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

Application of polygenic scores to a deeply phenotyped sample enriched for substance use disorders reveals extensive pleiotropy with psychiatric and somatic traits

Co-occurring psychiatric, medical, and substance use disorders (SUDs) are common, but the complex pathways leading to such comorbidities are poorly understood. A greater understanding of genetic influences on this phenomenon could inform precision medicine efforts. We used the Yale-Penn dataset, a cross-sectional sample enriched for individuals with SUDs, to examine pleiotropic effects of genetic liability for psychiatric and somatic traits. Participants completed an in-depth interview that provides information on demographics, environment, medical illnesses, and psychiatric and SUDs. Polygenic scores (PGS) for psychiatric disorders and somatic traits were calculated in European-ancestry (EUR; n = 5691) participants and, when discovery datasets were available, for African-ancestry (AFR; n = 4918) participants. Phenome-wide association studies (PheWAS) were then conducted. In AFR participants, the only PGS with significant associations was bipolar disorder (BD), all of which were with substance use phenotypes. In EUR participants, PGS for major depressive disorder (MDD), generalized anxiety disorder (GAD), post-traumatic stress disorder (PTSD), schizophrenia (SCZ), body mass index (BMI), coronary artery disease (CAD), and type 2 diabetes (T2D) all showed significant associations, the majority of which were with phenotypes in the substance use categories. For instance, PGSMDD was associated with over 200 phenotypes, 15 of which were depression-related (e.g., depression criterion count), 55 of which were other psychiatric phenotypes, and 126 of which were substance use phenotypes; and PGSBMI was associated with 138 phenotypes, 105 of which were substance related. Genetic liability for psychiatric and somatic traits is associated with numerous phenotypes across multiple categories, indicative of the broad genetic liability of these traits.

Pediatric Obesity Prevalence in the U.S. Military Health System, Fiscal Years 2012-2018

INTRODUCTION

Obesity prevalence in Military Health System (MHS) children has been reported through fiscal year (FY) 2012 as consistently lower than in the general population. Our study reports military pediatric overweight, obesity, and severe obesity prevalence through FY2018. We compared FY2018 prevalence to a sample of the general population using National Health and National Health and Nutrition Examination Survey (NHANES) 2017-2018 data.

MATERIALS AND METHODS

The MHS Data Repository was queried for all children aged 2-17 years seen at any military treatment facility between FY2012 and FY2018. We calculated overweight and obesity (classes 1, 2, and 3) prevalence for each FY and performed subgroup analysis for sex, age, and sponsor rank. We also compared FY2018 to NHANES 2017-2018 data. This study was approved by the Walter Reed National Military Medical Center Institutional Review Board.

RESULTS

The prevalence of overweight and obesity was stable from FY2012 (14.4% and 11.3%, respectively) to FY2018 (14.1% and 10.7%). Rates of classes 2 and 3 obesity combined were also stable at around 2.5% of all children. In FY2018, obesity prevalence was greater in assigned males, increased with age, and was highest in 16-17-year-olds (odds ratio: 2.75) and children with an enlisted military sponsor (odds ratio: 1.78). Compared to NHANES, MHS children had lower rates of obesity (10.7% versus 19.3%) with a smaller proportion of severe obesity (24% versus 32%).

CONCLUSIONS

The prevalence of pediatric overweight and obesity in the MHS was stable over time. Disparities were observed between age and sponsor rank groups. When compared to the general population, overall obesity prevalence was lower in younger military children. Further research is needed to explore disparities and to identify optimal strategies to mitigate the increase in obesity prevalence with age.

Quality of life and psychosocial outcomes among children with metabolically healthy and unhealthy obesity

BACKGROUND

Obesity and obesity-related morbidities are associated with poor psychosocial adjustment and health-related quality of life (HRQoL). This study aims to examine HRQoL and psychosocial outcomes in children with metabolically healthy obesity (MHO) and metabolically unhealthy obesity (MUO), and the effects of familial health on these outcomes.

METHODS

Four hundred and six children with BMI for age ≥ 97th percentile were classified as having MHO and MUO based on the absence or presence of metabolic abnormalities. HRQoL and psychosocial outcomes were assessed using validated questionnaires such as PedsQL and DASS-21.

RESULTS

There were no significant differences in HRQoL and psychosocial outcomes between children with MHO and children with MUO. Children with MUO and prior knowledge of existing metabolic conditions reported significantly lower total HRQoL (71.18 ± 17.42 vs. 75.34 ± 15.33), and higher depression (12.16 ± 11.80 vs. 8.95 ± 8.52) and stress (12.11 ± 8.21 vs. 10.04 ± 7.92) compared to children with MHO. Children with MUO who had fathers with metabolically unhealthy phenotype reported significantly lower total HRQoL (72.41 ± 15.67 vs. 76.82 ± 14.91) compared to children with MUO who had fathers with metabolically healthy phenotype.

CONCLUSION

Prior knowledge of existing metabolic abnormalities was associated with poorer HRQoL and mental health in children with obesity. Paternal metabolic health status influenced HRQoL in children with MUO.

IMPACT

First study that compared health-related quality of life (HRQoL) and psychosocial outcomes between children with metabolically healthy obesity (MHO) and children with metabolically unhealthy obesity (MUO). No significant differences in HRQoL and psychosocial outcomes between children with metabolically healthy obesity (MHO) and children with metabolically unhealthy obesity (MUO). Children with MUO who had prior knowledge of existing metabolic conditions reported lower HRQoL, higher depression and stress compared to children with MHO. Paternal metabolic health status was found to influence HRQoL in children with MUO. Mental health support intervention with paternal involvement should be provided for children with MUO.

Internal and external modulation factors of the orexin system (REVIEW)

Orexin-A and -B (identical to hypocretin-1 and -2) are neuropeptides synthesized in the lateral hypothalamus and perifornical area, and orexin neurons project their axon terminals broadly throughout the entire central nervous system (CNS). The activity of orexins is mediated by two specific G protein-coupled receptors (GPCRs), termed orexin type1 receptor (OX1R) and orexin type2 receptor (OX2R). The orexin system plays a relevant role in various physiological functions, including arousal, feeding, reward, and thermogenesis, and is key to human health. Orexin neurons receive various signals related to environmental, physiological, and emotional stimuli. Previous studies have reported that several neurotransmitters and neuromodulators influence the activation or inhibition of orexin neuron activity. In this review, we summarize the modulating factors of orexin neurons in the sleep/wake rhythm and feeding behavior, particularly in the context of the modulation of appetite, body fluids, and circadian signaling. We also describe the effects of life activity, behavior, and diet on the orexin system. Some studies have observed phenomena that have been verified in animal experiments, revealing the detailed mechanism and neural pathway, while their applications to humans is expected in future research.

The Association between Obesity and Depression among Children and the Role of Family: A Systematic Review

One of the most critical factors that affects or leads to obesity is depression. However, another point of view is that obesity leads to depression. This systematic review estimates evidence arising from observational and systematic studies concerning the association between obesity and depression in children and adolescents. Moreover, the role of the family environment is investigated in this review. A systematic literature search was performed for research conducted between 2014 and 2021 on PubMed. The basic inclusion criteria were the language, study issue and type, and age of the participants. Studies that examined non-healthy populations, or were not related, or with no access were excluded. Titles and abstracts were screened independently, and full-text manuscripts meeting inclusion criteria were extracted. Finally, twenty-seven studies were retained. Most of them highlighted a positive association between obesity and depression. However, it is not clear whether obesity leads to depression or vice versa. Our review also revealed that the role of the family in this association has not been well studied and understood, since only one study addressed the issue. The evidence from our review emphasizes major public health issues; therefore, appropriate health policies should be developed. Moreover, additional research is required to fully understand the role of the family environment in the association between depression and obesity in childhood.

Disparities in the Prevalence of Childhood Obesity-Related Comorbidities: A Systematic Review

Background

Non-communicable diseases among children are serious consequences of childhood obesity. However, less is known about the disparities in childhood obesity comorbidities burden. This review describes the salient pattern of disparities in the prevalence of childhood obesity-related non-communicable diseases and relevant inequalities in both high- and low/medium-income countries.

Method

A systematic literature search was performed in MEDLINE, Embase, CINAHL, PsycInfo, Scopus, and Web of Science databases by two independent reviewers. Inclusion criteria were as follows: age 2–18 years; the prevalence or incidence of childhood obesity comorbidities reported; and studies published in English from January 2010 to date. No restrictions on the setting. The prevalence data were analyzed using range and median for subgroups based on the country's development status, gender, and geographical region.

Results

Our search identified 6,837 articles, out of which we examined 145 full-text articles and included 54 articles in the analysis. The median prevalence of childhood obesity-related hypertension was 35.6 vs. 12.7% among middle- and low-income countries compared with high-income countries; 37.7 vs. 32.9% among boys compared with girls; and 38.6, 25.3, and 20.1% in Asia, South America, and Europe, respectively. For metabolic syndrome, the median prevalence was 26.9 vs. 5.5% among middle- and low-income countries compared with high-income countries; 55.2 vs. 12.0% among boys compared with girls; and 40.3, 25.8, and 7.7% in South America, Asia, and Europe, respectively. The prevalence of childhood obesity-related non-alcoholic fatty liver disease was 47.5 vs. 23% among middle- and low-income countries compared with high-income countries; and 52.1, 39.7, and 23.0% in Asia, South America, and Europe, respectively. The median prevalence of dyslipidemia was 43.5 vs. 63% among middle- and low-income countries compared with high-income countries; 55.2 vs. 12.0% among boys compared to girls; and 73.7 and 49.2% in Australia and Europe, respectively.

Conclusion

There are disparities in the prevalence of childhood obesity-related hypertension, metabolic syndrome, and non-alcoholic fatty liver disease, with middle- and low-income countries, boys, and Asian region having higher prevalence. Implementing targeted interventions for childhood obesity comorbidities should consider socioeconomic disparities and strengthening of research surveillance methods for a better understanding of non-communicable disease burden in the pediatric population.

Systematic Review Registration

https://www.crd.york.ac.uk/PROSPERO, identifier: CRD42021288607.

Clinical and biological correlates of morning serum cortisol in children and adolescents with overweight and obesity

Background and aim

A fraction of children with obesity have increased serum cortisol levels. In this study, we describe the clinical characteristics of obese children and adolescents with elevated morning serum cortisol levels and the relationship between the cortisol levels and components of the metabolic syndrome.

Methods

Retrospective medical record review study of children aged 4 to 18 years with overweight or obesity seen for obesity management in the Pediatric Obesity Clinic of the UZ Brussel between 2013 and 2015.

Results

A total of 234 children (99 boys and 135 girls) with overweight (BMI z-score > 1.3) without underlying endocrine or genetic conditions were included. Mean (SD) age was 10.1 (2.8) years, BMI SD-score 2.5 (0.6), and body fat percentage 37% (7.9). Serum fasting cortisol levels were elevated (>180 μg/L) in 49 children, normal (62–180 μg/L) in 168, and decreased (<62 μg/L) in 12. Serum fasting cortisol was not significantly correlated with gender, age, or degree of adiposity. But correlated significantly with fasting glucose (R_s = 0.193; p < 0.005), triglycerides (R_s = 0. 143; p < 0.05), fibrinogen (R_s = 0.144; p < 0.05) and leptin levels (R_s = 0.145; p < 0.05). After adjustment for serum insulin and leptin, the correlation between serum cortisol and fasting glucose remained significant.

Conclusion

Elevated morning serum cortisol levels were found in 20% of overweight or obese children and adolescents, irrespective of the degree of adiposity, and were associated with higher fasting glucose, irrespective of underlying insulin resistance. The long-term cardiometabolic consequences of hypercortisolemia in childhood obesity needs further study.

Application of an Online Combination Exercise Intervention to Improve Physical and Mental Health in Obese Children: A Single Arm Longitudinal Study

Introduction: Childhood obesity has become a global public health concern in the past decade. The purpose of this study was to explore the effectiveness of an online combination exercise intervention in improving the physical and mental health of obese children.

Methods: This study adopted a one-group pre-test and post-test research design. A total of 28 obese children from 6 elementary schools in Heze City, Shandong Province, China, were recruited. All participants received an 8-week online combination exercise intervention and were tested at a three-month follow-up. Participants were tested and surveyed regarding their demographic, feasibility, and obesity indicators using mental health and quality of life questionnaires. The data were statistically analyzed using a one-way analysis of variance with repeated measures.

Results: A total of 26 obese children (Mean_age = 10.15 years) completed the study. The retention rate was 92.9% for the entire trial (two obese children withdrew due to their inability to exercise) and no adverse events were reported. In addition, the obese children completed 25/32 (78.1%) of the online courses. After 8 weeks of the intervention, the changes in the body fat percentage of the obese children [mean difference (MD) = –3.126, p < 0.001, Cohen’s d = –1.777], thinking dimension score (MD = 1.654, p < 0.001, Cohen’s d = 0.603), total quality of life score (MD = 6.385, p < 0.05, Cohen’s d = 0.610), and work attitude dimension score (MD = 1.346, p < 0.001, Cohen’s d = 0.744) showed significant differences compared to the baseline. However, no significant differences were identified between the post-intervention and three-month follow-up measurements (p > 0.05), and we assumed that the intervention effect was maintained three months after the intervention.

Conclusion: An online combination exercise intervention is a safe and feasible option to improve the mental health and quality of life of obese children and may have long-term health benefits.

Liraglutide combined with intense lifestyle modification in the management of obesity in adolescents

OBJECTIVES

Childhood obesity is a public health concern worldwide, with rates continuing to rise, despite preventive measures. Lifestyle modification remains the mainstay in the treatment of patients with excessive weight, but unfortunately, this is not always successful. Options for medical management of obesity in the paediatric population are limited.

METHODS

Seven adolescents (all girls, mean age 14.9 years) with a body mass index (BMI) above 98th percentile and serious complications secondary to obesity were offered an intense weight management programme. The participants were reviewed by a multidisciplinary team every two weeks for advice and support, and treated with daily subcutaneous injections of liraglutide (dose range 1.2-3.0 mg). Scores for anxiety and depression were evaluated using the Revised Child Anxiety and Depression Scale.

RESULTS

The results showed a significant weight loss over the three months with an average reduction of 5.4 kg (4.2%; 95% CI 1.93-8.78; p=0.0087). The mean drop in BMI was 2.1 kg/m², which is statistically significant (95% CI 0.973-3.199; p=0.0037). Resolution of complications (raised intracranial pressure and steatohepatitis) was noted following weight loss. Anxiety and depressive symptoms improved over the three-month intervention course, especially features of separation anxiety disorder. Liraglutide was well tolerated by all patients.

CONCLUSIONS

Liraglutide medication, alongside a dedicated multidisciplinary team guided lifestyle therapy, is effective and safe in the treatment for excessive weight in adolescents, leading to the reversal of the complications related to obesity and improvement in the psychological symptoms.

The association between obesity and hyperactivity/anxiety among elementary school students in Japan

BACKGROUND

We aimed to evaluate the association between hyperactivity/anxiety and obesity among elementary school students in Matsuyama City, Japan.

METHODS

We conducted a cross-sectional study of all 46 elementary school students (24, 296 students) in Matsuyama City. The questionnaire included question items from the Strengths and Difficulties Questionnaire (SDQ), as well as questions about height and weight. The students were classified into two groups according to Rohrer index. After separating the data by gender, we examined the association between (1) obesity and hyperactivity, (2) obesity and anxiety, and (3) obesity and combination of hyperactivity and anxiety, by estimating relative risk using Poisson regression model. We also conducted stratified analyses to examine the effect modification by age groups and unbalance of diet on those associations. Moreover, we calculated relative excess risk due to the interaction (RERI) to examine whether there was an additive interaction between hyperactivity and anxiety.

RESULTS

Sixteen thousand forty-eight students were included in the present analysis. The prevalence ratio (PR) of being obese in girls who had both hyperactivity and anxiety was higher compared to girls without those symptoms (PR = 1.80; 95% CI 1.04-3.13). There was no significant difference in the prevalence ratio for obesity in boys, whether they were hyperactive, anxious, or neither. RERI was 0.00 for boys and 0.18 for girls.

CONCLUSION

We found a significant association between obesity and co-existence of hyperactivity and anxiety among elementary school girls. Our findings strengthen the need to further explore the association between childhood obesity, hyperactivity, and anxiety.

Anxiety and depression in children and adolescents with obesity: a nationwide study in Sweden

BACKGROUND

Anxiety and depression are more common in children with obesity than in children of normal weight, but it is unclear whether this association is independent of other known risk factors. Interpretation of results from previous studies is hampered by methodological limitations, including self-reported assessment of anxiety, depression, and anthropometry. The aim of this study was to investigate whether obesity increases the risk of anxiety or depression independently of other risk factors in a large cohort of children and adolescents, using robust measures with regard to exposure and outcome.

METHODS

Children aged 6-17 years in the Swedish Childhood Obesity Treatment Register (BORIS, 2005-2015) were included (n = 12,507) and compared with a matched group (sex, year of birth, and area of residence) from the general population (n = 60,063). The main outcome was a diagnosis of anxiety or depression identified through ICD codes or dispensed prescribed medication within 3 years after the end of obesity treatment. Hazard ratios (HRs) with 95% confidence intervals (CIs) from Cox proportional models were adjusted for several known confounders.

RESULTS

Obesity remained a significant risk factor for anxiety and depression in children and adolescents after adjusting for Nordic background, neuropsychiatric disorders, family history of anxiety/depression, and socioeconomic status. Girls in the obesity cohort had a 43% higher risk of anxiety and depression compared to girls in the general population (adjusted HR 1.43, 95% CI 1.31-1.57; p < 0.0001). The risk in boys with obesity was similar (adjusted HR 1.33, 95% CI 1.20-1.48; p < 0.0001). In sensitivity analyses, excluding subjects with neuropsychiatric disorders and a family history of anxiety/depression, the estimated risks in individuals with obesity were even higher compared with results from the main analyses (adjusted HR [95% CI]: girls = 1.56 [1.31-1.87], boys = 2.04 [1.64-2.54]).

CONCLUSIONS

Results from this study support the hypothesis that obesity per se is associated with risk of both anxiety and depression in children and adolescents.

Improving the Metabolic and Mental Health of Children with Obesity: A School-Based Nutrition Education and Physical Activity Intervention in Wuhan, China

This study aimed to evaluate the effectiveness of a school-based nutrition education and physical activity intervention on cardiovascular risk profile and mental health outcomes among Chinese children with obesity. Two primary schools were randomly allocated to the control group (CG) and the intervention group (IG). We selected children with obesity from 1340 students in the third and fourth grades as participants. The IG received 8 months of nutrition education and physical activity intervention, while the CG was waitlisted. A generalized estimating equation model was applied to assess repeated variables over time. A total of 171 children with obesity (99 IG and 72 CG) aged 9.8 ± 0.7 years completed the post-intervention stage. Compared with baseline, significant reductions were observed within the IG for depression and fasting plasma glucose at post-intervention. After adjusting for confounders, group and time interaction effects showed that the IG achieved improvements in the risk of poor well-being (p = 0.051) and social anxiety (p = 0.029), had decreased diastolic blood pressure (p = 0.020) and fasting plasma glucose (p < 0.001), and had significantly increased high-density lipoprotein (p < 0.001) from baseline to post-intervention relative to the CG. The effects of school-based nutrition education and physical activity intervention on children with obesity are diverse, including not only the improvement of metabolic health but also mental health promotion.

An Update on Mental Health Problems and Cognitive Behavioral Therapy in Pediatric Obesity

Prevalence of pediatric obesity has increased worldwide in the last 20 years. Obese children suffer not only physical complications but also mental health problems such as depression, attention deficit hyperactivity disorder (ADHD), and eating disorders, as well as psychosocial impairments, such as school adjustment problems, bullying, and low self-esteem. Recently, there have been some studies on the association of mental health problems and pediatric obesity. In the treatment of pediatric obesity, many previous studies suggest multidisciplinary treatment. However, cognitive behavioral therapy (CBT) has attracted attention because obese children are accompanied by body image distortion, emotion dysregulation, and difficulties in stimulus control. This review is a narrative summary of the recent studies on mental health problems and CBT in pediatric obesity. The relationship between depression/anxiety and pediatric obesity is still inconsistent but recent studies have revealed a bidirectional relation between depression and obesity. Additionally, some studies suggest that obese children may have eating disorder symptoms, like loss of control eating, and require therapeutic intervention for pediatric obesity treatment. Furthermore, impulsivity and inattention of ADHD symptom is thought to increase the risk of obesity. It has also been suggested that CBT can be very effective for mental health problems such as depression, impulsivity, and body image distortion, that may coexist with pediatric obesity, and use of multimedia and application can be useful in CBT.

The relationship between parental locus of control and adolescent obesity: a longitudinal pre-birth cohort

OBJECTIVES

To investigate whether parental external locus of control (ELOC) measured in pregnancy is related to obesity in their adolescent offspring and whether the child's own ELOC measured at age 8 contributes. To determine whether associations are due to types of behaviour used by externally oriented participants.

SUBJECTS/METHODS

Longitudinal pre-birth cohort study (Avon Longitudinal Study of Parents & Children (ALSPAC)) set in south-west England. Families whose adolescent offspring had their fat mass measured using DXA scans at any of ages 9, 11, 13, 15 or 17 (range, n = 7329 at 9 to n = 4850 at 17). The primary outcome measures were mean fat mass, and obesity measured as ≥85th centile of fat mass at each age.

RESULTS

We found that parent and child externality was associated with greater fat mass [e.g., mean difference at age 15 associated with maternal ELOC was 1.70 kg (+1.17, +2.24), paternal ELOC 1.49 kg (+0.89, +2.09) and child's ELOC 1.50 kg (+0.93, +2.06) (P < 0.0001)]. Further analyses showed that factors associated with parent behaviour such as smoking in pregnancy, failure to breast feed, and early introduction of solids accounted for a third of the excess fat mass associated with maternal externality, whereas aspects of diet and energetic activity in later childhood were not. Further analyses demonstrated that the child's own ELOC only became independently important for adolescent obesity from age 13, whereas the mothers' and to a lesser extent the fathers' ELOC were associated at each age.

CONCLUSIONS

There is increased interest in determining factors that may be involved in the aetiology and maintenance of excessive weight in adolescents. We demonstrate that parental locus of control is a promising candidate. We suggest interventions to change parents' locus of control towards internality in pregnancy might have long-term preventative benefits on the likelihood of obesity in the offspring.

Co-morbidities of mental disorders and chronic physical diseases in developing and emerging countries: a meta-analysis

Background

As the data on the association of mental disorders and chronic physical diseases in developing and emerging countries is heterogeneous, this study aims to produce the first meta-analysis of these comorbidities.

Methodology

The meta-analysis protocol was registered in PROSPERO (N°CRD42017056521) and was performed in accordance with PRISMA guidelines. Initially, an article search was conducted on Medline, Embase, Lilacs and the Institut d’Epidémiologie et de Neurologie Tropicale database [Institute of Epidemiology and Tropical Neurology], as well as manually, with no restriction on language or date focusing on mental disorders, chronic diseases and neurotropic diseases. Two independent investigators assessed the quality of the studies which met the inclusion criteria using the Downs and Black assessment grid. The pooled estimates were calculated out using a random-effects method with CMA software Version 3.0. A meta-regression was then performed, and the significance level was set at 0.05.

Results

Of the 2604 articles identified, 40 articles involving 21,747 subjects met the inclusion criteria for co-morbidities between mental disorders and chronic physical diseases. Thirty-one articles were included in the meta-analysis of prevalence studies and 9 articles in that of the analytical studies. The pooled prevalence of mental disorders in patients with chronic physical diseases was 36.6% (95% CI, 31.4–42.1) and the pooled odds ratio was 3.1 (95% CI, 1.7–5.2). There was heterogeneity in all the estimates and in some cases, this was explained by the quality of the studies.

Conclusion

Some estimates regarding the prevalence of mental disorders in people with chronic physical diseases living in developing and emerging countries were similar to those in developed countries. Mental disorders are a burden in these countries. In order to respond effectively and efficiently to the morbidity and mortality associated with them, mental health care could be integrated with physical care.

Electronic supplementary material

The online version of this article (10.1186/s12889-019-6623-6) contains supplementary material, which is available to authorized users.

The synergic relationship of social anxiety, depressive symptoms and waist circumference in adolescents: Mediation analysis

BACKGROUND

It is not well established whether depression leads to weight loss or weight gain, or whether a relationship exists among depression, social anxiety, and weight status. The aim of this study was to evaluate the synergic association among social anxiety, depressive symptoms, and waist circumference (WC) during adolescence and examine whether depression mediated the relationship between social anxiety and WC.

METHODS

A cross-sectional study was performed with 1296 adolescents from a northeastern district in Brazil. It was used the Social Anxiety Scale for Adolescents (SAS-A) to evaluate symptoms of social anxiety and the Depression Scale of the Center for Epidemiologic Studies (CES-D) for symptoms of depression. Structural equation modeling was used to determine whether depression, social anxiety, and WC were synergically associated. Analysis was adjusted for sex, age, height, and mother's educational level.

RESULTS

Symptoms of social anxiety were directly associated with symptoms of depression and WC, whereas symptoms of depression were not associated with WC.

LIMITATIONS

This is a cross-sectional study, and so we cannot infer causality in the interpretation of results.

CONCLUSION

Social anxiety was found to be associated with depressive symptoms and WC. General medical doctors and health practitioners who observe overweight adolescents with any symptoms of anxiety might consider a thorough evaluation of the patient's mental health.

The Prevalence of Depression and Anxiety Symptoms among Overweight/Obese and Non-Overweight/Non-Obese Children/Adolescents in China: A Systematic Review and Meta-Analysis

With the dramatic growth of the Chinese economy, the number of children/adolescents with being overweight/having obesity is increasing, which has a certain impact on their psychology, such as depression and anxiety symptoms. Our purpose was to conduct a meta-analysis to assess the prevalence and odds ratios of depression and anxiety symptoms among overweight/obese children/adolescents and non-overweight/obese children/adolescents in China. As of July 2018, the three most comprehensive computerized academic databases in China have been systematically screened, namely China national knowledge infrastructure (CNKI) databases, Wanfang databases and Vip databases. The same operations are performed in PubMed and Web of Science (SCIE) databases without language restrictions. Case-control studies on prevalence of depression and anxiety symptoms in overweight/obese children/adolescents in China were analyzed. Study selection and evaluation were performed independently by three authors. Unweighted prevalence, pooled random-effects estimates of odds ratio (OR), and 95% confidence intervals (CI) were all calculated. A total of 11 eligible studies involving 17,894 subjects were included. The prevalence of depression and anxiety symptoms in overweight/obese children/adolescents was significantly higher than that in non-overweight/non-obese children/adolescents (depression: 21.73% vs. 17.96%, OR = 1.46, 95% CI: 1.14, 1.87, p = 0.003; anxiety: 39.80% vs. 13.99%, OR = 1.47, 95% CI: 1.21, 1.79, p < 0.001). Subgroup analyses conducted according to scale types showed that scale types have certain significance to evaluate the relationship between depression symptoms and overweight/obesity. The OR of depression symptoms between overweight/obese children/adolescents and non-overweight/non-obese children/adolescents was greatest on the Middle School Student Mental Health Scale (MSSMHS) was 2.06 (95% CI: 1.41, 3.02, I² = 0.00%), Center for Epidemiologic Studies Depression Scale (CES-D) was 1.03 (95% CI: 0.84, 1.25, I² = 0.00%), and Children’s Depression Inventory (CDI) was 1.21 (95% CI: 1.02, 1.42, I² = 0.00%). We concluded that the prevalence of depression and anxiety symptoms in overweight/obese children/adolescents in China is higher than that in the non-overweight/obese children/adolescents. The results of the study indicate that the prevalence of depression and anxiety symptoms among overweight/obese children/adolescents in Chinese medical institutions should receive more attention. Physical exercise and psychological interventions should be strengthened to prevent psychological problems. However, because of some clear limitations (no clinical interview and few studies), these results should be interpreted with caution.

Neuropsychological and Neurophysiological Indicators of General and Food-Specific Impulsivity in Children with Overweight and Obesity: A Pilot Study

Impulsivity, particularly towards food, is a potential risk factor for increased energy intake and the development and maintenance of obesity in children. However, neuropsychological and neurophysiological indicators of general and food-specific impulsivity and their association with children's weight status are poorly understood. This pilot study examined electroencephalography (EEG) frequency band profiles during eyes-closed and eyes-open resting state in n = 12 children with overweight or obesity versus n = 22 normal-weight controls and their link to child- and parent-reported and experimentally assessed impulsivity of children (e.g., risk-taking behavior, approach-avoidance behavior towards food). The main results indicated that children with overweight/obesity versus normal weight showed significantly increased delta and decreased alpha band activity during eyes-closed resting state. Across the total sample, EEG slow-wave band activity was particularly linked to self- and parent-reported impulsivity and greater risk-taking behavior, but not to approach behavior towards food, after controlling for children's age and weight status. The identification of specific EEG patterns in children with excess weight may provide a new basis for developing neurophysiological diagnostic and treatment approaches for childhood obesity. Future studies with larger samples and longitudinal designs are needed to replicate the present findings and test their stability over time.

Systematic Review of Screening Instruments for Psychosocial Problems in Children and Adolescents With Long-Term Physical Conditions

Children and adolescents with long-term physical conditions (LTPCs) are at greater risk of developing psychosocial problems. Screening for such problems may be undertaken using validated psychometric instruments to facilitate early intervention. A systematic review was undertaken to identify clinically utilized and psychometrically validated instruments for identifying depression, anxiety, behavior problems, substance use problems, family problems, and multiple problems in children and adolescents with LTPCs. Comprehensive searches of articles published in English between 1994 and 2014 were completed via Medline, Embase, PsycINFO, CINAHL, and Cochrane CENTRAL databases, and by examining reference lists of identified articles and previous related reviews. Forty-four potential screening instruments were identified, described, and evaluated against predetermined clinical and psychometric criteria. Despite limitations in the evidence regarding their clinical and psychometric validity in this population, a handful of instruments, available at varying cost, in multiple languages and formats, were identified to support targeted, but not universal, screening for psychosocial problems in children and adolescents with LTPCs.

Visual-spatial training efficacy in children affected by migraine without aura: a multicenter study

Routinely in the clinical practice, children affected by migraine without aura (MwA) tend to exhibit severe and persistent difficulties within cognitive processes such as attention, memory, and visual-motor integration (VMI) skills. The aim of this study was to assess the visual-spatial and visual-motor abilities among a sample of children with MwA and the effects of a specific computerized training. The study population was composed of 84 patients affected by MwA (39 girls and 45 boys; mean age: 8.91±2.46 years), and they were randomly divided into two groups (group A and group B) comparable for age (P=0.581), gender (P=0.826), socioeconomic status (SES), migraine frequency (P=0.415), and intensity (P=0.323). At baseline (T0), the two groups were comparable for movement assessment battery for children (M-ABC) and VMI performances. After 6 months of treatment (T1), group A showed lower scores in the dexterity item of M-ABC test (P<0.001) and higher scores in M-ABC global performance centile (P<0.001) and total (P<0.001), visual (P=0.017), and motor (P<0.001) tasks of VMI test than group B. Moreover, at T1, group A showed higher scores in total (P<0.001) and motor (P<0.001) tasks of VMI test and in M-ABC global performance centile (P<0.001) and lower scores in the dexterity item of M-ABC test (P<0.001) than at T0. Group B showed, at T1, performances comparable to T0 for all evaluations. As reported by recent studies about alteration MwA among children in motor abilities, our study confirmed these difficulties and the efficacy of a specific software training, suggesting a new rehabilitative proposal in childhood.

Correlation between obesity and emotional, social, and behavioral problems associated with physical limitation among children and adolescents in Western Saudi Arabia

Objectives:

To evaluate the impact of body mass index (BMI) on limitation of physical activity and the associated effect on behavioral, school, and social problems among obese children in Western Saudi Arabia.

Methods:

A cross-sectional obesity survey was conducted in Jeddah, Saudi Arabia. Data were collected between August 2014 and February 2015 from 281 obese children aged between 2-18 (girls: 130, boys: 151). Participants were selected randomly to represent different economic status, level of education, and family structure.

Results:

The mean age of participants was 10.5 years for girls and 10.6 years for boys. Higher BMI was associated with physical activity problems in walking (50.6%), running (55.8%), and exercise (44.3%), with school problems in attention (37.4%) and follow-up duties fade (31.3%), and with social problems in doing things other children could do (42.8%), playing with others (46%), and continuing play (33.4%). There was no significant relationship between BMI and emotional problems and school attendance.

Conclusion:

Higher BMI significantly increased physical limitation, problems maintaining attention in school, and social problems among obese children. However, emotional problems and school attendance did not show a significant correlation with BMI.

Quality of life in overweight (obese) and normal-weight women with polycystic ovary syndrome

OBJECTIVE

Polycystic ovary syndrome (PCOS) is characterized by phenotypic heterogeneity and has a wide variety of consequences. Approximately half of women with PCOS are overweight or obese, and their obesity may be a contributing factor to PCOS pathogenesis through different mechanisms. The aim of this study was to evaluate if PCOS alone affects the patients' quality of life and to what extent obesity contributes to worsen this disease.

DESIGN

To evaluate the impact of PCOS on health-related quality-of-life (HRQoL), 100 Mediterranean women with PCOS (group A), 50 with a body mass index (BMI) >25 kg/m² (group A₁) and 50 with BMI <25 kg/m² (group A₂), were recruited. They were evaluated with a specific combination of standardized psychometric questionnaires: the Symptom Checklist-90 Revised, the 36-Item Short-Form Health Survey, and the Polycystic Ovary Syndrome Questionnaire. The patients were compared with a normal-weight healthy control group of 40 subjects (group B). Another control group of 40 obese healthy women (group C) was used to make a comparison with PCOS obese patients (A₁).

RESULTS

Our results showed a considerable worsening of HRQoL in PCOS patients (A) compared with controls (B). In addition, patients with PCOS and BMI >25 (A₁) showed a significant and more marked reduction in scores, suggesting a lower quality of life, compared with controls (B) and with normal-weight PCOS patients (A₂).

CONCLUSION

PCOS is a complex disease that alone determines a deterioration of HRQoL. The innovative use of these psychometric questionnaires in this study, in particular the PCOS questionnaire, has highlighted that obesity has a negative effect on HRQoL. It follows that a weight decrease is associated to phenotypic spectrum improvement and relative decrement in psychological distress.

24-h actigraphic monitoring of motor activity, sleeping and eating behaviors in underweight, normal weight, overweight and obese children

PURPOSE

Within a chronobiological perspective, the present study aimed to describe 24 h of sleep-wake cycle, motor activity, and food intake patterns in different body mass index (BMI) categories of children through 7 days of actigraphic recording.

METHODS

Height and weight were objectively measured for BMI calculation in a sample of 115 Italian primary schoolchildren (10.21 ± 0.48 years, 62.61 % females). According to BMI values, 2.60 % were underweight, 61.70 % were of normal weight, 29.60 % were overweight and 6.10 % were obese. Participants wore a wrist actigraph continuously for 7 days to record motor activity and describe sleep-wake patterns. In addition, participants were requested to push the event-marker button of the actigraph each time they consumed food to describe their circadian eating patterns.

RESULTS

BMI group differences were found for sleep quantity (i.e. midpoint of sleep and amplitude), while sleep quality, 24-h motor activity and food intake patterns were similar between groups. Regression analyses showed that BMI was negatively predicted by sleep duration on schooldays. BMI was also predicted by motor activity and by food intake frequencies recorded at particular times of day during schooldays and at the weekend.

CONCLUSIONS

The circadian perspective seems to provide promising insight into childhood obesity, but this aspect needs to be further explored.

Role of the Orexin System on the Hypothalamus-Pituitary-Thyroid Axis

Hypocretin/orexin (ORX) are two hypothalamic neuropeptides discovered in 1998. Since their discovery, they have been one of the most studied neuropeptide systems because of their projecting fields innervating various brain areas. The orexinergic system is tied to sleep-wakefulness cycle, and narcolepsy is a consequence of their system hypofunction. Orexinergic system is also involved in many other autonomic functions such as feeding, thermoregulation, cardiovascular and neuroendocrine regulation. The main aim of this mini review article is to investigate the relationship between ORX and thyroid system regulation. Although knowledge about the ORX system is evolving, its putative effects on hypothalamic-pituitary-thyroid (HPT) axis still appear unclear. We analyzed some studies about ORX control of HPT axis to know better the relationship between them. The studies that were analyzed suggest Hypocretin/ORX to modulate the thyroid regulation, but the nature (excitatory or inhibitory) of this possible interaction remains actually unclear and needs to be confirmed.

Treatment outcomes after methylphenidate in adults with attention-deficit/hyperactivity disorder treated with lisdexamfetamine dimesylate or atomoxetine

PURPOSE

To compare treatment adherence, discontinuation, add-on, and daily average consumption (DACON) among adults with attention-deficit/hyperactivity disorder receiving second-line lisdexamfetamine dimesylate (LDX) or atomoxetine (ATX), following methylphenidate.

PATIENTS AND METHODS

A retrospective cohort study using US commercial claims databases (Q2/2009-Q3/2013).

RESULTS

At month 12, the LDX cohort (N=2,718) had a higher adherence level (proportion of days covered: 0.48 versus 0.30, P<0.001) and was less likely to discontinue (Kaplan-Meier estimate: 63% versus 85%, P<0.001) than the ATX cohort (N=674). There were no statistical differences in treatment add-on rates between cohorts (Kaplan-Meier estimate: 26% versus 25%, P=0.297). The LDX cohort had a lower DACON (1.10 versus 1.31, P<0.001) and was less likely to have a DACON >1 (adjusted odds ratio: 0.20, 95% confidence interval: 0.15-0.25, P<0.001) than the ATX cohort.

CONCLUSION

Adults with attention-deficit/hyperactivity disorder treated with LDX following methylphenidate had a higher treatment adherence and lower discontinuation and DACON relative to those treated with ATX following methylphenidate.

Liraglutide and obesity: a review of the data so far

The prevalence of obesity worldwide has nearly doubled since 1980 with current estimates of 2.1 billion in 2013. Overweight and obesity lead to numerous adverse conditions including type 2 diabetes, cardiovascular disease, stroke, and certain cancers. The worldwide spread of obesity and associated comorbidities not only threatens quality of life but also presents a significant economic burden. While bariatric surgery has proven to be a viable treatment option for the morbidly obese, there is clearly a need for less invasive alternatives. Recent research has suggested that long-acting analogs of the gut hormone, glucagon-like peptide 1 (GLP-1), may have potential as an antiobesity treatment. The GLP-1 receptor agonist, liraglutide (trade name Saxenda), was recently approved by the US Food and Drug Administration as an obesity treatment option and shown in clinical trials to be effective in reducing and sustaining body weight loss. This review presents the basis for GLP-1-based therapies with a specific focus on animal and human studies examining liraglutide's effects on food intake and body weight.

The importance of community consultation and social support in adhering to an obesity reduction program: results from the Healthy Weights Initiative

BACKGROUND

Few community-based obesity reduction programs have been evaluated. After 153 community consultations, the City of Moose Jaw, SK, Canada, decided to initiate a free comprehensive program. The initiative included 71 letters of support from the Mayor, every family physician, cardiologist, and internist in the city, and every relevant community group including the Heart and Stroke Foundation, the Canadian Cancer Society, and the Public Health Agency of Canada.

OBJECTIVE

To promote strong adherence while positively influencing a wide range of physical and mental health variables measured through objective assessment or validated surveys.

METHODS

The only inclusion criterion was that the individuals must be obese adults (body mass index >30 kg/m(2)). Participants were requested to sign up with a "buddy" who was also obese and identify three family members or friends to sign a social support contract. During the initial 12 weeks, each individual received 60 group exercise sessions, 12 group cognitive behavioral therapy sessions, and 12 group dietary sessions with licensed professionals. During the second 12-week period, maintenance therapy included 12 group exercise sessions (24 weeks in total).

RESULTS

To date, 243 people have been referred with 229 starting. Among those who started, 183 completed the program (79.9%), while 15 quit for medical reasons and 31 quit for personal reasons. Mean objective reductions included the following: 31.0 lbs of body fat, 3.9% body fat, 2.9 in from the waist, 2.3 in from the hip, blood cholesterol by 0.5 mmol/L, systolic blood pressure by 5.9 mmHg, and diastolic blood pressure by 3.2 mmHg (all P<0.000). There were no changes in blood sugar levels. There was also statistically significant differences in aerobic fitness, self-report health, quality of life measured by Short Form-36, and depressed mood measured by Beck Depression Inventory-II (all P<0.000). Independent risk factors for not completing the program were not having a family member or friend sign a social support contract (odds ratio 2.91, 95% confidence interval 1.01-8.34, P=0.047) and lower education (odds ratio 2.90, 95% confidence interval 1.20-7.03, P=0.018).

CONCLUSION

Comprehensive obesity reduction programs can be effective when there is extensive consultation at the community level and social support at the individual level.

Comorbid personality disorders among patients with depression

PURPOSE

To investigate the personality disorders (PDs) diagnosed in patients with depressive disorders.

MATERIAL AND METHODS

This study included a cross-sectional analysis, and was an extension of the Thai Study of Affective Disorder (THAISAD) project. Eighty-five outpatients with depressive disorders were interviewed using the Mini International Neuropsychiatric Inventory to assess for depression, in accordance with the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision and using the Thai version of the Structured Clinical Interview for PDs to assess for PD.

RESULTS

Seventy-seven percent of the patients had at least one PD, 40% had one PD and 60% had two or more PDs (mixed cluster). The most common PDs found were borderline PD (20%) and obsessive-compulsive PD (10.6%), while the occurrence of avoidant PD was low when compared to the findings of previous, related studies. Among the mixed cluster, cluster A combined with cluster C was the common mix. Both dysthymic disorder and double depression were found to have a higher proportion of PDs than major depressive disorder (85.7% versus 76.1%). Dependent PD was found to be less common in this study than in previous studies, including those carried out in Asia.

CONCLUSION

The prevalence of PDs among those with depressive disorder varied, and only borderline PD seems to be consistently high within and across cultures. Mixed cluster plays a prominent role in depression, so more attention should be paid to patients in this category.