Negative peer perceptions of obese children in the classroom environment

Young children's choices and thoughts about pro-social behaviour towards others with overweight

OBJECTIVES

This study aimed to investigate weight bias within young children's pro-social choices between characters who differed in body size.

METHODS

Seventy-six children aged 4-6 years read stories asking them to choose who they would first help, share with, comfort, and steal from, between a healthy weight and child with overweight. They also selected the one character they would most like to play with. Children's reasoning for these choices was recorded and analysed.

RESULTS

The character with overweight was helped first in only a third of the choices made. Children chose the characters with overweight more often as the target for anti-social action. In friendship selections, children overwhelmingly rejected the characters with overweight. However, weight bias was not prominent in the reasons children gave for the choices. Most children were not negative about body shape, weight or appearance. Similarly, in friendship choices, these were mostly expressed positively to the character chosen. Only a small minority of children were explicitly negative about the character with overweight.

CONCLUSIONS

A better understanding of weight bias acquisition and variation between children will benefit those working in health care and educational settings. Future research should link with developmental theory, such as on social categorization and theory of mind.

Emotion-Driven Eating and Overeating Among Fourth Graders: The Roles of Body Image, Academic Achievement, and Peer and School Factors

BACKGROUND

Eating patterns such as breakfast consumption and fruit and vegetable intake have been associated with academic achievement and cognitive function.

METHOD

The purpose of this study was to learn more about psychological (emotion-driven eating) and behavioral (over-eating) eating patterns and motives, and the roles of body image, academic achievement (reading and math), and social supports (peer acceptance and school attachment), among 378 fourth-grade students (55% boys) from 14 classrooms across 6 schools within a large Midwestern urban area.

RESULTS

Results were analyzed through a 2-group (male and female) path analysis. Boys' overeating (R2  = 9%) was not significantly predicted. Their emotional eating (R2  = 22.2%) was negatively, significantly predicted by peer acceptance and interaction of peer acceptance and school attachment. Girls' overeating (R2  = 13.6%) was negatively, significantly predicted by positive body image. Girls' emotional eating (R2  = 24.1%) was negatively significantly predicted by positive body image, math scores, and peer acceptance.

CONCLUSIONS

Boys' and girls' eating patterns are differentially affected by their school experiences.

Living with obesity is related to peer problems in children: A national cross-sectional study

AIM

To assess the association between obesity and problems in peer relations in children (4-15 years) in a large (n = 11 279), nationally representative data set.

METHODS

The chi-square test was used to compare differences in numbers of children with and without obesity and with and without abnormal peer problem scores. Then multivariable logistic regression was used to determine any association between obesity and peer problems after accounting for deprivation and life-style factors.

RESULTS

The results of the chi-square test were statistically significant (P < 0.05) for all groups except older girls. The multivariable logistic regression identified a small but significant association between children living with obesity and abnormal peer problems, odds ratio (OR) 1.06 (95% confidence interval, CI: 1.04-1.08, P = 0.001). When explored by subsets of children using sex and age, this association was strongest for girls aged 4-10 years, OR 1.12 (95% CI: 1.07-1.16, P = 0.001).

CONCLUSION

This is the first nationally representative study of children to identify this association in younger children. Whilst further research is needed to corroborate this finding, as a precautionary measure solutions to improve peer relationships and reduce stigma for school-aged children living with obesity are indicated.

Height dissatisfaction and loneliness among adolescents: the chain mediating role of social anxiety and social support

Previous research on body dissatisfaction has mainly focused on the dissatisfaction with weight and appearance. Limited research has examined the dissatisfaction with another major body feature that is important to our social relationships and personal well-being, namely, body height. We hypothesized that height dissatisfaction would predict more intense loneliness among adolescents, and that this relationship is mediated by greater social anxiety and reduced social support. Participants of this study were 515 Chinese high school students. The Shortness subscale of the Negative Physical Self Scale, Social Anxiety Scale for Adolescents, Perceived Social Support Scale, and ULS-8 were integrated into a paper-and-pencil survey. The results revealed that adolescents with high levels of height dissatisfaction reported higher levels of loneliness. A chain mediation model showed that the relationship between height dissatisfaction and loneliness could be both sequentially mediated by social anxiety and social support, and mediated by social anxiety. However, no mediating role of social support was found. We also found that body height did not predict social anxiety or social support, but can predict loneliness. The current findings provide novel insights into the occurrence of loneliness among adolescents, and indicate that negative self-perceptions of body height and the resulting social anxiety can lead to loneliness.

Body mass index and bullying victimization as antecedents for depressive symptoms in a Swedish youth cohort

Aim

The bidirectional association between obesity and depression seen in adults is not clearly established in adolescents. The aim of this study was to investigate the longitudinal association between body mass index (BMI), depressive symptoms and interactions between bullying victimization and BMI, taking gender differences into account.

Subjects and methods

In a Swedish county, self-reported bullying victimization, BMI and depressive symptoms from 1729 adolescents ($$ \overline{y} $$ y ¯ = 14.4, 56% females) were collected in 2012 (wave 1), in 2015 (wave 2) ($$ \overline{y}=17.3 $$ y ¯ = 17.3 ) and in 2018 (wave 3) ($$ \overline{y} $$ y ¯ = 19.9). Longitudinal associations were assessed using binary logistic regression models controlling for confounding factors. Interaction effects between BMI and victimization on depressive symptoms were also assessed.

Results

Wave 1 obese males had approximately six times increased odds ratio compared to normal weight, for wave 2 depressive symptoms. W1 overweight was associated with an odds ratio of 1.5 in all participants for wave 3 depressive symptoms. Victimization was consistently associated with higher odds ratio for future depressive symptoms. We found interaction effects between bullying victimization and BMI for future depressive symptoms with different patterns depending on sex.

Conclusion

Given the present findings, bullying needs to be prevented, and, if it occurs, it needs to be stopped at an early stage to prevent future depressive symptoms.

Prevalence of Obesity and Associated Risk Factors among Children and Adolescents in the Eastern Cape Province

Obesity is a global public health concern that begins in childhood and is on the rise among people aged 18 and up, with substantial health consequences that offer socioeconomic challenges at all levels, from households to governments. Obesity and associated risk factors were investigated in children and adolescents in the Eastern Cape Province of South Africa. A cross-sectional study was conducted at Mt Frere among 209 conveniently selected participants using anthropometric measurements and a structured questionnaire. Chi-squared statistics or Fisher's exact test were used to evaluate the risk factors predicting different outcomes such as hypertension or diabetes mellitus. A 5% level of significance was used for statistical significance (p-value 0.05). The prevalence of overweight or obesity among females when using waist circumference (2.7%), triceps skinfold (6.9%), and body mass index cut-offs (16.4%) were respectively higher when compared to those of males. About 89% engaged in physical activities. After school, 53% watched television. About 24.9% of participants did not eat breakfast. Most of overweight or obese participants (92.9%) brought pocket money to school. Use of single anthropometric measurements for assessing nutritional status indicated inconclusive results. Strengthening parental care, motivation for consumption of breakfast and limiting pocket money for children going to school are important steps to improve child health.

Bullying Victimization Profiles of School-Aged Adolescents and Associations With Weight Statuses: A Latent Class Analysis

Bullying and childhood obesity are public health concerns in the United States. While obesity has been found to be associated with bullying victimization, it is less clear how it is differentially associated with biological sex and grade level across varying patterns of bullying victimization. Based on the subset of U.S. students in the Health Behavior in School-Aged Children study, patterns of co-occurring bullying victimization and sex and grade level differences in the association between the patterns of bullying victimization and weight status were examined among 9,124 students in Grades 5 to 10. The latent class analysis revealed three patterns of bullying victimization: verbal-relational victimization (Class 1), all-type victimization (Class 2), and noninvolved pattern (Class 3). The results found that females had a higher likelihood of being in Class 1 than males. Moreover, fifth to sixth and seventh to eighth-graders were more likely than ninth to tenth graders to be in both Class 1 and Class 2. Obese males and overweight females were more likely to be in Class 1 and Class 2 than in Class 3. In addition, obesity and overweight status were positively associated with bullying victimization among fifth to sixth and seven to eighth-graders. However, no significant association was found between obesity and overweight status and bullying victimization among ninth to tenth graders. Findings from the study suggest that school-based strategies, especially sex- and age-specific programs, need to take into consideration the bullying involvement of students who are overweight or obese.

Behaviours involved in the role of victim and aggressor in bullying: Relationship with physical fitness in adolescents

Physical fitness is related to well-being and health. Adolescence is a key period in the psychological and social development of the person, in which interpersonal relationships gain strength, being bullying a type of violence that can affect the personality of those involved. At present, there is not enough research to determine the relationships between bullying and physical condition. The purpose of this study is to find out if there are any relationships among physical fitness, victimisation, and aggression in bullying, and to identify these behaviours. This is a descriptive study done in 1035 adolescents aged 12 to 17 years (M = 14.67, SD = 1.49). The European Bullying Intervention Project Questionnaire (EBIPQ) scale was used, and anthropometric characteristics of weight and height were measured. In addition, physical fitness tests from the Eurofit battery, sit-and-reach, 30-second sit-ups, horizontal jump, manual dynamometry, and 20-meter Multistage Shuttle Run Test (SRT) were included. The relationships between variables were analysed using Spearman correlations, linear regressions, and ordinal regressions. The most relevant findings indicate an inverse relationship between being a victim of bullying and having a better cardiorespiratory cardiovascular endurance. These also show a direct relationship between being a bully and skeletal muscle strength measured through the horizontal jump, 30-second sit-ups, and manual dynamometry tests. Theoretically, we can conclude that physical condition can be considered a predictor to consider in bullying. Specifically, cardiorespiratory fitness, in addition to its multiple physical and mental benefits, may be a protective element against bullying victimisation. In contrast, muscular strength, especially in boys, may be an important predictor, especially in the physical component, of aggression in bullying.

Adults' attitudes toward children, adolescents, and adults who are obese and tax-funded programs to combat obesity

The goals of the present study were to assess (1) adults' patterns of beliefs about and attitudes toward children, adolescents, and adults who are obese and (2) their attitudes toward hypothetical tax-funded programs designed to combat obesity in children, adolescents, and adults. A total of 267 participants, ranging in age from 19 to 88 years old, were recruited through Amazon's Mechanical Turk (MTurk) to participate online in the present study. The participants rated adults who are obese less favorably, and as less malleable, than children or adolescents who are obese. Furthermore, they were less supportive of tax-funded programs designed to combat obesity in adults than children or adolescents. In general, the participants' relatively unfavorable response to adults who are obese appears to be associated with the beliefs that older individuals who are obese are relatively unchangeable and have heightened personal fault for their plight.

Stringent immigration enforcement and the mental health and health-risk behaviors of Hispanic adolescent students in Arizona

This study investigates the impact of the enforcement of SB 1070, a stringent immigration law, on the mental health, health-risk behaviors, and academic performance of Hispanic adolescent residents in Arizona. Using the difference-in-differences method, this study finds that SB 1070 increases their probability of feeling sad and decreases their physical activeness. The impact of SB 1070 on sad feelings and level of physical activity could have serious repercussions while it lasts. In addition, obese male Hispanic adolescents are more likely than their female or non-obese counterparts to develop mental health problems and engage in health-risk behaviors attributable to the stringent immigration policy. This study's empirical evidence on adverse mental health repercussions for Hispanic adolescents of state-level immigration enforcement suggests the need to be careful in formulating and implementing immigration policies.

Cross-lagged associations between behaviour problems and obesity in head start preschoolers

BACKGROUND

Behaviour problems and obesity are related but research findings have been inconclusive regarding the direction of effects.

OBJECTIVES

This study examined the cross-lagged associations between behaviour problems, body mass index (BMI) and obesity in preschoolers, and whether sex modified these associations.

METHODS

Repeated measures of teacher-reported externalizing (EXT) and internalizing behaviour problems (clinically significant T scores were >90th percentile), BMI z-scores (BMI-Z) and obesity status (BMI ≥95th for age and sex) were assessed in the fall (T1) and spring (T2) of the school year in Head Start preschoolers (N = 423). Associations were examined with cross-lagged modelling.

RESULTS

Prospective paths from T1 clinically significant EXT to both T2 BMI-Z (β = .05) and obesity (β = .18) were significant. There was no evidence that T1 BMI-Z or obesity preceded T2 behaviour problems. However, sex-specific models indicated that T1 BMI-Z was prospectively associated with higher T2 EXT for boys (β = .13), but not girls. T1 EXT was predictive of subsequent BMI-Z (β = .09) and obesity (β = .33) at T2 for girls only.

CONCLUSION

Findings suggest that behaviour problems, particularly externalizing behaviours, are prospectively related to childhood obesity, and early prevention methods should reflect sex-specific modifications.

Is Weight Bias Evident in Peer Interactions Between Young and Older Children?

OBJECTIVE

This study aimed to investigate whether weight bias is apparent in young and older children's interactions during a paired reading activity.

METHODS

One hundred seventy-two children (57% girls) read a book in which the main character, "Alfie," was portrayed either as average weight or as having obesity. Younger children (mean = 6.1 years) were paired with a same-sex older child (mean = 9.5 years). Questions within and at the end of the story prompted discussion. Children's conversations were analyzed according to valence (emotional tone). Nonverbal behavior was noted via observation.

RESULTS

Pairs of children reading about the Alfie character with obesity made significantly more negative and fewer positive comments when offering story completions. Just one pair of boys spoke about him being "fat." There was no evidence that older children passed negative attitudes to younger children. Covertly expressed weight bias was more common. There was more frequent laughter while reading about the character with obesity, and two pairs made nonverbal reference to Alfie's appearance.

CONCLUSIONS

Covert weight bias was apparent in the interactions of some of these children, but overt weight bias was rare. There is a need to establish a better chronology of children's awareness of, and attitudes toward, obesity and how they are acquired.

Weight Bias in Educational Settings: a Systematic Review

PURPOSE

To conduct a systematic literature review of empirical peer-reviewed published studies on the prevalence of weight bias among students, pre-service, and in-service teachers and its impact on the educational experiences and health of students from kindergarten to postsecondary settings.

METHODS

Keywords were searched on three main concepts, (i) weight bias/stigma, (ii) obesity/overweight, and (iii) education, within eight databases. Our search yielded 8323 individual records, of which 45 studies satisfied our inclusion criteria.

RESULTS

Most studies were conducted in K-12 school settings (n = 41), were quantitative in design (n = 37), and used student samples (n = 18). Weight bias is prevalent in educational settings, among peers at school as well as pre-service and in-service teachers, and negatively impacts students' health and educational experiences.

CONCLUSION

These results highlighted the impact of weight bias in creating inequity for students with obesity as well as several underexamined areas, such as weight bias in postsecondary settings and attitudes among teachers and pre-service teachers. Innovative strategies to address weight bias in educational settings are needed.

Psychosocial measures and weight change in a clinical paediatric population with obesity

PURPOSE

Poor quality of life has been shown to occur in youth with obesity. This study aimed to assess associations between health-related quality of life, general mental health and general psychological distress measures, collectively termed psychosocial health questionnaires (PSH), with weight outcomes in a busy paediatric weight management service.

METHODS

A cross-sectional longitudinal clinical cohort, 'Childhood Overweight BioRepository of Australia (COBRA)', was used (n = 250, median age 11, range 2-18 year, mean BMI z-score 2.5 ± 0.2). Clinical data were collected and HRQOL questionnaires; Pediatric Quality of Life 4.0 (PedsQL), 'Sizing Me/Them Up' (SMU/STU), and psychological well-being questionnaires; strengths and difficulties questionnaire (SDQ) and Kessler 10 (K10) were completed by the child and primary caregiver. PSH results were compared to age- and sex-adjusted BMI z-score at baseline and follow-up. Direct logistic regression modelling was performed to assess the impact of PSH factors on the likelihood of successful weight reduction over a period of ≥ 12 months.

RESULTS

Mean self-report PSH scores were: 68.0 ± 15.28 (PedsQL, range 0-100), 64.8 ± 15.8, (SMU, range 0-100), 17.3 ± 4.4 (SDQ, range 0-40) and 20.0 ± 7.7 (K10, range 0-50). A significant negative correlation was observed between PSH scores and childhood obesity (baseline BMI z-scores (p < 0.01)). No correlations were observed between psychological well-being measures and BMI z-scores. Higher subscale scores of the PedsQL and SDQ, which measure impaired psychosocial health and more difficulties with hyperactivity and inattention, significantly predict weight loss in children with obesity after 12 months.

CONCLUSION

PSH questionnaires may be useful in identifying individuals who require additional support to achieve weight loss goals in a tertiary weight management service.

An update on obesity: Mental consequences and psychological interventions

Besides physical consequences, obesity has negative psychological effects, thereby lowering human life quality. Major psychological consequences of this disorder includes depression, impaired body image, low self-esteem, eating disorders, stress and poor quality of life, which are correlated with age and gender. Physical interventions, mainly diet control and energy balance, have been widely applied to treat obesity; and some psychological interventions including behavioral therapy, cognitive behavioral therapy and hypnotherapy have showed some effects on obesity treatment. Other psychological therapies, such as relaxation and psychodynamic therapies, are paid less attention. This review aims to update scientific evidence regarding the mental consequences and psychological interventions for obesity.

Clinical Practice Guideline for the Diagnosis and Treatment of Pediatric Obesity: Recommendations from the Committee on Pediatric Obesity of the Korean Society of Pediatric Gastroenterology Hepatology and Nutrition

The Committee on Pediatric Obesity of the Korean Society of Pediatric Gastroenterology, Hepatology and Nutrition newly developed the first Korean Guideline on the Diagnosis and Treatment of Obesity in Children and Adolescents to deliver an evidence-based systematic approach to childhood obesity in South Korea. The following areas were systematically reviewed, especially on the basis of all available references published in South Korea and worldwide, and new guidelines were established in each area with the strength of recommendations based on the levels of evidence: 1) definition and diagnosis of overweight and obesity in children and adolescents; 2) principles of treatment of pediatric obesity; 3) behavioral interventions for children and adolescents with obesity, including diet, exercise, lifestyle, and mental health; 4) pharmacotherapy; and 5) bariatric surgery.

Clinical practice guideline for the diagnosis and treatment of pediatric obesity: recommendations from the Committee on Pediatric Obesity of the Korean Society of Pediatric Gastroenterology Hepatology and Nutrition

The Committee on Pediatric Obesity of the Korean Society of Pediatric Gastroenterology, Hepatology and Nutrition newly developed the first Korean Guideline on the Diagnosis and Treatment of Obesity in Children and Adolescents to deliver an evidence-based systematic approach to childhood obesity in South Korea. The following areas were systematically reviewed, especially on the basis of all available references published in South Korea and worldwide, and new guidelines were established in each area with the strength of recommendations based on the levels of evidence: (1) definition and diagnosis of overweight and obesity in children and adolescents; (2) principles of treatment of pediatric obesity; (3) behavioral interventions for children and adolescents with obesity, including diet, exercise, lifestyle, and mental health; (4) pharmacotherapy; and (5) bariatric surgery.

Parenting With a Substance Abuse History: The Moderating Role of Parenting Behaviors on Obesity and Internalizing Symptoms in Adolescence

Although numerous studies have shown that child obesity is associated with internalizing symptoms, relatively few studies have examined the role of parenting behaviors on this relationship. Youth meeting obesity status may be at higher risk of psychosocial maladjustment when exposed to more vulnerable parenting contexts. The current study interviewed mothers with a history of substance abuse to assess whether parenting behaviors moderated the relationship between obesity and internalizing symptoms among adolescents (N = 160; 51% girls; M = 12.76 years). Hierarchical regression analyses identified physical discipline as a moderator; girls meeting obesity status displayed higher levels of internalizing symptoms when exposed to higher versus lower levels of physical discipline. Prevention/intervention efforts targeting mothers with substance abuse histories should aim to not only improve physical and emotional health but also highlight the connections between physical and emotional health and the influence of parenting behaviors on associations.

Quality of Life Is Influenced by Body Weight, Education, and Family Income in Adolescents with Chronic Diseases

Objective

To evaluate the health-related quality of life (HRQoL) of adolescents diagnosed with different chronic conditions and to identify demographic, socioeconomic, and health-status outcomes associated with the impairment in HRQoL.

Study Design

Cross-sectional study.

Methods

We evaluated 276 adolescents (50.7% male) aged 14 ± 2 years that were assisted by healthcare public service and diagnosed with cancer (CA), type 1 diabetes mellitus (DM1), overweight (OW), asthma (AS), and no chronic health condition—control group (CG). Adolescents and parent-proxy completed age-appropriate self-report and/or parent-proxy report on generic HRQoL measures using PedsQL™.

Results

Adolescents with CA had lower overall HRQoL as well as poorer scores in all dimensions than either healthy participants or other chronic disease sufferers. HRQoL scores reported by parent-proxy were similar to those reported by adolescents across all chronic diseases. CG members reported better scores in all dimensions. Maternal education, family income, and marital status of parents were correlated with HRQoL scores in all dimensions. The risk of having an affected HRQoL score was higher in adolescents with CA than in adolescents with other chronic diseases.

Conclusions

The likelihood of cancer affecting HRQoL was higher when compared to other chronic diseases, and the OW group had a worse overall score compared to CG. Adolescents with CA, AS, and OW reported worse school dimensions when compared to healthy adolescents. The education of adolescents and their parent-proxy, body weight, and family income influence the dimensions of HRQoL in adolescents with chronic diseases.

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.

Association between body mass index and health outcomes among adolescents: the mediating role of traditional and cyber bullying victimization

BACKGROUND

It is well-documented that obese children and adolescents tend to experience a variety of negative physical and psychological health consequences. Despite the association between obesity and physical and psychological well-being, few studies have examined the role of off-line and on-line forms of bullying victimization in this link. The main objective of the current study is to investigate the direct and mediating effects of traditional and cyber bullying victimization in explaining the relationship between the body mass index (BMI) and physical/psychological distress.

METHODS

A nationally representative sample of 10,160 school children (mean age = 12.95 ± 1.75) were collected from the 2009 Health Behavior in School-aged Children (HBSC) study. Data were collected on body mass index, physical and psychological health, bullying victimization experience, and demographic information. A seemingly unrelated regression (SUR) was employed to assess and compare the indirect effects in multiple mediation models.

RESULTS

While a significant direct association was found between BMI and both physical and psychological health, the indirect effect of BMI on physical distress was significant only via traditional bullying victimization. Both forms of bullying victimization had a mediating impact between BMI and psychological distress. However, the indirect effect on psychological distress was manifested through a negative mediating role of cyberbullying victimization. The negative relation between cyberbullying victimization and psychological distress warrants further exploration.

CONCLUSIONS

Obesity represents a serious risk to adolescent health and well-being, both physically and psychologically. If becoming a victim of traditional bullying mediates (specifically exacerbates) the level of physical and psychological distress among obese and overweight adolescents, health professionals need to focus on raising awareness of the importance of weight-based victimization for children and adolescents with obesity. School administrators and teachers could increase the efforts to identify school-age children who are stigmatized for their weight and recommend coping strategies for distressed victims of traditional and cyberbullying.

Relationship between early menarche, obesity, and disordered eating behaviors: a school-based cross-sectional survey in Northern Saudi Arabia

BACKGROUND

Obesity and disordered eating (DE) behaviors are serious health concerns, regularly observed among female adolescents, which could progress to adverse psychological and nutritional sequels.

AIM

The aim of this study was to determine the prevalence of obesity and the self-reported DE behaviors among high school female students and to evaluate their self-perception of body image, peer pressures, and need for dietary consultation.

METHODS

This is a school-based cross-sectional study conducted in 2018. Self-administered surveys and anthropometric measurements were obtained from adolescent females, randomly selected from eight schools in northern Saudi Arabia. Sample characteristics were age, menarche, and DE behaviors (binge eating, self-induced vomiting, and usage of laxatives). Body mass index was converted to percentiles using the age-to-gender scale. Self-perception of body image, perceived peer pressures, and the Eating Attitude Test-26 (EAT-26) were scored, summated, and then presented in percentage mean scores (PMSs) and mean scores (MSs).

RESULTS

Sample comprised 399 participants. One hundred twenty-eight (32.1%) participants reported early age of menarche (≤12 years). Sixty-five (16.3%) participants reported the prevalence of overweight/obesity, 123 (30.8%) participants reported binge eating, 28 (7.0%) participants reported self-induced vomiting, and 21 (5.3%) participants reported usage of laxatives. The PMS of self-perception of body weight and peer pressure was 68.7±27.1 and 41.9±23.5, respectively. One hundred ninety-two (48.1%) participants needed professional dietary help. Students with early age of menarche were 1.7 times more likely to be overweight/obese (adjusted [adj] P=0.018) compared to others. Overweight/obese participants had significantly poorer self-perception of body image (PMS =47.4±25.0) and higher perceived peer pressure (PMS =49.5±23.1) compared to underweight/normal weight students (PMS =72.8±25.6 [P<0.001] and PMS =40.5±23.3 [P=0.005], respectively). Participants with early age of menarche complained of higher perceived peer pressure compared to others (P=0.045). Participants with DE behaviors had higher peer pressure (PMS =46.8±23.5) and higher scores on E-26 (MS =22.2±11.4) compared to their counter groups (P=0.002 and 0.016, respectively).

CONCLUSION

The high rate of overweight/obesity and DE behaviors among female adolescents is alarming. Special consideration should be made for those with early menarche who were more prone to overweight/obesity.

Romantic, sexual, and sexual risk behaviours of adolescent females with severe obesity

BACKGROUND

There is an increasing adolescent population with severe obesity with impairments in social and romantic relationships that are seeking clinical weight management, including weight loss surgery (WLS).

OBJECTIVE

To document romantic, sexual and sexual risk behaviours in a clinical sample of adolescent females with severe obesity (BMI > 40 kg/m² ) compared to those of healthy weight (HW).

METHODS

This multi-site study-an ancillary to a prospective longitudinal observational study documenting health in adolescents having WLS-presents pre-operative/baseline data from 108 females undergoing WLS, 68 severely obese seeking lifestyle intervention and 118 of HW. Romantic and sexual risk behaviour and birth control information sources were assessed using the Sexual Activities and Attitudes Questionnaire (SAAQ).

RESULTS

Severely obese females reported engaging in fewer romantic and sexual behaviours compared to HW. Similar to HW, a subgroup (25%) of severely females were engaging in higher rates of sexual risk behaviours and reported pregnancies and sexually transmitted infections (STIs). A considerable number (28-44%) reported receiving no birth control information from physicians.

CONCLUSIONS

Discussion topics with the adolescent patient should extend beyond reproductive health needs (e.g. contraception, unintended pregnancies) to include guidance around navigating romantic and sexual health behaviours that are precursors to these outcomes.

How is weight stigma related to children's health-related quality of life? A model comparison approach

PURPOSE

Obesity is a highly stigmatizing condition for both adults and children, and both obesity and stigma experiences are negatively related with health-related quality of life (HRQoL). However, the relations among these constructs have been modeled in different and sometimes inconsistent terms in past research, and have been the object of surprisingly few studies in pediatric populations. The present study addresses this gap by comparing, in a sample of preadolescent children, four competing models (i.e., additive, mediation, moderation, and moderated mediation models) accounting for the role of stigma experiences in the concurrent relation between body weight and HRQoL.

METHODS

A community sample of 600 children aged 8-11 years completed the Perception of Teasing Scale to assess weight-based teasing experiences and the PedsQL 4.0 to assess HRQoL. Parent-reported height and weight were used to calculate age- and gender-adjusted zBMI. Log-likelihood test, BIC difference, and Wald test were used for model comparisons.

RESULTS

The mediation model outperformed both additive and moderation models and was found to be equally informative (but more parsimonious) as compared to the moderated mediation account. The same pattern of results was replicated for both global HRQoL and domain-specific quality of life domains (i.e., physical, emotional, social, and scholastic).

CONCLUSIONS

The mediation model provided the best fitting and more parsimonious representation of the relations between body weight, stigma experiences, and HRQoL, meaning that an increased likelihood of experiencing weight-based teasing episodes, rather than excess weight per se, is associated with reduced quality of life in middle childhood.

Longitudinal Associations Between Childhood Obesity and Academic Achievement: Systematic Review with Focus Group Data

PURPOSE

The purposes of this study were to review the evidence on longitudinal associations between child and adolescent obesity and academic achievement and to provide perceptions of adolescents with obesity and their parents on this topic.

RECENT FINDINGS

Synthesis of 31 studies (from 17 cohorts) suggested that relationships between obesity and academic achievement are not well established, except for adolescent girls' maths attainment, potentially mediated by both weight-related bullying and executive cognitive functions. Focus groups with adolescent girls with obesity confirmed experiences of psychosocial distress at school particularly during Physical Education. Adolescents perceived that obesity was not related to academic achievement directly, but by their attitude to school. Interventions are warranted to promote psychosocial wellbeing and cognitive abilities linked to academic achievement in adolescent girls with obesity. Physical Education should be a positive experience for children and adolescents with obesity.

Implementation of a School Nurse-led Intervention for Children With Severe Obesity in New York City Schools

PURPOSE

The Healthy Options and Physical Activity Program (HOP) is a school nurse-led intervention for children with severe obesity. HOP was developed by experts at the New York City Department of Health and Mental Hygiene and implemented in New York City schools beginning in 2012. The purpose of this study was to evaluate HOP implementation with the goal of informing HOP refinement and potential future HOP dissemination.

DESIGN AND METHODS

This study entailed a retrospective analysis of secondary data. Analytic methods included descriptive statistics, Wilcoxon rank sum and Chi square tests, and multivariate logistic regression.

RESULTS

During the 2012-2013 school year, 20,518 children were eligible for HOP. Of these, 1054 (5.1%) were enrolled in the program. On average, enrolled children attended one HOP session during the school year. Parent participation was low (3.2% of HOP sessions). Low nurse workload, low school poverty, higher grade level, higher BMI percentile, and chronic illness diagnosis were associated with student enrollment in HOP.

CONCLUSIONS

As currently delivered, HOP is not likely to be efficacious. Lessons learned from this evaluation are applicable to future nurse-led obesity interventions.

PRACTICE IMPLICATIONS

Prior to implementing a school nurse-led obesity intervention, nursing workload and available support must be carefully considered. Interventions should be designed to facilitate (and possibly require) parent involvement. Nurses who deliver obesity interventions may require additional training in obesity treatment. With attention to these lessons learned, evidence-based school nurse-led obesity interventions can be developed.

Association between obesity and behavioral/emotional disorders in primary school-aged children: a cross-sectional study

Background: Obesity in children can increase the risks of various chronic diseases. Mental disorders associated with obesity in children include: depression, anxiety, low self-esteem, hyperkinetic disorders, and increased aggressiveness. This relationship is estimated due to vulnerable genetic expressions in obese individuals. This study aimed to find the association between obesity and behavioral/emotional disorder in primary school-aged children.Methods: This cross-sectional study was conducted on 384 children at Menteng 1 Elementary School, Jakarta from July to September 2015. The study was conducted to find the association between the children’s nutritional status and behavioral/emotional disorders screened by the 17-item Pediatric Symptom Checklist (PSC-17). Chi square analysis was applied in this study.Results: The prevalence of obese children at Menteng 1 Elementary School, Jakarta reached 23.2%, which is higher than Jakarta’s prevalence (14%). 8.7% of the subjects were obese and 13.6% of them were having behavioral/emotional disorders. 20.0% of the obese subjects had behavioral/emotional disorders. The prevalence was higher for internalizing sub-scale, which was consistent with other studies. Association between obesity and behavioral/emotional disorders was significant for externalizing sub-scale (p=0.036). Externalizing problems caused by obesity might be affected by the social stigma of their peer group. However, obesity in children did not have a statistically significant relationship in internalization sub-scale, attention, and PSC-17 total score (p>0.05). No significant associations towards those sub-scales were thought to be influenced by other factors, playing a role in causing mental disorders in children.Conclusion: In general, obesity was not associated with behavioral and emotional disorders in children, but obesity was related to externalizing behavioral/emotional disorders.

Childhood Obesity and Academic Performance: The Role of Working Memory

The present study examined the role of working memory in the association between childhood obesity and academic performance, and further determined whether memory deficits in obese children are domain-specific to certain tasks or domain-general. A total of 227 primary school students aged 10-13 years were analyzed for weight and height, of which 159 children (44 "obese," 23 "overweight," and 92 "normal weight") filled out questionnaires on school performance and socioeconomic status. And then, all subjects finished three kinds of working memory tasks based on the digit memory task in 30 trials, which were image-generated with a series of numbers recall trial sets. After each trial set, subjects were given 5 s to recall and write down the numbers which hand appeared in the trial, in the inverse order in which they had appeared. The results showed there were significant academic performance differences among the three groups, with normal-weight children scoring higher than overweight and obese children after Bonferroni correction. A mediation model revealed a partial indirect effect of working memory in the relationship between obesity and academic performance. Although the performance of obese children in basic working memory tests was poorer than that of normal-weight children, they recalled more items than normal-weight children in working memory tasks involving with food/drink. Working memory deficits partially explain the poor academic performance of obese children. Those results indicated the obese children show domain-specific working memory deficits, whereas they recall more items than normal-weight children in working memory tasks associated with food/drink.

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

PURPOSE

To examine the associations between weight status and structural and functional dimensions of social relations among 11- to 15-year-old girls and boys.

METHODS

Analyses were based on cross-sectional data from the Danish contribution to the international Health Behavior in School-aged Children study 2010. The study population (n = 4,922) included students in the fifth, seventh, and ninth grade from a representative sample of Danish schools. Multinomial logistic regression analyses were used to study the associations between weight status and social relations, supported by a conceptual framework for the study of social relations.

RESULTS

Among girls, overweight/obese weight status was associated with spending less time with friends after school compared to normal-weight status (0 days/week: odds ratio: 6.25, 95% confidence interval: 2.18-17.95, 1 day/week: 2.81, 1.02-7.77, 2 days/week: 3.27, 1.25-8.56, 3 days/week: 3.32, 1.28-8.61, and 4 days/week: 3.23, 1.17-8.92, respectively vs. 5 days/week). Among girls, overweight/obese weight status was associated with being bullied (2.62, 1.55-4.43). Among boys, overweight/obese weight status was associated with infrequent (1 to 2 days vs. every day) communication with friends through cellphones, SMS messages, or Internet (1.66, 1.03-2.67). In the full population, overweight/obese weight status was associated with not perceiving best friend as a confidant (1.59, 1.11-2.28). No associations were found between weight status and number of close same-sex and opposite-sex friends, mother/father as confidant, and perceived classmate acceptance.

CONCLUSIONS

This study shows that overweight/obese adolescents have higher odds of numerous poor social relations than their normal-weight peers both in terms of structural and functional dimensions of social relations.

Pediatric Obesity-Assessment, Treatment, and Prevention: An Endocrine Society Clinical Practice Guideline

COSPONSORING ASSOCIATIONS

The European Society of Endocrinology and the Pediatric Endocrine Society. This guideline was funded by the Endocrine Society.

OBJECTIVE

To formulate clinical practice guidelines for the assessment, treatment, and prevention of pediatric obesity.

PARTICIPANTS

The participants include an Endocrine Society-appointed Task Force of 6 experts, a methodologist, and a medical writer.

EVIDENCE

This evidence-based guideline was developed using the Grading of Recommendations, Assessment, Development, and Evaluation approach to describe the strength of recommendations and the quality of evidence. The Task Force commissioned 2 systematic reviews and used the best available evidence from other published systematic reviews and individual studies.

CONSENSUS PROCESS

One group meeting, several conference calls, and e-mail communications enabled consensus. Endocrine Society committees and members and co-sponsoring organizations reviewed and commented on preliminary drafts of this guideline.

CONCLUSION

Pediatric obesity remains an ongoing serious international health concern affecting ∼17% of US children and adolescents, threatening their adult health and longevity. Pediatric obesity has its basis in genetic susceptibilities influenced by a permissive environment starting in utero and extending through childhood and adolescence. Endocrine etiologies for obesity are rare and usually are accompanied by attenuated growth patterns. Pediatric comorbidities are common and long-term health complications often result; screening for comorbidities of obesity should be applied in a hierarchal, logical manner for early identification before more serious complications result. Genetic screening for rare syndromes is indicated only in the presence of specific historical or physical features. The psychological toll of pediatric obesity on the individual and family necessitates screening for mental health issues and counseling as indicated. The prevention of pediatric obesity by promoting healthful diet, activity, and environment should be a primary goal, as achieving effective, long-lasting results with lifestyle modification once obesity occurs is difficult. Although some behavioral and pharmacotherapy studies report modest success, additional research into accessible and effective methods for preventing and treating pediatric obesity is needed. The use of weight loss medications during childhood and adolescence should be restricted to clinical trials. Increasing evidence demonstrates the effectiveness of bariatric surgery in the most seriously affected mature teenagers who have failed lifestyle modification, but the use of surgery requires experienced teams with resources for long-term follow-up. Adolescents undergoing lifestyle therapy, medication regimens, or bariatric surgery for obesity will need cohesive planning to help them effectively transition to adult care, with continued necessary monitoring, support, and intervention. Transition programs for obesity are an uncharted area requiring further research for efficacy. Despite a significant increase in research on pediatric obesity since the initial publication of these guidelines 8 years ago, further study is needed of the genetic and biological factors that increase the risk of weight gain and influence the response to therapeutic interventions. Also needed are more studies to better understand the genetic and biological factors that cause an obese individual to manifest one comorbidity vs another or to be free of comorbidities. Furthermore, continued investigation into the most effective methods of preventing and treating obesity and into methods for changing environmental and economic factors that will lead to worldwide cultural changes in diet and activity should be priorities. Particular attention to determining ways to effect systemic changes in food environments and total daily mobility, as well as methods for sustaining healthy body mass index changes, is of importance.

Overweight or obesity associations with physical aggression in children and adolescents

Being overweight or obese (overweight/obesity) or physically aggressive in childhood and adolescence can have lifelong consequences, hence are important public health problems. Identifying a relationship between these problems would assist in understanding their developmental origins. The present paper sought to review previous studies and use meta-analysis to evaluate whether there is evidence of a relationship between overweight/obesity and physical aggression in children and adolescents. A systematic search of studies that reported the effect of overweight/obesity (in the form of body mass index) on physical aggression was conducted. A total of 23 studies were identified, representing data from 255,377 participants. The results indicate that children and adolescents who are overweight or obese are more physically aggressive than their normal-weight or underweight peers. The average weighted standardized mean difference (the effect size) for aggression in overweight and obese children and adolescents compared to others was found to be 0.27 (95% confidence interval [CI95]: .17–.37), and was significant ( p<.001). Gender sub-analysis indicated that higher physical aggression amongst overweight or obese compared to normal-weight or underweight peers is a slightly larger effect for boys (standardized mean difference of .35, CI95: .18–.52, p<.001) than girls (standardized mean difference of .24, CI95: .07–.42, p<.01). High levels of heterogeneity (94.41%) were found between study-level effect sizes. The developmental processes that may explain the association between overweight/obesity and physical aggression in children and adolescents are discussed.

Obesity status trajectory groups among elementary school children

BACKGROUND

Little is known about patterns in the transition from healthy weight to overweight or obesity during the elementary school years. This study examined whether there were distinct body mass index (BMI) trajectory groups among elementary school children, and predictors of trajectory group membership.

METHODS

This is a secondary analysis of 1651 elementary school children with complete biannual longitudinal data from kindergarten to the beginning of 5(th) grade. Heights and weights were measured by trained school nurses using standard procedures at the beginning and end of each school year for 11 consecutive assessments. Group-based trajectory clustering and multinomial logit modeling were conducted.

RESULTS

When using BMIz score, six trajectory groups were identified revealing substantial consistency in BMIz score across time. When using a categorical variable separating overweight/obese children (BMI ≥ 85%ile) from the rest, five developmental trajectories (persistently non-overweight/obese weight: 51.1 %; early-onset overweight/obese: 9.2 %; late-onset overweight/obese: 9.7 %; becoming healthy weight: 8.2 %; and chronically overweight/obese: 21.8 %) were identified. When using a categorical variable separating obese children (BMI ≥ 95%ile) from the rest, three trajectories (persistently non-obese: 74.1 %, becoming obese: 12.8 %; and chronically obese: 13.2 %) were identified. For both cutoffs (≥ BMI percentile 85 % or 95 %), girls were more likely than boys to be classified in the persistently non-overweight and/or obese group (odds ratios (OR) ranged from 0.53 to 0.67); and Hispanic children and non-Hispanic Black children were more likely to be chronically overweight and/or obese than non-Hispanic White children (OR ranged from 1.57 to 2.44). Hispanic children were also more likely to become obese (OR: 1.84) than non-Hispanic White children when ≥ BMI percentile 95 % was used.

CONCLUSIONS

Boys, Hispanic and non-Hispanic Black children were at higher risk of being overweight or obese throughout their elementary school years, supporting the need for obesity treatment. Post kindergarten and post second grade summer months were times when some children transitioned into overweight/obesity. It will be important to identify which behavioral factors (e.g., diet, physical activity, sedentary behaviors, and/or sleep) predisposed children to becoming overweight/obese, and whether these factors differ by time (Kindergarten versus second grade). If behavioral predisposing factors could be identified early, targeted obesity prevention should be offered.

[Effect of motivational interviewing combined with peer participation on obesity management in adolescents]

OBJECTIVE

To investigate the effect of motivational interviewing combined with peer participation on obesity management in adolescents.

METHODS

A total of 100 adolescents with simple obesity were randomly divided into traditional management and peer participation groups (n=50 each). The traditional management group received traditional health management. The peer participation group received motivational interviewing performed by psychological consultants combined with peer participation through the entire process in addition to traditional health management. The physical exercise, dietary behavior, differences in body composition parameters, and effect of comprehensive intervention were compared between the two groups after intervention for half a year.

RESULTS

After the health management for six months, the peer participation group showed better improvements in the control of energy intake, adjustment of dietary structure, adherence to moderate/high intensity exercise, and increase in lean body mass compared with the traditional management group (P<0.05). The peer participation group had a significantly higher attendance rate for guidance and counseling performed by a multidisciplinary team once a week than the traditional management group (89% vs 57%; P<0.05), as well as a significantly higher response rate to health management than the traditional management group (83% vs 43%; P<0.05).

CONCLUSIONS

Motivational interviewing combined with peer participation for obesity management can improve the compliance and the effect of comprehensive intervention in losing weight in adolescents.

The Social and Emotional Lives of Overweight, Obese, and Severely Obese Children

This study examines inter- and intrapersonal problems associated with being overweight among one thousand one hundred sixty-four 6- to 7-year-olds (49% boys) in 29 rural schools. Socioemotional data include child self-reports, peer sociometrics, and teacher reports. Results support the hypothesis that children with weight problems struggle socially and emotionally, and extend current understanding of child obesity by demonstrating that problems appear early, are evident in a community sample, can be identified using standard sociometric methods, and are worse among children with severe obesity. Sociometric status difference between levels of obesity were also found. Although obese children were neglected by peers, severely obese children were rejected.

Overweight and isolated

This longitudinal study investigates whether there are particularly salient ages when being overweight is related to problems in interpersonal relationships (i.e., physical, relational, and verbal victimization, lack of friend social support, dating status, and romantic relationship worries). Participants were from a large, six-wave longitudinal study ( N = 662, 48% males, M age at T1 = 15.5 years, SD = 1.9 years). We use time-varying effect models to estimate how the associations between weight status and interpersonal problems differ from ages 12 to 28. Gender differences are also investigated. Findings show that youth who are overweight are more likely to experience verbal victimization, feel less supported by their peers, and are less likely to date than youth who are not overweight from mid-adolescence into early young adulthood. Further, females who are overweight are more likely to be physically victimized at ages 15 to 22 than females who are not overweight. The results provide a better understanding of age-related changes in interpersonal problems among youth who are overweight from adolescence into young adulthood.

Multidisciplinary Pediatric Obesity Clinic via Telemedicine Within the Los Angeles Metropolitan Area: Lessons Learned

Telemedicine has been shown to be effective for rural populations, but little is reported on pediatric obesity care via telemedicine in urban settings. This study aims to assess feasibility and acceptability of multidisciplinary pediatric obesity care via telemedicine within the same metropolitan area in terms of information technology, coordination, patient care, and clinical outcomes. All project notes and communications were reviewed to extract key lessons from implementation. Patient and Provider Satisfaction Questionnaires were conducted to assess overall satisfaction; baseline and follow-up information were collected from chart reviews to evaluate clinical outcomes. Based on the questionnaires, 93% of responding patients (n = 28) and 88.3% of referring providers (n = 17) felt satisfied with the appointment. Chart review indicated a trend for decreased or stabilized body mass index and blood pressure (n = 32). Implementation of telemedicine for tertiary multidisciplinary pediatric obesity care in urban settings is both feasible and acceptable to patients and health care providers.

Association of adolescents' weight status with life satisfaction: role of self, peers, family and school perception; the CASPIAN-IV Study

BACKGROUND

Although many public health programs have focused on prevention and control of obesity, their efficacy mostly depends on personal factors including perception of weight and personal understanding of the concept of being overweight. This study aims to investigate the association of adolescent's weight status with life satisfaction and explore the role of self, peers, family and school perception in this association.

METHODS

Data were obtained from the fourth school-based survey entitled "Childhood and Adolescence Surveillance and Prevention of Adult Non-communicable Disease" (CASPIAN) Study. This survey was conducted among 14,880 urban and rural students aged 6-18 years. Two sets of valid and reliable questionnaire obtained from Global School Health Survey (GSHS) were completed by students and their parents. The students' questionnaire had several questions including life satisfaction and the perception of weight, peers, family and school.

RESULTS

The study had a participation rate of 90.6% including 50.8% boys and 76% urban residents. Significant differences existed in Body Mass Index (BMI) and in perception of weight among girls and boys. Moreover, the prevalence of depression and being bullied were higher among girls and boys, respectively. Significant association was documented between life satisfaction and all variables including perception of weight, peers, family and school; the only exception was for BMI (P<0.05). In addition, students with normal weight had significantly higher life satisfaction in comparison with their obese counterparts (P<0.05).

CONCLUSIONS

The present study documented significant association between life satisfaction and perception of self, peer, family and school with the exception of BMI in both genders.

Obesity, Physical Activity, and Sedentary Behavior of Youth With Learning Disabilities and ADHD

Obesity, physical activity, and sedentary behavior in childhood are important indicators of present and future health and are associated with school-related outcomes such as academic achievement, behavior, peer relationships, and self-esteem. Using logistic regression models that controlled for gender, age, ethnicity/race, and socioeconomic status, we investigated the likelihood that youth with learning disabilities (LD) and attention-deficit/hyperactivity disorder (ADHD) are obese, physically active, and sedentary using a nationally representative sample of 45,897 youth in the United States from 10 to 17 years of age. Results indicated that youth with comorbid LD/ADHD were significantly more likely than peers without LD or ADHD to be obese; that youth with LD only, ADHD only, and comorbid LD/ADHD were significantly less likely to meet recommended levels of physical activity; and that youth with LD only were significantly more likely to exceed recommended levels of sedentary behavior. Medication status mediated outcomes for youth with ADHD. We offer school-based recommendations for improving health-related outcomes for students with LD and ADHD.

Associations between family religious practices, internalizing/externalizing behaviors, and body mass index in obese youth

The objective of the present study was to assess the associations among family religious practices, internalizing/externalizing behaviors, and body mass index in a sample of severely obese youth referred to an outpatient pediatric endocrinology clinic. The sample consisted of 43 obese youth (body mass index > 95th percentile) aged 6-16 years (mean age = 12.67 years). Approximately 93% of families endorsed their religious faith as Christian or Catholic. Parents of youth were administered a demographic questionnaire, religiosity questionnaire, and the Child Behavior Checklist. Three multiple linear regression models were examined with body mass index percentile, Child Behavior Checklist Internalizing Scale, and Child Behavior Checklist Externalizing Scale as outcome variables. A parent endorsing greater importance of religious faith in shaping family life was associated with lower child body mass index percentile (p < 0.05) in the present sample. Greater family attendance at religious services was associated with higher child body mass index percentile (p < 0.05). Our data suggest that church-based interventions may be one viable option for the delivery of lifestyle interventions in families of youth with severe obesity.

The Relationship between Obesity and Cognitive Performance in Children: A Longitudinal Study

BACKGROUND

The relationship between obesity and academic outcomes remains unclear. We evaluated the association between obesity and cognitive performance in US children.

METHODS

We analyzed two nationally representative prospective cohorts of children in the 1979 National Longitudinal Survey of Youth, ages 2 through 8 at baseline and followed for 6 years, from 1988 to 1994 (cohort 1, n=2672) and 1994 to 2000 (cohort 2, n=1991). The main exposure variable was obesity (defined as never obese, became obese, always obese, and became nonobese). The main outcomes were standardized scores on four cognitive assessments. Univariate regression analyses of test scores on obesity were performed. Fixed-effects regression models, controlling for measured and unmeasured time-invariant confounders, were additionally adjusted for time-variant confounders to analyze the impact of change in obesity status on change in test scores.

RESULTS

Unadjusted analyses revealed a significant association between obesity and Peabody Individual Achievement Test (PIAT) scores. In cohort 1, always obese children had lower PIAT math scores than never obese children (β=-7.48; p<0.05). Always obese boys had lower PIAT math scores than those who were never obese (β=-16.45; p<0.01). In cohort 2, PIAT math scores were lower in the became obese category than the never obese category (β=-4.10; p<0.05). Always obese girls had lower PIAT reading scores than those who were never obese (β=-11.28; p<0.01). Fixed-effects models additionally adjusted for Home Observation Measurement of the Environment, Short Form score and height percentile showed no significant relationship between obesity and test scores in either cohort.

CONCLUSION

Childhood obesity is unlikely to be causally related to cognitive performance.

Time with friends and physical activity as mechanisms linking obesity and television viewing among youth

Background

Though bivariate relationships between childhood obesity, physical activity, friendships and television viewing are well documented, empirical assessment of the extent to which links between obesity and television may be mediated by these factors is scarce. This study examines the possibility that time with friends and physical activity are potential mechanisms linking overweight/obesity to television viewing in youth.

Methods

Data were drawn from children ages 10-18 years old (M = 13.81, SD = 2.55) participating in the 2002 wave of Child Development Supplement (CDS) to the Panel Study of Income Dynamics (PSID) (n = 1,545). Data were collected both directly and via self-report from children and their parents. Path analysis was employed to examine a model whereby the relationships between youth overweight/obesity and television viewing were mediated by time spent with friends and moderate-to-vigorous physical activity (MVPA).

Results

Overweight/obesity was directly related to less time spent with friends, but not to MVPA. Time spent with friends was directly and positively related to MVPA, and directly and negatively related to time spent watching television without friends. In turn, MVPA was directly and negatively related to watching television without friends. There were significant indirect effects of both overweight/obesity and time with friends on television viewing through MVPA, and of overweight/obesity on MVPA through time with friends. Net of any indirect effects, the direct effect of overweight/obesity on television viewing remained. The final model fit the data extremely well (χ² = 5.77, df = 5, p<0.0001, RMSEA = 0.01, CFI = 0.99, TLI =0.99).

Conclusions

We found good evidence that the positive relationships between time with friends and physical activity are important mediators of links between overweight/obesity and television viewing in youth. These findings highlight the importance of moving from examinations of bivariate relationships between weight status and television viewing to more nuanced explanatory models which attempt to identify and unpack the possible mechanisms linking them.

Integrating fundamental concepts of obesity and eating disorders: implications for the obesity epidemic

Physiological mechanisms promote weight gain after famine. Because eating disorders, obesity, and dieting limit food intake, they are famine-like experiences. The development of the concept of meeting an ideal weight was the beginning of increasing obesity. Weight stigma, the perception of being fat, lack of understanding of normal growth and development, and increased concern about obesity on the part of health providers, parents, and caregivers have reinforced each other to promote dieting. Because weight suppression and disinhibition provoke long-term weight increase, dieting is a major factor producing the obesity epidemic. The integrated eating disorder-obesity theory included in this article emphasizes that, contrary to dieters, lifetime weight maintainers depend on physiological processes to control weight and experience minimal weight change.

Eating disorders and psychopathological traits in obese preadolescents and adolescents

OBJECTIVE

to investigate the presence of eating disorders (ED) and psychopathological traits in obese preadolescents and adolescents compared to normal-weight peers.

DESIGN

Overweight/obese patients aged 11 to 14 y and normal-weight peers' data collected by means of self-report questionnaires administered to parents and children.

SETTING

Clinical Nutrition Units in the Municipalities of Rome, Naples, Gallipoli and Atri, Italy.

SUBJECTS

376 preadolescents and adolescents. Patients were 187 (93 boys, BMI=27.9±;4.1; 94 girls, BMI=28.1±4.5); normal-weight controls were 189 subjects (94 boys, BMI=19.4±1.4; 95 girls, BMI=19.5±1.5).

MEASURES OF OUTCOME

eating disorder behaviors, psychopathological traits and symptoms estimated by means of the eating disorders scales (EDI-2) and psychopathological scales (CBCL 4-18).

RESULTS

Patients reached higher scores than controls in most of the eating disorders scales and psychopathological scales. Twenty-one (11.2%) patients were considered at risk of developing an eating disorder and 75 (40%) presented social problems. With regard to weight status, age-group and gender, main significant interaction effects were seen in social problems (F= 6.50; p<0.05) and ineffectiveness (F= 4.15; p<0.05).

CONCLUSIONS

Findings from our study demonstrate that in preadolescence and adolescence, obesity is significantly associated to some traits typical of ED and to psychological problems in general. Although no inference can be made with regard to direction of causality, it is possible to conclude that overweight preadolescents and adolescents can be prone to display problematic traits more commonly associated to eating disorders and to present a high degree of mental distress.

Associations between overweight, peer problems, and mental health in 12-13-year-old Norwegian children

Overweight and mental health problems represent two major challenges related to child and adolescent health. More knowledge of a possible relationship between the two problems and the influence of peer problems on the mental health of overweight children is needed. It has previously been hypothesized that peer problems may be an underlying factor in the association between overweight and mental health problems. The purpose of the present study was to investigate the associations between overweight, peer problems, and indications of mental health problems in a sample of 12-13-year-old Norwegian schoolchildren. Children aged 12-13 years were recruited from the seventh grade of primary schools in Telemark County, Norway. Parents gave information about mental health and peer problems by completing the extended version of the Strength and Difficulties Questionnaire (SDQ). Height and weight were objectively measured. Complete data were obtained for 744 children. Fisher's exact probability test and multiple logistic regressions were used. Most children had normal good mental health. Multiple logistic regression analysis showed that overweight children were more likely to have indications of psychiatric disorders (adjusted OR: 1.8, CI: 1.0-3.2) and peer problems (adjusted OR: 2.6, CI: 1.6-4.2) than normal-weight children, when adjusted for relevant background variables. When adjusted for peer problems, the association between overweight and indications of any psychiatric disorder was no longer significant. The results support the hypothesis that peer problems may be an important underlying factor for mental health problems in overweight children.

Developmental associations between victimization and body mass index from 3 to 10 years in a population sample

In the current prospective study, we investigated (1) whether high and low BMI in early childhood puts a child at risk of victimization by their peers, and (2) whether being victimized increases BMI over the short- and long-term, independent of the effect of BMI on victimization. We also examined whether gender moderated these prospective associations. Participants were 1,344 children who were assessed yearly from ages 3 to 10 years as part of the Québec Longitudinal Study of Child Development (QLSCD). BMI predicted annual increases in victimization for girls aged 6 years and over; for boys aged 7 and 8 years of age, higher BMI reduced victimization over the school year. Further, victimization predicted annual increases in BMI for girls after age 6 years. When these short-term effects were held constant, victimization was also shown to have a three and 5-year influence on annual BMI changes for girls from age 3 years. These short- and long-term cross-lagged effects were evident when the effects of family adversity were controlled. The findings support those from previous prospective research showing a link between higher BMI and victimization, but only for girls. Further, being victimized increased the likelihood that girls would put on weight over time, which then increased future victimization. The implications of these prospective findings for interventions are considered. Aggr. Behav. 42:109-122, 2015. © 2015 Wiley Periodicals, Inc.

Incorporating primary and secondary prevention approaches to address childhood obesity prevention and treatment in a low-income, ethnically diverse population: study design and demographic data from the Texas Childhood Obesity Research Demonstration (TX CORD) study

BACKGROUND

There is consensus that development and evaluation of a systems-oriented approach for child obesity prevention and treatment that includes both primary and secondary prevention efforts is needed. This article describes the study design and baseline data from the Texas Childhood Obesity Research Demonstration (TX CORD) project, which addresses child obesity among low-income, ethnically diverse overweight and obese children, ages 2-12 years; a two-tiered systems-oriented approach is hypothesized to reduce BMI z-scores, compared to primary prevention alone.

METHODS

Our study aims are to: (1) implement and evaluate a primary obesity prevention program; (2) implement and evaluate efficacy of a 12-month family-centered secondary obesity prevention program embedded within primary prevention; and (3) quantify the incremental cost-effectiveness of the secondary prevention program. Baseline demographic and behavioral data for the primary prevention community areas are presented.

RESULTS

Baseline data from preschool centers, elementary schools, and clinics indicate that most demographic variables are similar between intervention and comparison communities. Most families are low income (≤$25,000) and Hispanic/Latino (73.3-83.8%). The majority of parents were born outside of the United States. Child obesity rates exceed national values, ranging from 19.0% in preschool to 35.2% in fifth-grade children. Most parents report that their children consume sugary beverages, have a television in the bedroom, and do not consume adequate amounts of fruits and vegetables.

CONCLUSIONS

Interventions to address childhood obesity are warranted in low-income, ethnically diverse communities. Integrating primary and secondary approaches is anticipated to provide sufficient exposure that will lead to significant decreases in childhood obesity.

Predictors of caregiver feeding practices differentiating persistently obese from persistently non-overweight adolescents

Understanding the contribution of caregiver feeding practices to adolescent diet and weight is important to refining caregiver roles within the context of adolescent obesity prevention and treatment. This secondary data analysis examined whether feeding practices of female caregivers differentiated persistently non-overweight (n = 29) from persistently obese (n = 47) adolescents. Families who previously participated in a cross-sectional study on correlates of obesity were recruited for this follow-up study. At the time of the follow-up study, anthropometric measures were taken for all female caregivers and adolescents, and caregivers completed the Child Feeding Questionnaire-Adolescent version. Socioeconomic, demographic, female caregiver anthropometric, and psychological (caregiver perceived self-weight and concern for adolescent overweight) variables were examined as predictors of feeding practices found to differentiate the two groups. Female caregivers of persistently obese adolescents reported significantly greater use of restriction and monitoring compared to female caregivers of persistently non-overweight adolescents. Restriction was predicted by female caregiver age and concern for adolescent overweight whereas monitoring was predicted by concern for adolescent overweight only. Caregiver feeding strategies may be an important target for adolescent obesity prevention and intervention efforts particularly among those with heightened concern about their teen's weight status.