Psychiatric aspects of child and adolescent obesity: a review of the past 10 years

Bariatric Surgery in Adolescents with Obesity: Long-Term Perspectives and Potential Alternatives

BACKGROUND

Severe obesity among adolescent shows a worrisome trend in regard to its increasing prevalence and poses a great challenge for treatment. Conservative measures have modest effects on weight loss, usually fail in achieving a sustainable weight loss and resolution of comorbidities. This has led to greater utilization of bariatric surgery (BS) that offers a fast reduction in body mass index with little perioperative complications. Despite the increasing utilization of BS, data are still insufficient, regarding their long-term outcome in adolescents. We review short- and long-term effects of BS and their implications on bone health and nutritional deficiencies in adolescents. In addition, we discuss possible pharmaceutical alternatives.

SUMMARY

BS results in a substantial weight loss of roughly 37% in the first-year post-operation and is superior to conservative measures in resolution of metabolic comorbidities. BS significantly improves health-related quality of life. Longer follow-up (F/U) shows weight regain in 50% of patients. Furthermore, reduced bone mass and nutritional deficiencies were reported in up to 90% of patients. Most recently, alternative to BS became more relevant with approval of GLP-1 analogues use in adolescents. GLP-1 analogues are potent enough to induce moderate clinically meaningful weight loss and improvement of metabolic component.

KEY MESSAGES

We conclude that obese adolescents without major obesity-related complications may benefit from pharmacological interventions with lifestyle modification. We advise considering BS as treatment approach in adolescents with severe obesity and major obesity-related complications with proper preoperative preparation and postoperative F/U in excellence centers.

Best Practices and Challenges in Implementing Healthy Food Environment at School Setting toward Prevention of Obesity in Indonesia and Malaysia

Consumption habits and nutritional status during adolescence can affect nutrition and health status in the future related to the risk of degenerative or non-communicable diseases. Good environmental support can make teenagers also do a good habit as well. A school environment that pays attention to a healthy food environment can support changes in patterns or types of consumption of healthier food in adolescents. This study aims to analyze best practices and challenges in implementing healthy food environment. This study aims to analyze best practices and challenges in implementing healthy food environment. Online focus group discussion was held consisting of 15 high school teachers from Indonesia and 5 high school teachers from Malaysia. Data were triangulated to enhance validity and to create a more comprehensive understanding of healthy food environments in schools in Indonesia and Malaysia and were analyzed using a content analysis research technique. The results highlighted the current status of the food environment at schools in Indonesia and Malaysia, challenges to implementing healthy food environment, best practices, and future, including propose concept and solution to initiate too. The results emphasize the need to dig deeper to understand why the school food environment in Indonesia and Malaysia is still far from an ideal healthy food environment. Concepts and suggestions on how schools in Indonesia and Malaysia should move forward to build a healthy school food environment are also presented in this paper.

Effect of sleep habits on academic performance in schoolchildren age 6 to 12 years: a cross-sectional observation study

STUDY OBJECTIVES

Sleep plays a vital role in the cognitive and neurodevelopmental outcome of children; therefore, adequate sleep is needed to improve academic performance. The primary objective of this study was determine the prevalence of sleep behaviors and their effect on academic performance in schoolchildren age 6-12 years and to translate the findings into greater opportunity for healthy development and academic success.

METHODS

Our study included 791 healthy children between ages 6 and 12 years from schools that are parts of the Central Board of Secondary Education in the South Indian urban population. Pro forma and The Children's Sleep Habits Questionnaire (CSHQ in local language translation) was given to the parents, and any doubts regarding the questionnaire were clarified during parent-teacher meetings. The previous 2 cycles of academic grades for these children were collected and categorized into A, B, and C grades accordingly. Then a statistical analysis of the completed CSHQ questionnaires was performed.

RESULTS

On analyzing the CSHQ questionnaire, 71.9% of the children studied had a score higher than 41, which is in the clinical range indicating a significant prevalence of altered sleep habits. Other risk factors included nocturnal enuresis (3.5%), snoring (10.6%), night terrors (8%), and teeth grinding (6.4%).

CONCLUSIONS

Altered sleep habits have a major effect on the academic performance of the school-age children. Assessment of sleep habits should be included in routine pediatric office visits.

CITATION

Sivakumar CT, Rajan M, Pasupathy U, Chidambaram S, Baskar N. Effect of sleep habits on academic performance in schoolchildren age 6 to 12 years: a cross-sectional observation study. J Clin Sleep Med. 2022;18(1):145-149.

The built environment as determinant of childhood obesity: A systematic literature review

We evaluated the epidemiological evidence on the built environment and its link to childhood obesity, focusing on environmental factors such as traffic noise and air pollution, as well as physical factors potentially driving obesity-related behaviors, such as neighborhood walkability and availability and accessibility of parks and playgrounds. Eligible studies were (i) conducted on human children below the age of 18 years, (ii) focused on body size measurements in childhood, (iii) examined at least one built environment characteristic, (iv) reported effect sizes and associated confidence intervals, and (v) were published in English language. A z test, as alternative to the meta-analysis, was used to quantify associations due to heterogeneity in exposure and outcome definition. We found strong evidence for an association of traffic-related air pollution (nitrogen dioxide and nitrogen oxides exposure, p < 0.001) and built environment characteristics supportive of walking (street intersection density, p < 0.01 and access to parks, p < 0.001) with childhood obesity. We identified a lack of studies that account for interactions between different built environment exposures or verify the role and mechanism of important effect modifiers such as age.

School-Related Stressors and the Intensity of Perceived Stress Experienced by Adolescents in Poland

Higher stress reactivity during adolescence is a vulnerability marker of exposure to various environmental stressors. This study aimed to investigate the association between a high level of perceived stress experienced by adolescents and stressful stimuli induced from school environment, peer, and parental relationships. The data used were from a cross-sectional, observational study conducted in a stratified sample of 1846 adolescents (13-18 years) in the Wielkopolska province, Poland. Data were collected through self-administered questionnaires and anthropometric measurements. Perceived stress was assessed using the Perceived Stress Scale (PSS-10). The association of a high level of perceived stress with school-induced exposures was determined using multivariate logistic regression after adjusting for gender, age, height and weight status and interpersonal relationships (STATISTICA 13.1). It was found that girls were over three times more likely than boys to experience a high level of perceived stress. Moreover, girls appeared to be more vulnerable than boys to school-related stressors and weight status, while boys to stressors that can arise from interpersonal relationships. School environment was the only predictor factor of high perceived stress level with a large effect size in both boys (OR = 4.45; 95% CI: 3.11-6.36) and girls (OR = 6.22; 95% CI: 4.18-7.59). Given the findings of the present study, preventive programs are critical to mitigate the effect of stress from school on adolescents' health and well-being.

Racial and Ethnic Disparities in Childhood Growth Trajectories

Childhood overweight and obesity are a primary social and public health concern. Over the past 30 years, rates of childhood overweight and obesity in the United States of America (USA) have drastically increased, particularly among Black and Latino/a populations. However, they tend to be underrepresented in the childhood obesity literature. This study expands previous literature by identifying different BMI growth trajectories for Black, Latino/a, and White children from birth to age nine. This study found a high prevalence rate of overweight and obesity in a predominantly low-income minority group. Using growth-based trajectory modeling, this study also found different growth trajectories by racial/ethnic groups, with Latino/a children having the most concerning growth trajectories from birth to 9 years. These findings demonstrate that ethnic/racial disparities in childhood overweight and obesity start as early as birth, indicating the need to devote more attention from researchers and health policy-makers to address these disparities as early as possible.

Designing, implementing and evaluating an educational intervention targeting weight bias and fat stereotyping

Weight bias directed at individuals at a higher weight leaves them feeling victimised and judged. When possessed by health professionals, stigmatising attitudes may compromise professionalism and quality of care or education provided. An intervention study was conducted in the higher education setting (n = 124), through tailored course design and delivery. The intervention was embedded into a health elective that pre-service health professionals were enrolled in. Attitudes to weight and knowledge of nutrition were targeted simultaneously. Surveys conducted pre- and post-intervention revealed moderate success in achieving study aims of improving nutrition knowledge and decreasing bias. Focus group analyses supported the quantitative findings.

Familial Environment and Overweight/Obese Adolescents' Physical Activity

(1) Background: Family environments can impact obesity risk among adolescents. Little is known about the mechanisms by which parents can influence obesity-related adolescent health behaviours and specifically how parenting practices (e.g., rules or routines) and/or their own health behaviours relate to their adolescent’s behaviours. The primary aim of the study explored, in a sample of overweight/obese adolescents, how parenting practices and/or parental modeling of physical activity (PA) behaviours relate to adolescents’ PA while examining the moderating role of parenting styles and family functioning. (2) Methods: A total of 172 parent-adolescent dyads completed surveys about their PA and wore an accelerometer for eight days to objectively measure PA. Parents completed questionnaires about their family functioning, parenting practices, and styles (authoritative and permissive). Path analysis was used for the analyses. (3) Results: More healthful PA parenting practices and parental modeling of PA were both associated with higher levels of adolescents’ self-reported moderate-vigorous physical activity (MVPA). For accelerometer PA, more healthful PA parenting practices were associated with adolescents’ increased MVPA when parents used a more permissive parenting style. (4) Conclusions: This study suggests that parenting practices and parental modeling play a role in adolescent’s PA. The family’s emotional/relational context also warrants consideration since parenting style moderated these effects. This study emphasizes the importance of incorporating parenting styles into current familial interventions to improve their efficacy.

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

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

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

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

Increased deficits in emotion recognition and regulation in children and adolescents with exogenous obesity

OBJECTIVES

In this study we aimed to evaluate emotion recognition and emotion regulation skills of children with exogenous obesity between the ages of 11 and 18 years and compare them with healthy controls.

METHODS

The Schedule for Affective Disorders and Schizophrenia for School Aged Children was used for psychiatric evaluations. Emotion recognition skills were evaluated using Faces Test and Reading the Mind in the Eyes Test. The Difficulties in Emotions Regulation Scale was used for evaluating skills of emotion regulation.

RESULTS

Children with obesity had lower scores on Faces Test and Reading the Mind in the Eyes Test, and experienced greater difficulty in emotional regulation skills.

CONCLUSIONS

Improved understanding of emotional recognition and emotion regulation in young people with obesity may improve their social adaptation and help in the treatment of their disorder. To the best of our knowledge, this is the first study to evaluate both emotional recognition and emotion regulation functions in obese children and obese adolescents between 11 and 18 years of age.

Do Anxiety Disorders Play a Role in Adolescent Obesity?

BACKGROUND

There have been few prospective studies on the association between anxiety disorders and adolescent obesity; none examine potential reciprocal effects.

PURPOSE

The purpose of this paper is to examine the prospective association between anxiety disorders and obesity among adolescents.

METHODS

Using data from a two-wave, prospective study of 3134 adolescents, we examined reciprocal effects between body weight and DSM-IV anxiety disorders.

RESULTS

Weight status did not increase future risk of anxiety disorders nor did anxiety disorders at baseline increase risk of future obesity in the overall sample. Stratifying by gender revealed an increased risk of overweight and obesity in males with anxiety disorders, but not for females. Major depression did not mediate these associations.

CONCLUSION

Similar to prospective studies of depression, it appears anxiety disorders may increase risk of obesity. However, more research is needed on the role of psychopathology in adolescent obesity, in particular anxiety disorders and possible moderators (such as gender) and mediators.

Delphi Survey for Designing a Intervention Research Study on Childhood Obesity Prevention

Background

The prevalence of childhood obesity in South Korea has increased owing to economic improvement and the prevailing Westernized dietary pattern. As the incidence of chronic diseases caused by obesity is also expected to increase, effective interventions to prevent childhood obesity are needed. Therefore, we conducted a Delphi study to determine the priorities of a potential intervention research on childhood obesity prevention and its adequacy and feasibility.

Methods

The two-round Delphi technique was used with a panel of 10 childhood obesity experts. The panelists were asked to rate “priority populations,” “methods of intervention,” “measurement of outcomes,” “future intervention settings,” and “duration of intervention” by using a structured questionnaire. Finally, a portfolio analysis was performed with the adequacy and feasibility indexes as the two axes.

Results

For priority populations, the panel favored “elementary,” “preschool,” and “middle and high school” students in this order. Regarding intervention settings, the panelists assigned high adequacy and feasibility to “childcare centers” and “home” for preschool children, “school” and “home” for elementary school children, and “school” for adolescents in middle and high school. As the age of the target population increased, the panelists scored increasing numbers of anthropometric, clinical, and intermediate outcomes as highly adequate and feasible for assessing the effectiveness of the intervention.

Conclusion

According to the results of the Delphi survey, the highest-priority population for the research on childhood obesity prevention was that of elementary school students. Various settings, methods, outcome measures, and durations for the different age groups were also suggested.

Uso de redes sociais, influência da mídia e insatisfação com a imagem corporal de adolescentes brasileiras

RESUMO Objetivo Avaliar relações entre a influência da mídia e o uso de redes sociais na imagem corporal (IC) de adolescentes do sexo feminino. Métodos Estudo transversal realizado com meninas adolescentes estudantes de escola pública e de uma organização não governamental da capital e do interior de São Paulo. Além de variáveis sociodemográficas e antropométricas, a avaliação da (IC) foi realizada pela Escala de Silhuetas Brasileiras. A influência da mídia foi avaliada pela subescala 1 de internalização geral da Escala de Atitudes Socioculturais em Relação à Aparência (SATAQ-3). Por fim, foram aplicadas perguntas sobre a frequência de acesso às mídias sociais e possível influência delas na IC. Resultados Participaram 212 meninas (14,8; DP 1,69 anos), sendo a maioria eutrófica (65,1%), pertencentes às classes sociais D e E, com escolaridade materna correspondente ao ensino médio completo; 85,8% estavam insatisfeitas com a IC; a maioria desejava uma silhueta menor. As meninas que escolheram figuras menores como desejadas apresentaram valores superiores na SATAQ-3 (p < 0,001). O acesso diário maior de 10 vezes ao dia ao Facebook e Instagram aumentou a chance de insatisfação em 6,57 e 4,47 vezes, respectivamente. Conclusão As mídias, incluindo as redes sociais, estão associadas à insatisfação da IC de meninas adolescentes.

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

COSPONSORING ASSOCIATIONS

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

OBJECTIVE

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

PARTICIPANTS

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

EVIDENCE

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

CONSENSUS PROCESS

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

CONCLUSION

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

'Now I care': a qualitative study of how overweight adolescents managed their weight in the transition to adulthood

OBJECTIVES

A qualitative study of recalled experiences of early adolescent overweight/obesity revealed low levels of weight-related concern. This further analysis aimed to explore weight-related concern and weight-loss efforts as participants transitioned into adulthood.

DESIGN, PARTICIPANTS AND METHODS

Participants were 35 young adults from a population-based cohort study who had body mass index (BMI) >95th centile between ages 11 and 15 and participated in semistructured interviews aged 24. At age 24, they were categorised as: 'slimmers' (N=13) who had lower BMI Z-scores at 24 than their adolescent peak and were not obese (BMI<30 kg/m²); 'relapsers' (N=8, of whom 2 were morbidly obese (BMI>35 kg/m²) at age 24); 'stable' (N=3, of whom 1 morbidly obese); and 'gainers' (N=11, of whom 5 morbidly obese). Themes were identified and coded using NVivo qualitative data analysis software, blind to participants' current weight status.

RESULTS

Contrasting with the lack of concern recalled in respect of earlier adolescence, weight-related concerns and/or desire to lose weight generally increased around the time of school leaving and almost all participants described some form of exercise (formal/informal) and dietary weight-control strategies. Among 'slimmers', there was some (subtle) evidence of more consistent use of exercise, self-monitoring of diet and exercise and of lifestyle changes becoming habitual and/or part of identity. Few participants had accessed professional support. Diet clubs seemed to have been used most by 'gainers', some only recently. Labour-market and housing transitions were strong influences, described as facilitating weight losses by some, but increases by others. For some participants, it appeared that weight loss was simply a by-product of these transitions.

CONCLUSIONS

In contrast to earlier adolescence, even the heaviest participants tended to show actual weight loss action or preparation for action. The transition to adulthood could thus be a key life stage for interventions.

Prevalence and Associated Factors of Prehypertension and Hypertension in Iranian Population: The Lifestyle Promotion Project (LPP)

BACKGROUND

This population-based study aimed at investigating the prevalence and associated factors of prehypertension/hypertension in Iran.

METHODS AND FINDINGS

The data (n = 2818) for this study were collected in 2015 as a part of the major Lifestyle Promotion Project (LPP) conducted in East Azerbaijan (urban and regional parts). The data for socio-demographic status, dietary information, and physical activity and anxiety levels were collected through validated questionnaires. Then, physical examination including systolic and diastolic blood pressure (SBP, DBP), body mass index (BMI) and conicity index was performed. First-morning spot urine (SU) sample was collected to assume salt intake. The One-way ANOVA, logistic regression, chi-square test and independent t-test were used for statistical analysis. The prevalence of prehypertension, stage I and stage II hypertension, and overall hypertension was 47.3%, 13.6%, 5.45% and 22.6% respectively. The mean systolic (p = 0.004) and diastolic (p<0.001) blood pressure in men were significantly higher than women. Results of logistic regression analysis showed that in both sexes, family history of hypertension, obesity, abdominal obesity, anxiety and having high levels of sodium intake were associated with high blood pressure (p< 0.05). Additionally, 45.8% of the hypertensive patients were aware of their disease, 10.0% of the aware patients, and 44.5% of everyone with high blood pressure were receiving antihypertensive medication.

CONCLUSIONS

Our data showed that prehypertension/hypertension is a major health problem in Iran. Focusing on identifying risk factors to hypertension, regular drug intake, good nutrition, physical activity, and changing lifestyles of patients with hypertension are essential.

Adolescent Maturational Transitions in the Prefrontal Cortex and Dopamine Signaling as a Risk Factor for the Development of Obesity and High Fat/High Sugar Diet Induced Cognitive Deficits

Adolescence poses as both a transitional period in neurodevelopment and lifestyle practices. In particular, the developmental trajectory of the prefrontal cortex (PFC), a critical region for behavioral control and self-regulation, is enduring, not reaching functional maturity until the early 20 s in humans. Furthermore, the neurotransmitter dopamine is particularly abundant during adolescence, tuning the brain to rapidly learn about rewards and regulating aspects of neuroplasticity. Thus, adolescence is proposed to represent a period of vulnerability towards reward-driven behaviors such as the consumption of palatable high fat and high sugar diets. This is reflected in the increasing prevalence of obesity in children and adolescents as they are the greatest consumers of “junk foods”. Excessive consumption of diets laden in saturated fat and refined sugars not only leads to weight gain and the development of obesity, but experimental studies with rodents indicate they evoke cognitive deficits in learning and memory process by disrupting neuroplasticity and altering reward processing neurocircuitry. Consumption of these high fat and high sugar diets have been reported to have a particularly pronounced impact on cognition when consumed during adolescence, demonstrating a susceptibility of the adolescent brain to enduring cognitive deficits. The adolescent brain, with heightened reward sensitivity and diminished behavioral control compared to the mature adult brain, appears to be a risk for aberrant eating behaviors that may underpin the development of obesity. This review explores the neurodevelopmental changes in the PFC and mesocortical dopamine signaling that occur during adolescence, and how these potentially underpin the overconsumption of palatable food and development of obesogenic diet-induced cognitive deficits.

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

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

Assessment and preparation of obese adolescents for bariatric surgery

Obesity is generally considered an adult disease, although there has been a constant increase in the prevalence of overweight and obese children in the last few decades. Childhood obesity is not limited to developed countries, with increasing numbers being reported from developing countries as well as from Saudi Arabia. Young populations with obesity suffer from similar comorbidities as obese adults, including type 2 diabetes mellitus, dyslipidemia, obstructive sleep apnea, polycystic ovarian syndrome, pseudotumor cerebri, and fatty liver disease. Recent advances in weight loss surgery have given hope to obese adolescents who are refractory to lifestyle changes and low-calorie diet plans. This review emphasizes a holistic approach for obese adolescents and describes in detail a multidisciplinary team and their role in adolescent bariatric surgery. There are unique medical, psychological, and nutritional requirements during the pre-operative, immediate post-operative, and long-term phases to achieve a desirable outcome. Identification of an appropriate candidate for bariatric surgery is critical and must balance the risks and benefits of weight loss surgery. Different surgical procedures are available and should be tailored to the needs of the patient and the expertise of the surgeon.

Child Obesity and Mental Health: A Complex Interaction

Prevalence rates of childhood obesity have risen steeply over the last 3 decades. Given the increased national focus, the frequency of this clinical problem, and the multiple mental health factors that coexist with it, make obesity a public health concern. The complex relationships between mental health and obesity serve to potentiate the severity and interdependency of each. The purpose of this review is to create a contextual connection for the 2 conditions as outlined by the research literature and consider treatment options that affect both health problems.

Adiposity and early adolescent emotional/behavioral problems

OBJECTIVE

To examine whether life course adiposity is associated with emotional/behavioral problems in a non-Western developed setting with little social patterning of adiposity.

STUDY DESIGN

In a prospective, population-representative Chinese birth cohort, "Children of 1997," multivariable partial least squares regression was used to assess the adjusted associations of birth weight z-score, body mass index (BMI) z-scores at ages 3 months, 9 months, 3 years, 7 years, 9 years, and BMI z-score changes with emotional/behavioral problems at ∼ 11 years of age, assessed from the Chinese version of the Revised Parent's Rutter Scales.

RESULTS

Rutter score was available for 4976 (62.8% follow-up). Birth weight z-score, BMI z-scores at ages 3 months, 9 months, 3 years, 7 years, 9 years, and successive BMI z-scores changes had little association with Rutter score or subscores at ∼ 11 years of age, adjusted for socioeconomic position, although birth weight was negatively associated with specifically hyperactivity.

CONCLUSIONS

In a developed, non-Western setting, we did not find adiposity be a factor in the development of emotional/behavioral problems in early adolescence. Although, we cannot rule out the possibility of residual confounding by genetic or familial factors, our results suggest that the reported associations may be contextually specific rather than biologically based. Whether lower birth weight is associated with hyperactivity in early adolescence needs to be confirmed or refuted in other suitable settings.

Childhood obesity: causes and consequences

Childhood obesity has reached epidemic levels in developed as well as in developing countries. Overweight and obesity in childhood are known to have significant impact on both physical and psychological health. Overweight and obese children are likely to stay obese into adulthood and more likely to develop non-communicable diseases like diabetes and cardiovascular diseases at a younger age. The mechanism of obesity development is not fully understood and it is believed to be a disorder with multiple causes. Environmental factors, lifestyle preferences, and cultural environment play pivotal roles in the rising prevalence of obesity worldwide. In general, overweight and obesity are assumed to be the results of an increase in caloric and fat intake. On the other hand, there are supporting evidence that excessive sugar intake by soft drink, increased portion size, and steady decline in physical activity have been playing major roles in the rising rates of obesity all around the world. Childhood obesity can profoundly affect children's physical health, social, and emotional well-being, and self esteem. It is also associated with poor academic performance and a lower quality of life experienced by the child. Many co-morbid conditions like metabolic, cardiovascular, orthopedic, neurological, hepatic, pulmonary, and renal disorders are also seen in association with childhood obesity.

Addressing an overweight child and an unaware parent in the general practice consultation

KEY MESSAGES

General practitioners (GPs) can play a key role in tackling the current obesity epidemic, especially helping parents who may not realise that their child is overweight. In a ten-minute consultation, a GP should: explore a parent's ideas, concerns and expectations about food and exercise and build a picture of the home environmentexclude medical causes of overweight and plot height and weight on a growth chartoffer practical strategies and achievable goals, agree follow up and involve the multidisciplinary team for support.

WHY THIS MATTERS TO ME

Childhood obesity is a global epidemic that has significant impact on the physical and psychological health and development of children, and often persists into adulthood where the health sequelae are well known. Parents are key players in putting healthy living advice into practice but our recent systematic review showed that parents are poor at recognising overweight in their own children. We believe GPs are key to providing health promotion for this group. However, to approach this sensitive subject requires one to have confidence and skills at one's fingertips and we hope this guide can provide these.

A meta-analysis of weight status and anxiety in children and adolescents

OBJECTIVE

Although some posit that youth who are overweight/obese experience greater amounts of anxiety than their peers who are normal weight, extant literature shows that the association between weight status and anxiety in youth is equivocal. Therefore, the purpose of this study was to elucidate the association between weight status and anxiety in children and adolescents through meta-analytic methods.

METHOD

Electronic databases and review articles were searched for studies including quantitative data on weight status and anxiety in youth aged ≤18 years. Data were analyzed using a random effects model. Putative moderators were selected a priori.

RESULTS

A total of 61 studies yielded 78 effect sizes (N = 180,136) and a small but significant overall summary effect (r = .08; 95% confidence interval, 0.06-0.11; z = 6.41; p < .001). Gender, age group, and type of weight status measure significantly moderated the association. Specifically, studies with girls, children aged 12 years and under, or norm-referenced measures of weight status (e.g., body mass index [BMI] z-score) evidenced significantly higher effect sizes between weight status and anxiety than studies with boys, adolescents aged 13 years and over, or non-norm-referenced measures of weight status (e.g., BMI), respectively. Sample type, publication type, anxiety type, anxiety informant, and race/ethnicity were not significant moderators.

CONCLUSION

Overall, the association between weight status and anxiety is small; however, study or methodological characteristics may modestly influence the effect. Longitudinal studies are needed to determine the directionality of the association, and consequently, the intended target of intervention.

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

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

The moderating effect of self-efficacy on normal-weight, overweight, and obese children's math achievement: a longitudinal analysis

Increased body weight is associated with decreased cognitive function in school-aged children. The role of self-efficacy in shaping the connection between children's educational achievement and obesity-related comorbidities has not been examined to date. Evidence of the predictive ability of self-efficacy in children is demonstrated in cognitive tasks, including math achievement scores. This study examined the relationship between self-efficacy and math achievement in normal weight, overweight, and obese children. I hypothesized that overweight and obese children with higher self-efficacy will be less affected in math achievement than otherwise comparable children with lower self-efficacy. I tested this prediction with multilevel growth modeling techniques using the ECLS-K 1998-1999 survey data, a nationally representative sample of children. Increased self-efficacy moderates the link between body weight and children's math achievement by buffering the risks that increased weight status poses to children's cognitive function. My findings indicate that self-efficacy moderates math outcomes in overweight, but not obese, children.

Use of the extended Strengths and Difficulties Questionnaire (SDQ) to predict psychiatric caseness in Hong Kong

The extended Strengths and Difficulties Questionnaire (SDQ) provides information on problem behaviours and impairment measures. Western studies found impairment measures to be as good as symptom scores in predicting clinical caseness. The high levels of comorbidities among child psychiatric disorders also meant that disorders not specifically captured by the questionnaire could be identified. This study examines its applicability among Chinese school children in Hong Kong. Results found that impairment measures were more predictive of clinical status than were symptom scores. Children with low symptom but high impairment ratings had profiles that were intermediate between the low symptom low impairment and high symptom low impairment groups. The extended SDQ is useful in identifying children who might otherwise be missed if symptom scores alone were used in screening. The acceptance of child psychiatric care in Hong Kong is a multi-step process that depends on how symptoms are perceived.

The association between physical fitness and academic achievement in Texas state house legislative districts: an ecologic study

BACKGROUND

The association of physical fitness with cognitive function in children and adolescents is unclear. The purpose of this ecological study was to describe the association between academic achievement, body mass index (BMI), and cardiovascular fitness (CVF) in a large sample of elementary, middle, and high school students in Texas.

METHODS

FITNESSGRAM(®) results for 2,550,144 students were matched with standardized composite academic test (TAKS) results from 2008 to 2009. Analyses were conducted on the percent of students meeting TAKS standards by BMI and CVF quintiles. Analyses of variance with Tukey adjustment examined differences between the most favorable 5th quintile (referent) and all other quintiles.

RESULTS

The prevalence of students meeting the TAKS standard was significantly higher in the highest fitness category for BMI and CVF compared to all other categories, regardless of sex or grade category (p < .05). Linear modeling suggested a 5% increase in the prevalence of students meeting healthy BMI and CVF standards would result in a 2.25% and 0.65% increase in the prevalence of students meeting the TAKS standard (both p < .05).

CONCLUSION

Findings suggest a healthy BMI and CVF are associated with higher academic achievement, and the need for additional research examining the role of potential confounders and/or effect modifiers longitudinally.

Targeting childhood obesity in schools: an examination of the stability and utility of the value added index

BACKGROUND

High rates of childhood obesity and overweight have promoted interest in school-based interventions. As a way to identify schools with high unexpected prevalence of obesity and the greatest need, Procter and associates developed a 'Value Added Index' (VAI). It compares rates of obesity in entry level and advanced students in elementary schools, quantifying the extent to which rates for advanced students are higher than what would be expected given entry level rates and socio-demographic characteristics.

METHODS

This paper replicates their analysis using data over a 4 year time span from 17 schools in the western United States. Our analysis compared results obtained with the relatively complicated mixed-model approach, which was used by Procter and associates, and a more simple linear regression, which could be easily used by local school officials. Results were also compared across the 4 years for which data were available.

RESULTS

Identical results were found when the two methods were compared. There was little stability in the rank ordering of schools, based on the VAI, from 1 year to another.

CONCLUSIONS

Our results cast doubts on the utility of the VAI for policy makers and suggest policy makers consider a universalistic, rather than targeted, approach to interventions.

'It's on your conscience all the time': a systematic review of qualitative studies examining views on obesity among young people aged 12-18 years in the UK

OBJECTIVE

To explore the perspectives of young people in the UK on obesity, body size, shape and weight.

DESIGN

Systematic review of qualitative studies using thematic synthesis.

DATA SOURCES

Sensitive searches of 18 electronic databases from 1997 to February 2010 supplemented by grey literature searches.

STUDY SELECTION

Studies produced since 1997 using qualitative methods to collect perspectives of people aged 12-18 years in the UK, reporting methods for data collection or analysis. Studies of people with eating disorders and those rated low in reliability and usefulness were excluded.

RESULTS

Searches identified 30 studies involving over 1400 young people from a range of contexts. Young people of all sizes placed considerable emphasis on personal responsibility, and on the social, rather than health implications of being overweight. Young people with experience of obesity described severe, unrelenting, size-related abuse and isolation. Regardless of their own size, young people were judgemental of individuals who were overweight, but those with experience of obesity described an environment that contained multiple barriers to weight loss. Only one study asked young people directly what might support them to have a healthy body size. Study findings were configured under three main themes, labelled with quotes from included studies: general perceptions of size and society's responses ('It's on your conscience all the time'); the experiences of young people who were overweight ('If I had the choice I wouldn't be this size') and these larger young people's experiences of trying to loose weight and suggestions for action ('Make sure, even when it's hard, you've got people there').

CONCLUSIONS

The perspectives of young people in the UK, when synthesised across the spectrum of body sizes, paint a picture of a stigmatising and abusive social world. Research and policy need to engage young people actively so as to address the social implications of obesity.

Targeting and tailoring an intervention for adolescents who are overweight: some ethical concerns

There are important ethical issues to be examined before launching any public health intervention, particularly when targeting vulnerable groups. The aim of this article is to identify and discuss ethical concerns that may arise when intervening for health behavior change among adolescents identified as overweight. These concerns originate from an intervention designed to capacitate adolescents to increase self-determined physical activity. Utilizing an ethical framework for prevention of overweight and obesity, we identified three ethical aspects as particularly significant: the attribution of responsibility for health behavior, liberty to choose, and the effect on the participants' psychosocial well-being. It is discussed whether and how measures can be taken to deal with these aspects. It seems evident that the ethical aspects are mainly concerned with the vulnerability of adolescents identified as overweight. However, we claim that when individual feedback and counseling is provided, tailored interventions have a unique potential to empower adolescents to make ethically anchored decisions about their own health behavior.

Anxiety and depression levels in prepubertal obese children: a case-control study

INTRODUCTION

Childhood obesity has become a worldwide epidemic in Western and in developing countries and has been accompanied by many serious and severe comorbidities, such as diabetes, hypertension, sleep apnea syndrome, depression, dyslipidemia, impaired glucose homeostasis, steatohepatitis, and intracranial hypertension, as well as medical concerns unique to youth, such as accelerated pubertal and skeletal development and orthopedic disorders. To date, no specific studies about the psychological assessment in pediatric obesity are present. Therefore, the aim of this study was to evaluate the putative relationship between psychological troubles and obesity in a sample of school-aged children.

MATERIALS AND METHODS

The study population consists of 148 obese subjects (body mass index [BMI] >95th percentile) (69 males, mean age 8.9±1.23 years) consecutively referred from clinical pediatricians to the Child and Adolescent Neuropsychiatry department at the Second University of Naples. In all subjects, weight, height, and BMI z-score were evaluated. In order to assess the anxiety levels and the presence of depressive symptoms, the Children Depression Inventory (CDI) and the Italian Self-Administered Psychiatric Scales for Children and Adolescents (SAFA) were administered. The control group consisted of 273 healthy children (129 males and 144 females) (mean age 9.1±1.8 years), enrolled in schools within the Campania region of Italy.

RESULTS

No significant differences between the two study groups were found for age (8.9±1.23 years in the obese sample and 9.1±1.8 years in the control group) (P=0.228) or sex (ratio male/female: 69/79 in the obese group versus 129/144 in the control group) (P=0.983). Obviously, significant difference was found for the BMI z-score (2.46±0.31 in the obese group vs 0.73±0.51 in the control group) (P<0.001). The obese subjects showed significant higher level of depressive symptoms (CDI total score) (16.82±7.73 vs 8.2±2.9) (P<0.001) and anxiety (SAFA - Anxiety [SAFA-A]) scale score (58.71±11.84 vs 27.75±11.5) (P<0.001) compared with the control group. Moreover, the Pearson's correlation analysis showed a significantly positive relationship between the BMI z-score and both the CDI (r=0.677; P<0.001) and SAFA-A scores (r=0.591; P<0.001).

CONCLUSION

Our findings highlighted the importance of assessing the presence of internalizing problems, such as anxiety and depression, in the common management of childhood obesity.

The assessment of eating behaviour in children who are obese: a psychological approach. A position paper from the European childhood obesity group

OBJECTIVE

This paper introduces health professionals to the different psychological models thought to influence eating behaviour in the absence of hunger in children who are obese and to propose a method of assessing these behaviours in practice.

METHODS

Clinical researchers from the European Childhood Obesity Group (ECOG) adopted an evidence-based approach to examine the literature concerning the assessment of eating behaviour in children who are obese. Studies published in English were filtered out of the medical and psychological literature from 1960 to the present, and the resulting bibliography was searched for relevant articles. Key themes from the current evidence were compiled and classified according to the underpinning psychological models. Based on the current evidence and the authors' combined clinical experience, a three-staged approach to assessment was agreed by consensus.

RESULTS

Valid and reliable tools for assessing and monitoring each of the three identified models (Dietary Restraint Theory, Emotional Eating and the Diathesis-Stress Model) are suggested for use in clinical practice, and the ECOG three-staged approach to assessing eating behaviours in the absence of hunger is described.

CONCLUSIONS

This paper presents practical guidance on how to assess eating behaviour in the absence of hunger in children who are clinically obese and suggests a focus for future research.

Overweight trajectories and psychosocial adjustment among adolescents

OBJECTIVES

Few studies have investigated overweight trajectories and psychosocial adjustment among adolescents. We conducted analyses with data from the multisite Study of Early Child Care and Youth Development (SECCYD).

METHODS

The sample included 1350 youths born in 1991. Data consisted of repeated measures of weight, height, and multiple subscales of internalizing and externalizing behavioral problems measured by the Child Behavior Checklist (CBCL) from age 9 to age 15.

RESULTS

Three trajectory patterns were identified: never/rarely overweight/obese (59.5%), late start/light overweight/obese (12.1%), and chronically/heavy overweight/obese (28.4%). Youths with chronically/heavy overweight/obese trajectory pattern had significantly higher scores of internalizing problems over time, as well as syndrome subscales of somatic complaints, social problems and social withdrawal over time than youths with the never/rare overweight/obese trajectory pattern. There was no significant difference in either broad-band behavioral problems or narrow-band syndrome subscales between youths with the never/rare overweight/obese trajectory pattern and those with the late start/light overweight/obesity trajectory pattern.

CONCLUSIONS

Study findings may advance knowledge on the distinct developmental trajectory patterns of overweight youth and their linkages to the psychosocial adjustment during the period of pubertal transition. The results highlight the need for future prevention research to improve the physical development and mental well-being of adolescents.

Cognitive, sensory, and psychosocial characteristics in patients with Bardet-Biedl syndrome

Forty-two patients with a clinical diagnosis of Bardet-Biedl syndrome ages 2-61 years were given a neuropsychological test battery to evaluate cognitive, sensory, and behavioral functioning. These tests included the Wechsler scales of intelligence, Rey Auditory Verbal Learning Test, Boston Naming Test, D-KEFS Verbal Fluency Test, D-KEFS Color-Word Interference Test, D-KEFS Sorting Test, Wide Range Achievement Test: Math and Reading Subtests, Purdue Pegboard, The University of Pennsylvania Smell Identification Test, Social Communication Questionnaire, Social Responsiveness Scale, and Behavior Assessment System for Children, Second Edition, Parent Rating Scale. On the age appropriate Wechsler scale, the mean Verbal Comprehension was 81 (n = 36), Working Memory was 81 (n = 36), Perceptual Reasoning was 78 (n = 24) and Full Scale IQ was 75 (n = 26). Memory for a word list (Rey Auditory Verbal Learning Test) was in the average range with a mean of 89 (n = 19). Fine motor speed was slow on the Purdue with mean scores 3-4 standard deviations below norms. All subjects were microsmic on the University of Pennsylvania Smell Identification Test. Of these 42 patients, only 6 were able to complete all auditory and visual tests; 52% were unable to complete the visual tests due to impaired vision. A wide range of behavioral issues were endorsed on questionnaires given to parents. Most had social skill deficits but no pattern of either externalizing or internalizing problems. We identify a characteristic neuro-behavioral profile in our cohort comprised of reduced IQ, impaired fine-motor function, and decreased olfaction.

Effect of the Go4it multidisciplinary group treatment for obese adolescents on health related quality of life: a randomised controlled trial

Background

We developed a Dutch outpatient multidisciplinary group treatment (Go4it) for obese adolescents, including cognitive behavioural therapy and education on healthy dietary and physical activity behaviour. This study examined the effect of Go4it on Health Related Quality of Life (HRQoL).

Methods

At our outpatient paediatric obesity clinic, obese adolescents (n = 122, 11–18 years) were randomly assigned to 1) Go4it, 7 sessions with an interval of 2 weeks or 2) current regular care consisting of referral to a dietician in the home care setting (controls). Linear mixed model analysis was performed to evaluate the intervention effects on HRQoL at 6 and 18-month follow-ups. HRQoL indicators included the Child Health Questionnaire, the Paediatric Quality of Life Inventory™ Version 4.0 (PedsQL™4.0), and the Body Esteem Scale (BES).

Results

In total, 95 adolescents (Go4it 57, controls 38) were included in the current analysis with a mean age of 14.5 ± 1.7 and mean BMI-SDS of 2.9 ± 0.5. At baseline, all participants experienced lower levels of physical and psychosocial well-being compared to a normal weight reference group. At the 18 month follow-up, we found small but beneficial intervention effects on all subscales of the PedsQL™4.0 and BES questionnaires. Two subscales improved significantly; i.e., physical health (between group difference 5.4; 95%CI: 0.3; 10.6), and school functioning (between group difference 7.4; 95%CI: 1.6; 13.2).

Conclusion

Obese adolescents experienced lower HRQoL than their healthy peers. The Go4it intervention had small beneficial effects on HRQoL compared to the current regular care practices for obese adolescents.

Trial registration

Netherlands Trial Register: ISRCTN27626398, METC number: 05.134 (WMO, monocenter).

Obese youths are not more likely to become depressed, but depressed youths are more likely to become obese

BACKGROUND

Overweight/obesity and depression are both major public health problems among adolescents. However, the question of a link between overweight/obesity and depression remains unresolved in this age group. We examined whether obesity increases risk of depression, or depression increases risk of obesity, or whether there is a reciprocal effect.

METHOD

A two-wave prospective cohort study of adolescents aged 11–17 years at baseline (n=4175) followed up a year later (n=3134) sampled from the Houston metropolitan area. Overweight was defined as 95th percentile >body mass index (BMI) < or = 85th percentile and obese as BMI >95th percentile. Three indicators of depression were examined: any DSM-IV mood disorder, major depression, and symptoms of depression.

RESULTS

Data for the two-wave cohort indicated no evidence of reciprocal effects between weight and depression. Weight status predicted neither major depression nor depressive symptoms. However, mood disorders generally and major depression in particular increased risk of future obesity more than twofold. Depressed males had a sixfold increased risk of obesity. Females with depressive symptoms had a marginally increased risk of being overweight but not obese.

CONCLUSIONS

Our findings, combined with those of recent meta-analyses, suggest that obese youths are not more likely to become depressed but that depressed youths are more likely to become obese.

Perceived weight, not obesity, increases risk for major depression among adolescents

This study examined the association between major depression, obesity and body image among adolescents.

METHODS

Participants were 4175 youths 11-17 years of age sampled from the community who were interviewed using the Diagnostic Interview Schedule for Children and Adolescents, Version IV, completed a self-report questionnaire, and had their weight and height measured. There were 2 measures of body image: perceived weight and body satisfaction. Obesity was associated with increased risk of depression, with no controls for covariates. However, when the association was examined in models which included weight, major depression, and body image measures and covariates, there was no association between major depression and body weight, nor between body satisfaction and major depression. Perceived overweight was strongly and independently associated with body weight (O.R. = 2.62). We found no independent association between major depression and body weight. If there is an etiologic link between major depression and body weight among adolescents, it most likely operates through processes involving components of body image. Future research should focus on the role of depression and body image in the etiology of obesity.

Obesity has few effects on future psychosocial functioning of adolescents

We reexamine the effects of obesity on a wide range (n=17) of indicators of functioning drawn from five broad domains: interpersonal problems, psychological problems, suicidal behaviors, academic performance, and psychiatric disorders. Evidence on this question is mixed. Data are analyzed from a large community sample of adolescents 11-17 at baseline (n=4175) who were followed up a year later (n=3134). Using measured height and weight, overweight was defined as 95th>BMI≤85th percentile and obese as BMI >95th percentile. At baseline, obesity was associated with increased odds only for any mood disorder and poor perceived mental health. For boys, there were no significant associations, but girls had higher odds of problems at school, poor perceived mental health, and mood disorders. Results from the two-wave cohort reveal obesity increased future risk only for poor perceived mental health. For boys, the same pattern was observed, but for girls there were no significant associations. Overall, we found that weight status had few deleterious effects on adolescent social functioning, in multivariate, prospective analyses. If there is an effect of obesity on functioning, it may operate through mediators such as body image.

Anxiety as a consequence of modern dietary pattern in adults in Tehran--Iran

Food intake patterns in relation to mental health have already been revealed. To investigate the relationship between processed food consumption behavior and anxiety disorder, a cross sectional study was conducted. Overall, 1782 young adults aged 18-35 years were randomly selected using cluster sampling method from 22 districts of Tehran-Iran in 2011. Diet assessment was done using a 24 hour recall questionnaire in two times with a week interval. Anxiety level was determined using the validated Speilburger test (Persian version). A proportional odds regression model was used to assess the effect of processed food consumption on anxiety variables. A significant statistical difference was found between men and women in terms of processed food consumption (p<0.001). Adjusting for age, total calorie intake, gender, body mass index, socioeconomic status, and history of sedative drug consumption as well as mental health disorders, the proportional odds regression model showed a significant relationship between increased consumption of processed foods and anxiety (OR=4.73, 95% CI: 2.89-12.54 for state and OR=4.91, 95% CI: 2.88-13.99 for trait). Identification, modification and adjusting incorrect food patterns in the community could be considered as valuable steps to turn down nutritional-based health difficulties.

A community-based intervention to prevent obesity beginning at birth among American Indian children: study design and rationale for the PTOTS study

Eating and physical activity behaviors associated with adult obesity have early antecedents, yet few studies have focused on obesity prevention interventions targeting very young children. Efforts to prevent obesity beginning at birth seem particularly important in populations at risk for early-onset obesity. National estimates indicate that American Indian (AI) children have higher rates of overweight and obesity than children of other races/ethnicities. The Prevention of Toddler Obesity and Teeth Health Study (PTOTS) is a community-partnered randomized controlled trial designed to prevent obesity beginning at birth in AI children. PTOTS was developed to test the effectiveness of a multi-component intervention designed to: promote breastfeeding, reduce sugar-sweetened beverage consumption, appropriately time the introduction of healthy solid foods, and counsel parents to reduce sedentary lifestyles in their children. A birth cohort of 577 children from five AI tribes is randomized by tribe to either the intervention (three tribes) or the comparison condition (two tribes). The strengths and weaknesses of PTOTS include a focus on a critical growth phase, placement in the community, and intervention at many levels, using a variety of approaches.

Prevalence and prediction of overweight and obesity among elementary school students

BACKGROUND

The high rates of childhood overweight and obesity in the United States have generated interest in schools as sites for monitoring body mass index (BMI) information. This study established baseline values for a 5-year longitudinal assessment of BMI of elementary school children and examined variation across the schools, because little is known about factors that affect the distribution of overweight and obesity within school districts.

METHODS

Height and weight measurements were collected on 2317 elementary school children in 1 school district. BMI was calculated using the Centers for Disease Control and Prevention's NutStat program. Child characteristics included gender, age, eligibility for free and reduced lunch (proxy for socioeconomic status [SES]), school, grade, and ethnicity/race. Children were grouped into 2 BMI categories, <85th percentile or ≥85th percentile (overweight/obesity). Logistic regression was used to examine potential predictors of overweight/obesity.

RESULTS

Prevalence of ≥85th percentile was 30.9%, 34.4%, 35.3%, 36.4%, 37.1%, and 44.5% for K-5, respectively. Prevalence of ≥85th percentile was highest among Hispanic children. Ethnicity was the strongest predictor of inclusion in the ≥85th percentile category followed by grade and free and reduced lunch eligibility.

CONCLUSION

The data are consistent with the prevalence of overweight/obesity among American children and Hispanic children in particular. District prevalence of overweight/obesity is higher than available state statistics. Most of the BMI variation is accounted for by ethnicity, SES, and grade. The grade effect and high prevalence of overweight/obesity provide a rationale for BMI screening retention at the schools.