Stress, Stress Reduction and Obesity in Childhood and Adolescence

Circumstances Versus Efforts: Dissecting the Drivers of Adolescent Obesity Inequality

BACKGROUND

Previous studies have focused predominantly on socioeconomic disparities in adolescent obesity, but the sources of inequality may be more extensive.

OBJECTIVES

We aim to quantify and decompose the inequality of opportunity (IOp) in adolescent obesity caused by circumstances and examine the indirect effects of these circumstances on obesity through key effort factors.

METHODS

Based on the IOp framework and previous evidence, we categorised age, gender, socioeconomic status, and family-school environments of adolescents (N = 9117) as circumstances and obesity-related behaviours as efforts. The IOp was quantified and decomposed to determine the contribution of each circumstance. We also analysed the association between sleep debt and the circumstances to calculate the magnitude of indirect effects.

RESULTS

Of the obesity-related behaviours, only sleep debt showed a significant association with obesity (OR = 1.21, p < 0.05). Age and gender contributed 45.97% to the IOp, whereas socioeconomic status contributed 10.43% and family-school environments contributed 43.59%. Older and female adolescents whose fathers held high-status occupations tended to suffer from obesity due to sleep debt, while the opposite was true for adolescents whose mothers exercised, only children, boarders, high school students, and those from wealthier families.

CONCLUSIONS

Family-school environments contribute much greater to the IOp in adolescent obesity than socioeconomic status, and sleep debt plays an essential mediating role. The government bears the responsibility to undertake corresponding prioritised actions.

Body mass index trajectories from birth to adolescence and associated factors in the PARIS cohort

AIM

Development of body mass index (BMI) trajectories is essential for understanding childhood overweight, a public health concern. This study aimed to identify BMI trajectories from birth to adolescence and examine associated factors in the Pollution and Asthma Risk: an Infant Study (PARIS) birth cohort.

METHODS

Data on height, weight, birth parameters, lifestyle, parental weight status and stress were collected via questionnaires and health check-ups. BMI z-score (BMIz) trajectories were developed using group-based trajectory modelling on anthropometric data collected at least six times. Associated factors were investigated in multivariable multinomial logistic regression models, adjusted for confounders.

RESULTS

Five BMIz trajectories were identified in 540 adolescents. The early high stable BMI trajectory grouped participants who reached overweight status in early childhood. Four trajectories remained within the normal weight status: low stable BMI, continuous decrease BMI, continuous increase BMI, and early increase and slight decrease BMI trajectories. Compared with low stable BMI, high BMI trajectories were associated with higher parental weight status, early rebound age, excessive TV watching, lower food avoidance score, stressful events in early life and parent-child relationship stress.

CONCLUSION

High BMI trajectories shared several modifiable factors, emphasising the need for multifactorial interventions to tackle the childhood overweight epidemic.

The Effect of Diaphragmatic Breathing as a Complementary Therapeutic Strategy in Stress of Children and Teenagers 6-18 Years Old

BACKGROUND

Few studies are reported on interventions that have been carried out in children and adolescents using diaphragmatic breathing (DB) together with methods like counseling, muscle relaxation, therapeutic exercise, and music therapy.

OBJECTIVE

The goal of the review is to evaluate the effectiveness of DB as complementary therapy in the stress of the pediatric population (6-18 years old).

METHODS

Detailed research was carried out in the current literature to find relevant studies published from 2010 to October 2024 in PubMed and Cochrane Library. Thirteen studies that fulfilled the inclusion criteria were included in the study. Nine studies involved obese and overweight pediatric populations and the other four involved pediatric patients.

RESULTS

The interventions comprised two 8-week studies in an obese pediatric population, seven studies in healthy children and adolescents with normal weight. The studies were based on DB, muscle relaxation, nutrition, counseling, music therapy, and slow breathing exercises. The participants in the intervention group improved in comparison to those in the control group in terms of stress and depression in most included studies, in terms of school performance in two studies, in terms of better family relationships in one study, and showed improvement in anthropometric indicators in two studies. In four studies that involved pediatric patients, stress and fear of medical procedures were reduced.

CONCLUSIONS

DB can effectively contribute on its own or in combination with other therapeutic methods to improving physiological and psychological indicators in the pediatric population. It is useful to integrate stress management programs that include DB training as clinical practice in primary healthcare and in school schedules for elementary and high-school students.

Systematic review of the efficacy of yoga and mindfulness in the management of pediatric obesity

The neuroplasticity of adolescents could make them responsive to interventions affecting brain maturation such as yoga and mindfulness. We aimed to determine their efficacy and safety for the management of children and adolescents with obesity. A systematic search using MEDLINE, EMBASE, and PsycInfo was performed up to March 2024. We considered randomized controlled trials (RCTs) using yoga or mindfulness alone (or combined with standard therapy) compared to placebo, nothing, or standard therapy for weight loss. Methodological quality of studies was assessed with the Risk of Bias 2 tool. The primary outcomes were changes in weight and adiposity (kg, body mass index [BMI], BMI z-score, fat mass, waist circumference, waist-to-hip ratio). We assessed 4 yoga and 7 mindfulness RCTs, including 620 participants 8-19 years old. The number of participants varied per type of intervention (yoga, n = 10-63; mindfulness, n = 11-47). Comparators were no-intervention or active controls. All yoga trials reported anthropometric improvements, but all trials combined yoga with extra physical activity. Five out of seven mindfulness trials reported anthropometric improvements. The methodological quality of the RCTs was low. No safety information was reported. The effect of yoga and mindfulness on psychological and metabolic variables was inconsistent. This evidence is insufficient to recommend yoga or mindfulness for the management of adolescents with obesity.

Psychological well-being and the reversal of childhood overweight and obesity in the UK: a longitudinal national cohort study

OBJECTIVE

This study aimed to examine the prospective association between psychological well-being and overweight and obesity reversal.

METHODS

We analyzed data of UK children with overweight or obesity at ages 11 (n = 4556, baseline), 14 (n = 3791, baseline), and 17 years (follow-up). Psychological well-being-related measures were characterized into indexes of caregiver-reported child mental health and child-reported psychosocial well-being, with a higher score indicating better mental health or psychosocial well-being. Weight changes were presented as reversal versus persistence of overweight or obesity and residualized-change BMI z scores. Data were analyzed using regression analysis.

RESULTS

Better child mental health and psychosocial well-being at age 11 years were independently associated with increased odds of reversal versus persistence (odds ratio [OR] = 1.16, 95% CI: 1.03 to 1.29; OR = 1.29, 95% CI: 1.15 to 1.44, respectively) and decreased BMI z scores (β = -0.08, 95% CI: -0.13 to -0.03; β = -0.07, 95% CI: -0.11 to -0.03, respectively) at age 17 years. However, neither of the indexes was associated with weight changes when measured at age 14 years. Analyses between psychological well-being-related measures and timing of measures indicated that psychological well-being-related measures were more likely to prospectively predict weight changes when measured at age 11 versus age 14 years.

CONCLUSIONS

Better psychological well-being at age 11 years is a prognostic factor that may be associated with an increased likelihood of reversing childhood overweight and obesity by age 17 years.

Recommendations for Clinicians to Combat Environmental Disparities in Pediatric Asthma: A Review

TOPIC IMPORTANCE

Asthma is a common and complex lung disease in children, with disproportionally higher prevalence and related adverse outcomes among children in racial and ethnic minority groups and of lower socioeconomic position. Environmental factors, including unhealthy housing and school-based exposures, can contribute to increased asthma morbidity and widening disparities. This underscores a significant environmental justice issue and suggests the need for clinical interventions to reduce sources of environmental exposures and ultimately diminish the observed disparities in childhood asthma.

REVIEW FINDINGS

Unhealthy housing conditions, including secondhand tobacco smoke, allergen exposure, and indoor air pollution, can exacerbate asthma symptoms in children. Although unhealthy housing can occur anywhere, such situations most frequently occur in urban, low-income environments where renting is common. To reduce environmental triggers, clinicians can recommend smoking cessation, cleaning techniques to mitigate exposure, and even directly contacting landlords to address poor housing conditions. Children spend much of their time in schools, where this built environment is also a source of asthma triggers (eg, poor ventilation) and allergens (eg, mold and pests, chemicals). As such, a multidisciplinary approach is needed to adequately address the burden of childhood asthma to equitably reduce disparities to both harmful exposures and negative health outcomes.

SUMMARY

Racial, ethnic, and socioeconomic disparities exist in asthma morbidity in children, and such disparities are driven in part by environmental factors at the housing and school level. Clinicians can make evidence-based recommendations to drive effective exposure reduction strategies to mitigate asthma morbidity and reduce observed disparities.

Weight Loss Programs: Why Do They Fail? A Multidimensional Approach for Obesity Management

PURPOSE OF REVIEW

Despite the prevalence of weight loss programs, their success rates remain discouraging, with around half of individuals regaining lost weight within two years. The primary objective of this review is to explore the factors contributing to the failure of weight loss programs and to provide insights into effective weight management strategies.

RECENT FINDINGS

Factors contributing to the failure of weight loss programs include the impracticality of restrictive diets, potential metabolic impacts, limited focus on lifestyle changes, genetic predispositions, psychological influences, socioeconomic status, and medical conditions. A holistic approach considering these factors is crucial for safe and sustainable weight loss. Key findings indicate the importance of holistic approaches to weight management, including lifestyle modifications, medical interventions, and behavioral and psychological strategies. Effective weight loss strategies emphasize low-calorie, nutrient-rich diets, regular physical activity, and interventions tailored to individual needs. Combining multiple approaches offers the best chance of successful weight management and improved health outcomes. This review provides insights into the complexities of obesity management and the factors contributing to the failure of weight loss programs. It highlights the necessity of adopting a holistic approach that addresses dietary habits, physical activity, genetic factors, psychological well-being, and socioeconomic influences. Recommendations include implementing lifestyle modifications, medical interventions when necessary, and integrating behavioral and psychological support to achieve sustainable weight loss and mitigate the global health challenge posed by obesity.

Adverse Childhood Experiences and Risk of Abnormal Body Mass Index: A Global Systematic Review and Meta-Analysis

(1) Objectives: The impact of abnormal body mass index (BMI) on health is extensive, and various risk factors contribute to its effects. This study aimed to examine the association between adverse childhood experiences (ACEs) and BMI categories, including underweight, overweight, obesity, severe obesity, and morbid obesity; (2) Methods: Three databases were searched: Web of Science, PubMed, and Scopus. Manual searches were conducted using Google Scholar and ResearchGate. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated to assess the association between ACEs and BMI. A random-effects model was used to combine the ORs and CIs across studies; (3) Results: This meta-analysis included 71 studies. The pooled ORs for the relationship between ACEs and obesity was 1.42 (95% CI: 1.24-1.63, Z = 4.96, p < 0.001), indicating a significant association. ACEs showed a positive association with overweight (OR = 1.16, 95% CI: 1.06-1.27, Z = 3.24, p = 0.001). Specifically, ACEs ≥ 4 were strongly associated with obesity (OR = 2.06, 95% CI: 1.27-3.36, Z = 2.90, p = 0.004). Sexual abuse was also found to be significantly associated with obesity (OR = 1.46, 95% CI: 1.29-1.65, Z = 5.98, p < 0.001); (4) Conclusion: This study finds that individuals who have experienced ACEs are more likely to have a higher BMI in adulthood. Therefore, ACEs should be considered a factor associated with abnormal BMI.

Is oxidative stress - antioxidants imbalance the physiopathogenic core in pediatric obesity?

Despite the early recognition of obesity as an epidemic with global implications, research on its pathogenesis and therapeutic approach is still on the rise. The literature of the 21st century records an excess weight found in up to 1/3 of children. Both the determining factors and its systemic effects are multiple and variable. Regarding its involvement in the potentiation of cardio-vascular, pulmonary, digestive, metabolic, neuro-psychic or even dermatological diseases, the information is already broadly outlined. The connection between the underlying disease and the associated comorbidities seems to be partially attributable to oxidative stress. In addition to these, and in the light of the recent COVID-19 pandemic, the role played by oxidative stress in the induction, maintenance and potentiation of chronic inflammation among overweight children and adolescents becomes a topic of interest again. Thus, this review's purpose is to update general data on obesity, with an emphasis on the physiopathological mechanisms that underlie it and involve oxidative stress. At the same time, we briefly present the latest principles of pathology diagnosis and management. Among these, we will mainly emphasize the impact played by endogenous and exogenous antioxidants in the evolutionary course of pediatric obesity. In order to achieve our objectives, we will refer to the most recent studies published in the specialized literature.

Attention-Deficit/Hyperactivity Disorder and Unhealthy Lifestyle in Adolescence: Unforeseen Role of Allostatic Overload and Psychological Well-Being

Unhealthy lifestyle behaviors (ULBs) are common in early adolescence and could be worsened by Attention-Deficit/Hyperactivity Disorder (ADHD), as well as by specific psychosocial factors, such as stress and unbalanced (i.e., too high or low scores of) psychological well-being (PWB) dimensions. This multi-center study aimed to evaluate how interactions between ADHD symptoms and psychosocial factors associated with ULBs (i.e., Allostatic Overload and multidimensional Psychological Well-Being), considered as moderators, could affect the adoption of ULBs during adolescence. A total of 440 fourteen-year-old adolescents were recruited from six upper secondary schools in Bologna and Rome (Italy) and completed self-report questionnaires on ULBs, ADHD, and psychosocial factors. Relations between ADHD symptomatology and specific ULBs (i.e., impaired sleep, problematic Internet use) were moderated by variables deemed as "negative" (i.e., Allostatic Overload) or "positive" (i.e., PWB dimensions of Self-Acceptance, Personal Growth, Positive Relations, Purpose in Life, Environmental Mastery): when the "negative" moderator is absent and the levels of the "positive" moderators are higher, ULBs decrease among students with lower ADHD symptomatology but increase among students with more severe ADHD. Based on ADHD severity, interventions should aim at promoting a state of euthymia, which consists in balanced PWB dimensions and reflects the optimal level of well-being to fulfill one's own potential and self-realization.

What causes obesity in children and adolescents?

OBJECTIVE

To present the different aspects that may be involved in the genesis and maintenance of obesity in children and adolescents.

DATA SOURCE

Narrative review of articles published in the PubMed, Scielo, Lilacs, Scopus and Google Scholar databases, using the search terms: overweight, obesity, pre-conception, prenatal, infants, schoolchildren, children, and adolescents. The search was conducted in studies written in Portuguese, English and Spanish, including narrative, integrative or systematic reviews, meta-analyses, cross-sectional, case-control and cohort studies, published between 2003 and 2023.

DATA SYNTHESIS

A total of 598 studies were initially screened and 60 of them, which showed the main biopsychosocial aspects related to greater risks of excessive adiposity in the pediatric age, were included in the review. The data were presented taking into account the incidence of risk factors and their consequences in six periods: pre-conception, pre-natal, infant, preschool, school age, and adolescence.

CONCLUSIONS

The causal factors described in the scientific literature that have been shown to be related to obesity in childhood and adolescence are presented.

Healthy Lifestyle in Adolescence: Associations with Stress, Self-Esteem and the Roles of School Violence

A healthy lifestyle is considered by young people as the adoption of positive behaviors, such as a balanced diet, regular exercise, or the decreased consumption of harmful substances. Living a healthy lifestyle during adolescence promotes a better quality of life and psychological well-being in adulthood. The objective of this research is to identify how a healthy lifestyle is related to stress, self-esteem, and school violence roles. The sample is composed of a total of 743 adolescents aged between 14 and 19 years. The instruments used were the Healthy Lifestyles Questionnaire (CEVS-II), the Student Stress Inventory (SSI-SM), the Rosenberg Self-Esteem Scale (RSES), and an ad hoc questionnaire to evaluate school violence roles. The results obtained indicate that there are negative correlations between healthy lifestyle and stress, but positive correlations between healthy lifestyle and self-esteem. Adolescents who participate in situations of school violence have a higher mean of substance use and stress. However, those who do not experience such situations have higher mean self-esteem and lead a healthy lifestyle. In addition, the fact of suffering stress increases the probability of being a victim or an aggressor. Living a healthy lifestyle can have significant implications for health promotion and positive adolescent development.

Risk of body weight changes among Danish children and adolescents during the COVID-19 pandemic

BACKGROUND

Knowledge of COVID-19 and the pandemic's effects on Danish children's body weight is limited.

OBJECTIVE

Objectives were to investigate (I) risk of weight changes among Danish children with and without SARS-CoV-2, (II) associations between weight changes, psychological symptoms, and long COVID symptoms, and (III) weight distribution pre- and post-pandemic.

METHODS

A national survey was administered to all Danish children aged 0-18 years, with prior COVID-19 (cases) and matched references including questions on weight, weight changes during the pandemic and long COVID-related symptoms. Descriptive statistics and logistic regression were used. Weight distribution was compared with a pre-pandemic database.

RESULTS

In all, 17 627 cases and 54 656 references were included. The 4-18-year-old cases had lower odds of unintended weight gain. The 2-3-year-old cases had higher odds and the 15-18-year-old cases lower odds of weight loss compared to references. Regardless of COVID-19 status, any reported long COVID-related symptom was associated with a change in body weight. No sign of increasing obesity rates was found among Danish children post-pandemic.

CONCLUSION

COVID-19 was associated with higher odds of weight loss in 2-3-year-olds and lower odds of unintended weight gain in 4-18-year-olds. Any long COVID-related symptom was associated with higher odds of weight changes regardless of COVID-19 status.

Stress, Inflammation and Metabolic Biomarkers Are Associated with Body Composition Measures in Lean, Overweight, and Obese Children and Adolescents

The aim of this study was to examine the associations between multiple indices of stress, inflammation and metabolism vs. body composition parameters in 121 (43 boys, 78 girls) children and adolescents, aged 5–15 y. Subjects were divided into two groups: normal weight (N) (N = 40, BMI z-score = −0.1923 ± 0.6), and overweight/obese (OB) (N = 81, BMI z-score = 2.1947 ± 1.4). All subjects completed the State-Trait Anxiety Inventory for Children (STAIC) and Children’s Depression Inventory, and underwent cortisol measurements in hair, diurnal series of saliva, and morning serum. Circulating concentrations of high sensitivity C-reactive protein (hsCRP) and other inflammation biomarkers were also obtained. Body composition analysis was performed with a clinically validated, advanced bioimpedance apparatus (BIA), while heart rate variability (HRV) was measured as a stress biomarker by photoplethysmography (PPG). The OB group had a higher STAIC-state score, waist-to-hip ratio, skeletal muscle mass, and total and abdominal fat mass, and a lower percent fat-free mass (FFM) and bone density than the N group. HRV did not differ between the groups. In the entire population, percent fat mass correlated strongly with circulating hsCRP (r = 0.397, p = 0.001), ferritin, and other inflammatory biomarkers, as well as with indices of insulin resistance. A strong correlation between serum hsCRP and hair cortisol was also observed (r = 0.777, p < 0.001), suggesting interrelation of chronic stress and inflammation. Thus, body fat accumulation in children and adolescents was associated with an elevation in clinical and laboratory biomarkers of stress, inflammation, and insulin resistance. BIA-ACC and PPG can be utilized as a direct screening tool for assessing overweight- and obesity -related health risks in children and adolescents.