The Interplay among BMI z-Score, Peer Victmization, and Self-Concept in Outpatient Children and Adolescents with Overweight or Obesity

Evaluation of depression, anxiety symptoms, emotion regulation difficulties, and self-esteem in children and adolescents with obesity

OBJECTIVE

Pediatric obesity negatively affects many areas of mental health, especially anxiety and depression. This study aimed to investigate the effects of obesity on anxiety, depression, self-esteem, and emotion regulation in children and adolescents.

METHODS

Our study included 50 children and adolescents aged 11-17 years with a diagnosis of obesity and 48 control participants. The Revised Child Anxiety and Depression Scale (RCADS), Rosenberg Self-Esteem Scale (RSE), Difficulties in Emotion Regulation Scale (DERS), and Piers-Harris Children's Self-Concept Scale 1 (PHCSCS) were administered to all participants.

RESULTS

A significant difference was found between the groups (p < 0.05) in the analysis of the PHCSCS and RCADS total score; the GAD, PD, SOC, and MDD subscale scores; the DERS total score; the Clarity, Impulse, Strategies, Goals subscale scores; and the RSE Self-Esteem subscale. A significant correlation was found between the PHCSCS, RCADS, DERS, and RSE total scores and some subscale scores (p < 0.05).

CONCLUSION

On the basis of the results, it was determined that children and adolescents with obesity had high levels of anxiety and depression symptoms, they had lower self-esteem, and had more difficulties in emotion regulation. Furthermore, those with anxiety and depression symptoms had lower self-esteem, and the children who had problems in emotion regulation also had lower self-esteem. Anxiety, depression, low self-esteem, and difficulties in emotion regulation can negatively affect obesity treatment. Therefore, screening and treatment of these conditions are of great importance.

Physical, Psychological, and Body Composition Differences between Active and Sedentary Adolescents According to the "Fat but Fit" Paradigm

The practice of physical activity during adolescence is essential for the proper development of the population. In recent decades, the relevance of physical activity has been increasing, due to the development of the "fat but fit" paradigm. This paradigm shows that adolescents with a high level of physical fitness are healthier than adolescents with poorer physical fitness, regardless of their weight, giving importance to sports practice over other aspects. However, few previous studies have analyzed the differences in physical and body composition between active and sedentary adolescents in this paradigm. For this reason, the objectives of the present study were to establish the differences in body composition, physical performance, and adherence to the Mediterranean diet between active and sedentary adolescents; and to analyze the differences between active and sedentary adolescents according to the "fat but fit" paradigm. The sample consisted of 791 adolescent whose body composition, level of physical activity, adherence to the Mediterranean diet, and physical fitness were measured. It was found significant between active and sedentary adolescents in most of the anthropometric, AMD, and physical fitness variables, with a significant effect of the covariates gender, age, BMI, and biological maturation on the model. The binary logistic regression analysis performed shows that anthropometric variables, AMD, and VO2 max can be considered as primary outcomes to distinguish between active and sedentary groups of adolescents. Furthermore, the results showed that the active adolescents, regardless of their weight status, had lower fat mass and greater muscle mass, as well as a higher performance in the physical fitness tests, and greater adherence to the Mediterranean diet than the sedentary adolescents. To conclude, the practice of physical activity is a determinant for the improvement of body composition, physical performance, and adherence to the Mediterranean diet of the adolescent population, regardless of their gender, age, weight, or maturity status.

Associations Between Weight-Based Bullying, Developmental Internal Assets, and Perceived Social Support Among Youth

BACKGROUND

Youth with obesity are likely to experience weight-based bullying victimization, and adolescents have the highest obesity rates among children. Factors that protect youth from traditional bullying victimization may protect youth from weight-based bullying victimization: internal assets such as positive identity and social competence, and external assets such as perceived support from parents and friends.

METHODS

To examine this proposition, data from 8th, 9th, and 11th graders were obtained from the 2016 Minnesota Student Survey (N = 126,495). Logistic regressions were conducted to identify the relationship between assets and weight-based bullying and to determine possible moderation by weight status.

RESULTS

Results demonstrate that positive identity, parent support, and friend support were associated with lower odds of experiencing weight-based bullying victimization. Moderation analyses revealed that perceived parent support was most protective against experiencing weight-based bullying victimization among youth with obesity compared to youth with overweight, normal weight, or underweight.

CONCLUSION

School administrators, counselors, and teachers should be aware of the increased risk of weight-based bullying for youth with obesity and underweight. Results underscore the need to foster youth's internal assets like positive identity to promote a strength-based approach for prevention. Parent involvement is warranted in weight-based bullying prevention efforts.

Determine the BMI levels, self-concept and healthy life behaviours of children during a school based obesity training programme

Sedentary lifestyles and unhealthy nutrition, in particular, cause childhood obesity. The purpose of this semi-experimental research is to determine the changes in body mass index, self-concept, and healthy lifestyle behaviours of children during a training programme to prevent obesity. Children 9 and 15 years old were included from two public secondary schools. A total of 1609 students completed the study in the intervention and control groups (1022 vs 587, respectively). The training programme for the intervention group at the schools had three sessions in 12 weeks and was about obesity, body mass index (BMI) calculation, a healthy lifestyle and coping with stress. Data was collected through a sociodemographic data form, healthy lifestyle behaviours data form, Piers-Harris Children's Self-Concept Scale and weight-height measurements during the first and last weeks of the programme (except for the sociodemographic form). Before training, BMI's of children in the intervention group were higher than in the control group (19.61 ± 3.8 vs 19.00 ± 3.5, respectively). The gap between BMI scores of the groups was narrowed after the training (p > 0.05). The mean score on the Self-Concept Scale increased in the intervention group after the training (63.21 ± 9.5) as compared to before the training (61.16 ± 10.4); whereas in the control group, there were no differences found (p = 0.908). In the intervention group, the number of children who had breakfast after the training (81.1%) increased compared to before the training (74.1%) (p = 0.001). The trainings were provided to students to increase healthy nutrition, physical activity and to decrease sedentary lifestyles.

Association of bullying victimization with overweight and obesity among adolescents from 41 low- and middle-income countries

BACKGROUND

Data on the association between overweight/obesity and bullying victimization among adolescents are scarce from low- and middle-income countries.

OBJECTIVES

We assessed the associations between overweight/obesity and bullying victimization in 41 low- and middle-income countries.

METHODS

Cross-sectional data from the Global School-based Student Health Survey were analysed. Data on past 30-day bullying victimization (including type) and body mass index based on measured weight and height were collected. The 2007 WHO Child Growth reference was used to define overweight and obesity. Multivariable logistic regression (multinomial and binary) and meta-analyses based on country-wise estimates were conducted. Data on 114 240 adolescents aged 12 to 15 years were analysed (mean age [SD], 13.8 [1.0] y; 48.8% girls).

RESULTS

Among girls, compared with normal weight, overweight (OR = 1.08; 95% CI, 1.02-1.16; between-country heterogeneity I²  = 0.0%) and obesity (OR = 1.20; 95% CI, 1.07-1.34; I²  = 0.0%) were associated with significantly higher odds for any bullying victimization, but no significant association was observed among boys. However, overweight and obesity were both associated with significantly increased odds for bullying by being made fun of because of physical appearance among both sexes-obesity (vs normal weight): girls OR = 3.42 (95% CI, 2.49-4.71); boys OR = 2.38 (95% CI, 1.67-3.37).

CONCLUSIONS

Effective strategies to reduce bullying of children with overweight/obesity are needed in low- and middle-income countries.

Explanatory model of violent behaviours, self-concept and empathy in schoolchildren. Structural equations analysis

The increased visibility of bullying cases has led the scientific community to be more interested in analysing the factors affecting these behaviours in order to reduce bullying cases and their negative consequences. The aim of this study was to define and contrast an explanatory model that makes it possible to analyse the relationships between self-concept, empathy and violent behaviours in schoolchildren through structural equation analysis. The sample of this study is made up of 734 schoolchildren from the province of Granada (Spain), both male and female, aged between 10 and 12, and it consists of analysing self-concept (AF-5), empathy levels (TECA) and violent behaviour at schools (ECV). A structural equation model was performed and successfully adjusted (χ2 = 563.203; DF = 59; p < 0.001; CFI = 0.943; NFI = 0.937; IFI = 0.943; RMSEA = 0.076). A positive and direct relationship between self-concept and cognitive empathy has been found; manifest aggression is negatively related to self-concept. Similarly, affective empathy has a negative relationship with relational aggression. The main conclusions of this study are that the levels of self-concept and empathy represent protective factors against the development of violent and victimisation behaviours in schoolchildren.

Health-related quality of life in adolescents with excess weight

OBJECTIVE

To identify health-related quality of life in adolescents with excess weight and associated factors, such as gender, age, and weight categories.

METHOD

A cross-sectional study with collected and secondary data from 276 adolescents aged between 10 and 19 years with overweight and obesity, and whose parents or guardians authorized their participation. Anthropometric data, pubertal development, and the PedsQL 4.0 questionnaire were collected for the health-related quality of life assessment. Categorical data were described as numbers and percentages. For the description of health-related quality of life subscales, medians and the 25^th and 75^th percentiles were used, as well as the Mann-Whitney test for comparisons between age group, gender, and weight categories.

RESULTS

The median health-related quality of life total score was 78.3 (68.5-87.4). The lowest scale was the "emotional score", 65 (50-80). Higher health-related quality of life was found in boys in most of the scores (p<0.05), except for the "school score" (p=0.09). Regarding the age group, the median of the "physical scores" (p=0.03) and "social score" (p=0.02) were significantly lower in the group younger than 14 years. When separated according to weight categories, it was verified that obese adolescents differed significantly in relation to the "physical score" (p=0.00), "school score" (p=0.04), and "total score" (p=0.02) of the health-related quality of life. However, there was no significant difference between the emotional, social, and psychosocial scores.

CONCLUSIONS

Adolescents with overweight and obesity show losses in the health-related quality of life and also between the different domains, when separated by age, gender, and weight categories.

Associations between overweight and mental health problems among adolescents, and the mediating role of victimization

Background

Evidence has not been conclusive on whether adolescent overweight is associated with mental health, possibly caused by indirect, yet untested associations. Therefore, the purpose of this study was to examine the association between overweight or obesity and mental health problems among adolescents, and to determine whether victimization plays a mediating role in these associations.

Methods

Self-reported data on mental health and victimization and objectively measured Body Mass Index data were used, using three cohorts (2010–2011 until 2012–2013) and an interval between the measurement waves of two years later. We performed a multi-level mediation analysis with a two-level structure to incorporate the clustering of the measurements within individuals. The study population consisted of 13,740 secondary school students, 13–14 years old at the first measurement moment, in Amsterdam, the Netherlands.

Results

Compared to their normal-weight peers, adolescents with overweight or obesity reported psychosocial problems and suicidal thoughts more often. Victimization was a significant mediator in the relationship between having overweight, and psychosocial problems (indirect effect OR: 2.3; 95% CI 1.5, 3.7 and direct effect OR: 1.4; 95% CI 1.2, 1.7) or suicidal thoughts (indirect effect OR: 2.1; 95% CI 1.4, 3.2 and direct effect OR: 1.3; 95% CI 1.1, 1.5). The associations between obesity, and psychosocial problems (indirect OR: 6.2; 95% CI 2.8, 14.7 and direct effect OR: 1.4; 95% CI 1.0, 2.0), or suicidal thoughts (indirect OR: 4.5; 95% CI 2.3, 9.1 and direct effect OR: 1.5; 95% CI 1.1, 2.0) were even stronger.

Conclusions

Overweight and obesity were significantly associated with mental health problems in adolescents, and victimization played a mediating role in this association. Victimization and mental health should be integrated into prevention programs that address healthy weight development. Moreover, overweight should be given more attention in programs to prevent victimization and promote adolescent mental health.

Electronic supplementary material

The online version of this article (10.1186/s12889-019-6832-z) contains supplementary material, which is available to authorized users.

The association between chronic bullying victimization with weight status and body self-image: a cross-national study in 39 countries

BACKGROUND

Childhood obesity and school bullying are pervasive public health issues and known to co-occur in adolescents. However, the association between underweight or thinness and chronic bullying victimization is unclear. The current study examined whether chronic bullying victimization is associated with weight status and body self-image.

METHODS

A school-based, cross-sectional study in 39 North American and European countries and regions was conducted. A total of 213,595 adolescents aged 11, 13, and 15 years were surveyed in 2009/10. Chronic bullying victimization was identified using the Revised Olweus Bully/Victim Questionnaire. Weight status was determined using self-reported height and weight and the body mass index (BMI), and body self-image was based on perceived weight. We tested associations between underweight and bullying victimization using three-level logistic regression models.

RESULTS

Of the 213,595 adolescents investigated, 11.28% adolescents reported chronic bullying victimization, 14.80% were classified as overweight/obese according to age- and sex-specific BMI criteria, 12.97% were underweight, and 28.36% considered themselves a little bit fat or too fat, 14.57% were too thin. Bullying victimization was less common in older adolescent boys and girls. Weight status was associated with chronic bullying victimization (adjusted ORunderweight = 1.10, 95% CI = 1.05-1.16, p = 0.002; adjusted ORoverweight = 1.40, 95% CI = 1.32-1.49, p < 0.0001; adjusted ORobese = 1.91, 95% CI = 1.71-2.14, p < 0.0001). Body self-image also related to chronic bullying victimization (adjusted ORtoo thin = 1.42, 95% CI = 1.36-1.49, p < 0.0001; adjusted ORa little bit fat = 1.54, 95% CI = 1.48-1.61, p < 0.0001; adjusted ORtoo fat = 3.30, 95% CI = 2.96-3.68, p < 0.0001).

CONCLUSION

Both perceived weight and self-rated overweight are associated with chronic bullying victimization. Both overweight and underweight children are at risk of being chronically bullied.

Neural and Endocrine Correlates of Early Life Abuse in Youth With Depression and Obesity

Depression and insulin resistance are becoming increasingly prevalent in younger populations. The origin and consequence of insulin resistance in depressed youth may, in part, be rooted in exposure to environmental stressors, such as early life abuse, that may lead to aberrant brain motivational networks mediating maladaptive food-seeking behaviors and insipient insulin resistance. In this paper, we aimed to investigate the impact of early life abuse on the development of insulin resistance in depressed and overweight youth aged 9 to 17 years. We hypothesized that youth with the greatest burden of early life abuse would have the highest levels of insulin resistance and corresponding aberrant reward network connectivities. To test this hypothesis, we evaluated sixty-nine depressed and overweight youth aged 9 to 17, using multimodal assessments of early life abuse, food-seeking behavior, and insulin resistance. Based on results of the Childhood Trauma Questionnaire (CTQ), we separated our study participants into two groups: 35 youth who reported high levels of the sum of emotional, physical, or sexual abuse and 34 youth who reported insignificant or no levels of any abuse. Results of an oral glucose tolerance test (OGTT) and resting state functional connectivity (RSFC), using the amygdala, insula, and nucleus accumbens (NAcc) as seed-based reward network regions of interest, were analyzed for group differences between high abuse and low abuse groups. High abuse youth exhibited differences from low abuse youth in amygdala-precuneus, NAcc-paracingulate gyrus, and NAcc-prefrontal cortex connectivities, that correlated with levels of abuse experienced. The more different their connectivity from of that of low abuse youth, the higher were their fasting glucose and glucose at OGTT endpoint. Importantly, level of abuse moderated the relation between reward network connectivity and OGTT glucose response. In contrast, low abuse youth showed hyperinsulinemia and more insulin resistance than high abuse youth, and their higher OGTT insulin areas under the curve correlated with more negative insula-precuneus connectivity. Our findings suggest distinct neural and endocrine profiles of youth with depression and obesity based on their histories of early life abuse.