Development of mental health problems and overweight between ages 4 and 11 years: a population-based longitudinal study of Australian children

Body mass index, internalizing behavior and executive function: examining trait-state effects from age 2 to 15

This study aimed to examine the reciprocal relation between body mass index and internalizing behavior from age 2 to 15, and also the predictive role of executive function. This study included a subset sample of 640 children (47% were male) from the National Institute of Child Health and Development Study of Early Child Care and Youth Development. A refined random-intercept cross-lagged model was employed to analyze: (1) the reciprocal relation between children's body mass index and internalizing behavior assessed in eight waves from age 2 to 15; (2) the predictive role of executive functioning in both children's body mass index and internalizing behavior. Trait-level body mass index-to-internalizing behavior association was not found; a significant state-level prediction from body mass index in 5th grade to internalizing behavior in 6th grade was found. Executive function was significantly associated with trait-level body mass index, trait-level internalizing behaviors, and state-level internalizing behaviors. The findings suggest that deficits in children's executive functioning may be a shared risk associated with both high body mass index and internalizing behaviors. From an intervention perspective, this study highlighted the importance of targeting executive function to intervene in children's obesity or internalizing behaviors.

Reframing interventions for optimal child nutrition and childhood obesity: the importance of considering psychological factors

This review aims to emphasise the impact of poor nutrition on children's health and psychological well-being, urging those involved in childhood obesity or nutrition services to broaden their intervention approach. Poor nutrition and childhood obesity affect physical and psychological health. The stress of living with obesity further impacts quality of life, well-being and self-esteem. Children living with obesity may experience adverse childhood events and stress, and young people are able to recall the impact of psychosocial issues such as experiencing stigma and discrimination. Food is often a coping mechanism for managing negative emotions, perpetuating cycles of emotional coping and unhealthy eating behaviours. UK guidelines recommend family-based, multi-component weight management interventions for children living with obesity. Interventions mainly target health behaviours and utilise behaviour change techniques attempting to directly improve diet and physical activity as behavioural outcomes. Whilst these interventions may show some improvements in psychological well-being, there is limited consideration or understanding of the underlying mechanisms of action which indirectly influence engagement and the sustainability of the behaviour change. Lack of attention and inclusion of psychosocial variables in intervention implementation may help explain the variable effectiveness reported across childhood obesity interventions. In conclusion, enhancing the effectiveness of childhood obesity interventions requires a broader approach that fully incorporates psychosocial factors. Those responsible for commissioning, designing and implementing these interventions should adopt a holistic approach that addresses psychological and emotional needs while incorporating underlying mechanisms of action. This shift in focus could result in more sustainable and comprehensive treatment for childhood obesity.

A school-based physical activity intervention on psychosocial health outcomes among 11- and 12-year-olds - HOPP-project

The purpose was to investigate the effect of a school-based physical activity (PA)-intervention among 11- and 12-year-olds (6th- and 7th graders) across 4 years. Seven primary schools in Horten municipality in Norway received 45 min daily extra PA as part of the curriculum. The intervention started in 2015 with follow-up in 2016-2019. The effect was measured after 1-4 years of participation, among the same children (6th to 7th grade) and among new children starting in 6th grade. Two control schools received no additional PA beyond the regular PA at school. The Self-reported Strength and Difficulties Questionnaire (SDQ-S) focusing on internalizing and externalizing difficulties were administrated. A statistical model for repeated measurements was used and adjusted for parents' educational level, sex, age, and waist-to-height ratio (WHtR). The significance level was p ≤ 0.01. In total, 1221 children completed the SDQ-S. SDQ-S scores were stable, and difficulties were relatively low. The control group had significantly lower SDQ-S scores than the intervention group at start, indicating fewer difficulties. The adjusted effect within the intervention schools showed a borderline significant increase in total difficulty scores between 2018 and 2019 (mean difference: 1.02, 95% CI: -1.82, -0.23, p ≤ 0.01). Educational level showed a weak negative correlation with total difficulty score (r = -0.1). No significant change was reported within the control schools. Few psychosocial health problems among 11- and 12-year-olds were detected. The borderline increase in total difficulty score that was seen for the intervention schools, is believed to be of limited clinical relevance.

Body Weight at Age Four Years and Readiness to Start School: A Prospective Cohort Study

Background: Adolescents with obesity have lower academic performance, but little is known about the association between body weight in early childhood and school readiness. The objective was to examine the association between age- and sex-standardized body mass index (zBMI) and body weight status and school readiness in young children. Methods: A prospective cohort study in Toronto, Canada, was conducted in young children enrolled in TARGet Kids!. Children's weight and height were measured before the start of kindergarten. Children's school readiness was measured by the Early Development Instrument (EDI), a validated teacher-completed instrument that assesses children's skills and behaviors in five developmental domains in kindergarten. Generalized estimating equations, adjusted for relevant confounders, were used in the analysis. Results: The study included 1015 children (1217 observations): 52% were male and mean age at zBMI was 4.2 years [50 months (SD 12.1)] and school readiness was 5.2 years [62.7 months (SD 6.9)]. There was no evidence found that zBMI was associated with school readiness. However, in a post hoc analysis, being classified as overweight or with obesity in kindergarten was associated with twofold higher odds of vulnerability in school readiness and a lower social competence score compared with their normal weight peers. Conclusions: Being classified as overweight or with obesity was associated with poor school readiness in year 2 of kindergarten. Early interventions to promote healthy growth before school entry may help promote development and school readiness in young children. www.clinicaltrials.gov (NCT01869530).

Body mass index and internalizing symptoms from early childhood through early adolescence: Trend of codevelopment and directionality

BACKGROUND

Higher body mass index (BMI) and internalizing symptoms often codevelop with each other, and both of them have been widely linked to child later maladjustment. However, existing studies on the association between BMI and internalizing symptoms predominantly focus on the between-person association (i.e., the average association for a given group) and use continuous measures of BMI. To address these gaps, using approaches that can effectively partition within-person from between-person variation, this study aimed to delineate temporal dynamics (i.e., directionality) of the associations between BMI and internalizing symptoms (as continuous and clinical cut-off categorical measures for both of them). The trend of codevelopment between BMI and internalizing symptoms is also investigated.

METHODS

This study used data from the Early Childhood Longitudinal Studies, Kindergarten Class of 2010-2011 (ECLS:2011), a nationally representative birth cohort study in the United States. Participants were 17,552 children (48.78% female, M_age  = 5.6 years old at the first wave) who were assessed seven times from kindergarten through Grade 5.

RESULTS

Results of the random intercept, cross-lagged panel model suggested reciprocal within-person associations between BMI and internalizing symptoms from child 7.1 to 11.1 years old.

CONCLUSIONS

Our findings highlight both the necessity of disaggregating between-person and within-person effects in cross-lagged associations between BMI and internalizing symptoms and the importance of interventions that target body weight and mental health issues in middle childhood to reduce the negative impact of both in the long run.

Association between child/adolescent overweight/obesity and conduct disorder: A systematic review and meta-analysis

BACKGROUND

Research findings of the association and its pattern between obesity and psychiatric/psychological comorbidities are not consistent across the types of comorbidities or the study subgroups.

OBJECTIVES

We aimed to perform meta-analysis of cross-sectional studies and longitudinal studies analysing obesity as a risk factor for conduct disorder in order to assess the association between child/adolescent overweight/obesity and conduct disorder.

METHODS

Systematic literature search, study selection and data extraction were performed independently by the two authors. Data were analysed by Comprehensive Meta-analysis software.

RESULTS

Analysis of 13 high-quality cross-sectional studies including 79 027 children and adolescents indicated a significant association between overweight/obesity and conduct disorder among children and adolescents (OR 1.32 [95% CI, 1.18-1.49], I² = 86.68), with no publication bias. Subgroup analyses yielded a significant difference (P < .01) between boys and girls. Analysis of four low- to moderate-quality longitudinal studies (OR 1.11 [95% CI, 0.89-1.38], I² = 57.69) showed no prospective association between overweight/obesity and conduct disorder. Subgroup analysis according to gender revealed a significant positive association for boys and negative association for girls.

CONCLUSIONS

Based on the high-quality cross-sectional data, overweight and obesity are associated with conduct disorder among children and adolescents, affecting boys more frequently than girls. Results of the longitudinal analysis indicated possible association in boys, while girls seem to be protected from conduct disorder. However, these results are very unreliable, indicating the need of well-designed longitudinal studies to elucidate the pattern of association between these disorders.

Early childhood screen time as a predictor of emotional and behavioral problems in children at 4 years: a birth cohort study in China

BACKGROUND

Previous studies have suggested that screen time (ST) has a negative effect on children's emotional and behavioral health, but there are few longitudinal studies that have been conducted with infants and toddlers. This study sought to examine the effect of ST in early childhood on emotional and behavioral problems in children aged 4 years, based on a birth cohort study in China.

METHODS

A total of 2492 children aged 4 years were enrolled in this study. The parents and guardians of each child completed a questionnaire that included items eliciting information on children's birth information, socio-demographic information at baseline, and ST at each follow-up. Emotional and behavioral problems were assessed using the Strengths and Difficulties Questionnaire (SDQ) at 4 years of age. Multivariate logistic analysis was used to explore the effects of ST on emotional and behavioral problems.

RESULTS

The percentages of children with ST > 0 h/day at age 0.5 years, ST > 2 h/day at age 2.5 years, and ST > 2 h/day at age 4 years were 45.7, 55.5, and 34.5% respectively. The prevalence of emotional and behavioral problems was 10.8%. ST at 6 months was a risk factor for emotional symptoms and hyperactivity at the age of 4 years. ST at age 2.5 years was a risk factor for hyperactivity at the age of 4 years. However, ST at age 4 years was a risk factor for total difficulties, conduct problems, peer problems, hyperactivity, and prosocial behavior.

CONCLUSIONS

Higher ST exposure at early childhood is associated with later emotional and behavioral problems. In particular, sustained high ST exposure is a risk factor for behavioral problems. These findings suggested the importance of controlling ST to prevent the occurrence of emotional and behavioral problems in the early years.

Physical Activity, Sleep, Body Mass Index, and Associated Risk of Behavioral and Emotional Problems in Childhood

OBJECTIVE

Cross-sectional data indicate that physical activity, longer sleep duration, and normal body weight are associated with better mental health in childhood. It is less clear whether these factors protect against future emotional and behavioral problems. We investigated whether physical activity, sleep duration, and body mass index (BMI) at the age of 7 years are associated with emotional and behavioral problems at the age of 11 years.

METHODS

Children born to European mothers enrolled in the prospective longitudinal Auckland Birthweight Collaborative Study (N = 871) were assessed at birth and ages 7 and 11 years. Physical activity and sleep duration were measured using accelerometer. BMI was calculated from height and weight measurement. Outcome variables assessed at the age of 11 years were parent and child self-report Strengths and Difficulties Questionnaire and parent and teacher Conners' Rating Scale scores.

RESULTS

Physical activity, sleep duration, and BMI at the age of 7 years were not significantly associated with emotional and behavioral problems at the age of 11 years. In cross-sectional analysis at the age of 11 years, there was no significant association between physical activity or sleep duration and emotional and behavioral problems. Children with a BMI in the overweight or obese range were significantly more likely to have teacher-rated behavior problems and parent-rated emotional or behavioral problems after adjustment for potential confounders.

CONCLUSION

Although physical activity and sleep have physical health benefits, they may not be protective against future emotional and behavioral problems in childhood in the general population. BMI in the obese or overweight range was significantly associated with current emotional and behavioral problems at the age of 11 years.

Comorbidity, Codevelopment, and Temporal Associations Between Body Mass Index and Internalizing Symptoms From Early Childhood to Adolescence

IMPORTANCE

Obesity and internalizing mental illness begin in childhood, have common risk factors, and are leading causes of disease burden.

OBJECTIVES

To examine the comorbidity, codevelopment, and temporal precedence in body mass index (BMI) and internalizing symptoms from early childhood to midadolescence and to investigate the sex differences and socioeconomic confounding in their association.

DESIGN, SETTING, AND PARTICIPANTS

This longitudinal study used data on individuals from the Millennium Cohort Study, a nationally representative, prospective birth cohort study in the United Kingdom of more than 19 000 individuals born from September 1, 2000, to January 11, 2002, who were assessed to date at the ages of 9 months and 3, 5, 7, 11, and 14 years. Data from 17 215 participants (88.21% of full cohort sample) with socioeconomic information in early childhood and BMI or internalizing symptoms during at least 1 assessment from 3 to 14 years of age were included in the present study. Data analysis was performed from May to November 2018.

MAIN OUTCOMES AND MEASURES

Outcomes were BMI estimated from objectively measured height and weight and internalizing symptoms assessed using parental reports. Three measures of socioeconomic position were controlled for: parent educational level, occupational status, and equivalized family income.

RESULTS

Among the 17 215 participants (8394 [48.8%] female), obesity and internalizing problems were not more likely to co-occur in early childhood (odds ratio [OR] at 3 years, 1.02; 95% CI, 0.69-1.50), whereas at 11 and 14 years of age, they were more likely to co-occur (OR at 11 years, 1.68; 95% CI, 1.38-2.05; OR at 14 years, 1.49; 95% CI, 1.22-1.83). Piecewise latent growth models revealed no codevelopment of BMI and internalizing symptoms from 3 to 7 years of age (r = 0.01), whereas their slopes were associated between 7 and 14 years of age (r = 0.23). Initial level and rate of change in each domain in early childhood was not associated with rate of change in the other domain at older ages. Cross-lagged models indicated no cross-domain pathways before 7 years of age, with some weak cross-domain pathways emerging between 7 and 14 years of age. Socioeconomic position attenuated some of these associations, leaving a BMI-to-internalizing symptoms pathway in later childhood and an internalizing symptoms-to-BMI pathway in early adolescence.

CONCLUSIONS AND RELEVANCE

The findings suggest that BMI and internalizing symptoms become more associated and reciprocal as children get older and that some of their temporal associations can be attributed to socioeconomic factors. The emergence of cross-domain temporal pathways in middle childhood suggests that social, physiologic, and psychological processes begin to play an increasingly important role in these health outcomes. Prevention and early intervention efforts may benefit from targeting both health outcomes in childhood.

Trajectories of aggressive and depressive symptoms in male and female overweight children: Do they share a common path or do they follow different routes?

The prevalence of childhood overweight is a major social and public health issue, and primary assessment should focus on early and middle childhood, because weight gain in these phases constitutes a strong predictor of subsequent negative outcomes. Studies on community samples have shown that growth curves may follow linear or non-linear trajectories from early to middle childhood, and can differ based on sex. Overweight children may exhibit a combination of physiological and psychosocial issues, and several studies have demonstrated an association between overweight and internalizing/externalizing behavior. Nevertheless, there is a dearth of longitudinal studies on depressive and aggressive symptoms in children with high BMI. This study adopted a growth curve modeling over three phases to: (1) describe BMI trajectories in two groups of children aged 2–8 (overweight and normal weight) from a community sample; (2) describe the developmental trajectories of children’s aggressive and depressive symptoms from 2 to 8 years of age. Results indicate higher BMI in 2-year-old girls, with males catching up with them by age 8. While overweight females’ BMIs were consistently high, males’ increased at 5 and 8 years. The mean scores for aggressive symptoms at T1 (2 years of age) were the same in all subjects, but a significant deviation occurred from T1 to T2 in both samples, in divergent directions. With regards to children’s depressive symptoms, the two groups had different starting points, with normal weight children scoring lower than overweight youths. Overweight females showed lower depressive scores than overweight males at T1, but they surpassed boys before T2, and showed more maladaptive symptoms at T3. This study solicits professionals working in pediatric settings to consider overweight children’s psychopathological risk, and to be aware that even when children’s BMI does not increase from 2 to 8 years, their psychopathological symptoms may grow in intensity.

Obesogenic eating behaviors mediate the relationships between psychological problems and BMI in children

OBJECTIVE

To examine the association between psychological problems and weight status in children aged 3.5 to 4 years and test whether obesogenic eating behaviors mediate this relationship.

METHODS

This study is a cross-sectional secondary analysis of data from first-time mothers (N = 194) in the control arm of the NOURISH randomized controlled trial. At child age 3.5 to 4 years, maternal-reported child eating behaviors and psychological problems were collected via valid tools, and child weight and height data were collected by trained study staff. Pearson's correlations and linear regressions examined associations between eating behaviors, psychological problems, and BMI z score. Multiple mediation models were tested by assessing indirect effects of psychological problems on BMI z score via obesogenic eating behaviors.

RESULTS

Peer problems were associated with both higher food responsiveness and emotional overeating and directly with higher BMI z score. This relationship was partially mediated by emotional overeating. Both emotional overeating and food responsiveness fully mediated the association between emotional problems and BMI z score, and food responsiveness fully mediated the association between conduct problems and BMI z score.

CONCLUSIONS

The findings suggest that children with psychological problems may also display obesogenic eating behaviors, which may result in higher BMI. This needs to be considered in the clinical management of both pediatric overweight/obesity and psychological problems.

Bidirectional associations between psychosocial well-being and body mass index in European children: longitudinal findings from the IDEFICS study

Background

The negative impact of childhood overweight on psychosocial well-being has been demonstrated in a number of studies. There is also evidence that psychosocial well-being may influence future overweight. We examined the bidirectional association between childhood overweight and psychosocial well-being in children from a large European cohort.

The dual aim was to investigate the chronology of associations between overweight and psychosocial health indicators and the extent to which these associations may be explained by parental education.

Methods

Participants from the IDEFICS study were recruited from eight countries between September 2007 and June 2008 when the children were aged 2 to 9.9 years old. Children and families provided data on lifestyle, psychosocial well-being, and measured anthropometry at baseline and at follow-up 2 years later. This study includes children with weight, height, and psychosocial well-being measurements at both time points (n = 7,831). Psychosocial well-being was measured by the KINDL® and Strengths and Difficulties Questionnaire respectively. The first instrument measures health-related quality of life including emotional well-being, self-esteem, parent relations and social relations while the second measures well-being based on emotional symptoms, conduct problems and peer-related problems. Logistic regression was used for modeling longitudinal associations.

Results

Children who were overweight at baseline had increased risk of poor health-related quality of life (odds ratio (OR) = 1.23; 95 % confidence interval (CI):1.03–1.48) measured 2 years later; this association was unidirectional. In contrast to health-related quality of life, poor well-being at baseline was associated with increased risk of overweight (OR = 1.39; 95 % CI:1.03–1.86) at 2 year follow-up; this association was also only observed in one direction. Adjustment for parental education did not change our findings.

Conclusion

Our findings indicate that the association between overweight and psychosocial well-being may be bidirectional but varies by assessment measures. Future research should further investigate which aspects of psychosocial well-being are most likely to precede overweight and which are more likely to be consequences of overweight.

Confident body, confident child: A randomized controlled trial evaluation of a parenting resource for promoting healthy body image and eating patterns in 2- to 6-year old children

OBJECTIVE

Body image and eating patterns develop in early childhood and are influenced by the family environment. This research evaluated Confident Body, Confident Child (CBCC), an intervention for parents of 2- to 6-year-old children, designed to promote body satisfaction, healthy eating, and weight management in early childhood.

METHOD

A randomized controlled trial compared four groups: (A) received the CBCC resource pack and a workshop, (B) received the CBCC resource pack only, (C) received a nutrition-only resource and (D) received no interventions until all questionnaires were completed (i.e., functioned as waitlist control). Measures of parenting variables relevant to child body image and eating patterns, parent-report of child weight, and evaluation questions about the resource, were implemented pre- and post-intervention.

RESULTS

At 6-weeks post-intervention, the CBCC resource was associated with significant reductions in parents' intentions to use behaviors that increase the risk of negative body attitudes or unhealthy eating in their children, in parents' use of feeding practices associated with childhood overweight, and in television watching during family meals. Significant increases in parents' intentions to use positive behaviors and knowledge of child body image and healthy eating patterns were also found. Superior results were found for the CBCC resource + workshop condition, suggesting it is the preferred delivery method.

DISCUSSION

CBCC positively impacts parenting variables associated with childhood risk for body dissatisfaction, unhealthy eating and weight. © 2016 Wiley Periodicals, Inc. (Int J Eat Disord 2016; 49:458-472).

Do thin, overweight and obese children have poorer development than their healthy-weight peers at the start of school? Findings from a South Australian data linkage study

Little is known about the holistic development of children who are not healthy-weight when they start school, despite one fifth of preschool-aged children in high income countries being overweight or obese. Further to this, there is a paucity of research examining low body mass index (BMI) in contemporary high-income populations, although evidence from the developing world demonstrates a range of negative consequences in childhood and beyond. We investigated the development of 4-6 year old children who were thin, healthy-weight, overweight, or obese (as defined by BMI z-scores) across the five domains of the Australian Early Development Census (AEDC): Physical Health and Wellbeing, Social Competence, Emotional Maturity, Language and Cognitive Skills, and Communication Skills and General Knowledge. We used a linked dataset of South Australian routinely collected data, which included the AEDC, school enrollment data, and perinatal records (n = 7533). We found that the risk of developmental vulnerability among children who were thin did not differ from healthy-weight children, after adjusting for a range of perinatal and socio-economic characteristics. On the whole, overweight children also had similar outcomes as their healthy-weight peers, though they may have better Language and Cognitive skills (adjusted Risk Ratio [aRR] = 0.73 [95% CI 0.50-1.05]). Obese children were more likely to be vulnerable on the Physical Health and Wellbeing (2.20 [1.69, 2.87]) and Social Competence (1.31 [0.94, 1.83]) domains, and to be vulnerable on one or more domains (1.45 [1.18, 1.78]). We conclude that children who are obese in the first year of school may already be exhibiting some developmental vulnerabilities (relative to their healthy-weight peers), lending further support for strategies to promote healthy development of preschoolers.

Eating behaviours in preadolescence are associated with body dissatisfaction and mental disorders - Results of the CCC2000 study

Preadolescence is a key period in the early stages of eating disorder development. The aim of the present study was, firstly, to investigate restrained, emotional and external eating in a general population-based sample of 11-12 year olds. Secondly, we sought to explore how these eating behaviours are associated with possible predictors of eating disorders, such as body dissatisfaction, weight status and mental disorders. A subsample of 1567 children (47.7% boys; 52.3% girls) from the Copenhagen Child Cohort (CCC2000) completed web-based questionnaires on eating behaviours and body dissatisfaction using The Eating Pattern Inventory for Children (EPI-C) and The Children's Figure Rating Scale. Mental disorders were assessed using the online version of the Development and Well-Being Assessment (DAWBA) based on parental replies with final DSM-IV diagnoses determined by experienced child- and adolescent psychiatrists. Height and weight were measured at a face-to-face assessment. The results showed that restrained eating was significantly associated with overweight, body dissatisfaction and emotional disorders in both genders. Emotional eating showed similar associations with overweight and body dissatisfaction in both genders, but was only associated with mental disorders in girls. External eating was significantly associated with body dissatisfaction and neurodevelopmental disorders in both genders, but was only associated with overweight in girls. Our findings show that problematic eating behaviours can be identified in preadolescence, and co-exist with weight problems and mental disorders. Thus restrained, emotional and external eating was, in different ways, associated with overweight, body dissatisfaction and mental disorders. Our findings point to significant eating behaviours in preadolescence, which could constitute potential predictors of later eating disorder risk.

Longitudinal association between preschool fussy eating and body composition at 6 years of age: The Generation R Study

Background

Children’s fussy eating behavior has been related to both underweight and overweight in cross-sectional studies, but the direction of these associations and the relation with more detailed measures of body composition remains unclear. We aimed to examine whether fussy eating at age 4 years is longitudinally related to body mass index (BMI), fat mass index (FMI) and fat-free mass index (FFMI) at 6 years of age.

Methods

This study was embedded in Generation R, a population-based, prospective cohort. Data were available for 4191 children. The Children’s Eating Behaviour Questionnaire (CEBQ), administered at age 4 years, was used to derive a fussy eating profile. This profile is characterized by high scores on food avoidant scales and low scores on food approach scales. At age 6 years, height and weight were measured at our research center. Body fat and fat-free mass were measured using Dual-energy-X-ray absorptiometry. We used age- and sex-specific standard deviation scores (SDS) for all outcomes.

Results

After adjustment for confounders, the fussy eating profile was related to lower BMI-SDS (B = −0.37, 95 % CI: −0.47;−0.26), lower FMI-SDS (B = −0.22, 95 % CI: −0.33;−0.12) and lower FFMI-SDS (B = −0.41, 95 % CI: −0.54;−0.29). When adjusting for baseline BMI at 4 years, the fussy eating profile predicted a 0.11 lower BMI-SDS at age 6 (95 % CI: −0.19;−0.04). This change in BMI was mainly due to a decrease in FFMI (B = −0.19, 95 % CI: −0.29;−0.09). Fussy eaters also had a higher risk of becoming underweight than non-fussy eaters (OR = 2.28, 95 % CI: 1.34;3.87).

Conclusions

Our findings suggest that young fussy eaters are at risk of having a lower fat free mass and of becoming underweight over a 2-year period. This implies that fussy eaters may benefit from careful monitoring to prevent an adverse growth development.

Electronic supplementary material

The online version of this article (doi:10.1186/s12966-015-0313-2) contains supplementary material, which is available to authorized users.

Childhood obesity and its physical and psychological co-morbidities: a systematic review of Australian children and adolescents

Australia is predicted to have the highest overweight/obesity rate in the world by 2022 outranking the USA and UK. The purpose of this systematic review was to evaluate the associations between childhood obesity and physical and psychological health co-morbidities. Therefore, a systematic literature search was conducted from six databases (2004-2014). Studies were included if they investigated obesity-related co-morbidities with participants residing in Australia aged 0-18 years. Forty-seven studies fulfilled selection criteria. Evidence suggests that overweight/obese Australian children and adolescents, compared to normal-weight peers, had more cardio-metabolic risk factors and higher risk factors of non-alcohol fatty liver disease and were experiencing more negative psychological outcomes (depression, low self-esteem and lower scores of health-related quality of life). Many other health consequences have either not been investigated in Australia, or as frequently as in other countries.

CONCLUSIONS

Given Australia's current overweight/obesity prevalence and trajectory, Australia-based studies are needed to identify the suspected co-morbidities, understand the range of individual, social and environmental mechanisms driving obesity, and help identify policies, interventions and strategies that will change the future trajectory and 'disease burden' both in Australia and internationally.

WHAT IS KNOWN

• Trend analyses have shown that obesity prevalence in Australia is increasing and will outrank UK and the USA by 2022. • Every third Australian child/adolescent between 5 and 19 years old is predicted to be classified as overweight or obese by 2025. • Childhood obesity is associated with multiple immediate physical and psychological health co-morbidities as well as co-morbidities in adulthood. These have often been identified and examined individually. What is New: • This paper presents a holistic picture of childhood obesity and the associated multiple co-morbidities in Australia. • The extensive health-related outcomes from childhood obesity and those requiring further research are identified. • The findings of this paper will influence the development of local/regional, state and national strategies to change Australia's future trajectory.

Teacher and peer reports of overweight and bullying among young primary school children

BACKGROUND

Overweight is a potential risk factor for peer victimization in late childhood and adolescence. The current study investigated the association between BMI in early primary school and different bullying involvement roles (uninvolved, bully, victim, and bully-victim) as reported by teachers and children themselves.

METHODS

In a population-based study in the Netherlands, measured BMI and teacher-reported bullying behavior were available for 4364 children (mean age = 6.2 years). In a subsample of 1327 children, a peer nomination method was used to obtain child reports of bullying.

RESULTS

In both teacher- and child-reported data, a higher BMI was associated with more victimization and more bullying perpetration. For instance, a 1-point increase in BMI was associated with a 0.05 increase on the standardized teacher-reported victimization score (95% confidence interval, 0.03 to 0.07; P < .001). Combining the victimization and bullying scores into different types of bullying involvement showed that children with obesity, but not children with overweight, had a significantly higher risk to be a bully-victim (odds ratio = 2.25; 95% confidence interval, 1.62 to 3.14) than normal-weight peers.

CONCLUSIONS

At school entry, a high BMI is a risk factor associated with victimization and bullying perpetration, with obese children particularly likely to be victims and aggressors. Results were consistent for teacher and child reports of bullying, supporting the validity of our findings. Possibly, obesity triggers peer problems, but the association may also reflect a common underlying cause that makes obese children vulnerable to bullying involvement.