between depression severity and the prevalence of smoking, obesity and physical inactivity and between history of depression (never depressed, previously depressed, currently depressed) and the prevalence of smoking, obesity, physical inactivity, binge drinking and heavy drinking. Lifetime diagnosis of depression and anxiety had an additive association with smoking prevalence.

CONCLUSION

The associations between depression, anxiety, obesity and unhealthy behaviors among US adults suggest the need for a multidimensional and integrative approach to health care.

Feeling fat rather than being fat may be associated with psychological well-being in young dutch adolescents

PURPOSE

To contribute to a further exploration of the association of psychosocial well-being with overweight and weight perception among young Dutch adolescents.

METHODS

Data from the ongoing Rotterdam Youth Health Monitor were used from 1,923 9-10-year-olds and 3,841 12-13-year-olds. The association of mental health indicators with weight status based on self-report and measured height and weight was studied with logistic regression analyses in both age groups cross-sectionally. Additional longitudinal analyses were conducted among the 787 pupils for whom follow-up data were available. Interactions with gender and ethnic background were explored. Among the 12-13-year-olds, the role of weight perception was also studied.

RESULTS

We found that 9-10-year-old obese boys scored more favourably on social anxiety than nonoverweight boys. Among 12-13-year-olds body weight perception, rather than self-reported or measured weight status was associated with mental health indicators. Mental health indicators at age 9-10 years did not predict self-reported weight status at age 12-13 or change in weight status between 9-10 and 12-13 years, nor did weight status at age 9-10 years predict later mental health indicators or change in these indicators.

CONCLUSIONS

This study provides no evidence that overweight does coincide with less favorable psychological well-being in young adolescents. In 12-13-year-old adolescents, feeling overweight, rather than being overweight, appears to be important.

Clustering of psychosocial symptoms in overweight children

OBJECTIVE

The aims of the present study were to (i) examine the relationship between children's degree of adiposity and psychosocial functioning; and (ii) compare patterns of clustering of psychosocial measures between healthy weight and overweight/obese children.

METHOD

Cross-sectional data from a population-based cohort of 158 healthy weight, 77 overweight, and 27 obese children aged 8-13 years were analysed. Height, weight depression, quality of life, self-esteem, body dissatisfaction, eating disorder symptoms, peer relationships and behavioural and emotional problems were measured.

RESULTS

Multi-level analysis showed significant linear associations between child body mass index z-scores and the psychosocial variables, with increasing adiposity associated with increasing levels of psychosocial distress. Principal components analyses indicated subtle differences between the healthy weight and overweight/obese groups with regards to the clustering of psychosocial measures. In particular, in overweight/obese, but not in healthy weight children, global self-worth clustered with body image and eating disorder symptoms.

CONCLUSIONS

The psychosocial burden of excess weight is significant and broad reaching, with overweight/obese children showing multiple significant psychosocial problems.

Physical Activity: The Epidemic of Obesity and Overweight Among Youth: Trends, Consequences, and Interventions

Childhood and adolescent overweight and obesity are an epidemic problem in the United States. Studies show that approximately one third of youth are overweight or obese, representing a tripling since the 1960s and 1970s. The average male and female adult in the United States has gained 25 lbs and 24 lbs, respectively, since 1962. The body mass index of the average adult has increased from 25 to 28. Among youth, the average body mass index has increased from 21.3 to 24.1 since 1963. This increase in bodyweight among adults and youth is partially due to the decreased levels of physical activity. The economic and health consequences of this epidemic are enormous. Type 2 diabetes mellitus, a disease that was rare among youth 20 to 30 years ago, now represents as many as 45% of all cases of diabetes among youth. Cardiovascular risk factors are worsened in overweight and obese youth, and early evidence of atherosclerosis manifested by endothelial dysfunction and increased coronary artery calcium is present in a high percentage of overweight youth. Numerous psychosocial problems also are increased among overweight and obese youth. However, there are numerous examples in the scientific literature of successful approaches to the prevention and management of overweight and obesity in youth. This article summarizes statistics concerning the prevalence of overweight, obesity, and physical inactivity among youth; discusses the numerous physical and psychosocial consequences of overweight and obesity among youth; and presents information regarding interventions that have been demonstrated to be effective in preventing childhood and adolescent overweight and obesity.

Experimental investigation of the effects of naturalistic dieting on bulimic symptoms: Moderating effects of depressive symptoms

Prospective studies suggest that dieting increases risk for bulimic symptoms, but experimental trials indicate dieting reduces bulimic symptoms. However, these experiments may be unrepresentative of real-world weight loss dieting. In addition, the fact that most dieters do not develop eating disorders suggests moderating factors may be important. Accordingly, we randomly assigned 157 female intermittent dieters to either diet as they usually do for weight loss or eat as they normally do when not dieting for 4 weeks. Naturalistic dieting halted the weight gain shown by controls, but did not result in significant weight loss. Although there was no main effect of the dieting manipulation on bulimic symptoms, moderation analyses indicated that naturalistic dieting decreased bulimic symptoms among participants with initially low depressive symptoms. Results suggest that self-initiated weight loss dieting is not particularly effective, which appears to explain several discrepancies in the literature. Additionally, depressive symptoms may be an important determinant of bulimic symptoms that eclipses the effects of naturalistic dieting on this outcome.

Measurement matters in the association between early adolescent depressive symptoms and body mass index

OBJECTIVE

The objectives of this study were to examine associations between depressive symptoms and body mass over 1 year during early adolescence and to assess how the associations might differ depending upon whether self-reported or directly measured height and weight were used.

METHOD

Participants were 446 sixth-grade Seattle students. Depressive symptoms were assessed using the Mood and Feelings Questionnaire. Regression models were used to examine whether baseline depression status was associated with 12-month body mass index (BMI; using self-reported height and weight) and whether baseline overweight status was associated with 12-month depressive symptom score. Analyses were rerun among a subsample (n=165) who had height and weight directly measured.

RESULTS

Using BMI derived from self-reported values, depressed males had a significantly lower BMI than nondepressed males, while depressed females had a significantly higher BMI than nondepressed females, after adjusting for covariates. Among a subsample using measured height and weight values, however, depression was no longer associated with BMI in either gender. Baseline overweight status did not predict 12-month depression score.

CONCLUSIONS

Observed associations between depression and subsequent BMI were explained by differential misclassification of self-reported height and weight by depression status and gender. Direct measurement of height and weight may be necessary to ensure validity in studies of adolescent depression and weight-related outcomes.

Obesity and mental disorders in the adult general population

OBJECTIVE

The aim of this study was to investigate (i) the associations between mental disorders (in particular the anxiety disorders) and obesity in the general population and (ii) potential moderators of those associations (ethnicity, age, sex, and education).

METHODS

A nationally representative face-to-face household survey was conducted in New Zealand with 12,992 participants 16 years and older, achieving a response rate of 73.3%. Ethnic subgroups (Maori and Pacific peoples) were oversampled. Mental disorders were measured with the Composite International Diagnostic Interview (CIDI 3.0). Height and weight were self-reported. Obesity was defined as a body mass index (BMI) of 30 kg/m(2) or greater.

RESULTS

Obesity was significantly associated with any mood disorder (OR 1.23), major depressive disorder (OR 1.27), any anxiety disorder (OR 1.46), and most strongly with some individual anxiety disorders such as post-traumatic stress disorder (PTSD) (OR 2.64). Sociodemographic correlates moderated the association between obesity and mood disorders but were less influential in obesity-anxiety disorder associations. Adjustment for the comorbidity between anxiety and mood disorders made little difference to the relationship between obesity and anxiety disorders (OR 1.36) but rendered the association between obesity and mood disorders insignificant (OR 1.05).

CONCLUSION

Stronger associations were observed between anxiety disorders and obesity than between mood disorders and obesity; the association between PTSD and obesity is a novel finding. These findings are interpreted in light of research on the role of anxiety in eating pathology, and deserve the further attention of researchers and clinicians.

The association between maltreatment and obesity among preschool children

OBJECTIVE

To determine whether child maltreatment is associated with obesity in preschool children.

METHODS

Data were obtained from the Fragile Families and Child Wellbeing Study, a birth cohort study of 4898 children born between 1998 and 2000 in 20 large US cities. At 3 years of age, 2412 of these children had their height and weight measured, and mothers answered items on the Parent-Child Conflict Tactics Scales about three types of child maltreatment--neglect, corporal punishment, and psychological aggression. The frequency of each type of maltreatment behavior in the prior year was analyzed using categories--ever/never for neglect and quintiles for the other two types of maltreatment. Child obesity was defined as measured body mass index (kg/m(2)) > or =95th percentile.

RESULTS

Eighteen percent of the children were obese, and the prevalence of any episode of neglect, corporal punishment, and psychological aggression was 11%, 84%, and 93%, respectively. The odds of obesity were increased in children who had experienced neglect (odds ratio 1.56, 95% confidence interval, 1.14-2.14), after controlling for the income and number of children in the household, the mothers' race/ethnicity, education, marital status, body mass index, prenatal smoking, and age, and the children's sex and birth weight. Neither the frequency of corporal punishment nor psychological aggression was associated with an increased risk of obesity.

CONCLUSIONS

In a sample of preschool children from 20 large US cities, maternal self-report of neglectful behavior was associated with an increased risk of childhood obesity, after controlling for birth weight, maternal obesity, and multiple socioeconomic factors.

Adolescent obesity and risk for subsequent major depressive disorder and anxiety disorder: prospective evidence

OBJECTIVE

To assess whether adolescent obesity is associated with risk for development of major depressive disorder (MDD) or anxiety disorder. Obesity has been linked to psychosocial difficulties among youth.

METHODS

Analysis of a prospective community-based cohort originally from upstate New York, assessed four times over 20 years. Participants (n = 776) were 9 to 18 years old in 1983; subsequent assessments took place in 1985 to 1986 (n = 775), 1991 to 1994 (n = 776), and 2001 to 2003 (n = 661). Using Cox proportional hazards analysis, we evaluated the association of adolescent (age range, 12-17.99 years) weight status with risk for subsequent MDD or anxiety disorder (assessed at each wave by structured diagnostic interviews) in males and females. A total of 701 participants were not missing data on adolescent weight status and had > or = 1 subsequent assessments. MDD and anxiety disorder analyses included 674 and 559 participants (free of current or previous MDD or anxiety disorder), respectively. Adolescent obesity was defined as body mass index above the age- and gender-specific 95th percentile of the Centers for Disease Control and Prevention growth reference.

RESULTS

Adolescent obesity in females predicted an increased risk for subsequent MDD (adjusted hazard ratio (HR) = 3.9; 95% confidence interval (CI) = 1.3, 11.8) and for anxiety disorder (HR = 3.8; CI = 1.3, 11.3). Adolescent obesity in males was not statistically significantly associated with risk for MDD (HR = 1.5; CI = 0.5, 3.5) or anxiety disorder (HR = 0.7; CI = 0.2, 2.9).

CONCLUSION

Females obese as adolescents may be at increased risk for development of depression or anxiety disorders.

Depression and anxiety: effect on the migraine-obesity relationship

OBJECTIVE

To discern the effects of depression and anxiety on the migraine-obesity relationship.

BACKGROUND

Migraine and obesity are highly prevalent conditions and are both independently linked to psychiatric conditions, mainly depression and anxiety.

METHODS

Data are from an ongoing cross-sectional multicenter study on comorbid conditions in clinic patients seeking treatment for headache. The diagnosis of migraine was determined by the examining physician based on the International Classification of Headache Disorders (ICHD)-II criteria. Participants completed a self-administered questionnaire with information on demographics, headache features, and physician-diagnosed comorbid medical and psychiatric disorders. The questionnaire included scales for measuring current depression (PHQ-9), anxiety (BAI), and headache-related disability (HIT-6).

RESULTS

A total of 721 migraineurs (88% women) from 8 different headache treatment centers were included in this study (mean age = 42 years, SD = 12). Aura was reported in 45% and chronic headache (>or=15 headache days/month) in 35% of the participants. Prevalence of obesity in our population was 30% and only 38% had normal weight. Obesity was more common in men (P= .004), African Americans (P= .026), and in lower education (P= .05) and household income (P=.05) groups. Current depression (PHQ-9 score >or=10) was noted in 42% and current anxiety (BAI score >or=8) in 70% of the obese migraineurs. In ordinal logistic regression, obesity was associated with current depression (odds ratio [OR]= 1.86, 95% confidence interval [CI]: 1.25 to 2.78) and anxiety (OR = 1.58, 95% CI: 1.12 to 2.22). A significant effect of depression on the body mass index (BMI) and headache frequency relationship was noted. Obese migraineurs with depression were more likely to have higher headache frequency (OR = 4.16, 95% CI: 1.92 to 8.99) and headache-related disability (OR = 7.10, 95% CI: 2.69 to 18.77) compared to normal weight migraineurs without depression. Similarly, obese migraineurs with anxiety were more likely to have higher headache frequency (OR = 1.96, 95% CI: 1.07 to 3.61) and headache-related disability (OR = 3.59, 95% CI: 1.64 to 7.86) compared to normal weight migraineurs without depression. Compared to migraineurs with either current depression or anxiety, those with both these conditions were more likely to have higher headache frequency (OR = 3.18, 95% CI: 1.86 to 5.43) and headache disability (OR = 6.13, 95% CI: 2.58 to 14.59).

CONCLUSION

Depression and anxiety were common in obese migraineurs. The relationship of obesity with migraine frequency and migraine-related disability is modified by depression and by anxiety, with the strongest effect observed in migraineurs with both depression and anxiety.

Responses to weight loss treatment among obese individuals with and without BED: a matched-study meta-analysis

The moderating influence of binge eating status on obese individuals' responses to weight loss treatment was evaluated with a meta-analysis of 36 tests of weight loss treatment (n=792) that were matched to control key background variables. After controlling for pre-treatment weight, treatment produced more weight loss in samples of obese non-BED compared with obese BED participants. Weight loss treatment produced large posttreatment reductions in depression in both obese BED and non-BED samples. The results indicate that BED status moderated post-treatment weight loss among people in weight treatment programs. Obese BED (average weight loss=1.3 kg) samples lost negligible weight compared to obese non-BED (average weight loss=10.5 kg) samples. BED status did not moderate psychological responses to treatment: both BED and non-BED samples experienced large post-treatment reductions in depression. The clinical implications of these findings are discussed.

Preventing excessive weight gain in adolescents: interpersonal psychotherapy for binge eating

The most prevalent disordered eating pattern described in overweight youth is loss of control (LOC) eating, during which individuals experience an inability to control the type or amount of food they consume. LOC eating is associated cross-sectionally with greater adiposity in children and adolescents and seems to predispose youth to gain weight or body fat above that expected during normal growth, thus likely contributing to obesity in susceptible individuals. No prior studies have examined whether LOC eating can be decreased by interventions in children or adolescents without full-syndrome eating disorders or whether programs reducing LOC eating prevent inappropriate weight gain attributable to LOC eating. Interpersonal psychotherapy, a form of therapy that was designed to treat depression and has been adapted for the treatment of eating disorders, has shown efficacy in reducing binge eating episodes and inducing weight stabilization among adults diagnosed with binge eating disorder. In this paper, we propose a theoretical model of excessive weight gain in adolescents at high risk for adult obesity who engage in LOC eating and associated overeating patterns. A rationale is provided for interpersonal psychotherapy as an intervention to slow the trajectory of weight gain in at-risk youth, with the aim of preventing or ameliorating obesity in adulthood.

Relation between body mass index and depression: a structural equation modeling approach

BACKGROUND

Obesity and depression are two major diseases which are associated with many other health problems such as hypertension, dyslipidemia, diabetes mellitus, coronary heart disease, stroke, myocardial infarction, heart failure in patients with systolic hypertension, low bone mineral density and increased mortality. Both diseases share common health complications but there are inconsistent findings concerning the relationship between obesity and depression. In this work we used the structural equation modeling (SEM) technique to examine the relation between body mass index (BMI), as a proxy for obesity, and depression using the Canadian Community Health Survey, Cycle 1.2.

METHODS

In this SEM model we postulate that 1) BMI and depression are directly related, 2) BMI is directly affected by the physical activity and, 3)depression is directly influenced by stress. SEM was also used to assess the relation between BMI and depression separately for males and females.

RESULTS

The results indicate that higher BMI is associated with more severe form of depression. On the other hand, the more severe form of depression may result in less weight gain. However, the association between depression and BMI is gender dependent. In males, the higher BMI may result in a more severe form of depression while in females the relation may not be the same. Also, there was a negative relationship between physical activity and BMI.

CONCLUSION

In general, use of SEM method showed that the two major diseases, obesity and depression, are associated but the form of the relation is different among males and females. More research is necessary to further understand the complexity of the relationship between obesity and depression. It also demonstrated that SEM is a feasible technique for modeling the relation between obesity and depression.

Acne vulgaris: nutritional factors may be influencing psychological sequelae

Acne vulgaris is a distressing skin condition which can carry with it significant psychological disability. Patients with acne are more likely to experience anger and are at increased risk of depression, anxiety, suicidal ideation. Certain nutrients which have been implicated as influencing the pathophysiology of acne have also been identified as important mediators of human cognition, behavior and emotions. Zinc, folic acid, selenium, chromium and omega-3 fatty acids are all examples of nutrients which have been shown to influence depression, anger and/or anxiety. These same nutrients, along with systemic oxidative stress and an altered intestinal microflora have been implicated in acne vulgaris. It is our contention that certain nutritional factors, a weakened antioxidant defense system and altered intestinal microflora may interplay to increase the risk of psychological sequelae in acne vulgaris.

Relation of depression to coronary endothelial function

The purpose of this study was to determine the association between depression and coronary endothelial function and cardiac risk factors in men and women without obstructive coronary artery disease. Patients with no significant coronary artery disease who underwent invasive coronary endothelial function assessment with acetylcholine were studied. Men and women were divided into 2 groups: those with depression and those without. Endothelial function and risk factor profiles were compared between the 2 groups. Seven hundred fifty-nine patients were studied, 603 (79%) without depression and 156 (21%) with depression. Patients with depression were more likely to be women (71% vs 60%, p = 0.02), have greater body mass indexes (29.9 +/- 6.7 vs 28.2 +/- 5.9 kg/m(2), p = 0.002), and be diabetic (12% vs 6%, p = 0.02). Depressed patients also had higher levels of C-reactive protein (0.35 vs 0.30 mg/dl, p = 0.02). There was no difference in the change in coronary blood flow or diameter in response to acetylcholine between the 2 groups in men and women. In conclusion, the results of this study demonstrate that depression is not associated with coronary endothelial dysfunction in men and women without significant coronary artery disease. It is, however, associated with a cluster of cardiac risk factors that are linked to the progression of atherosclerotic disease.

The public health aspects of bipolar disorder in children and adolescents

Bipolar disorder in children and adolescents is a major public health problem associated with significant functional impairment. Similar to adults with bipolar disorder, children and adolescents are at increased risk for substance-related disorders, weight problems, and impaired social support systems. Substance-related problems complicate treatment course. They often follow the onset of bipolar disorder; thus, the opportunity for prevention and/or early intervention exists. Evidence supports an association between mood disorders and weight gain. Psychotropic agents to treat bipolar disorder, particularly some second-generation antipsychotics, may be associated with weight gain. Obesity is associated with worse outcomes in bipolar disorder, so prevention of weight gain is clinically important. Environmental factors may contribute to relapse, so interventions to optimize social support systems are being evaluated. Pediatric bipolar disorder requires comprehensive management to achieve optimal outcome. Further research to study modifiable factors that contribute to its morbidity and chronicity is needed.

Epidemiology of depression and its treatment in the general population

This study examines the correlates of a major depressive disorder and its treatment in the general population. The sample was composed of 6694 individuals aged between 18 and 96 years, representative of the general population of the states of California and New York (48 million inhabitants aged 18 years or older). They were interviewed by telephone using the Sleep-EVAL system. The interviews included various sleep and health topics and the assessment of DSM-IV sleep and psychiatric disorders. The 1-month prevalence of a major depressive disorder was 5.2% in the sample, and was higher in women, middle-aged and non-Hispanic white individuals. Obesity (BMI > or =30kg/m(2)), poor health status and smoking were also strongly correlated with a major depressive disorder. A total of 57.7% of depressed subjects were receiving some forms of treatment for depression: 28.3% were taking antidepressants (alone or in combination with psychiatric health care) and 29.4% received psychiatric health care (without antidepressant medication). Severity of depression, ethnicity and weight (overweight or obese) were strongly associated with the presence of treatment. A major depressive disorder is frequent in the general population. Although its identification and treatment have improved over the years, some segments of the population, namely elderly and non-white individuals are less likely to receive appropriate care.

Olfactory bulbectomy increases food intake and hypothalamic neuropeptide Y in obesity-prone but not obesity-resistant rats

Obese individuals often suffer from depression. The olfactory bulbectomy (OBX) model is an animal model of depression that produces behavioral, physiological, and neurochemical alterations resembling clinical depression. The OBX model was employed to assess depression-related changes in food intake in obesity-prone, Osborne-Mendel (OM) rats and obesity-resistant, S5B/Pl rats. OBX increased food intake in OM rats beginning 7 days following surgery, however, OBX did not alter food intake in S5B/Pl rats at any time point. Fourteen days following surgery, OBX significantly increased locomotor activity (total lines crossed and rears) in the openfield test in OM and S5B/Pl rats. Fifteen days following surgery, prepro-neuropeptide Y (NPY) mRNA levels were significantly increased in the hypothalamus of bulbectomized OM rats and in the medial nucleus of the amygdala of bulbectomized OM and S5B/Pl rats. OBX decreased NPY Y2 receptor mRNA levels in the hypothalamus and medial nucleus of the amygdala in OM rats, while increasing NPY Y2 receptor mRNA levels in the medial nucleus of the amygdala of S5B/Pl rats. These data indicate that though both obesity-prone and obesity-resistant strains were susceptible to the locomotor effects of OBX, food intake and hypothalamic prepro-NPY mRNA were only increased in OM rats. Therefore, strain specific alterations in hypothalamic NPY may account for increased food intake in the obesity-prone rats following OBX, and suggests a potential mechanism to explain the comorbidity of obesity and depression.

Obesidad Infantil. Recomendaciones del Comité de Nutrición de la Asociación Española de Pediatría. Parte II. Diagnóstico. Comorbilidades. Tratamiento

The present article reviews the diagnostic criteria for pediatric obesity and its comorbidities. Treatment is also reviewed, including promotion of physical activity, and dietetic, pharmacologic and surgical treatment.

Children at risk: the association between perceived weight status and suicidal thoughts and attempts in middle school youth

BACKGROUND

Suicide is one of the most common causes of death among young people. A report from the US Surgeon General called for strategies to prevent suicide, including increasing public awareness of suicide and risks factors, and enhancing research to understand risk and protective factors. Weight perception has been linked to depression and poor self-esteem in adolescents. The purpose of this study was to examine the relationship between perceived weight status and suicidal thoughts and actions by gender in middle school youth.

METHODS

All public middle school students in 4 eastern North Carolina counties presented, and with parental permission (n = 5174), completed the Youth Risk Behavior Survey: Middle School Questionnaire. The 3 dependent variables were self-reported thinking, planning, and attempting suicide. Bivariate analyses describe suicidal thoughts and actions; multiple logistic regression models examined the relationship between weight description and suicidal thoughts and actions controlling for age, race, household composition, grades on report cards, and parents' education.

RESULTS

Significantly more females than males reported thinking (26% vs 19%), planning (12% vs 9%), and attempting (11% vs 8%) suicide. For females, those who perceived themselves as overweight were significantly more likely to report suicidal thoughts and actions; while for males, perceptions of overweight and underweight were significantly associated with suicidal thoughts and actions.

CONCLUSIONS

Controlling for personal and family characteristics, perceived weight status was significantly associated with suicidal thoughts and actions in middle school boys and girls.

Short allele of serotonin transporter gene promoter is a risk factor for obesity in adolescents

Obesity and hypertension are increasing medical problems in adolescents. Serotonin transporter (5-HTT) is involved in mood and eating disturbances. Encoded by the gene SLC6A4, the promoter shows functional insertion/deletion alleles: long (L) and short (S). Because individuals who are carriers for the short version are known to be at risk for higher levels of anxiety, we hypothesized that this variant may be associated with overweight. Data and blood samples were collected from 172 adolescents out of a cross-sectional, population-based study of 934 high school students. To replicate the findings, we also included 119 outpatients from the Nutrition and Diabetes Section of the Children's County Hospital. We found that the S allele was associated with overweight (BMI > 85th percentile), being a risk factor for overweight independently of sex, age, and hypertension [odds ratio (OR): 1.85; 95% confidence interval (CI): 1.13, 3.05; p < 0.02]. Additionally, in the outpatient study, compared with the homozygous LL subjects, S allele carriers showed a higher BMI z-score (1.47 +/- 1.09 vs. 0.51 +/- 1.4; p < 0.002) and were more frequent in overweight children. In conclusion, the S allele of the SLC6A4 promoter variant is associated with overweight being an independent genetic risk factor for obesity.

Psychosocial and physical impairment in overweight adolescents at high risk for eating disorders

OBJECTIVE

Many overweight adolescents display elevated risk for the development of eating disorders, as seen in higher rates of weight/shape concerns and disordered eating behaviors, but the extent of impairment in this subset of high-risk adolescents has not been explored.

RESEARCH METHODS AND PROCEDURES

Eighty-one overweight adolescents (63% girls) presenting for an Internet-based weight loss program were assessed at baseline using the Eating Disorder Examination Questionnaire, the Depression, Anxiety, and Stress Scale, and the Pediatric Quality of Life questionnaire. Adolescents who earned elevated scores on both the Weight Concern and Shape Concern subscales of the Eating Disorder Examination Questionnaire were considered at high risk for the development of eating disorders (56.8%).

RESULTS

Comparisons of high- and normal-risk groups revealed that high-risk adolescents reported higher levels of depression [F(3,76) = 5.75, p = 0.019], anxiety [F(3,76) = 5.67, p = 0.020], and stress [F(3,75) = 8.50, p = 0.005], and greater impairments in physical health [F(3,77) = 10.7, p = 0.002], emotional functioning [F(3,77) = 5.3, p = 0.024], and social functioning [F(3,77) = 10.0, p = 0.002]. There were no differences in school functioning [F(3,77) = 1.5, p = 0.219]. Among the high-risk adolescents, over half (52.2%) reported binge eating at least once in the past month.

DISCUSSION

Results suggest that overweight adolescents at high risk for the development of eating disorders also experience elevated levels of negative affect, impairment in health-related quality of life, and eating disturbances, although prospective data are needed to determine the directionality between eating disorder pathology and general psychopathology. Further research is warranted to evaluate whether behavioral weight loss interventions should be enhanced for this high-risk subset.

Psychological status and weight-related distress in overweight or at-risk-for-overweight children

OBJECTIVE

To associate psychological status, weight-related distress, and weight status during childhood in overweight or at-risk-for-overweight children.

RESEARCH METHODS AND PROCEDURES

We associated self-report of depression, trait anxiety, and weight-related distress (body size dissatisfaction and weight-related peer teasing after controlling for the effects of weight) in 164 children (black 35%; age 11.9 +/- 2.5 years; girls 51%) who were overweight or at-high-risk-for-overweight and were not seeking weight loss.

RESULTS

Overall, heavier children reported more psychological and weight-related distress. Black children reported more anxiety and body size dissatisfaction than white children, despite equivalent weights. However, psychological distress was not significantly associated with weight in white children. Girls reported more weight-related distress than boys. Depression was associated with weight-related teasing in all predictive models, except in the model using only black subjects. Trait anxiety was associated with report of peer teasing when using all subjects. Depression was also significantly associated with children's report of body size dissatisfaction in models using all subjects, only girls, or white subjects, but not in analyses using only boys or black subjects. For boys peer teasing was associated with body size dissatisfaction. In models including only black children, depression and trait anxiety were not significantly associated with either report of peer teasing or body size dissatisfaction.

DISCUSSION

Regardless of race or sex, increasing weight is associated with emotional and weight-related distress in children. However, associations of psychological status, weight, and weight-related distress differ for girls and boys, and for black and white children.

Relationship of early life stress and psychological functioning to adult C-reactive protein in the coronary artery risk development in young adults study

BACKGROUND

Low socioeconomic status (SES) and a harsh family environment in childhood have been linked to mental and physical health disorders in adulthood. The objective of the present investigation was to evaluate a developmental model of pathways that may help explain these links and to relate them to C-reactive protein (CRP) in the Coronary Artery Risk Development in Young Adults (CARDIA) dataset.

METHODS

Participants (n = 3248) in the CARDIA study, age 32 to 47 years, completed measures of childhood SES (CSES), early family environment (risky families [RF]), adult psychosocial functioning (PsyF, a latent factor measured by depression, mastery, and positive and negative social contacts), body mass index (BMI), and C-reactive protein.

RESULTS

Structural equation modeling indicated that CSES and RF are associated with C-reactive protein via their association with PsyF (standardized path coefficients: CSES to RF, RF to PsyF, PsyF to CRP, CSES to CRP, all p < .05), with good overall model fit. The association between PsyF and CRP was partially mediated by BMI (PsyF to BMI, BMI to CRP, both p < .05).

CONCLUSIONS

Low childhood SES and a harsh early family environment appear to be related to elevated C-reactive protein in adulthood through pathways involving psychosocial dysfunction and high body mass index.

Treatment-resistant depression in adolescents: recognition and management

Approximately 20% of adolescents experience at least one depressive episode by the time they enter their adult years. For most adolescents, depression, although serious, either remits spontaneously or responds to treatment. For a smaller but significant proportion of adolescents, however, depression can be long-lasting and relatively unresponsive to initial treatment. In this article the authors provide an operational definition of treatment-resistant depression, identify factors associated with treatment nonresponse, describe an approach to the management of treatment-resistant depression, and advance suggestions for promising avenues of research.

Depressive disorders in childhood and adolescence: an overview: epidemiology, clinical manifestation and risk factors

The diagnostic category of depressive disorder in pediatric age is a relatively new concept that is rooted in empirical studies that date back to only the late 1980s. This article discusses the current consensus nosology and epidemiology of unipolar depressive disorders in young age and the risk factors for depression onset and recurrence. There is also a brief overview of psychosocial and pharmacologic evidence-based therapies and suggested areas for future research. This article also contains a brief description of the items discussed in detail in this issue.

Association of depression with Body Mass Index, sedentary behavior, and maladaptive eating attitudes and behaviors in 11 to 13-year old children

We examined the relation of different behavioral dimensions of depression with weight-related variables (BMI percentile, sedentary behavior, eating attitudes, and weight control behaviors) in children aged 11 to 13 years. Depression was assessed using the Children's Depression Inventory (CDI). Sedentary behavior was measured in 45 sixth grade students (23 boys and 22 girls) using a validated 24-hour recall instrument, the Self-Administered Physical Activity Checklist. BMI was calculated directly from measured height and weight (kg/m2). The Children's Eating Attitudes Test (ChEAT) was used to measure eating attitudes and weight control behaviors. There were not significant gender differences in reported minutes (142 vs. 91 minutes for boys vs. girls; p=0.25) of sedentary behavior (i.e., television watching and video game playing). The major finding of this study was that certain aspects of depression (i.e., interpersonal problems and feelings of ineffectiveness) were correlated with higher levels of sedentary behavior in children aged 11 to 13. A factor analysis of the study variables indicated that most dimensions of depression, sedentary behavior, and body size represent distinct but correlated behavioral dimensions. This study provides support for a link between specific aspects of depression (i.e., interpersonal problems and feelings of ineffectiveness) and sedentary behavior in children.

Associations between depressive symptoms and obesity during puberty

BACKGROUND

Adolescent depression has been shown to be associated with later development of obesity. The purpose of this study was to examine the association between depressive symptoms and obesity with progressive pubertal development.

METHODS

We conducted an analysis of the association between depressive symptoms and obesity using data from a cross-sectional study of 3101 youth aged 11-17 years. Logistic regression analyses were used to control for maternal education level, race and age. Analyses were stratified by pubertal status and sex to examine how the relationship between depressive symptoms and obesity varies with pubertal development.

RESULTS

Depressive symptoms increased with pubertal development for both boys and girls, but the increase was larger for girls. Obesity prevalence was similar for all categories of pubertal development in boys and girls. After controlling for age, pubertal development, parental education and race, an association was noted between depressive symptoms and obesity among both males and females. Youth above the 90th percentile in the depressive symptom score had two times the odds of being obese [males: odds ratio (OR)=1.95, 95% confidence interval (95% CI)=1.19-3.18; females: OR=2.17, 95% CI=1.25-3.77]. With the exception of males in late puberty (OR=0.91, 95% CI=0.29-2.87), the magnitude of this association between depressive symptoms and obesity was similar for all levels of pubertal development, with no apparent increase in later puberty among girls.

CONCLUSION

Depressive symptoms and obesity were associated during adolescence, and this association did not increase with advancing pubertal development.

Putative contributors to the secular increase in obesity: exploring the roads less traveled

OBJECTIVE

To investigate plausible contributors to the obesity epidemic beyond the two most commonly suggested factors, reduced physical activity and food marketing practices.

DESIGN

A narrative review of data and published materials that provide evidence of the role of additional putative factors in contributing to the increasing prevalence of obesity.

DATA

Information was drawn from ecological and epidemiological studies of humans, animal studies and studies addressing physiological mechanisms, when available.

RESULTS

For at least 10 putative additional explanations for the increased prevalence of obesity over the recent decades, we found supportive (although not conclusive) evidence that in many cases is as compelling as the evidence for more commonly discussed putative explanations.

CONCLUSION

Undue attention has been devoted to reduced physical activity and food marketing practices as postulated causes for increases in the prevalence of obesity, leading to neglect of other plausible mechanisms and well-intentioned, but potentially ill-founded proposals for reducing obesity rates.

Obesity and depression: results from the longitudinal Northern Finland 1966 Birth Cohort Study

OBJECTIVE

To examine the association between body size and depression in a longitudinal setting and to explore the connection between obesity and depression in young adults at the age of 31 years.

DESIGN

This study forms part of the longitudinal Northern Finland 1966 Birth Cohort Study (N = 12,058). The follow-up studies were performed at 14 and 31 years. Data were collected by postal inquiry at 14 years and by postal inquiry and clinical examination at 31 years.

SUBJECTS

A total of 8,451 subjects (4,029 men and 4,422 women) who gave a written informed consent and information on depression by three depression indicators at 31 years.

MEASUREMENTS

Body size at 14 (body mass index (BMI) and 31 (BMI and waist-to-hip ratio (WHR)) years and depression at 31 years by three different ways: depressive symptoms by the HSCL-25-depression questionnaire (HSCL-25), the use of antidepressants and self-reported physician-diagnosed depression.

RESULTS

Obesity at 14 years associated with depressive symptoms at 31 years; among male subjects using the cutoff point 2.01 in the HSCL-25 (adjusted odds ratio (OR) 1.97, 95% CI 1.06-3.68), among female subjects using the cutoff point 1.75 (adjusted OR 1.64, 95% CI 1.16-2.32). Female subjects who were obese both at baseline and follow-up had depressive symptoms relatively commonly (adjusted OR 1.40, 95% CI 1.06-1.85 at cutoff point 1.75); a similar association was not found among male subjects. The proportion of those who used antidepressants was 2.17-fold higher among female subjects who had gained weight compared to female subjects who had stayed normal-weighted (adjusted OR 2.17, 95% CI 1.28-3.68). In the cross-sectional analyses male subjects with abdominal obesity (WHR >or=85th percentile) had a 1.76-fold risk of depressive symptoms using the cutoff 2.01 in the HSCL-25 (adjusted OR 1.76, 95% CI 1.08-2.88). Abdominally obese male subjects had a 2.07-fold risk for physician-diagnosed depression (adjusted OR 2.07, 95% CI 1.23-3.47) and the proportion of those who used antidepressants was 2.63-fold higher among obese male subjects than among male subjects without abdominal obesity (adjusted OR 2.63, 95% CI 1.33-5.21). Abdominal obesity did not associate with depression in female subjects.

CONCLUSION

Obesity in adolescence may be associated with later depression in young adulthood, abdominal obesity among male subjects may be closely related to concomitant depression, and being overweight/obese both in adolescence and adulthood may be a risk for depression among female subjects.

A prospective study of psychological predictors of body fat gain among children at high risk for adult obesity

OBJECTIVE

Limited data suggest that psychological factors, including binge eating, dieting, and depressive symptoms, may predispose children to excessive weight gain. We investigated the relationship between baseline psychological measures and changes in body fat (measured with dual-energy x-ray absorptiometry) over time among children thought to be at high risk for adult obesity.

METHODS

A cohort study of a convenience sample of children (age: 6-12 years) recruited from Washington, DC, and its suburbs was performed. Subjects were selected to be at increased risk for adult obesity, either because they were overweight when first examined or because their parents were overweight. Children completed questionnaires at baseline that assessed dieting, binge eating, disordered eating attitudes, and depressive symptoms; they underwent measurements of body fat mass at baseline and annually for an average of 4.2 years (SD: 1.8 years).

RESULTS

Five hundred sixty-eight measurements were obtained between July 1996 and December 2004, for 146 children. Both binge eating and dieting predicted increases in body fat. Neither depressive symptoms nor disturbed eating attitudes served as significant predictors. Children who reported binge eating gained, on average, 15% more fat mass, compared with children who did not report binge eating.

CONCLUSIONS

Children's reports of binge eating and dieting were salient predictors of gains in fat mass during middle childhood among children at high risk for adult obesity. Interventions targeting disordered eating behaviors may be useful in preventing excessive fat gain in this high-risk group.

Asthma and body weight change: a 20-year prospective community study of young adults

OBJECTIVE

There is increasing evidence for an association between asthma and body weight change. The objectives of these analyses were to examine the temporal relationships of this association and to explore the role of childhood depression as an explanatory factor.

METHODS

Data were derived from six subsequent semistructured interviews on health habits and health conditions from a single-age community study of 591 young adults followed up between ages 20 and 40 years.

RESULTS

Cross-sectionally (over the whole study period), asthma was significantly associated with obesity (odds ratio=3.9 [95% confidence interval 1.2, 12.2]). Multivariate longitudinal analyses revealed that asthma was associated with increased later weight gain and later obesity among women after controlling for potentially confounding variables, whereas weight gain and obesity were not associated with later asthma. A secondary analysis showed that depressive symptoms during childhood were associated with adult obesity and asthma, partially explaining the asthma-obesity comorbidity.

CONCLUSION

This study encourages further research on mechanisms underlying the asthma-obesity comorbidity, particularly on shared psychosocial factors operating during critical periods in childhood and adolescence that may influence the development and persistence of both obesity and asthma during adulthood.

Major depression predicts an increase in long-term body weight variability in young adults

OBJECTIVE

To test the hypothesis that major depression predicts an increase in long-term body weight variability (BWV).

RESEARCH METHODS AND PROCEDURES

This was a prospective community-based single-age cohort study of young adults (N = 591) followed between the ages of 19 and 40. Following initial screening, information was derived from six subsequent semistructured diagnostic interviews conducted by mental health professionals. Major depression was diagnosed on the basis of DSM criteria. BWV was defined as the root mean square error of a regression line fitted to each individual's BMI values over time. Multiple regression analysis was used to test the association between major depression and BWV while controlling for potentially confounding variables including antidepressant treatment, eating disorder symptoms, and physical activity. We used random effects models to determine the temporal relationship between repeated measures of major depression and body weight change.

RESULTS

A highly significant positive association between major depression and BWV was found, whereas major depression was not associated with BMI level or BMI trend. Depression severity showed a dose-response-type relationship with the magnitude of BWV. After controlling for potentially confounding variables including antidepressant use, eating disorder symptoms, smoking, and physical activity, major depression remained a significant predictor of BWV (beta= 0.13, p < 0.001). Longitudinal analysis revealed a unidirectional association between major depression and a later increase in body weight change rate irrespective of antidepressant medication.

DISCUSSION

Results from this study implicate depression as an important risk factor for increased BWV. Given increasing evidence for a link between major depression and both diabetes and cardiovascular disease, current results encourage further research on depression, BWV, and negative health outcomes.

Adolescent depression: challenges and opportunities: a review and current recommendations for clinical practice

Many aspects of the treatment for adolescent depression are still uncertain. However, our body of knowledge continues to accumulate, and our approaches continue to be refined. When we remember that 40 years ago the field was still arguing about the existence of depression in youth, it is clear that significant progress has been made. Recent controversies have provided another opportunity to step back and re-evaluate. Given the chronicity, morbidity, and mortality associated with adolescent depression, the risks of doing nothing are too great. Evidence-based research has provided us with some direction during this unsettling time. After careful reviews, the major professional organizations representing pediatric medicine and psychiatry all support the continued use of SSRI antidepressant medications but emphasize close monitoring. The debates also have heightened interest in effective psychotherapy approaches, particularly CBT and IPT. Given the risk for suicidality in depressed adolescents, assessment and management of safety concerns remain critical, regardless of medication usage. Above all, it is most important that we remain hopeful about our ability to guide adolescents and families through the struggles with depression toward recovery.

Overweight in children and adolescents: pathophysiology, consequences, prevention, and treatment

The prevalence of overweight among children and adolescents has dramatically increased. There may be vulnerable periods for weight gain during childhood and adolescence that also offer opportunities for prevention of overweight. Overweight in children and adolescents can result in a variety of adverse health outcomes, including type 2 diabetes, obstructive sleep apnea, hypertension, dyslipidemia, and the metabolic syndrome. The best approach to this problem is prevention of abnormal weight gain. Several strategies for prevention are presented. In addition, treatment approaches are presented, including behavioral, pharmacological, and surgical treatment. Childhood and adolescent overweight is one of the most important current public health concerns.

Temperament in childhood predicts body mass in adulthood: the Cardiovascular Risk in Young Finns Study

This study examined associations of temperament at ages 6 to 12 with body-mass index (BMI) and waist circumference (WC) at ages 24 to 30 years. The participants were 619 men and women derived from the population-based Cardiovascular Risk in Young Finns Study. Temperament was operationalized as (negative) emotionality, sociability, and activity. High emotionality predicted increased BMI, independently of WC, and independently of childhood and adulthood risk factors for adult obesity. None of the temperament dimensions had any associations with WC after controlling for BMI. The findings suggest that temperamental difficulty in childhood may be a useful risk indicator for general body mass in adulthood, and the mechanisms relating temperament with body mass should be further explored.