Adolescent Weight Status: Associations With Structural and Functional Dimensions of Social Relations

'Teenagers are into perfect-looking things': Dating, sexual attitudes and experiences of adolescents with severe obesity

BACKGROUND

This qualitative study explored the dating and sexual health attitudes and behaviours among adolescents with severe obesity (body mass index [BMI] > 99th%) attending a multidisciplinary weight-management programme.

METHODS

Semi-structured interviews were conducted with 19 participants (12 females, 7 males; M_age  = 16.8) and analysed through reflective thematic analysis.

RESULTS

Participants described polarized dating behaviours in which dating and sexual relationships were either avoided due to this not being a priority, lack of time, feared rejection, and/or body size as perceived barrier or in contrast, when approached, involved greater sexual risk.

CONCLUSIONS

These findings have numerous implications including the need for increased education on the romantic developmental challenges faced by adolescents with severe obesity, the importance of ongoing screening of high-risk sexual behaviours and body dissatisfaction from frontline care providers, and the ability to support referrals to psychosocial services when appropriate.

Study Protocol for Evaluation of an Extended Maintenance Intervention on Life Satisfaction and BMI Among 7-14-Year-Old Children Following a Stay at a Residential Health Camp in Denmark

Background: It is challenging to maintain effects of public health interventions. For residential health camps benefits often disappear as the child returns home. Furthermore, long-term effects are often not measured or reported. This paper presents the study protocol for an evaluation of an extended maintenance intervention offered to children who have completed a 10-week residential health camp at one of the five Danish Christmas Seal Houses (DCSH). The target group of DSCH is 7–14-year-olds with social, mental, and/or overweight issues and the overall aim of the camp is to increase life satisfaction and a healthy lifestyle. The primary aim of this study is to assess the effectiveness of the maintenance intervention on children's life satisfaction (primary outcome) and BMI Z-score (secondary outcome) 1 year after health camp.

Methods: The extended maintenance intervention is developed by DCSH and delivered to each child and family individually by an intervention coordinator to help children maintain positive benefits of the health camp on life satisfaction and health behaviors after returning to their homes. Intervention activities target the child and the family. The effect will be tested in a quasi-experimental design: The intervention is offered to half of the children at one of the five DSCH (intervention group, N~144) while the other half and the children at the other four DSCH receive a standard maintenance intervention (control group, N~894). Children will complete questionnaires on life satisfaction measured by an adapted version of the Cantril ladder and height and weight prior to health camp, at the end of health camp, 3 months and 1 year after the end of health camp. To enable per protocol analysis and nuanced interpretation of effect estimates, we will monitor the implementation of the intervention by a process evaluation study among children, parents, and follow up coordinators using qualitative and quantitative methods.

Discussion: We present a systematic approach to evaluating practice-based interventions in a research design. The study will provide new knowledge on the effectiveness of individualized maintenance interventions on long-term effects on life satisfaction and weight loss among children.

Trial registration: Prospectively registered at Current Controlled Trials ISRCTN 13011465 https://www.isrctn.com/ISRCTN13011465

Dietary patterns and health-related quality of life among Iranian adolescents

PURPOSE

Examining the associations of a-posteriori-defined dietary patterns and health-related quality of life (HRQOL) among Iranian adolescents.

METHODS

This cross-sectional study was conducted among 900 apparently healthy students (mean age 15.33 years; 53.0% female) during 2020-21. The validated Persian version of self-report Pediatric Quality of Life Inventory™ Version 4.0 Generic Core Scales (PedsQL) for healthy adolescents was used in an online survey to assess HRQOL. Total, physical health, psychosocial health, emotional functioning, social functioning, and school functioning PedsQL scores were calculated, and impaired HRQOL was defined as > 1 standard deviation below the total population sample mean PedsQL scores. A validated food frequency questionnaire was used to assess dietary intakes during telephone interviews. Daily intakes of 20 predefined food groups were calculated and submitted to the principal component factor analysis to identify a-posteriori-defined dietary patterns.

RESULTS

Three major dietary patterns labeled as Mediterranean, mixed, and unhealthy were identified, of which only the Mediterranean pattern characterized by high intakes of vegetables, fruits, olives, potatoes, eggs, nuts and legumes, pickles, low-fat dairy, fish, poultry, and vegetable oils was consistently associated with HRQOL. Controlling for covariates in the multivariable-adjusted binary logistic regression analysis, participants in the top tertile of Mediterranean pattern score were less likely to have impaired HRQOL than those in the bottom tertile (total: OR 0.25; physical health: OR 0.35; psychosocial health: OR 0.15; emotional functioning: OR 0.17; social functioning: OR 0.15; and school functioning: OR 0.18; all P < 0.010).

CONCLUSION

Current findings indicate that an a-posteriori-defined Mediterranean-style dietary pattern is associated with better HRQOL among healthy Iranian adolescents.

Persian Version of the Yale Food Addiction Scale 2.0: Psychometric Analysis and Setting Cutoff Point for the Food Cravings Questionnaire-Trait-Reduced

OBJECTIVE

The aims of this study were to evaluate the psychometric properties of Persian translation of the Yale Food Addiction Scale 2.0 (YFAS 2.0) as a widely accepted questionnaire for the first time and to establish a cut off score for Food Craving Questionnaire-Trait-reduced (FCQ-T-r).

METHODS

In this cross-sectional study, 330 visitors of family physician clinics in Shiraz, a city located in south of Iran, were selected. The English version of YFAS 2.0 was translated into Persian and used in this study as well as the Persian version of FCQ-T-r.

RESULTS

Confirmatory factor analysis of YFAS-2 confirmed one dimensional structure and factor loading in all eleven symptoms was above 0.4. Internal consistency for eleven symptoms was 0.813. Prevalence of food addiction in participants was 6.7% (22 participants). BMI and FCQ-T-r questionnaire score both were positively correlated with the number of food addiction symptoms but age was negatively correlated with the number of the symptoms. The ROC curve analysis showed the best suggested cut-off point for FCQ-T-r questionnaire to detect food addiction was 32.5.

CONCLUSION

The present study confirmed validity and reliability of Persian version of YFAS-2. It is suggested that food addiction occurs in different level of food craving behavior in different food cultures or genetics.

Connections between Friendship Quality, Peer Competence, and Obesity in Early Childhood through Adolescence

Background: Research indicates that youths with overweight and obesity often face difficulties in peer relationships. The current research examined longitudinal associations between youths' peer competence (i.e., successful interactions with peers), friendship quality (i.e., disclosure, conflict resolution, and companionship with a best friend), and body mass index (BMI) z-score when they were 3 to 15 years of age. Methods: A subsample of 1292 majority White families from the National Institute of Child Health and Human Development (NICHD) Study of Early Child Care and Youth Development (SECCYD) were included in the analyses. Measured height and weight were used to compute BMI z-scores. Youths reported on their friendship quality starting when they were 8-9 years. Peer competence was assessed with an observation of dyadic peer play when participants were 3 years old, and with maternal reports after that. Associations were examined using autoregressive cross-lagged path models. Results: Bidirectional associations between peer competence and friendship quality were noted when participants were 8-9 and 15 years old. Greater BMI z-scores when youths were 3 and 10-11 years old predicted lower peer competence when they were 15 and 11-12 years old, respectively. Peer competence when youths were 11-12 years old was negatively associated with BMI z-score at 15 years old. Multigroup Structural Equation Modeling (SEM) indicated that significant paths differed between boys and girls. Conclusions: Findings extend previous literature considering peer outcomes and weight by examining associations as early as 3 years old, and indicate the need for early outreach to buffer against detrimental effects on developing peer competencies, especially for girls.

Time-trends and correlates of obesity in Czech adolescents in relation to family socioeconomic status over a 16-year study period (2002-2018)

Background

The main objective of the study is to analyse the changes in the prevalence of obesity among Czech adolescents between 2002 and 2018 with regard to the socioeconomic status (SES) of adolescents’ families and to find SES-separated correlates of adolescents’ obesity in 2018.

Methods

A nationally representative sample of 29,879 adolescents (49.6% of them boys) aged 10.5–16.5 years was drawn from the Health Behaviour in School-aged Children cross-sectional, self-reported questionnaire surveys conducted in 2002, 2006, 2010, 2014, and 2018 in Czechia. Chi-square (χ²) tests were performed to assess the changes in the prevalence of obesity in both genders and all SES categories of adolescents between 2002 and 2018, and SES category-related differences in the prevalence of obesity in 2018 separately for boys and girls. A series of multiple stepwise logistic regression (backward elimination) analyses were used to reveal obesity correlates separately for SES categories of adolescents.

Results

Across the quadrennial surveys from 2002 to 2018, we observed a clear increase in the prevalence of obesity in all SES categories of adolescents, which was most striking (p < 0.05) in adolescents with low SES (boys: + 7.5% points (p.p.); girls + 2.4 p.p.). When all the survey cycles were compared, the highest prevalence of obesity was evident in the low-SES adolescents in 2018, both in girls (5.1%) and boys (12.0%). Regardless of the adolescent SES category, the lower odds of obesity were significantly (p < 0.05) associated with regular vigorous physical activity (PA), participation in organized sport, and daily consumption of sweets. In addition, at least 60 min of moderate-to-vigorous PA significantly reduced the odds of obesity in adolescents of low and high SES categories.

Conclusions

An unreasonable increase in the prevalence of obesity in adolescents with low SES highlights the need to prevent obesity in adolescents with a low-SES background. Additionally, significantly higher odds of obesity in 11- and 13-year-old adolescents from low-SES families, compared with their peers aged 15, indicated an expectable rise in obesity in older low-SES adolescents in the near future.

The association of weight status and weight perception with number of confidants in adolescents

Weight status and self-weight perception are related to social relationship issues. Studies have suggested links between non-normal weight status or weight perception and youths having fewer confidants, but these relationships are unclear and remain to be studied. This preliminary cross-sectional study examined the effects of weight status and weight perception on the number of confidants in adolescents. Self-report data from 15,279 grade 7–12 students (54.2% boys) were analyzed. The number of confidants (0–3 or ≥ 4) was examined, according to five weight status categories (underweight, low-normal weight, mid-normal weight (reference), high-normal weight, overweight, with Body Mass Index corresponding to ≤ 18.5, ≤ 20.0, ≤ 22.5, ≤ 25.0 and > 25.0 in adults, respectively), and five weight perception categories (too thin, a bit thin, good (reference), a bit fat, too fat). Boys and girls who were overweight and those who perceived themselves to be too fat were significantly more likely to have few confidants. High-normal weight in girls and self-perception of being a bit fat in boys were also associated with having few confidants. In boys, underweight and self-perception of being too thin were additionally associated with having few confidants. Adolescents with non-normal weight status or weight perception may have fewer confidants and require more social support.

Interpersonal difficulties in obesity: A systematic review and meta-analysis to inform a rejection sensitivity-based model

Obesity is associated with difficulties due to stigma and loneliness. These impact negatively on individuals' quality of life and behaviour change efforts. Increased sensitivity to others' negative feedback might play a role in the maintenance of these difficulties and could be addressed in psychological interventions. We conducted a systematic review of interpersonal difficulties in individuals with obesity, across the lifespan. We investigated early interpersonal adversity (i.e. frequency of teasing/bullying), perceived interpersonal stress and quality of social life, based on a rejection sensitivity model. The databases PubMed, Web of Knowledge and AGRIS, Embase, Medline and PsychINFO were searched for published peer-reviewed journal articles (1980-June 2018). Thirty-two studies met inclusion criteria. Results from the meta-analyses (n = 16 studies) indicated that overweight/obese individuals reported more frequent experiences of teasing/bullying, greater interpersonal stress and poorer quality of social life than healthy weight individuals. Findings in the systematic review aligned to this evidence. Psychological interventions targeting increased sensitivity to negative interpersonal feedback could improve interpersonal functioning and, in turn, eating behaviours in individuals with obesity.

Food Addiction: Implications for the Diagnosis and Treatment of Overeating

With the obesity epidemic being largely attributed to overeating, much research has been aimed at understanding the psychological causes of overeating and using this knowledge to develop targeted interventions. Here, we review this literature under a model of food addiction and present evidence according to the fifth edition of the Diagnostic and Statistical Manual (DSM-5) criteria for substance use disorders. We review several innovative treatments related to a food addiction model ranging from cognitive intervention tasks to neuromodulation techniques. We conclude that there is evidence to suggest that, for some individuals, food can induce addictive-type behaviours similar to those seen with other addictive substances. However, with several DSM-5 criteria having limited application to overeating, the term ‘food addiction’ is likely to apply only in a minority of cases. Nevertheless, research investigating the underlying psychological causes of overeating within the context of food addiction has led to some novel and potentially effective interventions. Understanding the similarities and differences between the addictive characteristics of food and illicit substances should prove fruitful in further developing these interventions.

Barriers and Enablers That Influence Overweight/Obesity/Obesogenic Behavior in Adolescents From Lower-Middle Income Countries: A Systematic Review

BACKGROUND

Overweight/obesity during adolescence in lower-middle income countries has become a public health problem with consequences in adulthood. Inadequate dietary habits, poor diet quality, sedentary behavior, and parental obesity have been reported.

OBJECTIVE

To describe management of obesity-like food habits and behavior of adolescents from lower-middle income countries with respect to what keeps them using this diet (barriers) and what helps them avoid it (enablers).

METHODS

Systematic review of the literature related to obesity and food intake of adolescents conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA).

RESULTS

We classified 11 eligible studies describing the barriers to and enablers of the management of obesity-like food intake and obesity lifestyle. The dual burdens of malnutrition and increased urbanization have been observed. There is preference for processed food, dietary habits, and obesity-like food intake and sedentary behavior. Barriers to managing body weight gain included mostly consumption of fast-food and snack food, less vegetable and fruit intake, skipping meals, and sedentary behavior. Enablers of managing body weight gain included changes in nutritional habits, perception of the consumption of healthy food, physical activity, and engagement in programs to change lifestyle.

CONCLUSION

The globalization of the fast food industry has provided an obesogenic environmental stimulus for adolescents in lower-middle income countries.

Higher Adherence to the Mediterranean Diet is Related to More Subjective Happiness in Adolescents: The Role of Health-Related Quality of Life

Adherence to the Mediterranean diet (MD) has previously been related to better quality of life in the general population. Further, children and adolescents have obtained better health outcomes when they have shown high adherence to the MD in recent studies. Nevertheless, the association between the adherence to this type of diet and subjective happiness have not been previously analysed in this population. The main aim of the present study was to evaluate the relationship between MD adherence, health-related quality of life (HRQOL) and subjective happiness in a sample of 527 Spanish adolescents. Results obtained show positive associations of MD adherence with higher levels of subjective happiness and better HRQOL. Moreover, mediation analyses showed a full mediation effect of some components of HRQOL, namely, emotional well-being, mood and emotions, financial resources and social acceptance, in the association between MD adherence and subjective happiness. This study advances our understanding of the association of MD and levels of happiness in the general population, specifically in adolescents, through the positive effects of specific components of HRQOL. Future studies should evaluate other variables that could influence or also mediate this relationship, evaluating specific groups of adolescents, such as clinical samples.

[Temporalities of care for obese teenagers]

Obesity in adolescents is a common reason for consulting a physician for angst associated with a need to lose weight. The multidisciplinary treatment takes into account the teenager's temporality. The duration of the initial treatment must be optimised in order to construct, with the teenager, a project which corresponds to his or her particular difficulties.

Longitudinal impacts of pubertal timing and weight status on adolescent Internet use: Analysis from a cohort study of Taiwanese youths

Aim

To investigate the longitudinal impacts of pubertal timing and weight status on Internet use in adolescents.

Methods

Three waves of data on a longitudinal cohort of 7^th grade students (N = 2430) were retrieved from the Taiwan Youth Project. Univariate and multivariate regression models were applied using crude and adjusted odds ratios (OR) with 95% confidence intervals (CI) to examine the concomitant impacts of pubertal timing and weight status on adolescent Internet use.

Results

The dataset identified 210 (8.7%) students using the Internet for more than 20 hours/week, and 81 (3.3%) were viewing pornographic material online. Early maturing and thin-weight adolescents were at 35% and 46% increased risks of spending long hours on Internet use, respectively. While early puberty was associated with online pornography viewing among males (adjusted OR 1.84, 95% CI 1.04–3.28), early puberty was contrarily a protective factor against online gaming in females (adjusted OR 0.59, 95% CI 0.36–0.96).

Conclusion

Early puberty was found to be positively related to adolescent Internet use. Appropriate health education and guidance regarding Internet use should be provided to those with different developing needs.