Longitudinal associations between teasing and health-related quality of life among treatment-seeking overweight and obese youth

Development of an mHealth Platform for Adolescent Obesity Prevention: User-Centered Design Approach

Obesity is a chronic condition that influences the quality of life of patients and families while increasing the economic burden for the world population. Multidisciplinary prevention programs are crucial to address it, allowing an early introduction of healthy behaviors into daily habits. Mobile health interventions provide adequate support for these programs, especially considering the gamification techniques used to promote users' engagement. TeenPower is a multidisciplinary mHealth intervention program conducted in Portugal during 2018 to empower adolescents, promoting healthy behaviors while preventing obesity. An agile software development process was applied to the development of the digital platform that holds a web-based application and a mobile application. We also propose a model for future developments based on the user-centered design approach adopted for this development and the assessment conducted in each phase. The user-centered design approach model proposed has three distinct phases: (1) design study; (2) pre-production usability tests; and (3) post-production data. Phase 1 allowed us to obtain the high-fidelity version of the graphical user interfaces (n = 5). Phase 2 showed a task completion success rate of 100% (n = 5). Phase 3 was derived from statistical analysis of the usage of the platform by real end users (n = 90). We achieved an average retention rate of 35% (31 out of 90 participants). Each technique has provided input for the continuous design and improvement of the platform. This allowed the creation of a tailored platform that could meet users' expectations. Nevertheless, the retention rate decreased significantly over a short period of time, revealing the need for further work in the improvement of the gamification experience.

Weight Stigma and Mental Health in Youth: A Systematic Review and Meta-Analysis

OBJECTIVE

Over the past two decades, there has been a steady increase in research focused on the association between weight-based stigma and mental health outcomes in children and adolescents. The present study is a systematic review and meta-analysis of the associations between weight stigma and mental health in youth.

METHODS

A systematic search of PubMed, PsychInfo, and Embase databases was conducted in January 2020. Inclusion criteria included the following: (a) examined an association between weight stigma and a mental health outcome, (b) mean sample age <18 (+1 standard deviation) years, (c) written in English, and (d) peer reviewed. Forty eligible articles were identified. The moderating effects of age, sex (percent female), weight status (percent with overweight/obesity), and study quality were examined.

RESULTS

Overall, meta-analytic findings using a random-effects model indicated a statistically significant moderate association between weight stigma and poorer mental health outcomes (r = .32, 95% confidence interval [0.292, 0.347], p < .001). Age and study quality each moderated the association between weight stigma and mental health. Generally, the study quality was fair to poor, with many studies lacking validated measurement of weight stigma.

CONCLUSIONS

Although there was a significant association between weight stigma and mental health in youth, study quality hinders the current body of literature. Furthermore, findings highlight the lack of consideration of internalized weight stigma in child populations, the importance of using validated measures of weight stigma, and the need for increased awareness of how these associations affect populations of diverse backgrounds.

Change, predictors and correlates of weight- and health-related quality of life in adolescents 2-years following bariatric surgery

Background/Objectives:

Weight-related quality of life (WRQOL) and generic health-related quality of life (HRQOL) have been identified as important patient reported outcomes for obesity treatment and outcome research. This study evaluated patterns of WRQOL and HRQOL outcomes for adolescents at 24-months post-bariatric surgery relative to a non-surgical comparator sample of youth with severe obesity, and examined potential weight-based (e.g., BMI, weight dissatisfaction) and psychosocial predictors and correlates of these outcomes.

Subjects/Methods:

Multi-site data from 139 adolescents undergoing bariatric surgery (M_age=16.9; 79.9% female, 66.2% White; M_{Body Mass Index [BMI]=} 51.5kg/m²) and 83 comparators (M_age=16.1; 81.9 % female, 54.2% White; M_BMI= 46.9kg/m²) were collected at pre-surgery/baseline, 6-, 12-, and 24-months post-surgery/baseline with high participation rates across time points (>85%). Self-reports with standardized measures of WRQOL/HRQOL as well as predictors/covariates (e.g., weight dissatisfaction, social support, peer victimization, family dysfunction, loss of control eating, self-worth, and internalizing symptoms) were obtained. Growth curve models using structural equation modeling examined WRQOL/HRQOL over time and linear regressions examined predictors and correlates of WRQOL/HRQOL outcomes.

Results:

Significant improvement in WRQOL and Physical HRQOL, particularly in the first post-operative year with a leveling off subsequently, was found for the surgical group relative to comparators, but with no significant Mental HRQOL change. At 24 months, the surgical group had signficantly greater WRQOL/HRQOL across most subscales. Within the surgical group at 24 months, weight-based variables were signficantly associated with WRQOL and Physical HRQOL, but not Mental HRQOL. Mental HRQOL was associated with greater internalizing symptoms and loss of control eating.

Conclusions:

For adolescents undergoing bariatric surgery, most clinically meaningful changes in WRQOL and Physical HRQOL occurred early post-operatively, with weight-based variables as the primary drivers of 24-month levels. In contrast, expectations for Mental HRQOL improvement following surgery should be tempered, with 24-month levels significantly associated with psychosocial rather than weight-based correlates.

Weight-Related Teasing of Adolescents Who Are Primarily Obese: Roles of Sociocultural Attitudes Towards Appearance and Physical Activity Self-Efficacy

Adolescents who are obese are at risk for being teased about their appearance with the concomitant negative psychological sequelae. Identifying modifiable variables associated with teasing could inform pediatric weight-management interventions. Characterizing society's role in the victimization of these at-risk individuals could guide anti-bullying programs for schools and broader public health efforts. This study aims to examine novel societal and cognitive factors associated with weight-related teasing frequency. Participants were adolescents (N = 334) being evaluated for a hospital-affiliated weight-management program. The outcome was perceived weight-related teasing frequency. Predictors were sociocultural awareness and internalization of appearance-related attitudes, physical activity self-efficacy, and psychological functioning. Multivariate regressions controlled for demographics and body mass index (BMI) z-scores with separate regressions testing interactions of BMI z-scores with all predictors. In adjusted analyses, higher physical activity self-efficacy and fewer depressive symptoms related to lower teasing frequency. Interactions indicated that less awareness/internalization of sociocultural attitudes towards appearance, more positive body image, and higher self-esteem related to lower teasing frequency regardless of BMI. Targeted interventions and public health campaigns should be developed and tested for adolescents that improve body image with promotion of diverse views about attractiveness, bolster confidence in overcoming physical activity barriers, and identify and treat mood symptoms.

Intergenerational Transmission of Parent Encouragement to Diet From Adolescence Into Adulthood

BACKGROUND

Although previous cross-sectional research has revealed potential harmful outcomes associated with parent encouragement to diet, it is unclear whether these effects are long lasting and whether they are transmitted to the next generation. The main aim of the current study was to examine longitudinal associations between exposure to parent encouragement to diet in adolescence and weight-related and emotional health outcomes in adulthood and to examine whether intergenerational transmission of encouragement to diet occurs.

METHODS

This is a longitudinal, population-based study (ie, Project Eating and Activity in Teens and Young Adults) of socioeconomically and racially and/or ethnically diverse adolescents managed into adulthood and/or parenthood (n = 556; mean age = 31.4; 64.6% female). Surveys and anthropometrics were completed at school by adolescents in 1998-1999 and surveys were completed online in 2015-2016 by young adults.

RESULTS

Experiencing parent encouragement to diet as an adolescent was significantly associated with a higher risk of overweight or obesity, dieting, binge eating, engaging in unhealthy weight control behaviors, and lower body satisfaction 15 years later as a parent, after adjusting for sociodemographics and baseline measures of the outcomes (P < .05). Additionally, intergenerational transmission of encouragement to diet occurred and resulted in parents being more likely to report other weight-focused communication in the home environment.

CONCLUSIONS

Exposure to parent encouragement to diet as an adolescent had long-term harmful associations with weight-related and emotional health outcomes in parenthood and was transmitted to the next generation. It may be important for health care providers to educate parents about the potential harmful and long-lasting consequences of engaging in encouragement to diet with their children.

Adolescent self-report and parent proxy-report of health-related quality of life: an analysis of validity and reliability of PedsQL 4.0 among a sample of Malaysian adolescents and their parents

BACKGROUND

The Pediatric Quality of Life Inventory Generic Core Scales (PedsQL) 4.0 is a generalized assessment of health-related quality of life (HRQoL) based on adolescent self-report and parent proxy-report. This study aims to determine the construct validity and reliability of PedsQL 4.0 among a sample of Malaysian adolescents and parents.

METHODS

A cross-sectional study was carried out at three selected public schools in the state of Selangor. A total of 379 Malaysian adolescents completed the PedsQL 4.0 adolescent self-report and 218 (55.9%) parents completed the PedsQL 4.0 parent proxy-report. Weight and height of adolescents were measured and BMI-for-age by sex was used to determine their body weight status.

RESULTS

There were 50.8% male and 49.2% female adolescents who participated in this study (14.25 ± 1.23 years). The prevalence of overweight and obesity (25.8%) was four times higher than the prevalence of severe thinness and thinness (6.1%). Construct validity was analyzed using Confirmatory Factor Analysis (CFA). Based on CFA, adolescent self-report and parent proxy-report met the criteria of convergent validity (factor loading > 0.5, Average Variance Extracted (AVE) > 0.5, Construct Reliability > 0.7) and showed good fit to the data. The adolescent self-report and parent proxy-report exhibited discriminant validity as the AVE values were larger than the R(2) values. Cronbach's alpha coefficients of the adolescent self-report (α = 0.862) and parent proxy-report (α = 0.922) showed these instruments are reliable. Parents perceived the HRQoL of adolescents was poorer compared to the perception of the adolescent themselves (t = 5.92, p < 0.01). There was no significant difference in total HRQoL score between male and female adolescents (t = 0.858, p > 0.05). Parent proxy-report was negatively associated with the adolescents' BMI-for-age (r = -0.152, p < 0.05) whereas no significant association was found between adolescent self-report and BMI-for-age (r = 0.001, p > 0.05).

CONCLUSION

Adolescent self-report and parent proxy-report of the PedsQL 4.0 are valid and reliable to assess HRQoL of Malaysian adolescents. Future studies are recommended to use both adolescent self-report and parent-proxy report of HRQoL as adolescents and parents can provide different perspectives on HRQoL of adolescents.

Severe obesity and comorbid condition impact on the weight-related quality of life of the adolescent patient

OBJECTIVES

To assess links between comorbid health status, severe excess weight, and weight-related quality of life (WRQOL) in adolescents with severe obesity and undergoing weight-loss surgery (WLS) to inform clinical care.

STUDY DESIGN

Baseline (preoperative) data from Teen Longitudinal Assessment of Bariatric Surgery, a prospective multicenter observational study of 242 adolescents with severe obesity (MedianBMI = 50.5 kg/m(2); Meanage = 17.1; 75.6% female; 71.9% white) undergoing WLS, were used to examine the impact of demographics, body mass index (BMI), presence/absence of 16 comorbid conditions, and a cumulative comorbidity load (CLoad) index on WRQOL scores (Impact of Weight on Quality of Life-Kids).

RESULTS

WRQOL was significantly lower than reference samples of healthy weight, overweight, and obese samples. Of 16 comorbid conditions, the most prevalent were dyslipidemia (74.4%), chronic pain (58.3%), and obstructive sleep apnea (56.6%). Male subjects had a greater CLoad (P = .01) and BMI (P = .01), yet less impairment in total WRQOL (P < .01) than females. CLoad was a significant predictor of male WRQOL. For females, psychosocial (vs physical) comorbidities, BMI, and white race were significant predictors of WRQOL impairment. Less prevalent conditions (eg, stress urinary incontinence) also emerged as contributors to lower WRQOL.

CONCLUSIONS

WRQOL impairment is substantial for adolescents with severe obesity undergoing WLS, with predictors varying by sex. These patient-data highlight targets for education, support, and adjunctive care referrals before WLS. Furthermore, they provide a comprehensive empirical base for understanding heterogeneity in adolescent WRQOL outcomes after WLS, as weight and comorbidity profiles change over time.

Associations between teasing, quality of life, and physical activity among preadolescent children

OBJECTIVE

This study assessed longitudinal associations between preadolescent's physical activity engagement (PA), health-related quality of life (HRQOL), and teasing during physical activity (TDPA).

METHODS

108 children completed measures of PA, HRQOL, and TDPA during fourth or fifth grade and 1 year later. Potential longitudinal associations between study variables were tested using structural equation modeling.

RESULTS

Weight status emerged as an important moderator of the structural relationships. TDPA predicted later HRQOL for children with overweight and obesity, whereas HRQOL predicted later PA in children with normal weight. Both groups demonstrated a significant association between TDPA and HRQOL cross-sectionally.

CONCLUSIONS

Children with overweight or obesity who experience TDPA are more likely to report poorer subsequent HRQOL. Children with normal weight who experience TDPA are at increased risk for reduced PA 1 year later. Efforts to reduce TDPA may benefit children's HRQOL and increase PA participation.

Weight-based victimization: bullying experiences of weight loss treatment-seeking youth

OBJECTIVE

Few studies have comprehensively examined weight-based victimization (WBV) in youth, despite its serious consequences for their psychosocial and physical health. Given that obese and treatment-seeking youth may be highly vulnerable to WBV and its negative consequences, the current study provides a comprehensive assessment of WBV in a weight loss treatment-seeking sample.

METHODS

Adolescents (aged 14-18 years; N = 361) enrolled in 2 national weight loss camps were surveyed. An in-depth assessment of WBV was conducted by using an online survey, in which participants indicated the duration, typical locations, frequent perpetrators, and forms of WBV they had experienced.

RESULTS

Findings indicate that 64% of the study participants reported WBV at school, and the risk of WBV increased with body weight. Most participants reported WBV enduring for 1 year (78%), and 36% were teased/bullied for 5 years. Peers (92%) and friends (70%) were the most commonly reported perpetrators, followed by adult perpetrators, including physical education teachers/sport coaches (42%), parents (37%), and teachers (27%). WBV was most frequently reported in the form of verbal teasing (75%-88%), relational victimization (74%-82%), cyberbullying (59%-61%), and physical aggression (33%-61%). WBV was commonly experienced in multiple locations at school.

CONCLUSIONS

WBV is a prevalent experience for weight loss treatment-seeking youth, even when they are no longer overweight. Given the frequent reports of WBV from adult perpetrators in addition to peers, treatment providers and school personnel can play an important role in identifying and supporting youth who may be at risk for pervasive teasing and bullying.