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

Body image and depressive symptoms in Danish adolescents: A cross-sectional national study

BACKGROUND

Depressive symptoms are prevalent in adolescents. We aimed to investigate the association between body image and depressive symptoms, and how Body Mass Index (BMI) affects this.

METHODS

Survey data from 2017 with 9963 9th-grade Danish adolescents. Information from the survey about the exposure, body image, was divided into 3 categories: too fat, too thin, and adequate. Depressive symptoms, was measured with Center for Epidemiological Studies Depression Scale for Children (CES-DC4). BMI was categorized as underweight, normal weight and overweight. We used logistic regression and examined for effect modification by sex and BMI and adjusted for self-esteem and bullying.

RESULTS

An association was found between body image and depressive symptoms, when adjusting for BMI, sex, self-esteem, and bullying. The association was strongest for adolescents feeling too fat compared with adolescents feeling adequate OR:1.61(1.45-1.78), for adolescents feeling to thin compared to adequate: OR:1.21 (1.06-1.37). No effect modification by either BMI or sex was found, but those who perceive their bodies in contrast to their reported BMI faced the highest odds of depressive symptoms, and the results were confounded by self-esteem and bullying, that reduced the estimates after adjusting.

LIMITATIONS

This is a cross-sectional study with limited information regarding drop-out, with risk of selection bias.

CONCLUSION

We found an association between negative body image and depressive symptoms among Danish adolescents. This confirms previous studies and is a relevant aspect to adolescents' mental health, especially the contrast between BMI and perceived body image, and the confounding by self-esteem and bulling, with potential for prevention.

Overview of Pediatric Obesity as a Disease

The authors highlight well-known and hypothesized pathophysiologic mechanistic links underlying obesity and the various pediatric disorders across multiple organ systems with which it is associated. Obesity is attributed to an imbalance in energy intake versus expenditure; there is growing knowledge regarding its multifactorial origins, dysfunctional physiologic processes, and adverse health consequences. Individuals with obesity exhibit variations in metabolic rate, genetic predisposition, and hormonal regulation, influencing diverse responses in regulating energy balance. Understanding the complex mechanistic relationships surrounding the pathophysiology of obesity assists in its consideration as a disease process, allowing pediatric health practitioners to manage its sequelae more effectively.

Global self-esteem and degree of overweight/obesity: are they linked in the adult population? A systematic review and meta-analysis

OBJECTIVE

Self-esteem may be adversely affected in adults with overweight or obesity, particularly women and those showing higher BMIs, although there is no consensus in the literature. The objective of the current study, based on reported cross-sectional associations, was to clarify the relationship between global self-esteem and overweight/obesity in adults.

METHODS

Four databases were searched to identify eligible literature published prior to June 2024, and a systematic review was conducted of the 120 articles identified. Meta-analytic processing of 38 eligible articles at the study level and of the participant data obtained from 16 studies (n = 2,972) was conducted for quantitative synthesis. Potential moderators, such as gender, age, BMI, type of assessment, and treatment-seeking status, were tested.

RESULTS

The summary correlation between BMI and self-esteem across studies was r = -0.11, 95% CI [-0.17, -0.05], z = -3.70, p < .001. None of the tested moderators affected this association, although the meta-analysis of the individual participant data provided by the authors revealed a small effect of gender and a non-linear evolution of self-esteem linked to BMI.

CONCLUSION

The present study found a negative relationship between global self-esteem and overweight/obesity in adults, which suggests a negative, although weak, effect of excess weight on self-perception.

Assessment of Motor Performance and Self-Perceived Psychophysical Well-Being in Relation to Body Mass Index in Italian Adolescents

BACKGROUND/OBJECTIVES

The relationship between psychophysical self-perception (PSP), body mass index (BMI) and motor performance (MP) levels, in quantitative and qualitative terms, can be a very interesting connection to investigate. This study aimed to assess MP and PSP according to gender and weight differences (normal weight-Nw/overweight-obese-Ov-Ob) and their relationship to BMI in Italian adolescents.

METHODS

In total, 144 students (F = 72; M = 72) aged between 11 and 13 y.o. participated in this study. They were divided into two groups by gender and into two subgroups based on weight (Nw/Ov-Ob). Standing long jump, sit-and-reach, 10 × 5 m shuttle and sit-up tests to assess MP were carried out, and an ad hoc questionnaire to evaluate PSP was administrated.

RESULTS

In comparing the Nw and Ov-Ob subgroups on the basis of BMI for each gender, statistically significant differences emerged in all motor skill tests administered. Regarding PSP, the Nw subgroup showed high and positive levels, while Ov-Ob showed low and negative levels, highlighting a relationship between high BMI and poor motor performance as well as negative psychophysical perception in the Ov-Ob subgroup.

CONCLUSIONS

this study supports the importance of physical sport activity to regulate excess weight but also contribute to better psychophysical well-being.

Uncovering the key working mechanisms of a complex community-based obesity prevention programme in the Netherlands using ripple effects mapping

BACKGROUND

Much remains unknown about how complex community-based programmes can successfully achieve long-term impact. More insight is needed to understand the key mechanisms through which these programmes work. Therefore, we conducted an in-depth study in five communities that implemented the Healthy Youth, Healthy Future (JOGG) approach, a Dutch community-based obesity prevention programme. We aimed to identify perceived outcomes and long-term impacts among local stakeholders and explore potential causal pathways and working mechanisms.

METHODS

We used ripple effects mapping (REM), a qualitative participatory method to map outcomes and identify causal pathways, in five communities. We involved 26 stakeholders, professionals and policy-makers affiliated with the local JOGG approach, spread over eight REM sessions and conducted individual interviews with 24 additional stakeholders. To uncover working mechanisms, we compared outcomes and causal pathways across communities.

RESULTS

Over 5-9 years of implementation, participants perceived that JOGG had improved ownership of local stakeholders, health policies, intersectoral collaboration and social norms towards promoting healthy lifestyles. Causal pathways comprised small initial outcomes that created the preconditions to enable the achievement of long-term impact. Although exact JOGG actions varied widely between communities, we identified five common working mechanisms through which the JOGG approach contributed to causal pathways: (1) creating a positive connotation with JOGG, (2) mobilizing stakeholders to participate in the JOGG approach, (3) facilitating projects to promote knowledge and awareness among stakeholders while creating successful experiences with promoting healthy lifestyles, (4) connecting stakeholders, thereby stimulating intersectoral collaboration and (5) sharing stakeholder successes that promote healthy lifestyles, which gradually created a social norm of participation.

CONCLUSIONS

The JOGG approach seems to work through activating initial stakeholder participation and bolstering the process towards ownership, policy change, and intersectoral collaboration to promote healthy lifestyles. Key working mechanisms can inform further development of JOGG as well as other complex community-based prevention programmes.

Childhood obesity and adolescent follow-up depressive symptoms: exploring a moderated mediation model of body esteem and gender

Obesity is a well-recognized risk factor for adolescent depressive symptoms, but mediating mechanisms of this association have scarcely been studied. This study is unique in examining an indirect pathway of this link via body esteem (BE) prospectively from childhood (8-12 years) to adolescence (13-18 years). In addition, potential gender moderation was examined. This study utilized data from a case-control study comparing 100 children with and without obesity matched on important confounders (age, gender, and socioeconomic status). Our findings provide support for the mediating role of BE in the link between childhood weight status and adolescent depressive symptoms at a 5-year follow-up. This mediation effect did not differ between boys and girls. The findings suggest the relevance of specifically targeting children's BE in preventive intervention programs among children with obesity to prevent future mental health problems.

The impact of excess body weight on employment outcomes: A systematic review of the evidence

BACKGROUND

Excess body weight has been recognised as an important factor in influencing labour market outcomes. Several hypotheses explain the causal effect of excess body weight on employment outcomes, including productivity, labour supply, and discrimination. In this review, we provide a systematic synthesis of the evidence on the causal impact of excess body weight on labour market outcomes worldwide.

METHODS

We searched Econ Lit, and Web of Science databases for relevant studies published from 1st Jan 2010-20 th Jan 2023. Studies were included if they were either longitudinal analysis, pooled cross-sectional or cross-sectional studies if they used instrumental variable methodology based on Mendelian Randomisation. Only studies with measures of body weight and employment outcomes were included.

RESULTS

The number of potentially relevant studies constituted 4321 hits. A total of 59 studies met the inclusion criteria and were qualitatively reviewed by the authors. Most of the included studies were conducted in the USA (N=18), followed by the UK (N=9), Germany (N=6), Finland (N=4), and non-EU countries (N=22). Evidence from the included studies suggests that the effect of excess weight differs by gender, ethnicity, country, and time period. White women with excess weight in the USA, the UK, Germany, Canada, and in the EU (multi-country analyses) are less likely to be employed, and when employed they face lower wages compared to normal weight counterparts. For men there is no effect of excess weight on employment outcomes or the magnitude of the effect is much smaller or even positive in some cases.

CONCLUSIONS

This review has shown that despite ample research on the relationship between excess weight and employment status and wages, robust causal evidence of the effects of excess weight on employment outcomes remains scarce and relies significantly on strong statistical and theoretical assumptions. Further research into these relationships outside of USA and Western Europe context is needed.

Self-Esteem Among U.S. African American and Latinx Adolescents With Depressive Symptoms and Overweight and/or Obesity

PURPOSE

To examine the concept of self-esteem among African American and Latinx adolescents with overweight and/or obesity and depressive symptoms in the United States.

METHOD

Using key terms in CINAHL, PubMed, and PsycINFO databases, an initial search yielded 371 articles; after examining title, abstract, and full text, 33 articles remained. The concept of adolescent self-esteem was analyzed using Rodger's evolutionary method.

RESULTS

Several antecedents of self-esteem in this context were identified, including bullying, negative portrayal in the media, stressors and hassles, low socioeconomic status, dieting, and family dietary influences. Attributes identified were body image and misperception, body image dissatisfaction, diminished social status, and isolation. Consequences included stigma, somatic complaints, decreased earnings over a lifetime, decreased quality of life, lower educational attainment over a lifetime, and increased substance use. Increased self-esteem, increased number of friends, and in-depth friendships were associated with a lower risk of being overweight or obese.

CONCLUSION

Adolescent self-esteem varied based on gender, racial and ethnic group, and changed over time in the African American population but remained static in the Latinx population. [Journal of Psychosocial Nursing and Mental Health Services, xx(xx), xx-xx.].

Effects of Educational Program Based on Self-Esteem Enhancement on Weight Status in Obese Women

Background

Most obese people do not have high self-esteem. This study was conducted to evaluate the effect of self-esteem education on the weight status of obese women.

Methods

This Randomized Clinical Trial (RCT) was performed on 46 obese women (BMI >30) in Hamadan during 2021-2022. By simple convenient sampling and block randomization, the samples were divided into two equal groups. In both groups, routine lifestyle and diet recommendations were prescribed. In the intervention group, eight sessions of self-esteem training were performed specifically. In two groups BMI was measured and the Cooper-Smith Self-Esteem Inventory (CSEI) was filled out before and after the intervention. SPSS 20 was used to analyze the data. Statistical significance was considered at p < 0.05.

Results

The mean age of the participants in the intervention and control groups was 27.95 (5.02) and 30.25 (5.46) years respectively (t38 = 1.39, p = 0.17). BMI was comparable in two groups before the study (32.47 vs. 33.13 in the intervention and control group respectively, (t38 = 1.02, p = 0.31), but decreased significantly in the intervention group at the end (30.38 vs. 32.90, t38 = 3.76, p = 0.001). The mean self-esteem scores of the two groups were similar at the beginning (27.10 vs. 27.60 in the intervention and control group respectively, (t38 = 0.52, p = 0.60) but increased significantly in the intervention group at the end (30.10 vs. 27.35, t38 = 2.99, p < 0.001).

Conclusions

The findings suggest that self-esteem educational programs can increase the self-esteem score and decrease BMI in obese women and should be considered as a treatment modality in these women.

What is the disease burden from childhood and adolescent obesity?: a narrative review

The prevalence of childhood and adolescent obesity has increased and exacerbated during the coronavirus disease 2019 pandemic, both in Korea and globally. Childhood and adolescent obesity poses significant risks for premature morbidity and mortality. The development of serious comorbidities depends not only on the duration of obesity but also on the age of onset. Obesity in children and adolescents affects almost all organ systems, including the endocrine, cardiovascular, gastrointestinal, reproductive, nervous, and immune systems. Obesity in children and adolescents affects growth, cognitive function, and psychosocial interactions during development, in addition to aggravating known adult comorbidities such as type 2 diabetes mellitus, hypertension, dyslipidemia, nonalcoholic fatty liver disease, obstructive sleep apnea, and cancer. Childhood and adolescent obesity are highly associated with increased cardiometabolic risk factors and prevalence of metabolic syndrome. The risk of cardiovascular and metabolic diseases in later life can be considerably decreased by even a small weight loss before the onset of puberty. Childhood and adolescent obesity is a disease that requires treatment and is associated with many comorbidities and disease burdens. Therefore, early detection and therapeutic intervention are crucial.

Self-Perception Profile, Body Image Perception and Satisfaction in Relation to Body Mass Index: An Investigation in a Sample of Adolescents from the Campania Region, Italy

(1) Background: Body image dissatisfaction has been commonly reported in adolescents with overweight/obesity and has been related to a lack of motivation to change lifestyle behaviors. Plus, a better perception of physical fitness has been related to a higher self-perception in physical aspect and social items in youths. (2) Methods: A total of 120 (59.2% males, mean age of 12.3 ± 0.9 years) middle-school adolescents participated in the present study. Anthropometric measurements were assessed following the standard procedures. Body weight perception and body image satisfaction were assessed using the Silhouette Figure Body Images Test. Self-perception profile, perceived physical fitness, and perceived difficulties in conducting physical tasks were assessed by using structured questionnaires. (3) Results: Overweight was present in 27.5% adolescents and obesity in 32.5%. A total of 89.7% of adolescents with obesity did not have a real perception of his/her weight status and 84.6% of adolescents with obesity were not satisfied with his/her body image. The self-perception of physical appearance, perceived difficulties in running, perceived overall fitness, and perceived speed/agility were lower in adolescents who were unsatisfied with their body image. Body image satisfaction was positively associated with the self-perception of physical appearance and overall fitness and negatively associated with perceived difficulties in running, independently of sex, age, and BMI. (4) Conclusions: Adolescents with obesity did not have a real perception of their weight status and were unsatisfied with their body image. The positive association between body satisfaction, a better perception of overall fitness, and less difficulties in conducting physical tasks suggests the protective role of the components of physical activity and health-related fitness on body acceptance in a critical period of life.

Mental health and BMI in children and adolescents during one year in obesity treatment

BACKGROUND

Mental health plays a major role in children and adolescents with obesity. The aim of this study was (1) to compare mental health in children with obesity with the background population and (2) to investigate if mental health changed during one year in an obesity treatment program.

METHODS

Data on self-reported mental health was collected in 107 children and adolescents (mean age 13.2 years) with obesity at first visit in an obesity treatment program and at one year follow-up (n = 47). Mental health was assessed by eight questions from the Danish Health Behaviour in School-aged Children (HBSC) questionnaire: (1) self-rated health (2) life satisfaction (3) feeling low (4) body-image (5) loneliness (6) self-esteem (7) self-efficacy and (8) social competence. Data was compared to a reference population based on HBSC data. BMI-SDS was based on Danish reference values.

RESULTS

Children and adolescents with obesity had significantly higher odds of reporting negative body image and feeling low and lower odds of reporting high self-rated health and high self-esteem compared to a reference population. There was no difference between the groups regarding life-satisfaction, social competence, self-efficacy or feeling lonely. There were no significant changes in mental health from first visit to one-year follow-up.

CONCLUSION

Our findings highlight the mental health difficulties in children and adolescents with obesity, and the importance of addressing these issues in obesity treatment. The results also indicate that children with obesity have psychosocial resources that should be exploited in treatment protocols.

Trajectory of the body mass index of children and adolescents attending a reference mental health center

OBJECTIVES

The primary objective was to describe the standardized body mass index (z-BMI) trajectory of children and adolescents admitted to a psychiatric reference center in Mexico City according to their diagnosis and medication use. The secondary objective was to compare z-BMI between antipsychotic users and non-users.

METHODS

This is a retrospective cohort study. The psychiatric diagnosis, prescribed medications, serial heights, and weights were collected from the medical records.

RESULTS

The median baseline z-BMI of the 129 analyzed cases was 0.88 (interquartile range [IQR]: 0-1.92), and the prevalence of excessive weight (obesity or overweight) was 46.8 %. At the end of follow-up (median 50.3 weeks), the median change in z-BMI was -0.09 (IQR: -0.68 to 0.42). New long-term users of antipsychotics (n=29) had an increase in their z-BMI, in contrast to never-users (median difference 0.73, p=0.01) and to previous users (median difference 0.92, p=0.047). The 59 subjects with excessive weight at admission had a median z-BMI change of -0.39 (IQR: -0.81 to -0.04). Among patients with excessive weight and depression, there was a greater decrease in z-BMI in sertraline users (n=13) compared with fluoxetine users (n=15) (median -0.65 vs. 0.21, p<0.001).

CONCLUSIONS

New long-term users of antipsychotics showed a significant increase in their z-BMI. Patients with depressive disorders and obesity on sertraline therapy tended to show a decrease in their z-BMI.

How to reduce anxiety symptoms through individual sport in youth: A longitudinal study over 8-month observation

Background

Anxiety symptoms are widely observed among the youth, and engagement in sports has been demonstrated to mitigate these symptoms. Nonetheless, the effectiveness of specific sports and the potential moderating role of psychological factors, such as self-esteem and self-efficacy, on the influence of sports on anxiety, remains to be elucidated. This study was designed to longitudinally assess the impact of sports participation on anxiety symptoms among young individuals.

Methods

The study encompassed 163 university students, with a male predominance of 81.6%, and explored the influence of sport-related factors (such as mastery of table tennis skills, level and engagement) and psychological aspects (including self-efficacy, self-esteem and resilience) on anxiety symptoms, employing an 8-month longitudinal approach. Physical activity, sedentary and sleep behaviour, along with age, body mass index (BMI), and sex, were accounted for as confounding variables.

Results

The study found that high table tennis performance score was found to buffer the development of anxiety symptoms in students with decreased self-esteem in an exploratory moderation model. Self-esteem and self-efficacy were negatively associated with the development of anxiety symptoms, whereas physical activity factors did not have a direct effect.

Conclusion

This study highlights the potential of table tennis as a form of sport to alleviate anxiety symptoms in university students, particularly among those with decreased self-esteem. Future research should address the study's limitations and explore the potential moderating effects of other psychological factors. Overall, these findings suggest a potential new approach to treating anxiety symptoms among university students.

Vigorous physical activity and weight status in school-aged children: a cross-sectional study

Aim

To explore the association between VPA and weight status in adolescents.

Methods

The 2017/2018 Health Behavior in School-aged Children survey (HBSC) targeted children and adolescents aged 11, 13 and 15. A systematic multistage stratified cluster randomized sampling method was used in each participating country. The 2017/2018 survey enrolled over 240,951 adolescents across 45 countries and regions. Frequency of VPA, weight status and confounding factors were collected using a self-reported questionnaire.

Results

Compared to daily VPA, less frequent VPA was linked to higher odds of obesity. For example, those who participating in VPA for 4-6 times a week (OR = 1.10, 95% CI = 1.06-1.13), 2-3 times a week (OR = 1.21, 95% CI = 1.17-1.25), or once a week (OR = 1.21, 95% CI = 1.16-1.25) all have higher odds of abnormal weight status. For boys, the frequency of 4-6 times a week (OR = 1.09, 95% CI = 1.04-1.13), 2-3 times a week (OR = 1.22, 95% CI = 1.17-1.27), or once a week (OR = 1.25, 95% CI = 1.19-1.32) were associated with higher odds of abnormal weight status. For girls, those who participating in VPA 4-6 times a week (OR = 1.11, 95% CI = 1.06-1.16), 2-3 times a week (OR = 1.20, 95% CI = 1.14-1.25), or once a week (OR = 1.17, 95% CI = 1.11-1.23) all have higher odds of abnormal weight status (i.e., overweight or obesity).

Conclusion

This population-based study suggests that infrequent VPA participation is associated with unhealthy weight status in adolescents compared to their physically active counterparts. Additionally, this association remains consistent in both boys and girls.

Parent Intention to Participate in an Online Intervention to Enhance Health Behavior Change Among Youth Treated with Psychotropic Medication Who are Overweight or Obese: An Application of the Theory of Planned Behavior

Youth with mental health disorders (MHD), particularly those who take psychotropic medications, are at increased risk of being overweight or obese (OW/OB) when compared to typical youth. Parents are important resources for interventions addressing OW/OB. However, parents of youth with MHD may face challenges that require interventions designed to address their needs. Prior to investing research funding in the development of interventions for this group, research is needed to understand factors associated with parents' decisions to enroll in these programs. The theory of planned behavior (TPB) provided a framework for examining parents' salient beliefs, direct attitudes, and intention to enroll in a hypothetical online healthy lifestyle intervention for their youth (ages 11-17) with OW/OB and treated with psychotropic medication. Parents who were enrolled in the study (n = 84) completed demographic questionnaires and a TPB questionnaire which was constructed for this study. A confirmatory factor analysis (CFA) of the direct attitude (i.e., attitude toward the behavior, subjective norm, perceived behavioral control) questions generally supported the three-factor model (i.e., RMSEA = .07, 90% CI .03-.11, p = .18; CFI = .96, SRMR = .06). Results from a multiple regression analysis demonstrated that direct attitudes predicted parent intention to participate in an online healthy lifestyle intervention for this sample of youth accounting for 84% of variance. In this preliminary study, the TPB appears to be a promising framework for understanding direct attitudes associated with parent intentions toward intervention participation in this population of youth. Interventions for parents of youth with OW/OB who are prescribed psychotropic medication should consider addressing these direct attitudes to improve intention.

Nursing students' self-esteem levels and attitudes toward the nursing profession

AIM

This study aimed to examine nursing students' self-esteem levels and attitudes toward the nursing profession.

BACKGROUND

Although it is important to choose a profession that will make the person happy in many aspects such as one's abilities, interests, values, attitudes, personal goals, and social expectations, it has an important place, especially in a profession such as nursing, which involves intense emotional and physical load.

METHODS

The study population was 390 nursing students at a foundation university in Istanbul, while the sample included 202 students. Data were collected between January 16, 2023, and February 15, 2023, with the Demographic Data Collection Tool, Coopersmith Self-Esteem Inventory, and the Attitude Scale for Nursing Profession. The data were analyzed using the SPSS 27.0 program. The STROBE checklist was used to report the study.

RESULTS

The mean age of the participants was 20.79 ± 1.72 (years), among which 65.3% were in the 20-22 age range, 76.7% were female, and 29.7% were in the first grade. A positive but very weak relationship was found between the Coopersmith Self-Esteem Inventory and the Attitude Scale for Nursing Profession scores (p < 0.05).

CONCLUSION

The results show that professionalization and socialization processes greatly affect nursing students' self-esteem. Considering the extended period that students spend in academic institutions under the guidance of faculty members, this matter deserves greater attention.

IMPLICATIONS FOR NURSING

While developing the curriculum and education process, factors that support the development of self-esteem in nursing students should be taken into account and initiatives should be planned to increase positive attitudes toward the profession. Nursing students can gain different perspectives by spending more time with nurses in hospitals.

Association between anxiety and elevated blood pressure in adolescent patients: a single-center cross-sectional study

OBJECTIVE

Although anxiety is known to be associated with elevated blood pressure and hypertension in adults, this has not been studied in children. The aim of this study was to determine the association between anxiety and elevated blood pressures in adolescents.

METHODS

Adolescents, aged 12-18 years old, referred to the nephrology clinic were eligible to participate. Elevated blood pressure was defined as either SBP or DBP measurement above the 95th percentile for age, height, and sex. Participants were evaluated for anxiety using the validated Screen for Child Anxiety Related Disorders questionnaire filled independently by the child (SCARED-C) and parent (SCARED-P) evaluating the child.

RESULTS

Two hundred adolescents participated in this study. Thirty-one (53%) of SCARED-P-positive participants were found to have elevated blood pressure compared with 27 (19%) of SCARED-P negative, P 0.03. Twenty-five (43%) of SCARED-P positive had elevated DBP compared with 31 (28%) of SCARED-P negative ( P 0.003). In SCARED-P positive, mean DBP (78.4 ± 9.9) was higher compared with SCARED-P negative (74.9 ± 9.2) ( P 0.03). In a subgroup of adolescents (№ 130) not treated with blood pressure medications mean DBP was higher in both SCARED-P (79.0 ± 10.1) and SCARED-C (77.1 ± 10.4) positive groups compared with SCARED-P (73.6 ± 9.3) and SCARED-C (73 ± 8.9) negative, respectively.

CONCLUSION

Our study demonstrates an association between anxiety and elevated DBP in adolescent children. Screening adolescents for anxiety should be a part of the routine evaluation of adolescent children.

The relationship between psychological distress and weight maintenance in weight cycling: mediating role of eating behavior

BACKGROUND

Obesity is a global public health concern. The goal of this study was to see if eating habits could mediate the relationship between psychological distress and weight maintenance in a population with a history of weight cycling.

METHODS

A 3-month outpatient intervention consisting of a diet and exercise program was provided to 153 participants. Psychological distress, appetite, and behavior were assessed at the beginning and end of the study. Anthropometric measurements were taken at baseline and six months.

RESULTS

After the structural equation model was developed, it was discovered that the psychological status of people with obesity and weight cycling histories correlated with the weight loss outcome effect (three and six months). This effect was mediated by factors related to eating behavior. Associative psychological factors had a direct effect on eating behavior (three months: β = 0.181, 95% CI: 0.055-0.310; six months: β = 0.182, 95% CI: 0.039-0.332) and appetite had a direct effect on eating behavior (three months: β = 0.600, 95% CI: 0.514-0.717; six months: β = 0.581, 95% CI: 0.457-0.713), both of which were significant (p < 0.01). At three months, psychological distress has a more substantial positive impact on weight change, with eating behavior acting as a partial mediator. At six months, there was no support for appetite's moderating role in eating behavior.

CONCLUSIONS

The findings suggest that psychological interventions should be strengthened to improve weight loss effectiveness, particularly in participants with a history of weight cycling, making weight loss more complicated and prone to rebound.

CLINICAL TRIAL REGISTRATION

The study has been registered in Clinical Trials (NCT05311462).

Unexpected identification of obesity-associated mutations in LEP and MC4R genes in patients with anorexia nervosa

Mutations leading to a reduced or loss of function in genes of the leptin-melanocortin system confer a risk for monogenic forms of obesity. Yet, gain of function variants in the melanocortin-4-receptor (MC4R) gene predispose to a lower BMI. In individuals with reduced body weight, we thus expected mutations leading to an enhanced function in the respective genes, like leptin (LEP) and MC4R. Therefore, we have Sanger sequenced the coding regions of LEP and MC4R in 462 female patients with anorexia nervosa (AN), and 445 healthy-lean controls. In total, we have observed four and eight variants in LEP and MC4R, respectively. Previous studies showed different functional in vitro effects for the detected frameshift and non-synonymous variants: (1) LEP: reduced/loss of function (p.Val94Met), (2) MC4R: gain of function (p.Val103Ile, p.Ile251Leu), reduced or loss of function (p.Thr112Met, p.Ser127Leu, p.Leu211fsX) and without functional in vitro data (p.Val50Leut). In LEP, the variant p.Val94Met was detected in one patient with AN. For MC4R variants, one patient with AN carried the frameshift variant p.Leu211fsX. One patient with AN was heterozygous for two variants at the MC4R (p.Val103Ile and p.Ser127Leu). All other functionally relevant variants were detected in similar frequencies in patients with AN and lean individuals.

Urinary neonicotinoid concentrations and obesity: A cross-sectional study among Chinese adolescents

Epidemiological and toxicological studies on neonicotinoids and obesity have been relevant to adults and young children, but data are limited in adolescents. This study aimed to examine the association between urinary neonicotinoid concentrations and obesity measures among Chinese adolescent. A total of 524 urine samples from 300 boys (11.3-16.1 years) and 224 girls (12.1-15.8 years) were collected to detect the concentrations of eleven neonicotinoids. Generalized linear regression, weighted quantile sum regression (WQS) and Bayesian kernel machine regression (BKMR) were used to estimate covariate-adjusted associations between detectable neonicotinoids and ten indicators of obesity. Nitenpyram concentration was associated with increased body mass index z-score (β = 0.170, 95% CI: 0.041, 0.299) and greater odds of being general obesity (OR = 2.46, 95% CI: 1.11, 5.46). N-desmethyl- acetamiprid concentration was associated with an increase in waist-to-height ratio (β = 0.102, 95% CI: 0.029, 0.176) and waist-to-hip ratio (β = 0.083, 95% CI: 0.011, 0.155). The concentrations of clothianidin (OR = 2.06, 95% CI: 1.10, 3.88) and flonicamid (OR = 2.39, 95% CI: 1.07, 5.32) were associated with greater odds of being abdominal obesity. In contrast, the concentrations of imidacloprid (OR = 0.35, 95% CI: 0.14, 0.88) and thiacloprid (OR = 0.28, 95% CI: 0.08, 0.99) were associated with lower odds of being general obesity. The estimates of general obesity and abdominal obesity increased significantly when concentrations of neonicotinoids mixture were at or above the 55th and 65th percentiles, respectively, compared to the 50th percentile concentration. Sex modified the association between nitenpyram and clothianidin and the risk of obesity with a positive association among boys, and a nonsignificant inverse association among girls. The findings suggest that these associations may be mixed and sex-specific.

Dietary habits, depression and obesity: an intricate relationship to explore in pediatric preventive strategies

Obesity and depression represent major health problems due to their high prevalence and morbidity rates. Numerous evidences elucidated the connections between dietary habits and the incidence or severity of depression. This overview aims to investigate the intricate relationship between dietary patterns and depression with the objective of elaborating preventive strategies for childhood obesity. Literature data recognized that there is a link between mood and food choices, with certain foods selected for their impact on the brain's reward centers. This behavior parallels the one observed in substance addiction, suggesting a specific neural mechanism for food addiction that contributes to overeating and obesity. It is important to note the significant correlation between obesity and depression, indicating a shared biological pathway influencing these conditions. Stress substantially affects also eating behaviors, often leading to increased consumption of pleasurable and rewarding foods. This can trigger a cycle of overeating, weight gain, and psychological distress, exacerbating mood disorders and obesity. In addition, consumption of certain types of foods, especially "comfort foods" high in fat and calories, may provide temporary relief from symptoms of depression, but can lead to long-term obesity and further mental health problems. Understanding these complex interactions is critical to developing preventive strategies focusing on dietary, emotional, and environmental factors, thereby reducing the risk of obesity and mood disorders.

Metabolic and Bariatric Surgery in Children: Current Practices and Outcomes

PURPOSE OF REVIEW

This review will examine the most current evidence for Metabolic and Bariatric Surgery (MBS) in the pediatric population, specifically in terms of weight loss outcomes and improvement in comorbid conditions and complications. Additionally, we compare surgical and non-surgical interventions, review current guidelines, and propose a stepwise evidence-based approach to the management of obesity in children.

RECENT FINDINGS

MBS is a safe option for appropriately selected pediatric patients which leads to significant and sustained weight loss. This weight loss is associated with improvement of related comorbid conditions. Laparoscopic sleeve gastrectomy (LSG) has emerged as the procedure of choice with a better safety profile. Despite the evidence, very few adolescents undergo MBS. New pharmacologic agents specifically the GLP-1/GIP agents have shown early promise especially in patients under body mass index 40, but the long-term effects are unknown. MBS is an effective tool in the management of pediatric obesity, and its use has been recommended by professional societies. Early referral to a multidisciplinary obesity team can help identify appropriate patients.

Influence of body mass index on health complains and life satisfaction

PURPOSE

This research work investigates the influence of children's weight status on well-being and school context in a sample of Spanish adolescences.

METHODS

The Spanish records from the 2013-14 Health Behaviour in School-Aged Children Survey are used, which gathers 9,565 adolescences aged 11, 13 and 15. Studies do not usually address the endogeneity of body mass index when analysing their effect on life satisfaction and health complaints, thus resulting in biased estimates. Considering the endogeneity of body mass index, we use the frequency of alcohol consumption as an instrumental variable in order to obtain consistent estimates of its influence.

RESULTS

The two-stage least squares estimation shows that children's body mass index has a significant negative influence on health complaints and it conditions the way children relate to each other at school. Likewise, results report significant influence on children's subjective well-being and their self-assessment of general health.

CONCLUSIONS

The results of this study provide compelling evidence that BMI plays a crucial role in shaping adolescents' well-being and their interactions with peers at school. These findings underscore the importance of addressing childhood overweight and promoting healthy body mass index levels. Furthermore, the study highlights the need for targeted policy interventions to combat the social stigma associated with being overweight, fostering a more inclusive and supportive school environment for all students.

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.

Current status of weight bias and stigma in pediatrics and the need for greater focus on populations at risk

PURPOSE OF REVIEW

Obesity is one of the most common pediatric chronic conditions in the United States, affecting approximately 20% of American youth and is more common amongst Black, Latino, and Indigenous and low socioeconomic populations. The condition places children and adolescents at increased risk of physical and mental health conditions partly mediated by the weight bias and stigmatization experienced during the potentially vulnerable periods of childhood and adolescence.

RECENT FINDINGS

Weight bias and the resulting stigma are pervasive in society. Children have been shown to internalize this bias and its devaluation, which have been shown to contribute to worsening metabolic and mental health outcomes independently. Studies suggest weight stigmatization more adversely affects Black, Latino, and Indigenous children, suggesting the potential for adverse synergistic effects of these historical biases on such youth.

SUMMARY

Addressing childhood obesity successfully across all racial, ethnic, and socioeconomic lines requires addressing weight bias and stigma. Steps toward this end include collaborative efforts to promote cross-cultural competence and upstander bias education and training for those who care for children, person-centered communication, and a culture of inclusivity across governmental, healthcare, educational, entertainment, and advertising sectors.

Not All Levels of Social Re-Inclusion Allow for Recovery from Negative Outcomes of Social Exclusion: The Moderating Role of Self-Esteem

Previous studies on social exclusion have focused on its adverse effects, rarely exploring how social re-inclusion can aid recovery from exclusion-induced distress. The level of social re-inclusion that can help individuals recover from social exclusion, and whether the recovery effect is influenced by individual characteristics are unclear. The present experimental study extends the Cyberball paradigm, adding a re-inclusion stage to explore the recovery effects of four levels of social re-inclusion on affect; furthermore, it tests the moderating role of self-esteem in the recovery effect. A total of 154 Chinese college students participated in the experiment. Results showed that (1) recovery was effective when the level of re-inclusion was equal to (replica re-inclusion) or greater than (moderate and high over-re-inclusions) the pre-exclusion level of inclusion, but ineffective when it was below this level (token re-inclusion); (2) the re-inclusion level positively predicted recovery, and this was moderated by self-esteem-the prediction was effective for participants with middle and high self-esteem, but not for participants with low self-esteem. These results are discussed from a group process and self-psychology perspective.

Inhibition of Pancreatic Lipase by Flavonoid Derivatives: In Vitro and In Silico Investigations

Obesity, characterized by excessive adipose tissue accumulation, has emerged as a crucial determinant for a wide range of chronic medical conditions. The identification of effective interventions for obesity is of utmost importance. Widely researched antiobesity agents focus on pancreatic lipase, a significant therapeutic target. This study presented the evaluation of ten flavonoid compounds in terms of their inhibitory activities against pancreatic lipase, utilizing both in vitro and in silico approaches. The results indicated that all tested compounds demonstrated modest and weaker inhibitory activities compared to the reference compound, orlistat. Among the compounds investigated, F01 exhibited the highest potency, with an IC50 value of 17.68 ± 1.43 µM. The enzymatic inhibition kinetic analysis revealed that F01 operated through a competitive inhibition mechanism with a determined Ki of 7.16 μM. This value suggested a moderate binding affinity for the pancreatic lipase enzyme. Furthermore, the associated Vmax value was quantified at 0.03272 ΔA·min-1. In silico studies revealed that F01 displayed a binding mode similar to that of orlistat, despite lacking an active functional group capable of forming a covalent bond with Ser152 of the catalytic triad. However, F01 formed a hydrogen bond with this crucial amino acid. Furthermore, F01 interacted with other significant residues at the enzyme's active site, particularly those within the lid domain. Based on these findings, F01 demonstrates substantial potential as a candidate for further investigations.

A Close Association between Body Weight, Health-Related Quality of Life, and Risk Behaviors in a Sample of Italian High School Students

INTRODUCTION

Adolescents experience rapid physical, cognitive, and psychosocial growth with different factors contributing to health and well-being. In this view, an important role is played by body weight and related perceptions. The purpose was to determine, in a sample of Italian high school students, whether health-related quality of life (HRQoL) is associated with the different weight status categories (underweight, normal weight, overweight, obese), even considering sex differences.

MATERIAL AND METHODS

Data were collected from 1826 adolescents (n = 735 males). HRQOL was analyzed using the Italian version of KIDSCREEN-52.

RESULTS

Overweight adolescents showed reductions in psychological well-being (p < 0.05) and self-perception (p < 0.05) compared with individuals in other BMI categories. Subjects with obesity reported increased bullying victimization (p < 0.05) and reductions in self-perception and eating disorders (p < 0.001), while underweight individuals were characterized by altered adherence to the Mediterranean diet (p < 0.001), eating disorders (p < 0.001), and problematic use of social media (p < 0.05). No sex differences were found, except for socio-economic status perceptions, where underweight girls reported higher economic well-being than boys (p < 0.05).

CONCLUSIONS

Our findings may suggest that there is an association between weight status categories and HRQoL that is more pronounced in underweight and overweight adolescents. The association between BMI categories and psychosocial dimensions opens the need to define specific domains on which such preventive interventions should focus, always through a personalized perspective.

Saudi Adults' Understanding and Views of Weight Management Practices and Obesity

Background and Objective

The rising prevalence of overweight and obesity presents a significant global challenge. This study aimed to investigate the understanding and views of weight management practices and obesity among Saudi adults.

Methodology

A cross-sectional online survey was conducted from October 2022 to January 2023 among adults residing in Saudi Arabia. Participants completed a self-administered 41-item questionnaire designed to assess their understanding and views regarding weight management practices and obesity.

Results

A total of 1066 participants completed the survey. Gender distribution showed a majority of males (55.7%). Age-wise, the majority fell below 51 years, with 37.7% (young) between 18-24, 32.7% (young adult) between 25-33, and 21.3% (adult) between 34-51. Employment was reported by one-third (n = 315) of respondents, while 22.0% (n = 234) had a history of chronic diseases. Furthermore, 77.3% (n = 824) engaged in regular physical activity.The study results revealed that participants' mean score for understanding obesity was 3.28 ± 2.37 (range 0-6), while the average views score was 28.08 ± 8.79 (range 0-34). Furthermore, females displayed a higher level of understanding compared to males. Employment status also played a significant role, with employed individuals having a better understanding of obesity than those who were unemployed. Moreover, participants with higher qualifications demonstrated a more comprehensive understanding of obesity compared to those with lower qualifications. Additionally, individuals with higher monthly income levels displayed a greater understanding of obesity compared to those with lower incomes. Lastly, participants who engaged in regular physical activity exhibited a higher level of understanding compared to those who were physically inactive.

Conclusion

The study indicates that factors such as being older, being female, being employed, having higher education and income, and engaging in regular physical activity are associated with increased understanding and favorable views regarding weight management practices and obesity.

Editorial: Failing in our Responsibility to Address Obesity Caused by Psychotropic Medications

Obesity is the most common pediatric chronic disease, affecting close to 14.4 million children and adolescents in the US, according to a recent estimate.1 Despite a significant increase in systematic research and clinical focus in this area, the problem is estimated to worsen in the next 20 years, with estimates predicting that about 57% of children and adolescents between 2 and 19 years of age will be obese by 2050.2 Obesity is defined as a body mass index (BMI) at or greater than the 95th percentile for children and teens of the same age and sex. Because of changes in weight and height with age, and their relation to body fat percentage, BMI levels among children and teens are expressed relative to those of other children of the same sex and age. These percentiles are calculated from the Centers for Disease Control and Prevention (CDC) growth charts, which were based on national survey data collected from 1963-1965 to 1988-1994 (CDC.gov healthy weight webpage). Mental health providers, especially child and adolescent psychiatrists, have an important role in assessing, treating, and even preventing obesity, but current data indicate that we are failing in this responsibility. This is particularly relevant in the context of metabolic side effects of psychotropic agents.

Weight Suppression and Risk for Childhood Psychiatric Disorders

Weight suppression, defined as the discrepancy between an individual's highest historical weight and their current weight, has been implicated in the development and maintenance of eating disorders. Although weight suppression has also been found to impact mood, anxiety and suicidal behavior in patients with and without disordered eating, it has not been examined as a transdiagnostic risk factor for general psychopathology. The current study examined growth records of 281 children and adolescents (ages 7 to 17) newly diagnosed with psychiatric disorders to determine whether these children were more likely to be weight suppressed as compared to an age- and gender-matched control group. Findings suggest that weight suppression is related to an increased risk for anxiety disorders and externalizing disorders for males. These results underscore the need for psychiatric and behavioral health providers to review pediatric growth charts as a routine part of psychiatric evaluation. As weight restoration is a necessary precondition for eating disorder recovery, more research is necessary to determine if weight restoration can enhance treatments for psychiatric symptoms occurring in the context of weight suppression.

The burden of low back pain in children and adolescents with overweight and obesity: from pathophysiology to prevention and treatment strategies

Nonspecific low back pain (LBP) is one of the most common causes of disability, affecting all individuals at least once in their lifetime. Such a condition is also becoming increasingly frequent in the pediatric population, especially in children and adolescents with overweight/obesity. Furthermore, new-onset LBP during adolescence has been demonstrated to be a strong predictor of developing LBP later in life, contributing to poorer outcomes and increasing social and medical costs. Several causes and different mechanisms have been considered for the development of LBP in pediatric individuals affected by obesity. For this reason, planning adequate prevention and treatment strategies, mainly through conservative lifestyle changes, would be crucial to anticipate the negative consequences of persisting LBP in adulthood. The aim of this narrative review was to characterize the relationship between LBP and overweight/obesity in the pediatric population, highlighting epidemiological and pathophysiological aspects. In addition, prevention and treatment approaches will be reviewed considering the need to reduce the burden of LBP on this population. According to our search, LBP was more frequent in children and adolescents with overweight and obesity and has been associated with several anthropometric and lifestyle factors, including lumbar hyperlordosis, sedentary habits, physical inactivity, carrying a heavy schoolbag, low vitamin D levels, psychosocial ill-being, and premature intervertebral disc degeneration. Most of these conditions may be addressed with conservative strategies mainly consisting of dietary adjustments, physical exercise, education programs, and physical therapy.

The long-term effects of childhood adiposity on depression and anxiety in adulthood: A systematic review

OBJECTIVE

This review aimed to evaluate the association between childhood adiposity and depression and anxiety risk in adulthood.

METHODS

MEDLINE, PsychInfo, Embase, CINAHL, and Scopus were searched on June 6, 2022, to identify studies that investigated the association between childhood weight status (age ≤18 years) and outcomes of depression and/or anxiety in adulthood (age ≥19 years). Study quality was assessed using the Newcastle-Ottawa Scale and results were narratively synthesized.

RESULTS

Sixteen studies were eligible for inclusion, with heterogeneity in methods and follow-up durations complicating comparisons. Six out of eight studies found a statistically significant association between childhood adiposity and increased likelihood of depression in adulthood, particularly in females. However, overall evidence was of moderate quality and study limitations prevented causal conclusions. In contrast, limited evidence and mixed findings were reported for the associations between childhood adiposity and depressive symptom severity or anxiety outcomes in adulthood.

CONCLUSIONS

Evidence suggests that childhood adiposity is associated with greater vulnerability to depression in adulthood, particularly in females. However, further research is warranted to address the limitations discussed. Future research should also explore how changes in weight status from childhood to adulthood might differentially influence the likelihood of depression.

Weight self-misperception and obesity-related knowledge, attitudes, lifestyle behaviours and cardio-metabolic markers among Chinese school-aged children and adolescents

OBJECTIVE

The relationships between childhood weight self-misperception and obesity-related factors particularly health markers have not been extensively discussed. This study aims to examine the associations between weight self-misperception and obesity-related knowledge, attitudes, lifestyles and cardio-metabolic markers among Chinese paediatric population.

DESIGN

Cross-sectional study.

SETTING

Data sourced from a national survey in Chinese seven provinces in 2013.

PARTICIPANTS

Children and adolescents aged 5-19 years.

RESULTS

Of the total 14 079 participants, there were 14·5 % and 2·2 % participants over-estimated and under-perceived their weight, respectively. Multi-variable logistic regression was applied to calculate OR and 95 % CI (95 % Cl) of obesity-related behaviours and cardio-metabolic markers by actual and perceived weight status. Individuals who perceived themselves as overweight/obese were more likely to have prolonged screen time, insufficient dairy intake and over sugar-sweetened beverages consumption (all P < 0·05), regardless of their weight. Furthermore, actual overweight/obese individuals had higher odds of abnormal cardio-metabolic markers, but a smaller magnitude of association was found among weight under-estimators. Among non-overweight/obese individuals, weight over-estimation was positively associated with abdominal obesity (OR: 10·49, 95 % CI: 7·45, 14·76), elevated blood pressure (OR: 1·30, 95 % CI: 1·12, 1·51) and dyslipidemia (OR: 1·43, 95 % CI: 1·29, 1·58).

CONCLUSIONS

Weight over-perception was more prevalent than under-estimation, particularly in girls. Weight over-estimators tended to master better knowledge but behave more unhealthily; both weight over-perception and actual overweight/obesity status were associated with poorer cardio-metabolic markers. Future obesity intervention programmes should additionally pay attention to the population with inaccurate estimation of weight who were easily overlooked.

The need for future research into the assessment and monitoring of eating disorder risk in the context of obesity treatment

In adolescents and adults, the co-occurrence of eating disorders and overweight or obesity is continuing to increase, and the prevalence of eating disorders is higher in people with higher weight compared to those with lower weight. People with an eating disorder with higher weight are more likely to present for weight loss than for eating disorder treatment. However, there are no clinical practice guidelines on how to screen, assess, and monitor eating disorder risk in the context of obesity treatment. In this article, we first summarize current challenges and knowledge gaps related to the identification and assessment of eating disorder risk and symptoms in people with higher weight seeking obesity treatment. Specifically, we discuss considerations relating to the validation of current self-report measures, dietary restraint, body dissatisfaction, binge eating, and how change in eating disorder risk can be measured in this setting. Second, we propose avenues for further research to guide the development and implementation of clinical and research protocols for the identification and assessment of eating disorders in people with higher weight in the context of obesity treatment. PUBLIC SIGNIFICANCE: The number of people with both eating disorders and higher weight is increasing. Currently, there is little guidance for clinicians and researchers about how to identify and monitor risk of eating disorders in people with higher weight. We present limitations of current research and suggest future avenues for research to enhance care for people living with higher weight with eating disorders.

Body Image, Social Physique Anxiety Levels and Self-Esteem among Adults Participating in Physical Activity Programs

(1) Background: individuals may benefit from being involved in physical and athletic activities in order to improve their body appearance and promote their physical and mental health. This study aimed to investigate body image, body mass index (BMI) characteristics, social physique anxiety, self-esteem and possible correlations between the above factors. (2) Methods: 245 adults engaged in training programs in gyms, as well as in track and field, football and basketball athletic activities completed (a) a sociodemographic questionnaire which recorded their BMI values and utilized the (b) Body-Esteem Scale for Adolescents and Adults, (c) the Social Physique Anxiety Scale and (d) the Rosenberg Self-Esteem Scale. (3) Results: Females and individuals with higher BMI reported statistically significant lower body-esteem and greater social physique anxiety levels compared to males and individuals with lower BMI, respectively (p < 0.05). A total of 25.3% of our participants were labeled as "overweight", while 20.4% had been overweight in the past. Significant differences were reported between body-esteem and social physique anxiety levels (p < 0.001); age (p = 0.001); BMI value (p < 0.001) and never having a problem with body weight (p = 0.008). Additionally, individuals with lower body-esteem and greater social physique anxiety levels presented lower global self-esteem (p < 0.001). (4) Conclusions: individuals' engagement in physical activity promotes physical as well as mental well-being, contributing to an improved quality of life, which may be the most important issue for health care professionals.

Independent and Joined Association between Socioeconomic Indicators and Pediatric Obesity in Spain: The PASOS Study

Childhood obesity is a public health problem worldwide. An important determinant of child and adolescent obesity is socioeconomic status (SES). However, the magnitude of the impact of different SES indicators on pediatric obesity on the Spanish population scale is unclear. The aim of this study was to assess the association between three SES indicators and obesity in a nationwide, representative sample of Spanish children and adolescents. A total of 2791 boys and girls aged 8 to 16 years old were included. Their weight, height, and waist circumference were measured. SES was assessed using two parent/legal guardian self-reported indicators (educational level -University/non-University- and labor market status -Employed/Unemployed-). As a third SES indicator, the annual mean income per person was obtained from the census section where the participating schools were located (≥12.731€/<12.731€). The prevalence of obesity, severe obesity, and abdominal obesity was 11.5%, 1.4%, and 22.3%, respectively. Logistic regression models showed an inverse association of both education and labor market status with obesity, severe obesity, and abdominal obesity (all p < 0.001). Income was also inversely associated with obesity (p < 0.01) and abdominal obesity (p < 0.001). Finally, the highest composite SES category (University/Employed/≥12.731€ n = 517) showed a robust and inverse association with obesity (OR = 0.28; 95% CI: 0.16-0.48), severe obesity (OR = 0.20; 95% CI: 0.05-0.81), and abdominal obesity (OR = 0.36; 95% CI: 0.23-0.54) in comparison with the lowest composite SES category (Less than University/Unemployed/<12.731€; n = 164). No significant interaction between composite SES categories and age and gender was found. SES is strongly associated with pediatric obesity in Spain.

Examining the immunoepigenetic-gut microbiome axis in the context of self-esteem among Native Hawaiians and other Pacific Islanders

Introduction: Native Hawaiian and other Pacific Islander (NHPI) populations experience higher rates of immunometabolic diseases compared to other racial-ethnic groups in Hawaii. As annual NHPI mortality rates for suicide and type 2 diabetes mellitus (T2DM) exceed those of the state as a whole, understanding the social and biological mechanisms underlying these disparities are urgently needed to enable preventive strategies. Methods: A community-based approach was used to investigate the immunoepigenetic-gut microbiome axis in an NHPI-enriched cohort of Oahu residents (N = 68). Self-esteem (SE) data was collected using a modified Rosenberg self-esteem (SE) assessment as a proxy measure for mental wellbeing in consideration for cultural competency. T2DM status was evaluated using point-of-care A1c (%) tests. Stool samples were collected for 16s-based metagenomic sequencing analyses. Plasma from blood samples were isolated by density-gradient centrifugation. Peripheral blood mononuclear cells (PBMCs) were collected from the same samples and enriched for monocytes using negative selection techniques. Flow-cytometry was used for immunoprofiling assays. Monocyte DNA was extracted for Illumina EPIC array-based methylation analysis. Results: Compared to individuals with normal SE (NSE), those with low SE (LSE) exhibited significantly higher plasma concentrations (pg/ml) of proinflammatory cytokines IL-8 (p = 0.051) and TNF-α (p = 0.011). Metagenomic analysis revealed that the relative abundance (%) of specific gut bacteria significantly differed between SE groups - some of which directly correlated with SE scores. Gene ontology analysis revealed that 104 significantly differentially methylated loci (DML) between SE groups were preferentially located at genes involved in immunometabolic processes. Horvath clock analyses indicated epigenetic age (Epi-Age) deceleration in individuals with LSE and acceleration in individuals with NSE (p = 0.042), yet was not reproduced by other clocks. Discussion: These data reveal novel differences in the immunoepigenetic-gut microbiome axis with respect to SE, warranting further investigation into its relationship to brain activity and mental health in NHPI. Unexpected results from Epi-Age analyses warrant further investigation into the relationship between biological age and disparate health outcomes among the NHPI population. The modifiable component of epigenetic processes and the gut microbiome makes this axis an attractive target for potential therapeutics, biomarker discovery, and novel prevention strategies.

Gender differences in the associations between body mass index, depression, anxiety, and stress among endocrinologists in China

BACKGROUND

Depression, anxiety, and stress symptoms have been found to be associated with overweight or obesity, but the gender differences in the associations have not been well-examined. Based on a national sample of endocrinologists in China, we examined such associations with a focus on gender differences.

METHODS

Data were collected from endocrinologists in China using an online questionnaire, which included demographic data, body weight, and height. Depression, anxiety, and stress symptoms were assessed using the Depression, Anxiety, and Stress Scale-21 (DASS-21).

RESULTS

In total, 679 endocrinologists (174 males and 505 females) completed the survey. One-fourth (25.6%) were classified as overweight, with a significant gender difference (48.9% in males vs. 17.6% in females, p < 0.05). Overall, 43.4% of the participants endorsed probable depressive symptoms (54.6% in males and 39.6% in females, p = 0.004), 47.6% for anxiety (51.7% in males vs. 46.1% in females, p = 0.203), and 29.6% for stress symptoms (34.5% in males vs. 27.92% in females, p = 0.102). After controlling for confounders, in the whole group, male gender (aOR = 4.07, 95% CI:2.70-6.14, p < 0.001), depression (aOR = 1.05, 95% CI:1.00-1.10, p = 0.034) and age (aOR = 1.03, 95% CI:1.00-1.05, p = 0.018) were positively associated with overweight. In males, depression (aOR = 1.14, 95% CI:1.05-1.25, p = 0.002), administration position (aOR = 4.36, 95% CI:1.69-11.24, p = 0.002), and night shifts/month (aOR = 1.26, 95% CI:1.06-1.49, p = 0.008) were positively associated with overweight, while anxiety (aOR = 0.90, 95% CI:0.82-0.98, p = 0.020) was negatively associated with overweight. In females, only age (aOR = 1.04, 95% CI:1.01-1.07, p = 0.014) was significantly associated with overweight status, while depression and anxiety were not associated with overweight. Stress symptoms were not associated with overweight in either gender.

CONCLUSIONS

One-fourth of endocrinologists in China are overweight, with a rate in males nearly triple the one in females. Depression and anxiety are significantly associated with overweight in males but not females. This suggests possible differences in the mechanism. Our findings also highlight the need to screen depression and overweight in male physicians and the importance of developing gender-specific interventions.

The interaction between obesity and visceral hypersensitivity

Obesity has been a worldwide problem associated with numerous chronic diseases such as cardiovascular disease, type 2 diabetes, and metabolic disorders. It may also play a role in visceral hypersensitivity, contributing to irritable bowel syndrome. (i) Adipose tissue secretes various inflammatory mediators, causing intestinal hyperpermeability and nerve endings activation. (ii) Obesity and gastrointestinal microbiota could affect each other, and microbial metabolites can increase sensitivity of the colon. (iii) Vitamin D deficiency contributes to both fat accumulation and disruption of the intestinal mucosal barrier. (iv) Brain-gut axis may be another bridge from obesity to visceral hypersensitivity.

Psychiatric Disorders and Obesity in Childhood and Adolescence-A Systematic Review of Cross-Sectional Studies

Obesity and psychiatric disorders have high prevalence and are both considered major health problems. Within the last decades, the rates of obesity have risen over 6%, while the prevalence of psychiatric disorders is over 12% for children and adolescents. The aim of this study was to systematically review the evidence regarding the relation of obesity and psychiatric disorders in childhood and adolescence. This review, based on the PRISMA guidelines, included cross-sectional studies published within the last decade, pertaining to the relation between psychiatric disorders and obesity in children and adolescents up to the age of 19 years. Studies on eating disorders were excluded. A total of 14 studies of 23,442 children and adolescents that investigated the relation of obesity with anxiety, mood disorders, and psychosis were included in this systematic review. Nine of the included studies reported a significant relationship between the psychiatric disorder under investigation and obesity. Understanding the nexus between obesity and psychiatric disorders in children and adolescents is of great importance, given the alarming increase in both conditions in youth. Such findings could facilitate the development and implementation of targeted interventions.

Association between university student junk food consumption and mental health

Background: On a global scale, the mental health consequences of eating habits among the general population are becoming a concern. Particular attention should be directed to the youthful population. Aims: Determine the relationship between university students' consumption of junk food and their levels of stress, anxiety, and depression. Method: University students were asked to complete: a demographic questionnaire, questions on junk food consumption, and depression anxiety stress scores (DASS-21). Body mass index measurements were taken. Logistic regressions were utilized to construct odds ratios (ORs) with 95% confidence intervals to identify the association between university students' consumption of junk food and their levels of stress, anxiety, and depression. Results: There were (N = 509), 66% females and 34% males, mean age was (M = 18.1 ± .5) years participated in this study. Daily consumption of junk food was significantly linked to stress (odds ratio [OR], 4.5; 95% confidence interval [CI], 2.5-8.3), anxiety (OR, 11.1; 95% CI, 6.2-20.1), and depression (OR, 7.9; 95% CI, 4.5-13.9). Conclusions: This is the first thorough study conducted in Egypt to examine the relationship between stress, anxiety, and depression, and junk food consumption among undergraduates at a private Egyptian university. Many college students struggle emotionally, and those who are emotionally troubled are more likely to participate in eating unhealthy food. Our research will be used to inform regional policies on adolescent nutrition and to create preventative strategies.

Psychometric Properties of the Multidimensional Body-Self Relations Questionnaire-Appearance Scales (MBSRQ-AS) in Chilean Youth

The aim of this study is to analyze the factorial structure of the Multidimensional Body-Self Relations Questionnaire-Appearance Scales (MBSRQ-AS) to determine the adjustment of the study structure proposed in the Spanish short version in a young, non-clinical Chilean population and to evaluate the possible influence of sex, age, and BMI on body image measurement. The sample consisted of 614 Chilean youth (259 male and 355 female) between 15 and 28 years old (M = 18.81; SE = 2.46), from the Metropolitan Region, and four regions of the coast and south-central zone of the country. The average Body Mass Index (BMI) was 22.5 kg/m2 (SD = 3.16). The model fit was evaluated by confirmatory factor analysis (WLSMV) using the following: a model with a single general factor, a model with the five factors of the original version, a five-factor ESEM model, and a MIMIC model analyzed including sex, age, and BMI. The results show that the MIMIC sex, age, and BMI model presents an acceptable fit, observing that four factors, Appearance Orientation (AO), Body Areas Satisfaction (BAS), Overweight Preoccupation (OP), and Self-Classification Weight (SCW), are affected significantly for the sex variable, one for age, Appearance Evaluation (AE), and four for BMI (AE, BAS, OP, and SCW). In conclusion, MBSRQ-AS replicates the five-dimensional structure in a non-clinical sample of young Chileans; however, their scores are not invariant as they depend on sex, age, and BMI.

Dietary Patterns in Adolescent Obesity as Predictors of Long-Term Success Following an Intensive Inpatient Lifestyle Programme

(1) Background: Lifestyle interventions for adolescents with obesity show minor long-term effects on anthropometric parameters. The persistence of dietary changes after obesity inpatient rehabilitation has not been sufficiently investigated. (2) Objectives: To analyse dietary patterns in German adolescents with obesity as predictors of long-term success following an intensive inpatient lifestyle programme regarding food choices as well as body weight and comorbidities. (3) Methods: Food consumption data of 137 German adolescents with obesity aged 10-17 years were collected by a nutrition interview. Cluster analysis was used to group the participants according to their food consumption. Dietary patterns, changes in body weight and insulin resistance were compared over a 2-year-period. (4) Results: Three dietary patterns were identified. Big Eaters (n = 32) consume high amounts of total sugar and meat, Moderate Eaters (n = 66) have a diet comparable to the national average, and Snackers (n = 39) have a particularly high consumption of total sugar. Big Eaters and Snackers significantly reduced the consumption of total sugar. Among Moderate Eaters, no persistent changes were observed. (5) Conclusion: Weight reduction interventions can induce long-lasting changes in the diet of adolescents with obesity. Therefore, the success of a weight reduction intervention should not be determined by weight reduction only.

Misalignment among adolescents living with obesity, caregivers, and healthcare professionals: ACTION Teens global survey study

BACKGROUND

There is limited evidence regarding the experiences, challenges, and needs of adolescents living with obesity (ALwO), their caregivers, and healthcare professionals (HCPs).

OBJECTIVES

The cross-sectional, survey-based global ACTION Teens study aimed to identify perceptions, attitudes, behaviours, and barriers to effective obesity care among ALwO, caregivers of ALwO, and HCPs.

METHODS

ALwO (aged 12 to <18 years; N = 5275), caregivers (N = 5389), and HCPs treating ALwO (N = 2323) from 10 countries completed an online survey (August-December 2021).

RESULTS

Most ALwO perceived their weight as above normal (76% vs. 66% of caregivers), were worried about its impact on their health (85% vs. 80% of caregivers), and recently made a weight loss attempt (58%). While 45% of caregivers believed ALwO would slim down with age, only 24% of HCPs agreed. Most commonly reported weight loss motivators for ALwO were wanting to be more fit/in better shape according to ALwO (40%) and caregivers (32%), and improved confidence/social life according to HCPs (69%). ALwO weight loss barriers included lack of hunger control (most commonly reported by ALwO/caregivers), lack of motivation, unhealthy eating habits (most commonly agreed by HCPs), and lack of exercise.

CONCLUSIONS

Misalignment between ALwO, caregivers, and HCPs-including caregivers' underestimation of the impact of obesity on ALwO and HCPs' misperception of key motivators/barriers for weight loss-suggests a need for improved communication and education.