Is Obesity Associated With School Dropout? Key Developmental and Ethnic Differences

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

BACKGROUND

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

METHOD

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

RESULTS

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

CONCLUSIONS

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

Pediatric Obesity: Primary Care Perspective and Prevention

In 1997, the World Health Organization declared obesity a global epidemic. Despite multiple efforts, obesity rates have been exponentially increasing for the past few decades. In the last few years, obesity rates have reached an alarming number. Multiple factors play a role in pediatric obesity, such as diet, sedentarism, and poor sleep, as well as psychosocial and environmental factors. Pediatricians and primary care providers are key in the management of overweight and obesity. They have the advantage of observing children over a long period of time, having a family centered perspective, and often being seen as a reliable source of information. Studies have shown that not only is obesity underdiagnosed, but there is a lack of knowledge among physicians and available resources regarding pediatric obesity. This article reviews the principles of prevention in a primary care outpatient setting. Additionally, it discusses some of the challenges commonly faced when addressing pediatric obesity. [Pediatr Ann. 2023;52(2):e51-e56.].

Gender Differences in the Psychopathology of Obesity: How Relevant Is the Role of Binge Eating Behaviors?

Background: Obesity is a condition that affects humans both physically and mentally. Moreover, many psychopathological conditions can be observed in obese patients that may threaten the positive outcomes of bariatric surgery. Purpose: The aim of this study was to identify the main psychopathological correlates of obese candidates for bariatric surgery, with particular attention on the relationship between psychopathology and gender. Methods: In total, 273 candidates for bariatric surgery for obesity underwent a psychiatric evaluation using a compilation of psychometric scales: the Revised Symptom Checklist 90-R (SCL-90-R), the Eating Disorder Examination Questionnaire (EDE-Q), the Binge Eating Scale (BES), the Body Uneasiness Test (BUT) and the Obesity-Related Well-Being (ORWELL 97). The sample was divided on the basis of gender and binge eating disorder (BED) severity. Comparisons between the groups were performed using an analysis of variance model (ANOVA) or a Pearson’s chi-squared test. Further, we also divided our sample into a severe binge eating group (score > 27), a mild to moderate group (18 < score < 26) and a low/no symptoms group (score < 17). Results: Male and female subjects showed different results for the BES, with higher scores reported among women (17.50 ± 9.59) compared to men (14.08 ± 8.64). Women also showed higher scores across most of the SCL-90-R domains and worse outcomes in terms of quality of life. Both women and men in the severe binge eating group reported higher scores for the SCL-90-R. Conclusion: The symptoms of BED, along with body image dissatisfaction (BID), are among the most important to investigate for candidates for bariatric surgery in order to improve the surgery outcomes. Level of evidence: Level III as the evidence came from a cohort analytic study.

The effects of relative body weight on socioemotional and schooling outcomes among female adolescents in the United States

RATIONALE

An extensive literature has shown that individuals, especially women, with higher body mass index (BMI) face a range of negative life outcomes. Most previous studies rely on absolute measures of body weight, such as BMI and obesity status, to estimate the social impact of body weight. Using absolute measures of body weight, however, is inconsistent with social-psychological theories that explain the effects of body weight because they conflate the social effects of body weight with biological processes of body weight.

OBJECTIVE

This study extends the literature by utilizing a relative measure of body weight, or a student's BMI rank within her relevant peer group, to examine the impact of body weight on youth outcomes.

METHODS

Using data from the National Longitudinal Study of Adolescent to Adult Health and leveraging a quasi-experimental research design, this study examines the association between relative BMI and socioemotional and schooling outcomes among female adolescents in the United States.

RESULTS

Results show that female students with high relative BMI are more likely to experience a decrease in self-esteem and an increase in depressive symptoms, even after adjusting for absolute BMI and weight perceptions. These effects are partially explained by lower levels of school attachment (∼26% for self-esteem and ∼15% for depressive symptoms). This study also finds that relative BMI is associated with an increased risk of high school dropout, but not college attainment and completed years of schooling. The association between relative BMI and high school dropout is partially explained by a combination of lowered self-esteem (∼7%), increased depressive symptoms (∼12%), as well as a decline in academic achievement (∼33%) and aspirations (∼12%).

CONCLUSION

We argue that to better understand how body weight affects one' life outcomes, it is essential to take into consideration the social contexts in which one is embedded.

Intersections of Adolescent Well-Being: School, Work, and Weight Status in Brazil

Socioeconomic and health disadvantages can emerge early in the life course, making adolescence a key period to examine the association between socioeconomic status and health. Past research on obesity in adolescence has focused on family measures of socioeconomic status, overlooking the role of individual-level nascent indicators of socioeconomic disadvantage. Using measured height and weight from nationally representative data from Brazil, we estimate sibling fixed effects models to examine the independent effects of nascent socioeconomic characteristics-school enrollment and work status-on adolescent overweight and obesity, accounting for unobserved genetic and environmental factors shared by siblings. Results show that school enrollment is associated with lower odds of overweight and obesity. Working is not significantly associated with overweight/obesity risk. However, adolescents not enrolled but working face the highest risk of overweight/obesity. Findings suggest that adolescents face added layers of disadvantage from being out of school, with important implications for the accumulation of health disadvantages.

'Fat black sheep': Educational penalties of childhood obesity in an emerging country

OBJECTIVE

This article explores the relationship between childhood obesity and educational outcomes in Mexico, a country where excess weight is predominant.

DESIGN

Using complementary multivariate estimators, we empirically investigate the association between childhood excess weight, measured in 2002, and schooling attainment measured 10 years later. Non-linear specifications are tested, and heterogeneous effects according to gender, living area and economic backgrounds are investigated.

SETTING

To fill the literature gap, this study focuses on the understudied context of emerging countries such as Mexico.

PARTICIPANTS

Panel data from the Mexican Family Life Survey (2002-2012) are used. We restricted the sample to adolescent individuals who had between 9 and 15 years old in 2002 (attended primary or secondary school in 2002). The survey provides an accurate follow-up information on weight, height and waist circumference for each individual.

RESULTS

Controlling for a comprehensive set of covariates, we find that the relationship is non-linear in Mexico. While weight-based childhood obesity and abdominal adiposity are significantly associated with lower school attainment, at least in urban settings, no schooling gap is found between overweight students and their normal-weight counterparts. Along with rural-urban heterogeneity, obesity-based educational penalties appear to be stronger for girls and students from privileged economic backgrounds.

CONCLUSIONS

These results emphasise the co-occurrence of anti-fat and pro-fat social norms in Mexican schools: while anti-fat norms may particularly concern female, richer and urban students, pro-fat norms might persist among male, poorer and rural students. These findings have important implications for public policy, namely about awareness anti-obesity programmes.

Are weight status and weight perception associated with academic performance among youth?

BACKGROUND

Emerging evidence suggests perceptions of being overweight account for many of the psychosocial consequences commonly associated with obesity. Previous research suggests an obesity achievement gap, yet limited research has explored weight perception in association with academic performance. Moreover, underweight perceptions have typically been excluded from research. The current study examined how BMI classification and weight perception relate to academic performance in a large cohort of youth.

METHODS

We used cross-sectional survey data from 61,866 grade 9-12 students attending the 122 Canadian schools that participated in Year 6 (2017/2018) of the COMPASS study. Mixed effect regression models were used to examine associations between students' BMI classification and weight perceptions and their math and English/French course grades. All models were stratified by sex and adjusted for sociodemographic covariates and school clustering.

RESULTS

For English/French grades, males and females with overweight or underweight perceptions were less likely to achieve higher grades than their peers with perceptions of being at "about the right weight", controlling for BMI and covariates. For math grades, females with overweight perceptions, and all students with underweight perceptions, were less likely to achieve higher grades than their peers with "about the right weight" perceptions. All students with BMIs in the obesity range were less likely to report grades of 60% or higher than their peers with "normal-weight" BMIs, controlling for weight perception and covariates. Overweight BMIs were predictive of lower achievement in females for English/French grades, and in males for math grades, relative to "normal-weight" BMIs. Results for students that did not respond to the weight and weight perception items resembled those for obesity BMI and overweight/underweight perceptions, respectively.

CONCLUSIONS

Overall, this study demonstrates that an obesity achievement gap remains when controlling for students' perceptions of their weight, and that both underweight and overweight perceptions predict lower academic performance, regardless of BMI classification. Results suggest barriers to academic success exist among youth with larger body sizes, and those with perceptions of deviating from "about the right weight".

Cardiometabolic health in adolescence and its association with educational outcomes

Aim

To explore the association of selected cardiometabolic biomarkers and metabolic syndrome (MetS) with educational outcomes in adolescents from Chile.

Methods

Of 678 participants, 632 (52% males) met criteria for the study. At 16 years, waist circumference (WC), systolic blood pressure, triglycerides (TG), high-density lipoprotein and glucose were measured. A continuous cardiometabolic risk score (zMetS) using indicators of obesity, lipids, glucose and blood pressure was computed, with lower values denoting a healthier cardiometabolic profile. MetS was diagnosed with the International Diabetes Federation/American Heart Association/National Heart, Lung, and Blood Institute joint criteria. Data on high school (HS) graduation, grade point average (GPA), college examination rates and college test scores were collected. Data were analysed controlling for sociodemographic, lifestyle and educational confounders.

Result

zMetS, WC, TG and homeostatic model assessment of insulin resistance at 16 years were negatively and significantly associated with the odds of completing HS and taking college exams. Notably, for a one-unit increase in zMetS, we found 52% (OR: 0.48, 95% CI 0.227 to 0.98) and 39% (OR: 0.61, 95% CI 0.28 to 0.93) reduction in the odds of HS completion and taking college exams, respectively. The odds of HS completion and taking college exams in participants with MetS were 37% (95% CI 0.14 to 0.98) and 33% (95% CI 0.15 to 0.79) that of participants with no cardiometabolic risk factors. Compared with adolescents with no risk factors, those with MetS had lower GPA (515 vs 461 points; p=0.002; Cohen’s d=0.55). Adolescents having the MetS had significantly lower odds of passing the mathematics exam for college compared with peers with no cardiometabolic risk factors (OR: 0.49; 95% CI 0.16 to 0.95).

Conclusion

In Chilean adolescents, cardiometabolic health was associated with educational outcomes.

An update on obesity: Mental consequences and psychological interventions

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

School-Based Weight Management Program Curbs Summer Weight Gain Among Low-Income Hispanic Middle School Students

BACKGROUND

Research shows that elementary students gain weight over the summer. It is unknown if these findings apply to Hispanic adolescents. We evaluated school and summer standardized body mass index (zBMI) changes in Hispanic middle school students.

METHODS

Hispanic middle school students were randomly assigned to a weight management program (N = 230) or control condition (N = 195). Paired sample t-tests compared zBMI change scores during the school year versus summer when not enrolled in a weight management program (eg, control group). We used 2 × 2 repeated measures analysis of variances to determine program group differences in zBMI scores across school versus summer periods separately for normal and overweight/obese students.

RESULTS

In the control group, students' zBMI change scores decreased during the school year, but increased during summer for both normal weight and overweight/obese students. Program effects on zBMI indicated school year decreases and summer increases for both normal and overweight/obese students. However, zBMI scores did not differ by program status for normal weight students. Overweight/obese students in the program compared to the control group increased zBMI to a lesser extent over the summer.

CONCLUSION

For all students, zBMI increased during the summer. A school-based weight management program protected overweight/obese students against potentially greater summer weight gain.

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

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

Increased Adiposity as a Potential Risk Factor for Lower Academic Performance: A Cross-Sectional Study in Chilean Adolescents from Low-to-Middle Socioeconomic Background

We explored the association between excess body fat and academic performance in high school students from Santiago, Chile. In 632 16-year-olds (51% males) from low-to-middle socioeconomic status (SES), height, weight, and waist circumference were measured. Body-mass index (BMI) and BMI for age and sex were calculated. Weight status was evaluated with 2007 World Health Organization (WHO) references. Abdominal obesity was diagnosed with International Diabetes Federation (IDF) references. Total fat mass (TFM) was measured with dual-energy X-ray absorptiometry (DXA). TFM values ≥25% in males and ≥35% in females were considered high adiposity. School grades were obtained from administrative records. Analysis of covariance examined the association of fatness measures with academic performance, accounting for the effect of diet and physical activity, and controlling SES background and educational confounders. We found that: (1) having obesity, abdominal obesity, or high adiposity was associated with lower school performance alone or in combination with unhealthy dietary habits or reduced time allocation for exercise; (2) high adiposity and abdominal obesity were more clearly related with lower school grades compared to obesity; (3) the association of increased fatness with lower school grades was more salient in males compared to females.

Peer Crowd Identification and Adolescent Health Behaviors: Results From a Statewide Representative Study

Purpose. Peer crowds are macro-level subcultures that share similarities across geographic areas. Over the past decade, dozens of studies have explored the association between adolescent peer crowds and risk behaviors, and how they can inform public health efforts. However, despite the interest, researchers have not yet reported on crowd size and risk levels from a representative sample, making it difficult for practitioners to apply peer crowd science to interventions. The current study reports findings from the first statewide representative sample of adolescent peer crowd identification and health behaviors. Methods. Weighted data were analyzed from the 2015 Virginia Youth Survey of Health Behaviors ( n = 4,367). Peer crowds were measured via the I-Base Survey™, a photo-based peer crowd survey instrument. Frequencies and confidence intervals of select behaviors including tobacco use, substance use, nutrition, physical activity, and violence were examined to identify high- and low-risk crowds. Logistic regression was used to calculate adjusted odds ratios for each crowd and behavior. Results. Risky behaviors clustered in two peer crowds. Hip Hop crowd identification was associated with substance use, violence, and some depression and suicidal behaviors. Alternative crowd identification was associated with increased risk for some substance use behaviors, depression and suicide, bullying, physical inactivity, and obesity. Mainstream and, to a lesser extent, Popular, identities were associated with decreased risk for most behaviors. Conclusions. Findings from the first representative study of peer crowds and adolescent behavior identify two high-risk groups, providing critical insights for practitioners seeking to maximize public health interventions by targeting high-risk crowds.

Effect of Sleep Duration, Diet, and Physical Activity on Obesity and Overweight Elementary School Students in Shanghai

BACKGROUND

This was a cross-sectional survey to investigate the relationship of age, parent education, sleep duration, physical activity, and dietary habits with overweight or obesity in school-age children in Shanghai.

METHODS

The survey gathered information from 13,001 children in grades 1 through 5 (age 6 to 10 years) among 26 elementary schools in 7 districts. Activity level was evaluated using the International Children's Leisure Activities Study Survey Questionnaire (CLASS-C). The definitions of normal, overweight, and obese were adjusted for each age.

RESULTS

Logistic regression analysis indicated that age, being male, having ≤10 hours of sleep on non-school days, eating ≥1 vegetable/day, or drinking ≥1 sugar-sweetened drink/day increased the risk for a child being overweight or obese compared with having >10 hours of sleep or ≤3 vegetables or ≤3 sugar-sweetened drinks/month (p ≤ .008). Having >2 hours of outdoor activities on non-school days reduced the risk of being overweight or obese compared with ≤2 hours of outdoor activities on non-school days (p < .001).

CONCLUSIONS

We found that age, sex, sleep, and some dietary habits impacted weight, and suggests that specific cultural and economic factors may impact risk of a child being overweight or obese.