Obesity as a prospective predictor of depression in adolescent females

Associations between polygenic risk scores for cardiometabolic phenotypes and adolescent depression and body dissatisfaction

BACKGROUND

Adolescents with elevated body mass index (BMI) are at an increased risk for depression and body dissatisfaction. Type 2 diabetes (T2D) is an established risk factor for depression. However, shared genetic risk between cardiometabolic conditions and mental health outcomes remains understudied in youth.

METHODS

The current study examined associations between polygenic risk scores (PRS) for BMI and T2D, and symptoms of depression and body dissatisfaction, in a sample of 827 community adolescents (Mage = 13.63, SDage = 1.01; 76% girls). BMI, depressive symptoms, and body dissatisfaction were assessed using validated self-report questionnaires.

RESULTS

BMI-PRS was associated with phenotypic BMI (β = 0.24, p < 0.001) and body dissatisfaction (β = 0.17, p < 0.001), but not with depressive symptoms. The association between BMI-PRS and body dissatisfaction was significantly mediated by BMI (indirect effect = 0.10, CI [0.07-0.13]). T2D-PRS was not associated with depression or body dissatisfaction.

CONCLUSIONS

The results suggest phenotypic BMI may largely explain the association between genetic risk for elevated BMI and body dissatisfaction in adolescents. Further research on age-specific genetic effects is needed, as summary statistics from adult discovery samples may have limited utility in youth.

IMPACT

The association between genetic risk for elevated BMI and body dissatisfaction in adolescents may be largely explained by phenotypic BMI, indicating a potential pathway through which genetic predisposition influences body image perception. Furthermore, age-specific genetic research is needed to understand the unique influences on health outcomes during adolescence. By identifying BMI as a potential mediator in the association between genetic risk for elevated BMI and body dissatisfaction, the current findings offer insights that could inform interventions targeting body image concerns and mental health in this population.

Obesity and risk of depressive disorder in children and adolescents: A meta-analysis of observational studies

PURPOSE

This meta-analysis evaluated the relationship between overweight/obesity and depressive disorders in children and adolescents.

METHODS

We examined the databases of PubMed, Embase and Web of Science for pertinent observational studies released up until 20 February 2022. The pooled relative risks (RRs) and 95% confidence intervals (CIs) of obesity and overweight with depressive disorder were calculated by means of random-effects models. The Newcastle-Ottawa Quality Assessment Scale and Agency for Healthcare Research and Quality scale were adopted to evaluate the study quality.

RESULTS

Finally, for this meta-analysis, we evaluated 22 observational publications covering 175 135 participants (5 cohort study articles, 1 case-control study article and 16 cross-sectional study articles). A significant positive association was found between obesity and the risk of depression (RR 1.32, 95% CI 1.09-1.60, I2  = 79.90%, Pheterogeneity  < 0.001) and in the association between obesity and depressive symptoms (RR 1.16, 95% CI: 1.00-1.35, I2  = 25.0%, Pheterogeneity  = 0.247). On sensitivity analysis, the pooled RRs remained robust. Subgroup analysis indicated that obese children and teenagers in western countries were more prone to depression.

CONCLUSION

Evidence from this meta-analysis, based on observational studies, supported the idea that obese children and adolescents are more likely to experience depression and depressive symptoms.

The Relationship between Depressiveness and Eating Behaviors among Women

(1) The objective of the study was to determine the relationship between depressiveness and the occurrence of eating disorders, i.e., emotional eating, uncontrolled eating, cognitive restraint of eating, and the risk of orthorexia. (2) The study was conducted among 556 women from the West Pomeranian Voivodeship (Poland). The study employed the diagnostic survey method using a questionnaire technique: The Beck Depression Inventory, the ORTO-15 Questionnaire, the Three-Factor Eating Questionnaire, and a sociodemographic questionnaire. (3) Higher depressiveness severity is associated with a higher score on the "Cognitive Restraint of Eating" scale. The authors' original study demonstrated a statistically significant relationship only between depressiveness and the "Uncontrolled Eating" subscale (p = 0.001). (4) The results of this study suggest that depressiveness is an important factor that contributes to a better understanding of eating behaviors. In addition, the results of this study suggest that eating behaviors and psychological factors should be taken into account in psychological interventions in the treatment of eating disorders. The clinical goal can be considered to be an improvement in non-normative eating behaviors, such as a reduction in overeating episodes or eating less frequently in the absence of a feeling of hunger.

Longitudinal association between cardiovascular risk factors and depression in young people: a systematic review and meta-analysis of cohort studies

BACKGROUND

Depression is a common and serious mental illness that begins early in life. An association between cardiovascular disease (CVD) and subsequent depression is clear in adults. We examined associations between individual CVD risk factors and depression in young people.

METHODS

We searched MEDLINE, EMBASE, and PsycINFO databases from inception to 1 January 2020. We extracted data from cohort studies assessing the longitudinal association between CVD risk factors [body mass index (BMI), smoking, systolic blood pressure (SBP), total cholesterol, high-density lipoprotein] and depression, measured using a validated tool in individuals with mean age of 24 years or younger. Random effect meta-analysis was used to combine effect estimates from individual studies, including odds ratio (OR) for depression and standardised mean difference for depressive symptoms.

RESULTS

Based on meta-analysis of seven studies, comprising 15 753 participants, high BMI was associated with subsequent depression [pooled OR 1.61; 95% confidence interval (CI) 1.21-2.14; I2 = 31%]. Based on meta-analysis of eight studies, comprising 30 539 participants, smoking was associated with subsequent depression (pooled OR 1.73; 95% CI 1.36-2.20; I2 = 74%). Low, but not high, SBP was associated with an increased risk of depression (pooled OR 3.32; 95% CI 1.68-6.55; I2 = 0%), although this was based on a small pooled high-risk sample of 893 participants. Generalisability may be limited as most studies were based in North America or Europe.

CONCLUSIONS

Targeting childhood/adolescent smoking and obesity may be important for the prevention of both CVD and depression across the lifespan. Further research on other CVD risk factors including blood pressure and cholesterol in young people is required.

The moderating effect of physical activity on the relationship between bullying and mental health among sexual and gender minority youth

BACKGROUND

Sexual and gender minority youth frequently experience bullying, which often contributes to higher depressive symptoms and lower self-esteem. Given that physical activity (PA) can mitigate depressive symptoms and improve self-esteem, we examined the moderating effect of PA on the relationship between bullying and mental health among sexual and gender minority youth.

METHODS

Data from the Lesbian, Gay, Bisexual, Transgender, and Queer National Teen Survey (n = 9890) were analyzed. Hierarchical regression analyses examined the influence of history and frequency of being bullied, PA, and the interaction of these variables on depressive symptoms and self-esteem. Simple slopes analyses were used to probe significant interactions.

RESULTS

Results indicated the importance of accounting for bullying history when examining effects of PA on mental health. PA was negatively related to depression (t = -4.18, p < 0.001) and positively related to self-esteem (t = 12.11, p < 0.001). Bullying frequency was positively related to depression (t = 19.35, p < 0.001) and negatively related to self-esteem (t = -12.46, p < 0.001). There was a significant interaction between bullying frequency and PA for depression (t = 4.45, p < 0.001) and self-esteem (t = -4.69, p < 0.001). Post hoc analyses suggested that the positive effects of PA on mental health may be limited to those not bullied because it had a negligible effect on those who were bullied.

CONCLUSION

Results suggest that sexual and gender minority youth exercise interventions aiming to improve mental health should first address bullying history; otherwise, their effectiveness may be limited to those who have been bullied.

Obesity in adolescents may be associated with limitations in daily activities and an increased level of anxiety in patients and their parents - preliminary results of a pilot study

Obesity is a chronic disease, that in adolescents may lead to serious consequences affecting somatic and mental health. This study aimed to assess the prevalence of depressive symptoms and anxiety in adolescents with obesity and their parents. The relationships between depressive and anxiety symptoms and the somatic consequences of obesity were also analyzed.

MATERIAL AND METHODS

19 patients with obesity (BMI Z-SCORE 2.1-5.5), at the age 16-17, and their parents answered validated questionnaires (Children's Depression Inventory 2, The State-Trait Anxiety Inventory), and a survey assessing everyday functioning.

RESULTS

There were no significant differences in the occurrence of symptoms of depression in children and their parents: for the overall scale score of T-score (p=0.331), for the emotional problems (p=0.281) subscale, and the functional problems (p=0.147) subscale. The comparison of the results between boys and girls revealed no significant differences. A significantly higher level of anxiety was found in parents of children who gained weight in the year preceding the study (p = 0.046), and both in children and parents of children with metabolic-associated fatty liver disease - MAFLD (p=0.022 and p=0.007). According to adolescents, obesity affects the most leisure activities.

CONCLUSION

Obesity, like any chronic disease, can have a significant impact on the emotional state of children and adolescents as well as the possibility of realizing interests and spending free time. Much more important than depressive disorders are anxiety disorders concerning both patients and their parents.

Predicting South Korean adolescents vulnerable to obesity after the COVID-19 pandemic using categorical boosting and shapley additive explanation values: A population-based cross-sectional survey

OBJECTIVE

This study identified factors related to adolescent obesity during the COVID-19 pandemic by using machine learning techniques and developed a model for predicting high-risk obesity groups among South Korean adolescents based on the result.

MATERIALS AND METHODS

This study analyzed 50,858 subjects (male: 26,535 subjects, and female: 24,323 subjects) between 12 and 18 years old. Outcome variables were classified into two classes (normal or obesity) based on body mass index (BMI). The explanatory variables included demographic factors, mental health factors, life habit factors, exercise factors, and academic factors. This study developed a model for predicting adolescent obesity by using multiple logistic regressions that corrected all confounding factors to understand the relationship between predictors for South Korean adolescent obesity by inputting the seven variables with the highest Shapley values found in categorical boosting (CatBoost).

RESULTS

In this study, the top seven variables with a high impact on model output (based on SHAP values in CatBoost) were gender, mean sitting hours per day, the number of days of conducting strength training in the past seven days, academic performance, the number of days of drinking soda in the past seven days, the number of days of conducting the moderate-intensity physical activity for 60 min or more per day in the past seven days, and subjective stress perception level.

CONCLUSION

To prevent obesity in adolescents, it is required to detect adolescents vulnerable to obesity early and conduct monitoring continuously to manage their physical health.

Genetically-predicted prefrontal DRD4 gene expression modulates differentiated brain responses to food cues in adolescent girls and boys

The dopamine receptor 4 (DRD4) in the prefrontal cortex (PFC) acts to modulate behaviours including cognitive control and motivation, and has been implicated in behavioral inhibition and responsivity to food cues. Adolescence is a sensitive period for the development of habitual eating behaviors and obesity risk, with potential mediation by development of the PFC. We previously found that genetic variations influencing DRD4 function or expression were associated with measures of laboratory and real-world eating behavior in girls and boys. Here we investigated brain responses to high energy–density (ED) and low-ED food cues using an fMRI task conducted in the satiated state. We used the gene-based association method PrediXcan to estimate tissue-specific DRD4 gene expression in prefrontal brain areas from individual genotypes. Among girls, those with lower vs. higher predicted prefrontal DRD4 expression showed lesser activation to high-ED and low-ED vs. non-food cues in a distributed network of regions implicated in attention and sensorimotor processing including middle frontal gyrus, and lesser activation to low-ED vs non-food cues in key regions implicated in valuation including orbitofrontal cortex and ventromedial PFC. In contrast, males with lower vs. higher predicted prefrontal DRD4 expression showed minimal differences in food cue response, namely relatively greater activation to high-ED and low-ED vs. non-food cues in the inferior parietal lobule. Our data suggest sex-specific effects of prefrontal DRD4 on brain food responsiveness in adolescence, with modulation of distributed regions relevant to cognitive control and motivation observable in female adolescents.

Association of depressive disorder with biochemical and anthropometric indices in adult men and women

Depression is a common psychiatric disorder. Although many risk factors for depression have been reported, the associations of biochemical and anthropometric indices with depressive disorder remain unclear. The objective of this study was to assess whether there are significant associations of depressive disorder with biochemical and obesity indices. This study was based on data from the Korea National Health and Nutrition Examination Survey from 2007 to 2018, and logistic regression was performed to examine the association of depression with biochemical and obesity indices. A total of 33,993 subjects were included in the analyses. Study subjects consisted of 13,178 men in the control group (mean age of 51.12 years), 509 men in the depression group (53.67), 18,279 women in the control group (50.5), and 2027 women in the depression group (55.39). Among men, the depression group was significantly more likely to have a lower height and weight than the control group. Compared to the control group, the depression group was more likely to have higher triglyceride levels and tended to have lower hematocrit and blood urea nitrogen (BUN) levels. Among women, the depression group was more likely to have higher triglyceride, aspartate aminotransferase (AST), BUN, and creatinine levels and lower high-density lipoprotein cholesterol (HDL-C), hematocrit, and red blood cell counts. Several biochemical and anthropometric indices used in this study were associated with depressive disorder, but these associations may differ according to sex.

Costs associated with depression and obesity among cardiovascular patients: medical expenditure panel survey analysis

Background

There is a lack of information on the cost of depression associated with metabolic syndrome and cardiovascular diseases in the literature.

Methods

We evaluated the synergistic effects of depression and obesity on total expenditures for cardiovascular conditions using data from the Medical Expenditure Panel Survey (MEPS) database. We analyzed MEPS data from 1996 to 2017 comprising adult cardiovascular subjects. We categorized individuals following a combination of International Classification of Diseases ICD-9-CM and ICD-10 codes, and depression symptoms as evaluated using the Patient Health Questionnaire-2 (PHQ-2) depression screening tool. Our sample comprised cardiovascular patients aged 18 years and older, with a body mass index (BMI) between 18.5 and 60. Our study comprised unweighted sample of 96,697 (weighted sample of 938,835,031) adults, a US-nationwide representative sample of cardiovascular disease patients. The four response categories were: no depression; unrecognized depression; asymptomatic depression; and symptomatic depression. Our evaluated outcomes were total annual healthcare expenditures, including dental, emergency room, hospital outpatient, hospital inpatient, office-based, prescription, and home health care expenses.

Results

Asymptomatic and symptomatic depression was more frequent among obese individuals than in individuals with a normal BMI (p <  0.001). Total expenditure was highest among symptomatic depression individuals (17,536) and obese (9871) with cardiovascular disease. All the expenditure outcomes were significantly higher among symptomatic depression individuals than those without depression (p <  0.001), except for dental costs. All healthcare expenditures associated with obesity were higher compared to individuals with normal BMI with p <  0.001, except for emergency and home healthcare costs. Most importantly, among obese individuals, all healthcare expenditures were significantly higher (p <  0.001) in those with symptomatic depression than those without depression, except for dental costs, where the difference was not significant (0.899). Therefore, obesity and depression entail increased expenses in patients with cardiovascular disease.

Conclusions

We found incremental expenditures among unrecognized, asymptomatic, and symptomatic depressed individuals with obesity compared to non-depressed, non-obese subjects. However, these are preliminary results that should be further validated using different methodologies.

Study of the effect of family communication and function, and satisfaction with body image, on psychological well-being of obese girls: the mediating role of self-esteem and depression

BACKGROUND

Obesity has become a global problem in childhood and adolescence. The objective of the present study was to investigate the impact of family communication and function, and body image satisfaction, on psychological well-being by considering: the mediating role of self-esteem and depression.

METHODS

In this cross sectional study, 173 obese and overweight female students were selected and evaluated based on body image satisfaction, self-esteem, depression, psychological well-being, functioning, and family Communication. The proposed model was evaluated through structural equation modeling, using AMOS and SPSS software.

RESULTS

Results showed that family communication and function directly affected adolescents' psychological well-being. In addition, family communication and function, as well body image satisfaction indirectly affected psychological well-being through self-esteem and depression.

CONCLUSION

The current finding suggests that the psychological well-being of obese adolescent girls is associated with many factors, including family functioning and communication, body image satisfaction, self-esteem, and depression. The factors identified in this study may be helpful for mental health policy-makers, in planning and implementing preventive and therapeutic intervention programs.

Association between overweight/obesity with depression, anxiety, low self-esteem, and body dissatisfaction in children and adolescents: a systematic review and meta-analysis of observational studies

PURPOSE

Childhood and Adolescent overweight and obesity may be associated with psychological problems. We aimed to conduct a systematic review and summarize published articles on the association between overweight/obesity with risk of depression, anxiety, low self-esteem, and body dissatisfaction among children and adolescents.

METHODS

PubMed and Scopus databases were used to conduct a comprehensive search and identify eligible literature published prior to July 2020. The random-effects models (DerSimonian-Laird method) were applied to pool the effect sizes. Subgroup analysis was performed to find potential sources of heterogeneity.

RESULTS

28 studies (3 prospective cohorts and 25 cross-sectional) were included in the current systematic review and meta-analysis. The total sample sizes ranged from 244 to 60252. A positive significant association was found between overweight (pooled risk estimate: 1.15, 95% CI: 1.00-1.31, P = 0.04) and obesity (pooled risk estimate: 1.53, 95% CI: 1.16-2.02, P = 0.003) with risk of low self-esteem, respectively. A significant positive association was found between obesity and risk of body dissatisfaction (pooled risk estimate: 4.05, 95% CI: 2.34-7.023, P = 0.0001). Moreover, no association was found between overweight and risk of body dissatisfaction among children and adolescents. Also, no association was observed between overweight/obesity and risk of depression and anxiety.

CONCLUSIONS

Findings showed a positive association between obesity and the risk of body dissatisfaction and low self-esteem among children and adolescents. Moreover, there was a significant positive association between overweight and the risk of low self-esteem.

Predicted DRD4 prefrontal gene expression moderates snack intake and stress perception in response to the environment in adolescents

Body weight is substantially determined by eating behaviors, which are themselves driven by biological factors interacting with the environment. Previous studies in young children suggest that genetic influences on dopamine function may confer differential susceptibility to the environment in such a way that increases behavioral obesity risk in a lower socioeconomic status (SES) environment but decreases it in a higher SES environment. We aimed to test if this pattern of effect could also be observed in adolescence, another critical period for development in brain and behavior, using a novel measure of predicted expression of the dopamine receptor 4 (DRD4) gene in prefrontal cortex. In a sample of 76 adolescents (37 boys and 39 girls from Baltimore, Maryland/US, aged 14-18y), we estimated individual levels of DRD4 gene expression (PredDRD4) in prefrontal cortex from individual genomic data using PrediXcan, and tested interactions with a composite SES score derived from their annual household income, maternal education, food insecurity, perceived resource availability, and receipt of public assistance. Primary outcomes were snack intake during a multi-item ad libitum meal test, and food-related impulsivity assessed using a food-adapted go/no-go task. A linear regression model adjusted for sex, BMI z-score, and genetic ethnicity demonstrated a PredDRD4 by composite SES score interaction for snack intake (p = 0.009), such that adolescents who had lower PredDRD4 levels exhibited greater snack intake in the lower SES group, but lesser snack intake in the higher SES group. Exploratory analysis revealed a similar pattern for scores on the Perceived Stress Scale (p = 0.001) such that the low PredDRD4 group reported higher stress in the lower SES group, but less stress in the higher SES group, suggesting that PredDRD4 may act in part by affecting perceptions of the environment. These results are consistent with a differential susceptibility model in which genes influencing environmental responsiveness interact with environments varying in obesogenicity to confer behavioral obesity risk in a less favorable environment, but behavioral obesity protection in a favorable one.

The effects of parental and peer factors on psychiatric symptoms in adolescents with obesity

PURPOSE

The aim of this study was to examine the relationships among psychiatric symptoms, effect of beliefs and attitudes of parents about obese people and victimization or bullying in obese adolescents.

METHODS

The study group included 110 obese or overweight adolescents and 55 adolescents of normal weight as the control group. All adolescents completed the Brief Symptom Inventory (BSI) and Traditional Bullying Scale. The parents completed the Attitudes Toward Obese Persons (ATOP) Scale and Beliefs About Obese Persons (BAOP) Scale.

RESULTS

The BSI subscale scores for depression were significantly higher in the study group. There was no significant relationship found between psychiatric symptoms of obese or overweight adolescents and the ATOP and BAOP scores of parents. When victims, bullies/victims, bullies and those not included in any group among obese or overweight adolescents were examined, psychiatric symptoms of victims and bullies/victims were significantly higher.

CONCLUSIONS

The results of this study suggest that the clinical treatment of obesity is not just a matter of diet and exercise but additionally dealing with issues of depression and anxiety. A very satisfactory result of the study was that parents of obese or overweight adolescents did not show an increased weight bias. This study has also shown the association between negative social and psychological ramifications, as the study group was more likely to be the victims and perpetrators of bullying behaviors than their normal-weight peers.

LEVEL OF EVIDENCE

Level III, case-control analytic study.

The occurrence of depressive symptoms in obese subjects starting treatment and not seeking treatment for obesity

INTRODUCTION

The psychological profile of obese people deciding to start obesity treatment may be different from those not choosing to seek the therapy. Previous studies have shown a higher incidence of depression in obese than in normal weight people. However, data are lacking concerning the occurrence of depressive symptoms and their severity in obese subjects who do or do not decide to start treatment for obesity. Therefore, the aim of this study was to evaluate the prevalence and severity of depressive symptoms among obese people starting treatment and not seeking treatment for obesity.

MATERIALS AND METHODS

Enrolled subjects were 331 adults (241 women, 90 men), including 193 obese subjects starting treatment for obesity (46.8 ± 13.2 years, BMI 37.6 ± 5.5 kg/m2) and 138 obese volunteers never seeking treatment for obesity (44.3 ± 12.5 years, BMI 34.7 ± 4.3 kg/m2). Depression levels were determined using the Beck Depression Inventory (BDI).

RESULTS

The level of depression was significantly higher among those starting treatment for obesity than those never seeking treatment for obesity (13.2 ± 9.2 vs. 9.5 ± 7.9 points; p < 0.001). This difference was statistically significant in women (14.4 ± 9.2 and 11.0 ± 8.2 points, respectively; p < 0.01), but not in men (7.2 ± 6.4 and 7.3 ± 7.1 points, respectively; p = 0.95). There were more women with moderate/severe depressive symptoms in the group starting treatment than in the group not seeking treatment for obesity (44.7 and 24.4%, respectively). No such difference was observed in men.

CONCLUSIONS

Obese subjects, especially women, with depressive symptoms are more likely to start treatment for obesity.

LEVEL OF EVIDENCE

Level III, case-control analytic study.

Anxiety and depression in children and adolescents with obesity: a nationwide study in Sweden

BACKGROUND

Anxiety and depression are more common in children with obesity than in children of normal weight, but it is unclear whether this association is independent of other known risk factors. Interpretation of results from previous studies is hampered by methodological limitations, including self-reported assessment of anxiety, depression, and anthropometry. The aim of this study was to investigate whether obesity increases the risk of anxiety or depression independently of other risk factors in a large cohort of children and adolescents, using robust measures with regard to exposure and outcome.

METHODS

Children aged 6-17 years in the Swedish Childhood Obesity Treatment Register (BORIS, 2005-2015) were included (n = 12,507) and compared with a matched group (sex, year of birth, and area of residence) from the general population (n = 60,063). The main outcome was a diagnosis of anxiety or depression identified through ICD codes or dispensed prescribed medication within 3 years after the end of obesity treatment. Hazard ratios (HRs) with 95% confidence intervals (CIs) from Cox proportional models were adjusted for several known confounders.

RESULTS

Obesity remained a significant risk factor for anxiety and depression in children and adolescents after adjusting for Nordic background, neuropsychiatric disorders, family history of anxiety/depression, and socioeconomic status. Girls in the obesity cohort had a 43% higher risk of anxiety and depression compared to girls in the general population (adjusted HR 1.43, 95% CI 1.31-1.57; p < 0.0001). The risk in boys with obesity was similar (adjusted HR 1.33, 95% CI 1.20-1.48; p < 0.0001). In sensitivity analyses, excluding subjects with neuropsychiatric disorders and a family history of anxiety/depression, the estimated risks in individuals with obesity were even higher compared with results from the main analyses (adjusted HR [95% CI]: girls = 1.56 [1.31-1.87], boys = 2.04 [1.64-2.54]).

CONCLUSIONS

Results from this study support the hypothesis that obesity per se is associated with risk of both anxiety and depression in children and adolescents.

Childhood overweight and obesity and the risk of depression across the lifespan

BACKGROUND

Obesity has been longitudinally associated with depression but only few studies take a life course approach. This longitudinal study investigates whether being overweight or obese at age 8 and 13 years is associated with depressive symptoms more than 60 years later and whether this association is independent of late-life body mass index (BMI). We also investigated the association of being overweight/obese at age 8 or 13 years with ever having major depressive disorder (lifetime MDD).

METHOD

This analysis is based on a sub-sample of 889 AGES-Reykjavik participants with measured BMI data from early life. Late-life depressive symptoms were measured with the Geriatric Depression Scale (GDS) and lifetime MDD was assessed at late-life using the Mini International Neuropsychiatric Interview. Logistic regression analysis was used to estimate the relationships between BMI (continuous and categorical) at age 8 or 13 years, and late-life depressive symptoms (measured as GDS ≥ 5) or lifetime MDD, adjusted for sex, education, physical activity, smoking status and alcohol use. In a separate model, additional adjustments were made for late-life BMI.

RESULTS

One hundred and one subjects (11%) had depressive symptoms at late-life (GDS ≥ 5), and 39 subjects (4.4%) had lifetime MDD. Being overweight or obese at age 8 or 13 years was not associated with higher depressive symptoms during late-life, irrespective of late-life BMI. Being overweight or obese at age 8 years, but not age 13 years was associated with an increased risk of lifetime MDD (Odds Ratio (OR) (95% confidence interval [CI]) for age 8 = 4.03[1.16-13.96]P = 0.03 and age 13 = 2.65[0.69-10.26] P = 0.16, respectively).

CONCLUSION

Being overweight in childhood was associated with increased odds of lifetime MDD, although the magnitude of the risk is uncertain given the small numbers of participants with lifetime MDD. No clear association was observed between childhood and adolescent overweight/obesity and late-life depressive symptoms irrespective of late life BMI.

The Cognitive, Behavioral, and Emotional Aspects of Eating Habits and Association With Impulsivity, Chronotype, Anxiety, and Depression: A Cross-Sectional Study

Background and objectives: Understanding behavioral issues associated with eating would provide important insight into obesity development and possibly procure ways to prevent its occurrence or to treat it. This study's objectives were to examine links between cognitive, behavioral, and emotional aspects of eating habits and chronotype, impulsivity, anxiety, and depression among university students.

Subjects and methods: The following questionnaires were used: TFEQ-R 18, UPPS-short, HADS, and MEQ. All participants gave their informed written consent prior to enrolment.

Results: Among females, increased BMI was associated to uncontrolled eating and emotional eating, while in males, BMI was associated to emotional eating only. In males, no associations of BMI with impulsivity were found while in females they were present. Chronotype scores were positively correlated to cognitive restraint and negatively to uncontrolled eating among males. No associations were found for females. CR was lower among females with higher depression scores, while higher anxiety scores were associated to UE among males.

Conclusions: This was a cross-sectional study of three cognitive and emotional domains related to eating habits among university students (young adults). Results showed significant correlations between BMI, TFEQ-R18 scores, impulsivity and anxiety or depression. Future studies should replicate findings in samples of individuals with different aspects of eating disorders such as binge eating disorder, food addiction or bulimia nervosa.

Is obesity associated with depression in children? Systematic review and meta-analysis

OBJECTIVES

To compare the odds of depression in obese and overweight children with that in normal-weight children in the community.

DESIGN

Systematic review and random-effect meta-analysis of observational studies.

DATA SOURCES

EMBASE, PubMed and PsychINFO electronic databases, published between January 2000 and January 2017.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

Cross-sectional or longitudinal observational studies that recruited children (aged <18 years) drawn from the community who had their weight status classified by body mass index, using age-adjusted and sex-adjusted reference charts or the International Obesity Task Force age-sex specific cut-offs, and concurrent or prospective odds of depression were measured.

RESULTS

Twenty-two studies representing 143 603 children were included in the meta-analysis. Prevalence of depression among obese children was 10.4%. Compared with normal-weight children, odds of depression were 1.32 higher (95% CI 1.17 to 1.50) in obese children. Among obese female children, odds of depression were 1.44 (95% CI 1.20 to 1.72) higher compared with that of normal-weight female children. No association was found between overweight children and depression (OR 1.04, 95% CI 0.95 to 1.14) or among obese or overweight male subgroups and depression (OR 1.14, 95% CI 0.93 to 1.41% and 1.08, 95% CI 0.85 to 1.37, respectively). Subgroup analysis of cross-sectional and longitudinal studies separately revealed childhood obesity was associated with both concurrent (OR 1.26, 95% CI 1.09 to 1.45) and prospective odds (OR 1.51, 95% CI 1.21 to 1.88) of depression.

CONCLUSION

We found strong evidence that obese female children have a significantly higher odds of depression compared with normal-weight female children, and this risk persists into adulthood. Clinicians should consider screening obese female children for symptoms of depression.

BACKGROUND

Childhood mental illness is poorly recognised by healthcare providers and parents, despite half of all lifetime cases of diagnosable mental illness beginning by the age of 14 years. ¹ Globally, depression is the leading cause of disease burden, as measured by disability-adjusted life years, in children aged 10-19 years. ² Untreated, it is associated with poor school performance and social functioning, substance misuse, recurring depression in adulthood and increased suicide risk, which is the second leading cause of preventable death among young people. ^3-6 The resulting cost to the National Health Service of treating depression is estimated at over £2 billion, and the wider social and economic impact of depression is likely to be considerable. ⁷.

Identifying Differences in the Prevalence of Psychological Symptoms between Underweight, Normal Weight, Overweight, and Obese Children in Primary Care

BACKGROUND

The prevalence of childhood obesity continues to be a major public health problem. Nearly one-third of children in the United States can be classified as overweight or obese, which is particularly concerning given that obesity is associated with a number of physical and mental health problems. Past studies have examined childhood obesity and psychological symptoms using samples of referred children who have already been identified as overweight or obese, leaving out children who are classified as underweight or healthy weight. This study aims to bridge this gap in the literature by evaluating differences in psychological symptoms among children who fall within all weight ranges within primary care.

METHODS

Data was obtained from a systematic chart review using EMR (Electronic Medical Record) for children ages 6 to 16 years from two primary care health clinics. Differences between weight groups regarding reported internalizing and externalizing symptoms were evaluated utilizing data from the Pediatric Behavioral Health Screen (PBHS).

RESULTS

Significant overall psychological symptoms (internalizing and externalizing) were endorsed for 13.2% of the sample (p > .01). Chi-Square analyses determined that the relationship between internalizing symptoms and weight category were significant. Specifically, children who were classified as overweight or obese were more likely to report significant internalizing symptoms than underweight or healthy weight children.

CONCLUSIONS

Children who fall into the overweight and obese weight categories may need to be screened for psychological symptoms and referred for mental health services following overweight/obese classification in primary care.

Prevalence of childhood mental disorders in overweight and obese Spanish children: Identifying loss of control eating

The aim was to examine the prevalence of childhood mental disorders in overweight/obese pediatric sample and also to explore the relationship between these pathologies and loss of control eating (LOC). Another aim was to assess the association between psychopathology and severity of obesity. A total of 170 children from different Health Centers were evaluated (84 girls and 86 boys; aged 8 to 12 years). Childhood psychological problems were assessed through a standardized diagnostic interview schedule (K-SADS-R) and by questionnaires (STAIC for anxiety, CDI for depression and ChEAT for disordered eating). Loss of control eating episodes were evaluated through the diagnostic interview. Of the sample, 57.06% of overweight/obese children met a DSM-5 diagnosis, typically an anxiety disorder; and 33.53% of the overweight/obese children presented loss of control eating episodes. We found more pathologic eating attitudes (ChEAT) in children who presented LOC versus children who did not. Finally, the scores obtained in the STAIC correlated positively with z-BMI and a positive association was found between z-BMI and the presence of episodes of LOC. These results highlight the importance of including psychological component in the initial assessment and contribute to the understanding of LOC episodes, which are still underestimated in childhood obesity.

Vast Differences in Psychotropic Prescription Rates, But Not Outcomes, for Obese Adolescents in Immersion Treatment across Geographical Regions

BACKGROUND

Pediatric obesity is recognized as a worldwide epidemic. Treatment of this problem has proven difficult, but many promising interventions exist, including immersion treatment. The purpose of this study is to examine the potential influence of psychotropic medications on immersion treatment outcomes in a real-world treatment setting.

METHODS

This study examines the prescription rates of psychotropic medications and treatment process and outcomes of 642 adolescents in ten different cognitive behavioral therapeutic immersion weight-loss camps in the United States and in the United Kingdom.

RESULTS

The US participants received psychotropic medications at drastically varying rates by geographical location and overall at almost ten times the rate of UK participants. Those taking psychotropic medications engaged in treatment and decreased percentage overweight at similar rates as their nonmedicated peers. The medication group reported higher initial and final rates of distress, but both groups improved their moods during camp and exhibited smaller differences in mood ratings by the end of camp.

CONCLUSIONS

Significantly higher prescription rates of psychotropic medication, especially evident comparing the United States to the United Kingdom, were unrelated to immersion obesity treatment process and outcomes for youth. Immersion treatment for obese adolescents appears effective regardless of psychotropic medication status of the participant. This finding supports the use of cognitive behavioral immersion treatments for adolescent obesity and leads to several possible conclusions and directions for future study.

Estrogen signaling in the medial amygdala decreases emotional stress responses and obesity in ovariectomized rats

Declining estradiol (E2), as occurs during menopause, increases risk for obesity and psychopathology (i.e., depression, anxiety). E2 modulates mood and energy homeostasis via binding to estrogen receptors (ER) in the brain. The often comorbid and bidirectional relationship between mood and metabolic disorders suggests shared hormonal and/or brain networks. The medial amygdala (MeA) is abundant in ERs and regulates mood, endocrine, and metabolic stress responses; therefore we tested the hypothesis that E2 in the MeA mitigates emotional and metabolic dysfunction in a rodent model of surgical menopause. Adult female rats were ovariectomized (OVX) and received bilateral implants of E2 or cholesterol micropellets aimed at the MeA. E2-MeA decreased anxiety-like (center entries, center time) and depression-like (immobility) behaviors in the open field and forced swim tests (FST), respectively in ovariectomized rats. E2-MeA also prevented hyperphagia, body weight gain, increased visceral adiposity, and glucose intolerance in ovariectomized rats. E2-MeA decreased caloric efficiency, suggestive of increased energy expenditure. E2-MeA also modulated c-Fos neural activity in amygdalar (central and medial) and hypothalamic (paraventricular and arcuate) brain regions that regulate mood and energy homeostasis in response to the FST, a physically demanding task. Given the shared neural circuitry between mood and body weight regulation, c-Fos expression in discrete brain regions in response to the FST may be due to the psychologically stressful and/or metabolic demands of the task. Together, these findings suggest that the MeA is a critical node for mediating estrogenic effects on mood and energy homeostasis.

An individually tailored family-centered intervention for pediatric obesity in primary care: study protocol of a randomized type II hybrid effectiveness-implementation trial (Raising Healthy Children study)

BACKGROUND

Pediatric obesity is a multi-faceted public health concern that can lead to cardiovascular diseases, cancers, and early mortality. Small changes in diet, physical activity, or BMI can significantly reduce the possibility of developing cardiometabolic risk factors. Family-based behavioral interventions are an underutilized, evidence-based approach that have been found to significantly prevent excess weight gain and obesity in children and adolescents. Poor program availability, low participation rates, and non-adherence are noted barriers to positive outcomes. Effective interventions for pediatric obesity in primary care are hampered by low family functioning, motivation, and adherence to recommendations.

METHODS

This (type II) hybrid effectiveness-implementation randomized trial tests the Family Check-Up 4 Health (FCU4Health) program, which was designed to target health behavior change in children by improving family management practices and parenting skills, with the goal of preventing obesity and excess weight gain. The FCU4Health is assessment driven to tailor services and increase parent motivation. A sample of 350 families with children aged 6 to 12 years who are identified as overweight or obese (BMI ≥ 85th percentile for age and gender) will be enrolled at three primary care clinics [two Federally Qualified Healthcare Centers (FQHCs) and a children's hospital]. All clinics serve predominantly Medicaid patients and a large ethnic minority population, including Latinos, African Americans, and American Indians who face disparities in obesity, cardiometabolic risk, and access to care. The FCU4Health will be coordinated with usual care, using two different delivery strategies: an embedded approach for the two FQHCs and a referral model for the hospital-based clinic. To assess program effectiveness (BMI, body composition, child health behaviors, parenting, and utilization of support services) and implementation outcomes (such outcomes as acceptability, adoption, feasibility, appropriateness, fidelity, and cost), we use a multi-method and multi-informant assessment strategy including electronic health record data, behavioral observation, questionnaires, interviews, and cost capture methods.

DISCUSSION

This study has the potential to prevent excess weight gain, obesity, and health disparities in children by establishing the effectiveness of the FCU4Health and collecting information critical for healthcare decision makers to support sustainable implementation of family-based programs in primary care.

TRIAL REGISTRATION

NCT03013309 ClinicalTrials.gov.

A Nurse-Led and Teacher-Assisted Adolescent Healthy Weight Program to Improve Health Behaviors in the School Setting

Adolescents with overweight and obesity are at risk for future health problems. The purpose of this study was to examine the feasibility and initial efficacy of a weight management intervention to help adolescents develop healthy nutrition and physical activity behaviors and improve their anthropometrics. This study used a single-group repeated measures design in a small school in Durham, North Carolina (NC). The intervention consisted of a nurse-led and teacher-assisted nutrition and physical activity education and exercise classes that met twice each week for 45–60 minutes for 7 weeks. Data were collected at Time 1 (baseline), Time 2 (after intervention completion), and Time 3 (after 3 months on their own). Interview feedback, low cost, and successful completion of all planned activities indicated that all stakeholders found the project beneficial and suitable for their school. This study suggests that a weight management intervention for adolescents was feasible in the school setting.

Depressive Symptoms During Adolescence Predict Adulthood Obesity Among Black Females

AIM

This study aimed to investigate gender differences in the association between baseline depressive symptoms and subsequent changes in obesity in a sample of urban Black youth in the USA.

METHODS

The current study followed 681 Black youth (335 male and 346 female) for up to 18 years from 1994 to 2012. All youth were selected from an economically disadvantaged urban area in MI, USA. The main independent variable was baseline depressive symptoms measured in 1994. The main outcome was change in body mass index (BMI) from 1999 to 2012, calculated based on self-reported height and weight. Scio-demographics (age, number of parents in the household, and parental employment) were covariates. Gender was the focal moderator. We used linear regressions to test the predictive role of baseline depressive symptoms on change in BMI (from 1999 to 2012) in the pooled sample, and also based on gender.

RESULTS

Among Black females, but not Black males, baseline depressive symptoms predicted the BMI change from 1999 to 2012. The association remained significant for Black females after controlling for covariates.

CONCLUSION

High depressive symptoms at baseline better predict BMI change over the next decade for female than male Black youth. As a result, detection and reduction of depressive symptoms may be a vital element of obesity prevention programs for Black females. Policies and programs that address determinants of psychological distress as a strategy to prevent obesity among female Black youth in disadvantaged neighborhoods may be especially useful.

Exploring the association between childhood and adolescent obesity and depression: a meta-analysis

This meta-analysis aimed to evaluate the association between childhood and adolescent obesity and depression. We systematically searched PubMed, PsycInfo, EMBASE and Science Direct for studies that compared prevalence of depression and depressive symptoms in normal weight and obese children and adolescents. Observational studies were included if they reported body mass index and assessed depression by validated instruments or diagnostic interviews. Quality assessment was performed using the Newcastle-Ottawa scale. We used the random-effect model to calculate the pooled odds ratios, standard mean differences (SMDs) and subgroup analysis. Findings for a total of 51,272 participants were pooled across 18 studies and examined. Our analyses demonstrated a positive association between childhood and adolescent obesity and depression (pooled odds ratio = 1.34, 95% confidence interval [CI]: 1.1-1.64, p = 0.005) and more severe depressive symptoms (SMD = 0.23, 95% CI: 0.025-0.44, p = 0.028) in the obese groups. Overweight subjects were not more likely to have either depression (pooled odds ratio = 1.16, 95% CI: 0.93-1.44, p = 0.19) or depressive symptoms (SMD = 0, 95% CI: -0.101 to 0.102, p = 0.997). Non-Western and female obese subjects were significantly more likely to have depression and severe depressive symptoms (p < 0.05). In conclusion, obese children and adolescents are more likely to suffer from depression and depressive symptoms, with women and non-Western people at higher risk.

Effect of Motivational Interviewing on depression scale scores of adolescents with obesity and overweight

The aim of this study was to compare the effect of motivational interview (MI) with conventional care on the depression scale scores of adolescents with obesity/overweight. It was a controlled cluster randomized trial with parallel design, including two groups: intervention group [Motivational Interview Group (MIG)], control group [Conventional Intervention Group (CIG)].

INTERVENTION

three face-to-face 30min' interviews three months apart (only MIG interviews were based on MI principles).

OUTCOMES

change in Children Depression Inventory (CDI) scores. We used a mixed repeated-measures ANOVAs analysis to assess the group vs time interaction. Effect size was calculated for ANOVA with difference of means of the total score (DOMTS). CDI scores were compared by a paired t-test. Eighty-three (84%) adolescents finished the intervention. There was a significant time vs group interaction both groups. While in the CIG scores significantly increased, in the MIG the scores significantly decreased. The DOMTS was significantly different between the two groups. We concluded that MI showed a positive effect on depression scale scores over time relatively to conventional intervention.

Gynecologic and Obstetric Consequences of Obesity in Adolescent Girls

In the past few decades, there has been an overwhelming increase in childhood and adolescent obesity worldwide. Besides the well recognized cardiometabolic complications and other physical conditions associated with obesity, during adolescence, it causes psychological and social distress in a period of life that is already sensitive for a girl. This in turn increases their risk of low self-esteem and depression. Furthermore, obesity diminishes health-related quality of life and years of life. Overweight and obese teenagers are more likely to have gynecologic and obstetric complications, during adolescence and also later in life. Consequences of obese and overweight childhood and adolescence include sexual maturation and reproductive dysfunction, alterations in menstruation, dysmenorrhea, risky sexual behavior, and inefficient use of contraception, polycystic ovary syndrome, bone density abnormalities, macromastia, and an increased risk of breast and endometrial cancer. Obese adolescents are at greater risk of pregnancy and perinatal complications, such as preeclampsia, gestational hypertension and preeclampsia, gestational diabetes mellitus, primary cesarean delivery, and induction of labor, to mention a few. Evidence shows that infants born to obese teenagers are also more likely to have complications including preterm or post-term delivery, small-for-gestational age newborns, macrosomia, meconium aspiration, respiratory distress, and even stillbirth, among others. This comprehensive review focuses on the gynecological and obstetric consequences of obesity in adolescent girls.

The role of obesity measures in the development and persistence of major depressive disorder

BACKGROUND

The role of obesity with the development of major depressive disorder (MDD) requires conformation and whether obesity contributes to more chronic depression in persons with established (MDD) is unknown. This study examined the longitudinal relationship of body mass index (BMI) and waist circumference with the incidence and persistence of MDD over 2-year and 6-year periods.

METHOD

Data were sourced from the Netherlands Study of Depression and Anxiety. MDD was established with Composite International Diagnostic Interviews. The relationship of BMI and waist circumference with the development of depression two and six years later were estimated in the subsample with no current psychopathology at baseline. Associations with the persistence of depression was estimated in the subsample with current MDD.

RESULTS

Higher BMI at baseline, but not waist circumference, slightly increased the odds of the development of MDD after two years (odds ratio (OR) per standard deviation increase: 1.11; p=0.03), This relationship was not significant after adjustment for health and lifestyle variables. Conversely, over a 6-year period both BMI and waist circumference moderately increased the odds of developing MDD even after adjustment (OR:1.17; p=0.05, OR:1.20; p=0.05). Persistence of MDD in currently depressed subjects, is not related with BMI or waist circumference (adjusted OR:0.93; p=0.2, OR:0.91; p=0.15).

LIMITATIONS

Development of depression may differ in participants lost to follow-up.

CONCLUSION

Over a 6 year period, patients with higher BMI show a slightly increased risk of development of depression. However, in depressed patients there is no relationship between BMI and the persistence of depression.

A Qualitative Approach: Evaluating the Childhood Health and Obesity Initiative Communities Empowered for Success (CHOICES) Pilot Study

Low-income and minority children are susceptible to obesity due to the social and environmental barriers that influence their health behaviors. Many programs and interventions fail to account for these aforementioned barriers among this population. Given what we know about the complexity of childhood obesity, low-income and minority children require innovative prevention strategies from those used in traditional childhood obesity interventions. The purpose of this study was to describe the evaluation of a 6-week summer childhood obesity pilot intervention designed for low-income and minority children. Focus groups and interviews (N = 29) were conducted among caregivers. Overall, caregivers indicated that the experience was mostly positive for their children who obtained small amounts of knowledge and behavioral changes. Caregivers also noted several perceived barriers for intervention completion. The CHOICES intervention is a promising approach that warrants attention in future childhood obesity intervention design. Interventions involving low-income and minority children should aim to help participants make healthier choices given the environmental and social barriers that cannot be overlooked or changed.

Cognitive-Behavioral Therapy Plus Healthy Lifestyle Enhancement for Depressed, Overweight/Obese Adolescents: Results of a Pilot Trial

The objective of this article was to conduct a treatment development study to examine the feasibility, acceptability, and preliminary efficacy of treating depressed, overweight/obese adolescents using both an exercise regimen and a Cognitive Behavioral Therapy (CBT) protocol modified to address aspects of healthy living and nutrition (CBT plus healthy lifestyle; CBT-HL). A randomized controlled repeated measures design was used to test the hypothesis that CBT-HL would lead to greater reductions in depressed mood and weight compared to CBT for Depression Only (CBT). Participants (n=33; 24 in CBT-HL condition) included 33 adolescents (median age 15, 73% female, 61% white, 36% Hispanic) who met DSM-IV criteria for Current Major Depressive Episode (MDE) and had BMI ≥ 85th percentile. CBT-HL was found to be feasible to implement with most adolescents. Both conditions resulted in improvement in depressed mood. The CBT-HL protocol was more effective in stabilizing weight status as assessed by BMI. Percent time spent in MVPA was increased at 12 weeks for adolescents in CBT-HL compared to those in CBT. The CBT-HL protocol was acceptable to most, but not all, adolescents, and resulted in an improvement in depressed mood as well as stabilization of weight status. A larger study to test efficacy and moderators of treatment outcome is necessary to better understand which adolescents would benefit most from the increased demands of exercise and adhering to nutrition recommendations in addition to standard CBT for depression. Revisions to the treatment protocol to support weight loss, not just stabilization, are also suggested.

Prospective Associations between Depression and Obesity for Adolescent Males and Females- A Systematic Review and Meta-Analysis of Longitudinal Studies

Adolescent obesity and depression are increasingly prevalent and are currently recognised as major public health concerns worldwide. The aim of this study is to evaluate the bi-directional associations between obesity and depression in adolescents using longitudinal studies. A systematic literature search was conducted using Pubmed (including Medline), PsycINFO, Embase, CINAHL, BIOSIS Preview and the Cochrane Library databases. According to the inclusion criteria, 13 studies were found where seven studies evaluated depression leading to obesity and six other studies examined obesity leading to depression. Using a bias-adjusted quality effects model for the meta-analysis, we found that adolescents who were depressed had a 70% (RR 1.70, 95% CI: 1.40, 2.07) increased risk of being obese, conversely obese adolescents had an increased risk of 40% (RR 1.40, 95% CI: 1.16, 1.70) of being depressed. The risk difference (RD) of early adolescent depression leading to obesity is 3% higher risk than it is for obesity leading to depression. In sensitivity analysis, the association between depression leading to obesity was greater than that of obesity leading to depression for females in early adulthood compared with females in late adolescence. Overall, the findings of this study suggest a bi-directional association between depression and obesity that was stronger for female adolescents. However, this finding also underscores the importance of early detection and treatment strategies to inhibit the development of reciprocal disorders.

Risk Factors for Disordered Eating in Overweight Adolescents and Young Adults

OBJECTIVE

To investigate risk factors for disordered eating among overweight youth, a subset of the population particularly at risk for such behaviors.

METHODS

A population-based sample of overweight youth (n = 553) self-reported their disordered eating (binge eating, extreme weight control behaviors), depression-related symptoms, body dissatisfaction, and weight-related teasing at 5-year intervals spanning early/middle adolescence (Time 1; T1), middle adolescence/early young adulthood (Time 2; T2), and early/middle young adulthood (Time 3; T3).

RESULTS

Using logistic regression, we found that T2 depression-related symptoms (p = .02) and body dissatisfaction (p = .01), and increases in body dissatisfaction from T1 to T2 (p = .03), predicted disordered eating incidence at T3.

CONCLUSIONS

Depression-related symptoms and body dissatisfaction appear to be important risk factors for disordered eating among overweight youth. Eating disorder prevention programs should address these factors along with behaviors maintaining or exacerbating excess weight status.

Born Fat

Although some popular press and nonscholarly sources have claimed that weight is largely unchangeable, the relationship between this belief and objective measures of health remains unclear. We tested the hypothesis that people who believe weight is unchangeable will have poorer objective and subjective health, and fewer exercise behaviors and poorer eating habits, than people who believe weight is changeable. Participants were 4,166 men and 4,655 women enrolled in the National Health and Nutrition Examination Survey in the 2007 to 2010 iterations. Believing that weight was uncontrollable was negatively related to exercise and healthful dietary practices and positively related to unhealthful eating. Lack of exercise and unhealthful eating were, in turn, associated with poor physical health. Age, but not gender, moderated the relationships between belief in weight changeability and exercise behaviors, healthful eating, and unhealthful eating. This study suggests that believing weight is unchangeable is associated with poor health behaviors and poorer physical health.

Gender and Ethnic Differences in the Association Between Obesity and Depression Among Black Adolescents

AIM

This study aimed to investigate the association between obesity and major depression disorder (MDD) in a nationally representative sample of Black adolescents in the USA. The study also tested the effects of ethnicity and gender as possible moderators.

METHOD

Data came from the National Survey of American Life (NSAL)-Adolescents, a representative household mental health survey of Black adolescents in the USA. Participants consisted of 1170 Black adolescents (810 African Americans and 360 Caribbean Blacks). Obesity was defined determined by the cutoff points based on the body mass index (BMI) appropriate for age and gender. Twelve-month MDD was measured using the World Mental Health Composite International Diagnostic Interview (CIDI). In the first step, the association between obesity and MDD in the pooled sample, controlling for the main effects of gender and ethnicity. In the next steps, two interactions were tested: (1) obesity and ethnicity and (2) obesity and gender.

RESULTS

Although any associations between obesity and MDD in the pooled sample of Blacks were not found, there was a significant interaction between ethnicity and obesity on MDD. Upon testing the associations across intersections of ethnicity and gender, a positive association was found among Caribbean Black females but not Caribbean Black males, African American males, or African American female.

CONCLUSION

The link between BMI and MDD among Blacks depends on ethnicity and gender, and risk of comorbid depression among Black youth with obesity is highest among Caribbean Black females.

Association of depression & health related quality of life with body composition in children and youth with obesity

BACKGROUND

There is an increasing recognition of the relationship between mental illness and obesity in the pediatric population. Our objective was to explore the individual, biological and family determinants of depressive symptoms and HRQOL in youth with obesity in a clinical setting.

METHODS

We studied 244 youth aged 8-17 years at the time of entry to a weight management program. Depressive symptoms were evaluated using the Center for Epidemiological Studies Depression Scale for Children questionnaire, with a score of ≥15 or antidepressant use indicating depression. HRQOL was examined using the PedsQL4.0. We considered the influence of age, sex, health history, anthropometry, body fat, family health and socioeconomic status (SES) on depression and HRQOL.

RESULTS

Depression was common in this population (36.4%). In multivariate analysis, the extent of obesity (body fat) predicted both depression (OR 1.1 (1.0-1.2); p=0.05) and low HRQOL scores (β -0.63 (p<0.001)). Family SES was an important predictor of depression but not of HRQOL. In contrast to population-based studies, sex, age, pubertal status and family history of depression did not predict depressive symptoms.

LIMITATIONS

As this study included children and adolescents seeking obesity treatment, results may not be generalizable to the general population of obese youth.

CONCLUSIONS

Depression and low HRQOL are common in youth entering weight management programs. Extent of obesity predicted depressive symptoms and low HRQOL. Predictors of depression in this population differ from non-obese populations studied. It is important to consider these characteristics to assist clinicians in identifying these children.

Trajectories of overweight and their association with adolescent depressive symptoms

OBJECTIVE

To explore the potential for a developmental approach to reveal new insights into the well-documented link between weight and depressive symptoms.

METHOD

Latent class analysis identified multiple trajectories of overweight from 24 months to 15 years in the National Institute of Child Health and Human Development Study of Early Child Care and Youth Development (n = 957). Structural equation models then used these classes to predict depressive symptoms at age 15.

RESULTS

Five latent classes captured continuity and change in weight from early childhood into middle adolescence. Controlling for current weight, stably overweight girls tended to have the most depressive symptoms, but popularity and positive image appeared to buffer against some of the risks that girls faced from being stably overweight or becoming overweight in early to middle childhood. Notably, boys' longitudinal weight patterns were not associated with their depressive symptoms in adolescence.

CONCLUSIONS

Weight histories, controlling for current weight, are important for understanding the psychological experience of overweight, especially when such histories are considered in relation to other aspects of psychosocial functioning. (PsycINFO Database Record

Depressive symptoms are associated with excess weight and unhealthier lifestyle behaviors in urban adolescents

BACKGROUND

Adolescence is a critical period for the development of depressive symptoms and obesity. This study examined the association of depressive symptoms with standardized BMI (BMI z-score), lifestyle behaviors, and self-efficacy measures in a sample of urban adolescents.

METHODS

A school-based study was conducted among adolescents (N=1508) enrolled from 11 public schools. Depressive symptoms were assessed with Kandel's depressive symptoms scale for adolescents. Fruit and vegetable intake and intake of energy-dense foods were assessed by a short food frequency questionnaire. Sedentary behavior and physical activity (PA) were obtained by self-report. Height and weight were measured directly and BMI z-scores were calculated. Mixed-effects models were used to examine the association of depressive symptoms with BMI z-score and lifestyle behaviors, accounting for clustering at school level and adjusting for confounders. Self-efficacy measures were evaluated as potential mediators.

RESULTS

The sample was 53% female, 75% Hispanic, and 82% US born, with a mean age of 13.9 years. Higher depressive symptoms were associated with higher BMI z-score (β=0.02; p=0.02), intake of energy-dense foods (β=0.42; p<0.001), and sedentary behavior (β=0.48; p<0.001), but lower PA (β=-0.03; p=0.01). There was an interaction by gender in the association of depressive symptoms and PA. Self-efficacy mediated the association of depressive symptoms and PA.

CONCLUSIONS

Obesity prevention and treatment programs should consider addressing the role of negative emotions as part of their preventive strategies.

Depressive symptoms and observed eating in youth

Depressive symptoms in youth may be a risk factor for obesity, with altered eating behaviors as one possible mechanism. We tested whether depressive symptoms were associated with observed eating patterns expected to promote excessive weight gain in two separate samples. In Study 1, 228 non-treatment-seeking youth, ages 12-17y (15.3±1.4y; 54.7% female), self-reported depressive symptoms using the Beck Depression Inventory. Energy intake was measured as consumption from a 10,934-kcal buffet meal served at 11:00am after an overnight fast. In Study 2, 204 non-treatment-seeking youth, ages 8-17y (13.0±2.8y; 49.5% female), self-reported depressive symptoms using the Children's Depression Inventory. Energy intake was measured as consumption from a 9835-kcal buffet meal served at 2:30pm after a standard breakfast. In Study 1, controlling for body composition and other relevant covariates, depressive symptoms were positively related to total energy intake in girls and boys. In Study 2, adjusting for the same covariates, depressive symptoms among girls only were positively associated with total energy intake. Youth high in depressive symptoms and dietary restraint consumed the most energy from sweets. In both studies, the effects of depressive symptoms on intake were small. Nevertheless, depressive symptoms were associated with significantly greater consumption of total energy and energy from sweet snack foods, which, over time, could be anticipated to promote excess weight gain.

Associations between obesogenic risk factors and depression among adolescents: a systematic review

Adolescence is a transitional life phase that is associated with heightened risk for two major health conditions - obesity and mental health problems. Given the established comorbidity of obesity and depression, one avenue that warrants further exploration is the association between obesogenic risk and obesity in the expression and maintenance of depressive symptoms. The aim of the current systematic review was to identify and evaluate the empirical literature reporting the relationships between obesogenic risk factors (physical activity, sedentary behaviour, diet and weight status) and depression in adolescents. A search of five databases for studies published over the last decade found 24 studies eligible for review. Relationships were found between lack of physical exercise, heightened sedentary behaviour, poor diet quality, obese or overweight and depression in adolescence. However, the finding that obesogenic risk factors are associated with poor adolescent mental health should be interpreted with caution as data typically come from non-representative samples with less than optimal study design and methodology.

Feasibility and preliminary outcomes from a pilot study of an integrated health-mental health promotion program in school mental health services

The prevalence of unmet health and mental health needs among youth has spurred the growing consensus to develop strategies that integrate services to promote overall well-being. This pilot study reports on the feasibility and outcomes of a theory-driven, family-focused, integrated health-mental health promotion program for underserved adolescents receiving school mental health services. Parent and adolescent assessments conducted prior to and following the brief, 6-session promotion program showed significant improvements in family support, youth self-efficacy, health behaviors, and mental health outcomes. Clinician reports contributed to a characterization of the feasibility, acceptability, and future recommendations for the integrated program.