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Richardson KA, Punke ELA, Dabrowski BS, Teply AL, Walker J, McKibbin CL. Parent Intention to Participate in an Online Intervention to Enhance Health Behavior Change Among Youth Treated with Psychotropic Medication Who are Overweight or Obese: An Application of the Theory of Planned Behavior. JOURNAL OF PREVENTION (2022) 2024; 45:431-450. [PMID: 38446270 DOI: 10.1007/s10935-024-00773-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/31/2024] [Indexed: 03/07/2024]
Abstract
Youth with mental health disorders (MHD), particularly those who take psychotropic medications, are at increased risk of being overweight or obese (OW/OB) when compared to typical youth. Parents are important resources for interventions addressing OW/OB. However, parents of youth with MHD may face challenges that require interventions designed to address their needs. Prior to investing research funding in the development of interventions for this group, research is needed to understand factors associated with parents' decisions to enroll in these programs. The theory of planned behavior (TPB) provided a framework for examining parents' salient beliefs, direct attitudes, and intention to enroll in a hypothetical online healthy lifestyle intervention for their youth (ages 11-17) with OW/OB and treated with psychotropic medication. Parents who were enrolled in the study (n = 84) completed demographic questionnaires and a TPB questionnaire which was constructed for this study. A confirmatory factor analysis (CFA) of the direct attitude (i.e., attitude toward the behavior, subjective norm, perceived behavioral control) questions generally supported the three-factor model (i.e., RMSEA = .07, 90% CI .03-.11, p = .18; CFI = .96, SRMR = .06). Results from a multiple regression analysis demonstrated that direct attitudes predicted parent intention to participate in an online healthy lifestyle intervention for this sample of youth accounting for 84% of variance. In this preliminary study, the TPB appears to be a promising framework for understanding direct attitudes associated with parent intentions toward intervention participation in this population of youth. Interventions for parents of youth with OW/OB who are prescribed psychotropic medication should consider addressing these direct attitudes to improve intention.
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Affiliation(s)
| | | | | | - Abby L Teply
- Department of Psychology, University of Wyoming, Laramie, WY, 82072, USA
| | - Johnathan Walker
- Department of Psychology, University of Wyoming, Laramie, WY, 82072, USA
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2
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Leutner M, Dervic E, Bellach L, Klimek P, Thurner S, Kautzky A. Obesity as pleiotropic risk state for metabolic and mental health throughout life. Transl Psychiatry 2023; 13:175. [PMID: 37248222 DOI: 10.1038/s41398-023-02447-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 04/12/2023] [Accepted: 04/24/2023] [Indexed: 05/31/2023] Open
Abstract
Obesity, a highly prevalent disorder and central diagnosis of the metabolic syndrome, is linked to mental health by clinical observations and biological pathways. Patients with a diagnosis of obesity may show long-lasting increases in risk for receiving psychiatric co-diagnoses. Austrian national registry data of inpatient services from 1997 to 2014 were analyzed to detect associations between a hospital diagnosis of obesity (ICD-10: E66) and disorders grouped by level-3 ICD-10 codes. Data were stratified by age decades and associations between each pair of diagnoses were computed with the Cochran-Mantel-Haenszel method, providing odds ratios (OR) and p values corrected for multiple testing. Further, directions of the associations were assessed by calculating time-order-ratios. Receiving a diagnosis of obesity significantly increased the odds for a large spectrum of psychiatric disorders across all age groups, including depression, psychosis-spectrum, anxiety, eating and personality disorders (all pcorr < 0.01, all OR > 1.5). For all co-diagnoses except for psychosis-spectrum, obesity was significantly more often the diagnosis received first. Further, significant sex differences were found for most disorders, with women showing increased risk for all disorders except schizophrenia and nicotine addiction. In addition to the well-recognized role in promoting disorders related to the metabolic syndrome and severe cardiometabolic sequalae, obesity commonly precedes severe mental health disorders. Risk is most pronounced in young age groups and particularly increased in female patients. Consequently, thorough screening for mental health problems in patients with obesity is urgently called for to allow prevention and facilitate adequate treatment.
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Affiliation(s)
- Michael Leutner
- Department of Internal Medicine III, Clinical Division of Endocrinology and Metabolism, Medical University of Vienna, Waehringer Guertel 18-20, A-1090, Vienna, Austria
| | - Elma Dervic
- Section for Science of Complex Systems, CeMSIIS, Medical University of Vienna, Spitalgasse 23, A-1090, Vienna, Austria
- Complexity Science Hub Vienna, Josefstaedter Straße 39, 1080, Vienna, Austria
| | - Luise Bellach
- Department of Internal Medicine III, Clinical Division of Endocrinology and Metabolism, Medical University of Vienna, Waehringer Guertel 18-20, A-1090, Vienna, Austria
| | - Peter Klimek
- Section for Science of Complex Systems, CeMSIIS, Medical University of Vienna, Spitalgasse 23, A-1090, Vienna, Austria
- Complexity Science Hub Vienna, Josefstaedter Straße 39, 1080, Vienna, Austria
| | - Stefan Thurner
- Section for Science of Complex Systems, CeMSIIS, Medical University of Vienna, Spitalgasse 23, A-1090, Vienna, Austria
- Complexity Science Hub Vienna, Josefstaedter Straße 39, 1080, Vienna, Austria
| | - Alexander Kautzky
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Waehringer Guertel 18-20, A-1090, Vienna, Austria.
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Bauer LO. Altered brain activation in uncomplicated pediatric obesity: The second moment is more sensitive than the first. Brain Cogn 2022; 164:105923. [PMID: 36274388 PMCID: PMC10083723 DOI: 10.1016/j.bandc.2022.105923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 10/06/2022] [Accepted: 10/10/2022] [Indexed: 11/24/2022]
Abstract
Traditionally, studies of the neurocognitive correlates of obesity have computed a central tendency across trials of a task to estimate the functional abilities of individual members of obese and non-obese groups. This computation assumes that the correlate is stable over time-a questionable assumption when individuals are impulsive, periodically inattentive, and capable of overcompensation following awareness of failure. The present investigation departs from the tradition by focusing on the second moment, or variability, in brain activation during a simple selective attention task. It compared 124 non-obese and 80 obese teenaged girls on the across-trial average amplitude and inter-trial variability (ITV) of a sensitive biomarker of attention, the P300 event-related electroencephalographic potential. It found that P300 ITV outperformed P300 average amplitude in differentiating the groups. Further, it found that the elevated P300 ITV among obese teenagers was associated with other indicators of impulsivity and inattention as well as slower reaction times and a trend toward more variable reaction times. Future studies should investigate the value of P300 ITV as an objective and sensitive endpoint for cognitive training focused on improving the attention skills of obese children.
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Affiliation(s)
- Lance O Bauer
- Department of Psychiatry, University of Connecticut School of Medicine, Farmington, CT 06030-1410, USA
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Zhang S, Huang Y, Zaid M, Tong L. ADHD Symptoms and Obesity in Chinese Children and Adolescents: A Longitudinal Study With Abnormal Eating Behaviors as Moderating Factors. J Atten Disord 2022; 26:1452-1463. [PMID: 35240871 DOI: 10.1177/10870547221081005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Emerging studies have explored the possibility of ADHD and associated abnormal eating behaviors as catalysts for obesity in children and adolescents. However, results were largely inconsistent. This study aims to explore the effects of ADHD and abnormal eating behaviors (including eating disorders, emotional eating, and bedtime eating) on obesity, and to assess the moderating role of abnormal eating behaviors between ADHD symptoms and BMI in Chinese children and adolescents. METHODS We recruited 546 grade 3 to 11 students and their parents by stratified random sampling from three primary schools and four middle schools in Shanghai, China. This study used parent-reported versions of the ADHD Rating Scale-IV to assess ADHD symptoms, the Eating Attitudes Test and the Children's Eating Attitude Test to assess eating disorder (ED) symptoms, and the Child Eating Behavior Questionnaire to collect information about other abnormal eating behaviors at baseline and at a follow-up survey 1 year later. RESULTS Hierarchical linear regression analysis revealed that ED played a moderating role in the relationship between ADHD symptoms and BMI in addition to age (β = .003, p = .008). The simple slope test showed that ADHD symptoms positively correlated with BMI ofs in the older age group with a high level of ED symptoms (β = .16, p < .001). Moreover, the baseline ED symptoms (β = .03, p = .032) and ADHD symptoms (β = .12, p = .015) increased the students' BMI one year later after controlling for confounding factors. CONCLUSION Findings of this study suggest that ADHD and ED symptoms raised the students' BMI separately. Moreover, ADHD and ED symptoms raised the students' BMI separately. Moreover, a combined high level of ADHD and ED symptoms is correlated with students' high BMI in the older age group.
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Baweja R, Hale DE, Waxmonsky JG. Impact of CNS Stimulants for Attention-Deficit/Hyperactivity Disorder on Growth: Epidemiology and Approaches to Management in Children and Adolescents. CNS Drugs 2021; 35:839-859. [PMID: 34297331 DOI: 10.1007/s40263-021-00841-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/29/2021] [Indexed: 12/30/2022]
Abstract
Central nervous system stimulants are established treatments for pediatric attention-deficit/hyperactivity disorder with robust efficacy data. Reductions in appetite, weight, and growth velocity are some of the most common concerns regarding the long-term use of central nervous system stimulants in developing children. They are associated with suppression of weight and body mass index in childhood. However, both weight and body mass index often progressively increase over adolescence at rates faster than those seen in non-attention-deficit/hyperactivity disorder youth to the degree that attention-deficit/hyperactivity disorder is associated with elevated body mass index by the end of adolescence regardless of medication use. The capacity of central nervous system stimulants to slow growth was identified 50 years ago. Recent work has established that the growth deficits accumulate during the first 2 years of use and may persist provided medication is used. Early initiation coupled with persistent use through adolescence is most likely to be associated with clinical impactful growth suppression. There has been limited formal investigation of treatments for stimulant-associated reductions in weight and height. The most robust evidence exists for drug holidays improving weight gain. Observational studies suggest that limiting lifetime exposure or discontinuing medication is associated with greater adult height. Additional research is needed to identify the causal mechanisms driving the observed slowing in growth as well as the identification of predictors of clinically impactful growth suppression.
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Affiliation(s)
- Raman Baweja
- Department of Psychiatry and Behavioral Health, Penn State College of Medicine, 500 University Drive, Hershey, PA, 17033-0850, USA.
| | - Daniel E Hale
- Division of Pediatric Endocrinology, Department of Pediatrics, Penn State College of Medicine, Hershey, PA, USA
| | - James G Waxmonsky
- Department of Psychiatry and Behavioral Health, Penn State College of Medicine, 500 University Drive, Hershey, PA, 17033-0850, USA
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[Overweight/Obesity of Children and Adolescents and its Association with Internalising and Externalising Disorders]. Prax Kinderpsychol Kinderpsychiatr 2021; 70:182-197. [PMID: 33641646 DOI: 10.13109/prkk.2021.70.3.182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Overweight/Obesity of Children and Adolescents and its Association with Internalising and Externalising Disorders Research in child and adolescent psychiatry increasingly deals with the association between mental disorder and weight. This paper provides an overview of national and international studies on the relationship between body composition and mental illness in children and adolescents, with a focus on the representation of individual internalizing and externalizing disturbance patterns. The majority of studies in this area are based on the so-called one-compartment model of body composition in terms of the Body Mass Index (BMI) or on the classification as "overweight" or "obese". Associations between mental disorders and body composition were described in two directions: On one hand, both externalising and internalising symptoms are associated with obesity, and on the other hand there are also more psychopathological symptoms among overweight children and adolescents. Longitudinal studies suggest effects in both directions. While externalising symptoms and weight are thought to be related from infancy on, this connection seems to be evident for internalising disorders not earlier than for early school age. It is also known from the literature that psychopharmacological medication affects weight and body growth - especially with psychostimulants, but also with neuroleptics and antidepressants. We found only a few studies describing the relationship between body composition and psyche in more complex models with two or more compartments.
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Figueiredo T, Fortes D, Erthal P, Bortolini T, Segenreich D, Malloy-Diniz L, Mattos P. Impulsivity as an Endophenotype in ADHD: Negative Findings. J Atten Disord 2021; 25:502-507. [PMID: 30520670 DOI: 10.1177/1087054718816161] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Impulsivity has a strong genetic component and is considered an endophenotype in many psychiatric disorders. Impulsivity in adult ADHD has become a focus of interest more recently because of its suggested prominence in this age. Objective: This study aimed to access self-reported impulsivity levels in biological parents of ADHD offspring, according to their status: non-ADHD (controls), remitted, nonremitted. Method: Impulsivity levels of 155 parents of ADHD children were compared according to their status using the Barratt Impulsiveness Scale (BIS-11). Results: The ADHD group presented the highest levels of impulsivity compared with all other groups. The remitted ADHD and control groups showed no significant differences in impulsivity levels. Conclusion: Impulsivity tended to remit alongside ADHD symptoms in remitters and to persist in those presenting with the residual form of adult ADHD suggesting it should not be considered as an endophenotype. Only the attentional dimension was impaired, cautioning against Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) impulsivity proposed criteria.
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Affiliation(s)
- Tiago Figueiredo
- Federal University of Rio de Janeiro, Brazil.,D'Or Institute for Research and Education (IDOR), Rio de Janeiro, Brazil
| | - Dídia Fortes
- Federal University of Rio de Janeiro, Brazil.,D'Or Institute for Research and Education (IDOR), Rio de Janeiro, Brazil
| | - Pilar Erthal
- D'Or Institute for Research and Education (IDOR), Rio de Janeiro, Brazil
| | - Tiago Bortolini
- D'Or Institute for Research and Education (IDOR), Rio de Janeiro, Brazil
| | | | | | - Paulo Mattos
- Federal University of Rio de Janeiro, Brazil.,D'Or Institute for Research and Education (IDOR), Rio de Janeiro, Brazil
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Racicka-Pawlukiewicz E, Kuć K, Bielecki M, Hanć T, Cybulska-Klosowicz A, Bryńska A. The Association between Executive Functions and Body Weight/BMI in Children and Adolescents with ADHD. Brain Sci 2021; 11:brainsci11020178. [PMID: 33535492 PMCID: PMC7912721 DOI: 10.3390/brainsci11020178] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 01/25/2021] [Accepted: 01/27/2021] [Indexed: 11/21/2022] Open
Abstract
Despite the increasing body of research on Attention Deficit Hyperactivity Disorder (ADHD), the results of the studies assessing the relationship between executive function deficit and the risk of obesity in people with ADHD are incongruent. Our study aimed to assess the relationship between measures of executive functions and body weight and Body Mass Index (BMI) in children and adolescents with ADHD and control subjects. The study group consisted of 58 subjects aged from 8 to 17 years with ADHD. The Control group consisted of 62 healthy age and sex-matched participants from primary and secondary schools. Weight, height, and BMI measurements were standardized. The Sustained Attention to Response Test (SART) and the Attention Network Test (ANT) were used to assess executive functions. Based on the analysis of the correlation and analysis of moderation, we found that subjects with higher weight in the study group presented a lower efficiency of the inhibition processes and gave more impulsive and incorrect answers. The occurrence of impulsive reactions might contribute to the risk of excessive weight in children and adolescents with ADHD.
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Affiliation(s)
- Ewa Racicka-Pawlukiewicz
- Department of Child and Adolescent Psychiatry, Medical University of Warsaw, Żwirki i Wigury 61, 02-091 Warsaw, Poland;
- Correspondence:
| | - Katarzyna Kuć
- Department of Psychology, SWPS University of Social Sciences and Humanities, 03-815 Warsaw, Poland; (K.K.); (M.B.)
| | - Maksymilian Bielecki
- Department of Psychology, SWPS University of Social Sciences and Humanities, 03-815 Warsaw, Poland; (K.K.); (M.B.)
| | - Tomasz Hanć
- Institute of Human Biology and Evolution, Faculty of Biology, Adam Mickiewicz University, 61-614 Poznan, Poland;
| | - Anita Cybulska-Klosowicz
- Laboratory of Neuroplasticity, Nencki Institute of Experimental Biology of Polish Academy of Sciences, 02-093 Warsaw, Poland;
| | - Anita Bryńska
- Department of Child and Adolescent Psychiatry, Medical University of Warsaw, Żwirki i Wigury 61, 02-091 Warsaw, Poland;
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Li YJ, Xie XN, Lei X, Li YM, Lei X. Global prevalence of obesity, overweight and underweight in children, adolescents and adults with autism spectrum disorder, attention-deficit hyperactivity disorder: A systematic review and meta-analysis. Obes Rev 2020; 21:e13123. [PMID: 32783349 DOI: 10.1111/obr.13123] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 07/14/2020] [Accepted: 07/22/2020] [Indexed: 12/27/2022]
Abstract
Individuals with autism spectrum disorder (ASD) or attention-deficit hyperactivity disorder (ADHD) may have unhealthy bodyweight. This meta-analysis was performed to understand the weight status in individuals with ASD or ADHD. PubMed, Embase, Cochrane and ISI Web of Science databases were searched from inception until June 2020 to identify relevant studies. Prevalence estimates and their 95% confidence intervals (CIs) of obesity, overweight and underweight were separately pooled using random-effects models. A total of 95 studies were included in the meta-analysis. The pooled estimates of the prevalence of obesity, overweight and underweight were 21.8%, 19.8% and 6.4% in individuals with ASD and 14.7%, 20.9% and 4.0% in individuals with ADHD. In subgroup analyses, an increasing trend in the prevalence of unhealthy weight was observed from children aged 2 to 5 years to adults with ASD (obesity: from 16.7% to 31.3%, overweight: from 16.2% to 27.2%, underweight from 5.3% to 8.6%) and from children aged 6 to 12 years to adults with ADHD (obesity: from 13.5% to 19.3%, overweight: from 18.8% to 31.2%). The worrisome epidemic of obesity and overweight in individuals with ASD, ADHD highlighted the need for weight management.
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Affiliation(s)
- Yong-Jiang Li
- Department of Pharmacy, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Xue-Ni Xie
- Shuda College, Hunan Normal University, Changsha, China
| | - Xue Lei
- School of Psychology, University of Queensland, St Lucia, Queensland, Australia
| | - Ya-Min Li
- Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Xianyang Lei
- Office of the President, Central South University, Changsha, China
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10
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Goldstein BI, Korczak DJ. Links Between Child and Adolescent Psychiatric Disorders and Cardiovascular Risk. Can J Cardiol 2020; 36:1394-1405. [DOI: 10.1016/j.cjca.2020.06.023] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 06/28/2020] [Accepted: 06/29/2020] [Indexed: 12/27/2022] Open
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Eiffener E, Eli K, Ek A, Sandvik P, Somaraki M, Kremers S, Sleddens E, Nowicka P. The influence of preschoolers' emotional and behavioural problems on obesity treatment outcomes: Secondary findings from a randomized controlled trial. Pediatr Obes 2019; 14:e12556. [PMID: 31290278 DOI: 10.1111/ijpo.12556] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 05/13/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Few studies have explored the influence of preschoolers' behavioural problems on obesity treatment. OBJECTIVES To assess emotional and behavioural problems before and after an obesity intervention and examine relationships between changes in child behaviour and changes in weight status. METHOD The study included 77 children (4-6 years old, 53% girls, mean body mass index [BMI] z-score of 3.0 [SD 0.6]) who participated in the More and Less Study, a randomized controlled trial. Families were randomized to a parenting program or to standard treatment. The children's heights and weights (BMI z-score, primary outcome) were measured at baseline and 12 months post baseline. Parents rated their children's behaviours (secondary outcome) on the Child Behavior Checklist (CBCL) for ages 1.5 to 5 years, a questionnaire that measures psychosocial health and functioning, encompassing emotional and behavioural problems. Changes in child behaviour during treatment were examined through paired samples t tests; the influence of child behaviour on treatment effects was examined through linear regressions. RESULTS Child emotional and behavioural problems significantly improved after obesity treatment. Lower scores were found for Emotional Reactivity, Sleep Problems, Affective Problems, Aggressive Behaviour, Externalizing Behaviours, Oppositional Defiant Problems, and Total Problems. Child behaviour significantly affected obesity treatment results: Attention Problems and attention deficit hyperactivity disorder (ADHD) at baseline contributed to increasing BMI z-scores, whereas Oppositional Defiant Problems, Externalizing Behaviours, and a higher number of behavioural problems predicted decreasing BMI z-scores. CONCLUSIONS Child behaviours at baseline influenced treatment results. Child emotional and behavioural problems improved post treatment. The results suggest that obesity treatment may help in reducing emotional distress among preschoolers.
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Affiliation(s)
- Elodie Eiffener
- Department of Health Promotion, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Karin Eli
- Unit for Biocultural Variation and Obesity, Institute of Social and Cultural Anthropology, University of Oxford, Oxford, UK.,Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Anna Ek
- Unit of Pediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Pernilla Sandvik
- Department of Food Studies, Nutrition and Dietetics, Uppsala University, Uppsala, Sweden
| | - Maria Somaraki
- Department of Food Studies, Nutrition and Dietetics, Uppsala University, Uppsala, Sweden
| | - Stef Kremers
- Department of Health Promotion, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Ester Sleddens
- Department of Health Promotion, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Paulina Nowicka
- Unit of Pediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.,Department of Food Studies, Nutrition and Dietetics, Uppsala University, Uppsala, Sweden
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Racicka E, Hanć T, Giertuga K, Bryńska A, Wolańczyk T. Prevalence of Overweight and Obesity in Children and Adolescents With ADHD: The Significance of Comorbidities and Pharmacotherapy. J Atten Disord 2018; 22:1095-1108. [PMID: 25895508 DOI: 10.1177/1087054715578272] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVE Assessment of the prevalence of overweight and obesity in children and adolescents with ADHD with emphasis on pharmacological treatment and comorbid disorders. METHOD We analyzed 408 medical records of patients with ADHD aged 7 to 18. RESULTS The prevalence of overweight (14.71% vs. 12.83%, χ2 = 3,586.43, p < .001) and obesity (6.37% vs. 3.45%, χ2 = 3,588.19, p < .001) was significantly higher in children with ADHD compared with the population. There was significantly higher incidence of obesity in patients with comorbid diagnosis of adjustment disorder (22.22% vs. 4.42%, χ2 = 5.66, p = .02) and mental retardation (19.05% vs. 4.42%, χ2 = 7.63, p = .005). Pharmacological treatment was associated with a higher incidence of obesity (8.37% vs. 2.76%, χ2 = 4.92, p = .03). CONCLUSION Standardized body mass index (BMI), prevalence of overweight, and obesity was higher in patients with ADHD compared with the population. Higher incidence of obesity was shown in patients with analyzed comorbidities.
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Affiliation(s)
- Ewa Racicka
- 1 Department of Child Psychiatry, Medical University of Warsaw, Poland
| | - Tomasz Hanć
- 2 Department of Human Biological Development, Faculty of Biology, Institute of Anthropology, Adam Mickiewicz University in Poznan, Poland
| | - Katarzyna Giertuga
- 3 Laboratory of Neuroplasticity, Nencki Institute of Experimental Biology, Warsaw, Poland
| | - Anita Bryńska
- 1 Department of Child Psychiatry, Medical University of Warsaw, Poland
| | - Tomasz Wolańczyk
- 1 Department of Child Psychiatry, Medical University of Warsaw, Poland
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13
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Bowling AB, Tiemeier HW, Jaddoe VWV, Barker ED, Jansen PW. ADHD symptoms and body composition changes in childhood: a longitudinal study evaluating directionality of associations. Pediatr Obes 2018; 13:567-575. [PMID: 29869385 DOI: 10.1111/ijpo.12288] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 02/25/2018] [Accepted: 03/01/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Attention-deficit/hyperactivity disorder (ADHD) is linked to increased risk of overweight/obesity among children and adults. Studies have also implicated obesity as a risk factor for ADHD. However, no studies have evaluated bidirectional, longitudinal associations between childhood fat mass and ADHD symptom severity. OBJECTIVES We investigate bidirectional associations between ADHD symptoms and measures of body composition between ages 1.5 and 9. We further examine effects of specific eating patterns linked to ADHD on associations between symptom severity and body composition. METHODS The study utilized data from children (N = 3903) participating in the Generation R cohort (Netherlands). Children were enrolled at birth and retained regardless of ADHD symptoms over time. Cross-lagged and change models examined bidirectional associations between body composition (body mass index/dual-energy X-ray absorptiometry) and ADHD symptoms at four time points in childhood. RESULTS A child with a clinically concerning ADHD symptom z-score two standard deviations above the mean at age 6 would be expected to experience about 0.22 kg greater fat mass gain measured via dual-energy x-ray absorptiometry between ages 6 and 9, even if they displayed healthy eating patterns (95% CI: 0.11 - 0.28, p < 0.001). Conversely, fat mass at any age did not predict worse ADHD symptoms later. CONCLUSIONS Beginning in early childhood, more ADHD symptoms predict higher fat mass at later ages. We did not find evidence of a reverse association. Based on these and prior findings, lifestyle counselling during treatment for children with a diagnosis of ADHD should be considered, even if they are diagnosed in early childhood and do not yet have a body mass index of clinical concern.
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Affiliation(s)
- A B Bowling
- Department of Health Sciences, Merrimack College, North Andover, MA, USA.,Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - H W Tiemeier
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC-University Medical Center, Rotterdam, The Netherlands.,Department of Epidemiology, Erasmus MC-University Medical Center, Rotterdam, The Netherlands.,Department of Psychiatry, Erasmus MC-University Medical Center, Rotterdam, The Netherlands
| | - V W V Jaddoe
- Department of Epidemiology, Erasmus MC-University Medical Center, Rotterdam, The Netherlands.,The Generation R Study Group, Erasmus MC-University Medical Center, Rotterdam, The Netherlands.,Department of Pediatrics, Erasmus MC-University Medical Center, Rotterdam, The Netherlands
| | - E D Barker
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - P W Jansen
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC-University Medical Center, Rotterdam, The Netherlands.,Department of Psychology, Education and Child Studies, Erasmus University Rotterdam, The Netherlands
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14
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Hanć T, Cortese S. Attention deficit/hyperactivity-disorder and obesity: A review and model of current hypotheses explaining their comorbidity. Neurosci Biobehav Rev 2018; 92:16-28. [PMID: 29772309 DOI: 10.1016/j.neubiorev.2018.05.017] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 04/29/2018] [Accepted: 05/14/2018] [Indexed: 01/10/2023]
Abstract
Available meta-analyses point to a significant association between attention-deficit/hyperactivity disorder (ADHD) and obesity. The possible mechanisms underlying this relationship are unclear. Here, we overview the studies aimed at identifying the factors contributing to the comorbidity between ADHD and obesity, including genetic factors, fetal programming, executive dysfunctions, psychosocial stress, factors directly related to energy balance, and sleep patterns alterations. The bulk of current research has focused on reduced physical activity and abnormal eating patterns as possible causes of weight gain in individuals with ADHD. Further research is needed to explore the specific role of executive dysfunctions. None of the available published studies have evaluated physiological mechanisms such as hormonal and metabolic disorders or inappropriate neurobiological regulation of appetite. Research exploring the genetic basis for the coexistence of ADHD and obesity and epigenetic mechanisms, with particular emphasis on stress, both pre- and postnatal, seems particularly promising. Here, we propose a biopsychosocial model to integrate current findings and move the field forward to gain insight into the ADHD-obesity relationship.
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Affiliation(s)
- Tomasz Hanć
- Department of Human Biological Development, Institute of Anthropology, Faculty of Biology, Adam Mickiewicz University, Ul. Umultowska 89, 61-614, Poznan, Poland.
| | - Samuele Cortese
- Center for Innovation in Mental Health, Academic Unit of Psychology, University of Southampton, SO17 1BJ, UK; Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of Medicine, University of Southampton, SO17 1BJ, UK; Solent NHS Trust, Southampton, SO19 8BR, UK; New York University Child Study Center, New York, NY, 10016, USA; Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, NG7 2UH, UK
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15
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Matheson BE, Eichen DM. A Review of Childhood Behavioral Problems and Disorders in the Development of Obesity: Attention Deficit/Hyperactivity Disorder, Autism Spectrum Disorder, and Beyond. Curr Obes Rep 2018; 7:19-26. [PMID: 29411333 DOI: 10.1007/s13679-018-0293-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
PURPOSE OF REVIEW Given the high rates of pediatric and adult obesity, it is imperative to identify early risk factors that might contribute to excess weight gain. This review aims to investigate the relationship between childhood behavioral problems with the development and persistence of obesity. Specifically, this review highlights the association of obesity with (1) neurocognitive constructs, such as executive functioning and inhibition/impulsivity, and (2) disorders commonly diagnosed in childhood, including attention deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD). RECENT FINDINGS Consistent evidence supports a relationship between childhood behavioral problems, executive functioning, inhibition/impulsivity, ADHD, and ASD with obesity across the lifespan. Longitudinal studies suggest behavior problems, neurocognitive functioning deficits, and ADHD symptoms in childhood predict weight gain over time. Identifying risk factors in childhood that promote obesity may help develop targeted intervention and prevention programs. Additional research should elucidate mechanisms that account for these relationships.
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Affiliation(s)
- Brittany E Matheson
- Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego, 6363 Alvarado Court, San Diego, CA, 92120, USA.
- Department of Psychiatry, University of California, San Diego, 8950 Villa La Jolla Dr. Suite C-203, San Diego, CA, 92037, USA.
| | - Dawn M Eichen
- Department of Pediatrics, University of California, San Diego, 8950 Villa La Jolla Dr. Suite C-203, San Diego, CA, 92037, USA
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16
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Bauer LO, Houston RJ. The value of instability: an investigation of intrasubject variability in brain activity among obese adolescent girls. Int J Obes (Lond) 2017; 41:1489-1495. [PMID: 28630458 PMCID: PMC5626582 DOI: 10.1038/ijo.2017.144] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Revised: 04/20/2017] [Accepted: 06/06/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND The present study investigated the value of intrasubject variability (ISV) as a metric for revealing differences in cognition and brain activation associated with an obese versus lean body mass. METHODS Ninety-six adolescents with a lean body mass (body mass index (BMI) percentile=5-85), and 92 adolescents with an obese body mass (BMI percentile ⩾95), performed two tasks (Stroop and Go/No-Go) challenging response inhibition skills. The s.d. values and averages of their reaction time and P300 electroencephalographic responses to task stimuli were computed across trials. RESULTS During the Go/No-Go task, the reaction times of subjects with an obese body mass were more variable than those of their lean body mass peers. Accompanying the greater ISV in reaction times was a group difference in P300 amplitude ISV in the opposite direction across both tasks. The effect sizes associated with these group differences in ISV were marginally greater than the effect sizes for the comparisons of the group means. CONCLUSIONS ISV may be superior to the mean as a tool for differentiating groups without significant cognitive impairment. The co-occurrence of reduced ISV in P300 amplitude and elevated ISV in reaction time may indicate a constraint among obese adolescent girls in the range of information processing strategies and neural networks that can compete to optimize response output. It remains to be determined whether this decrement in neural plasticity has implications for their problem solving skills as well as their response to weight management interventions.
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Affiliation(s)
- Lance O. Bauer
- University of Connecticut School of Medicine, Farmington, CT 06030-2103, USA
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17
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Bowling A, Davison K, Haneuse S, Beardslee W, Miller DP. ADHD Medication, Dietary Patterns, Physical Activity, and BMI in Children: A Longitudinal Analysis of the ECLS-K Study. Obesity (Silver Spring) 2017; 25:1802-1808. [PMID: 28834373 DOI: 10.1002/oby.21949] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Revised: 07/10/2017] [Accepted: 07/11/2017] [Indexed: 11/10/2022]
Abstract
OBJECTIVE This study examined relationships between attention-deficit/hyperactivity disorder (ADHD), stimulant use, and BMI change in a nationally representative cohort of children as well as differences in diet and physical activity that may mediate associations between stimulant use and BMI change. METHODS By using the Early Childhood Longitudinal Study-Kindergarten Cohort 1998-1999 (N = 8,250), we modeled BMI and z score change by ADHD and stimulant start time, examined the odds of unhealthy diet and physical activity predicted by ADHD and stimulant use, and performed mediation analysis assessing indirect effects of health behaviors. RESULTS Early stimulant use predicted short-term BMI reductions, but any stimulant use predicted increased BMI growth between fifth grade (mean age = 11.2 years) and eighth grade (mean age = 14.3 years). Children with ADHD had higher odds of poor diet regardless of medication. Health behaviors were not associated with BMI change after controlling for medication use. CONCLUSIONS Stimulant use predicted higher BMI trajectory between fifth and eighth grade but did not affect dietary or physical activity patterns. Future research should explore potential mechanisms by which early and long-term stimulant use may affect metabolism, while clinicians should initiate nutrition counseling with families of children with ADHD, regardless of medication prescription, at or shortly after diagnosis.
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Affiliation(s)
- April Bowling
- Department of Health Sciences, Merrmack College, North Andover, Massachusetts, USA
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Kirsten Davison
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Sebastien Haneuse
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - William Beardslee
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
- Department of Psychiatry, Boston, Children's Hospital, Boston, Massachusetts, USA
| | - Daniel P Miller
- Boston University School of Social Work, Boston, Massachusetts, USA
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18
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Abstract
While psychiatric comorbidities of attention-deficit/hyperactivity disorder (ADHD) have been extensively explored, less attention has been paid to somatic conditions possibly associated with this disorder. However, mounting evidence in the last decade pointed to a possible significant association between ADHD and certain somatic conditions, including obesity. This papers provides an update of a previous systematic review on the relationship between obesity and ADHD (Cortese and Vincenzi, Curr Top Behav Neurosci 9:199-218, 2012), focusing on pertinent peer-reviewed empirical papers published since 2012. We conducted a systematic search in PubMed, Ovid, and Web of Knowledge databases (search dates: from January 1st, 2012, to July 16th, 2016). We retained a total of 41 studies, providing information on the prevalence of obesity in individuals with ADHD, focusing on the rates of ADHD in individuals with obesity, or reporting data useful to gain insight into possible mechanisms underlying the putative association between ADHD and obesity. Overall, over the past 4 years, an increasing number of studies have assessed the prevalence of obesity in individuals with ADHD or the rates of ADHD in patients with obesity. Although findings are mixed across individual studies, meta-analytic evidence shows a significant association between ADHD and obesity, regardless of possible confounding factors such as psychiatric comorbidities. An increasing number of studies have also addressed possible mechanisms underlying the link between ADHD and obesity, highlighting the role, among others, of abnormal eating patterns, sedentary lifestyle, and possible common genetic alterations. Importantly, recent longitudinal studies support a causal role of ADHD in contributing to weight gain. The next generation of studies in the field should explore if and to which extent the treatment of comorbid ADHD in individuals with obesity may lead to long-term weight loss, ultimately improving their overall well-being and quality of life.
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Affiliation(s)
- Samuele Cortese
- Academic Unit of Psychology, Developmental Brain-Behaviour Laboratory, University of Southampton, Southampton, UK.
- The Child Study Center at NYU Langone Medical Center, New York, NY, USA.
| | - Luca Tessari
- Academic Unit of Psychology, Developmental Brain-Behaviour Laboratory, University of Southampton, Southampton, UK
- Department of Woman and Child Health, University of Padua, Padua, Italy
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19
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Pauli-Pott U, Reinhardt A, Bagus E, Wollenberg B, Schroer A, Heinzel-Gutenbrunner M, Becker K. Psychosocial risk factors underlie the link between attention deficit hyperactivity symptoms and overweight at school entry. Eur Child Adolesc Psychiatry 2017; 26:67-73. [PMID: 27259487 DOI: 10.1007/s00787-016-0870-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Accepted: 05/17/2016] [Indexed: 12/25/2022]
Abstract
The link between symptoms of attention deficit hyperactivity disorder (ADHD) and increased body weight is well established, while the underlying mechanisms are not yet clear. Since increased body weight and ADHD symptoms have been found to be associated with psychosocial risk factors in childhood, we analyzed whether the psychosocial risks explain the association between the two conditions. The sample consisted of 360 children (age range 6-7 years, 173 boys) attending the obligatory medical health exam before school entry. The childrens' height and weight were measured during the examination. ADHD symptoms were ascertained by parent-report questionnaires. Psychosocial risks were ascertained by a structured interview. The link between ADHD symptoms and body weight could be completely explained by cumulative psychosocial risks while controlling for gender, symptoms of depression/anxiety and oppositional defiant disorder of the child, maternal smoking during pregnancy, parental body mass index, and potential diagnosis of ADHD in the parents. In current models pertaining to the etiology of overweight/obesity and ADHD, chronic stress caused by psychosocial adversity is assumed to act as a trigger for these conditions. Psychosocial risks experienced during childhood may activate processes that specifically lead to the combined ADHD-overweight phenotype.
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Affiliation(s)
- Ursula Pauli-Pott
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Philipps University of Marburg, Hans Sachs Str. 6, 35039, Marburg, Germany.
| | - Alexander Reinhardt
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Philipps University of Marburg, Hans Sachs Str. 6, 35039, Marburg, Germany
| | - Elena Bagus
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Philipps University of Marburg, Hans Sachs Str. 6, 35039, Marburg, Germany
| | - Birgit Wollenberg
- Department of Public Health, District administration Marburg-Biedenkopf, Schwanallee 23, 35037 , Marburg, Germany
| | - Andrea Schroer
- Department of Public Health, District administration Marburg-Biedenkopf, Schwanallee 23, 35037 , Marburg, Germany
| | - Monika Heinzel-Gutenbrunner
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Philipps University of Marburg, Hans Sachs Str. 6, 35039, Marburg, Germany
| | - Katja Becker
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Philipps University of Marburg, Hans Sachs Str. 6, 35039, Marburg, Germany
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20
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Rankin J, Matthews L, Cobley S, Han A, Sanders R, Wiltshire HD, Baker JS. Psychological consequences of childhood obesity: psychiatric comorbidity and prevention. Adolesc Health Med Ther 2016; 7:125-146. [PMID: 27881930 PMCID: PMC5115694 DOI: 10.2147/ahmt.s101631] [Citation(s) in RCA: 311] [Impact Index Per Article: 38.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Childhood obesity is one of the most serious public health challenges of the 21st century with far-reaching and enduring adverse consequences for health outcomes. Over 42 million children <5 years worldwide are estimated to be overweight (OW) or obese (OB), and if current trends continue, then an estimated 70 million children will be OW or OB by 2025. The purpose of this review was to focus on psychiatric, psychological, and psychosocial consequences of childhood obesity (OBy) to include a broad range of international studies. The aim was to establish what has recently changed in relation to the common psychological consequences associated with childhood OBy. A systematic search was conducted in MEDLINE, Web of Science, and the Cochrane Library for articles presenting information on the identification or prevention of psychiatric morbidity in childhood obesity. Relevant data were extracted and narratively reviewed. Findings established childhood OW/OBy was negatively associated with psychological comorbidities, such as depression, poorer perceived lower scores on health-related quality of life, emotional and behavioral disorders, and self-esteem during childhood. Evidence related to the association between attention-deficit/hyperactivity disorder (ADHD) and OBy remains unconvincing because of various findings from studies. OW children were more likely to experience multiple associated psychosocial problems than their healthy-weight peers, which may be adversely influenced by OBy stigma, teasing, and bullying. OBy stigma, teasing, and bullying are pervasive and can have serious consequences for emotional and physical health and performance. It remains unclear as to whether psychiatric disorders and psychological problems are a cause or a consequence of childhood obesity or whether common factors promote both obesity and psychiatric disturbances in susceptible children and adolescents. A cohesive and strategic approach to tackle this current obesity epidemic is necessary to combat this increasing trend which is compromising the health and well-being of the young generation and seriously impinging on resources and economic costs.
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Affiliation(s)
- Jean Rankin
- Department of Maternal and Child Health, University of the West of Scotland, Paisley
| | - Lynsay Matthews
- MRC/CSO Social and Public Health Sciences Unit, Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland
| | - Stephen Cobley
- Department of Exercise and Sport Science, University of Sydney, Sydney, Australia
| | - Ahreum Han
- Department of Exercise and Sport Science, University of Sydney, Sydney, Australia
| | - Ross Sanders
- Department of Exercise and Sport Science, University of Sydney, Sydney, Australia
| | - Huw D Wiltshire
- Cardiff School of Sport/Ysgol Chwaraeon Caerdydd, Cardiff Metropolitan University, Cardiff, UK
| | - Julien S Baker
- School of Science and Sport, Institute of Clinical Exercise and Health Science, University of the West of Scotland, Hamilton, Scotland
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21
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Sciberras E, Bisset M, Hazell P, Nicholson JM, Anderson V, Lycett K, Jongeling B, Efron D. Health-related impairments in young children with ADHD: a community-based study. Child Care Health Dev 2016; 42:709-17. [PMID: 27291781 DOI: 10.1111/cch.12363] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 04/20/2016] [Accepted: 05/11/2016] [Indexed: 12/22/2022]
Abstract
BACKGROUND We aimed to examine health-related impairments in young children with attention-deficit/hyperactivity disorder (ADHD) and non-ADHD controls and explore differences in children with ADHD by gender, ADHD subtype and mental health co-morbidity status. METHODS Children with ADHD (n = 177) and controls (n = 212) aged 6-8 years were recruited across 43 schools in Melbourne, Australia following a screening (Conners 3 ADHD Index) and case confirmation procedure (Diagnostic Interview Schedule for Children IV). Direct and blinded assessments of height and weight were used to calculate body mass index z-score and to identify overweight/obesity. Parents reported on child global health, sleep problems and physical injuries. Unadjusted and adjusted (socio-demographic factors and co-morbidities) logistic and linear regression were conducted to compare health-related impairments between (1) children with and without ADHD; (2) boys and girls with ADHD; (3) children with ADHD-inattentive and ADHD-combined types; and (4) children with ADHD by internalizing and externalizing disorder status. RESULTS Children with ADHD had poorer global health than controls when adjusted for socio-demographic characteristics (OR: 2.0; 95% CI 1.1, 3.9); however, this attenuated after adjusting for co-morbidities. In adjusted analyses, children with ADHD had increased odds of moderate/large sleep problems (OR: 3.1; 95% CI 1.4, 6.8), compared with controls. There were no differences between children with and without ADHD in terms of physical injuries or overweight/obesity. Findings were similar when excluding children taking ADHD medication, and health-related impairments did not differ between boys and girls with ADHD. Children with ADHD-combined type had higher BMI z-scores than controls in adjusted analyses (P = 0.04). Children with ADHD and co-occurring internalizing and externalizing co-morbidities were particularly vulnerable to health-related impairments. CONCLUSION Young children with ADHD experience a number of health-related impairments, which are exacerbated by the presence of internalizing and externalizing co-morbidities. Clinicians should consider the broader health of children with ADHD in clinical consultations.
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Affiliation(s)
- E Sciberras
- Deakin University, School of Psychology, Geelong, Vic., Australia.,Murdoch Childrens Research Institute, Melbourne, Vic., Australia.,The Royal Children's Hospital, Melbourne, Vic., Australia.,The University of Melbourne, Melbourne, Vic., Australia
| | - M Bisset
- Deakin University, School of Psychology, Geelong, Vic., Australia.,Murdoch Childrens Research Institute, Melbourne, Vic., Australia
| | - P Hazell
- Discipline of Psychiatry, Sydney Medical School, Sydney, NSW, Australia
| | - J M Nicholson
- Murdoch Childrens Research Institute, Melbourne, Vic., Australia.,La Trobe University, Melbourne, Vic., Australia
| | - V Anderson
- Murdoch Childrens Research Institute, Melbourne, Vic., Australia.,The Royal Children's Hospital, Melbourne, Vic., Australia.,The University of Melbourne, Melbourne, Vic., Australia
| | - K Lycett
- Murdoch Childrens Research Institute, Melbourne, Vic., Australia
| | - B Jongeling
- Child Development Service, Joondalup, WA, Australia.,The University of Western Australia, Perth, WA, Australia
| | - D Efron
- Murdoch Childrens Research Institute, Melbourne, Vic., Australia.,The Royal Children's Hospital, Melbourne, Vic., Australia.,The University of Melbourne, Melbourne, Vic., Australia
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22
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Ptacek R, Stefano GB, Weissenberger S, Akotia D, Raboch J, Papezova H, Domkarova L, Stepankova T, Goetz M. Attention deficit hyperactivity disorder and disordered eating behaviors: links, risks, and challenges faced. Neuropsychiatr Dis Treat 2016; 12:571-9. [PMID: 27042070 PMCID: PMC4780667 DOI: 10.2147/ndt.s68763] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder that often persists in adulthood. It is defined by inattention and/or hyperactivity-impulsivity. ADHD is associated with many comorbidities, including eating disorders (EDs). In the last decade, studies have reported that ADHD is linked with binge EDs, bulimia nervosa, and anorexia nervosa. Many postulates have been proposed to explain the association: 1) impulsive behavior in ADHD patients leads to disordered eating behavior; 2) other psychologic comorbidities present in ADHD patients account for eating behavior; 3) poor eating habits and resulting nutritional deficiencies contribute to ADHD symptoms; and 4) other risk factors common to both ADHD and EDs contribute to the coincidence of both diseases. Additionally, sex differences become a significant issue in the discussion of EDs and ADHD because of the higher incidence of bulimia nervosa and anorexia nervosa in females and the ability of females to mask the symptoms of ADHD. Interestingly, both EDs and ADHD rely on a common neural substrate, namely, dopaminergic signaling. Dopaminergic signaling is critical for motor activity and emotion, the latter enabling the former into a combined motivated movement like eating. This linkage aids in explaining the many comorbidities associated with ADHD. The interconnection of ADHD and EDs is discussed from both a historical perspective and the one based on the revealing nature of its comorbidities.
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Affiliation(s)
- Radek Ptacek
- Department of Psychiatry, Charles University 1st Medical Faculty and General Teaching Hospital, Prague, Czech Republic; Department of Psychology, University of New York in Prague, Prague, Czech Republic
| | - George B Stefano
- Department of Psychiatry, Charles University 1st Medical Faculty and General Teaching Hospital, Prague, Czech Republic; MitoGenetics Research Institute, MitoGenetics, LLC, Farmingdale, NY, USA
| | - Simon Weissenberger
- Department of Psychiatry, Charles University 1st Medical Faculty and General Teaching Hospital, Prague, Czech Republic
| | - Devang Akotia
- Department of Psychiatry, Charles University 1st Medical Faculty and General Teaching Hospital, Prague, Czech Republic
| | - Jiri Raboch
- Department of Psychiatry, Charles University 1st Medical Faculty and General Teaching Hospital, Prague, Czech Republic
| | - Hana Papezova
- Department of Psychiatry, Charles University 1st Medical Faculty and General Teaching Hospital, Prague, Czech Republic
| | - Lucie Domkarova
- Department of Psychiatry, Charles University 1st Medical Faculty and General Teaching Hospital, Prague, Czech Republic
| | - Tereza Stepankova
- Department of Psychiatry, Charles University 1st Medical Faculty and General Teaching Hospital, Prague, Czech Republic
| | - Michal Goetz
- Department of Child Psychiatry, Charles University Second Faculty of Medicine, University Hospital Motol, Prague, Czech Republic
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23
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Nigg JT, Johnstone JM, Musser ED, Long HG, Willoughby MT, Shannon J. Attention-deficit/hyperactivity disorder (ADHD) and being overweight/obesity: New data and meta-analysis. Clin Psychol Rev 2015; 43:67-79. [PMID: 26780581 DOI: 10.1016/j.cpr.2015.11.005] [Citation(s) in RCA: 120] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 09/18/2015] [Accepted: 11/24/2015] [Indexed: 01/08/2023]
Abstract
BACKGROUND Literature has suggested that ADHD may be associated with increased risk of obesity. If so, this would have important clinical implications. OBJECTIVE To clarify the size of the association between ADHD and obesity and to evaluate key moderators of the association including medication, gender, age, and psychiatric comorbidity. METHOD Two preliminary studies are presented to supply critical additional data for the meta-analysis: a two-year longitudinal study of an ADHD case-control sample of 313 children aged 7-11, and a national survey study of 45,309 families in the United States using the 2012 National Survey of Children's Health. Formal meta-analysis was then conducted. The identification procedure yielded 43 studies, reporting 225 comparisons or effect sizes, studying 703,937 participants An overall effect size was estimated with a random effects model (after pooling within study using a modified fixed effects model). Effect size was then examined in relation to medication, gender, age, and psychiatric comorbidity. RESULTS The new study of children revealed no reliable association of ADHD and body mass index at any age or time point. In the national survey, ADHD was associated with obesity only in adolescent girls but not in children or boys; this effect was statistically accounted for by covarying of depression and conduct disorder. In the meta-analysis, the composite effect size was OR=1.22 (95% CI=1.11-1.34); 22 studies provided effects with medication controlled, yielding a composite effect size of OR=1.30 (95% CI=1.12-1.50). Pooled across age the association without covariates was reliable in females (OR=1.19 [1.01-1.41]) but not males (OR=1.10 [0.95-1.23]) although males and females did not statistically differ. Pooled across gender, the association was significantly larger in adults (>18years) (OR=1.37 [1.19-1.58]) than in youth (OR=1.13 [1.00-1.27]), p=.04. CONCLUSIONS ADHD has a small overall association with obesity, but this effect is moderate in adults. The effect is likely to be of no clinical significance in children, possible clinical significance in adolescent girls with comorbid disorders, and of clinical relevance by adulthood.
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Affiliation(s)
- Joel T Nigg
- Oregon Health & Science University, Portland, OR, United States.
| | | | - Erica D Musser
- Florida International University, Miami, FL, United States
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24
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Türkoğlu S, Bilgiç A, Akça ÖF. ADHD symptoms, breast-feeding and obesity in children and adolescents. Pediatr Int 2015; 57:546-51. [PMID: 25625700 DOI: 10.1111/ped.12593] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Revised: 11/28/2014] [Accepted: 01/16/2015] [Indexed: 01/21/2023]
Abstract
BACKGROUND Attention-deficit-hyperactivity disorder (ADHD) has been found to be related to overweight/obesity in children and adolescents, but it is a heterogeneous disorder, and the relationships between the dimensions of ADHD and overweight/obesity are not clear. The aim of this study was to explore which dimensions of the disorder are specifically associated with overweight/obesity. METHODS The study sample consisted of 300 treatment-naive children with ADHD and 75 healthy controls aged 7-17 years. The ADHD module of the Kiddie Schedule for Affective Disorders and Schizophrenia-Present and Lifetime Version was used to diagnose ADHD. The severity of ADHD symptoms was assessed via Conners' Parent Rating Scale (CPRS). The weight, height, and breast-feeding duration of the study samples and controls were recorded. Body mass index (BMI) was categorized according to the national age/sex-specific reference values. RESULTS The rate of overweight/obese children was higher in the ADHD group. The association between ADHD symptoms and BMI percentile scores was evaluated using structural equation modeling. In that model, it was observed that the Cognitive Problems/Inattentive and Oppositional subscores of the CPRS had a positive predictive effect on the BMI percentile scores, but breast-feeding duration had a negative predictive effect on the BMI percentile scores. CONCLUSION Inattention, oppositionality and breast-feeding duration were associated with overweight/obesity in children and adolescents with ADHD. Longitudinal studies are needed to more fully understand this relationship and the mechanisms underlying the association between ADHD and overweight/obesity.
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Affiliation(s)
- Serhat Türkoğlu
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, Selçuk University, Konya, Turkey
| | - Ayhan Bilgiç
- Department of Child and Adolescent Psychiatry, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Ömer Faruk Akça
- Department of Child and Adolescent Psychiatry, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
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