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Paed Obesity – Improved mental health

Evidence Summary
A systematic review of 53 studies done by Rankin et al, 2016 showed that obesity or being overweight in childhood was negatively associated with depression and behavioural disorders during childhood. It was unclear as to whether psychiatric disorders are a cause or consequence.

Studies varied in relation to the strength of association between depression and childhood obesity.
In obese children no statistically significant difference was found in the rates of most common psychiatric disorders, including medically diagnosed depression. Overweight or obese boys were found to be at higher odds of depressive symptoms than boys of normal weight. There was more risk of mood disorder developing in adulthood if obese or overweight in childhood. Findings showed obesity increases the risk of depression in adult life, but also that depression predicts the development of obesity.

The same systematic review found that being obese or overweight in childhood was negatively associated with health-related quality of life, emotional and behavioural disorders, and self-esteem during childhood. They were more likely to experience multiple associated psychosocial problems than their healthy weight peers, which may be adversely influenced by obesity stigma, teasing and bullying.

Findings from studies suggested greater psychopathology among overweight or obese adolescents than non-obese adolescents. Obese girls also demonstrated more social anxiety than obese boys.
Obese or overweight children had significantly lower self-esteem than normal-weight peers. There was increased body dissatisfaction and lower perceived self-worth and self-confidence found in this group in comparison to their normal-weight peers.

Childhood obesity is consistently associated with a poorer health-related quality of life when compared with lower weight children. This becomes a stronger association in later childhood.

Overweight or obese children were more likely to experience multiple and clinically significant associated psychosocial problems than their healthy weight peers with increasing conduct issues/ disorders. Overweight or obese children between 6-13 years of age were 4-8 times more likely to be teased and bullied than normal weight peers. Obesity and weight-related teasing is a significant risk factor for the development of psychosocial problems. 25% of obese girls used extreme weight-control behaviours such as inducing vomiting, abusing laxatives, diet pills, fasting or smoking. Obese adolescents were clearly at risk of developing a restrictive eating disorder.
Obesity can be treated effectively in younger children and adolescents.

Multicomponent interventions targeting physical activity and healthy diet could benefit obese and overweight children specifically in overall school achievement and family-based intervention with maintenance follow-up can improve psychosocial and physical quality of life.

Another systematic review by Carson et al looked at 96 studies representing 71291 participants from 36 countries. Physical activity interventions were consistently associated with improved psychosocial health in obese or overweight children.

A systematic review of 14 studies by Ruotsalainen et al showed positive effects on self-perception, body satisfaction and eating disorder symptoms.

A study of iyengar yoga and its benefits on paediatric obesity was done and it showed reports of emotional function significantly improved. Relatively brief, non-invasive Iyengar yoga intervention can result in improved malalignment of the lower extremities during ambulation, as well as clinically meaningful improvements in emotional functioning. Evidence supports a role for yoga in paediatric obesity.

Increasing BMI z scores were associated with decreasing self-worth and global self-esteem, as well as decreased athletic competency, social acceptance and dissatisfaction with their physical appearance.
There is a higher than average risk of eating disorders and substance abuse among children and adolescents with obesity.
Factors that influence a low quality of life include the degree of obesity, symptoms of depression, a lack of social support from classmates/family and low socioeconomic status.
During adolescence, low self-esteem becomes more closely tied with body image and rapidly plummets. Adolescent females who have higher BMIs and body image dissatisfaction have the lowest self-esteem.
Bullying by peers and families contributes to poor body image and impaired psychosocial functioning and parental reaction to their child’s weight affects how their child responds.

Quality of Evidence
Grade A. multiple systematic reviews and meta-analyses.

Strength of Recommendation
Grade 2 – childhood obesity/overweight is associated with the development in depression, with an increased risk of developing it in adult life in both males and females, however, it was unclear there was any association between obesity and any other psychiatric disorder
Grade 1 – high quality evidence suggesting psychosocial benefit is gained.

Conclusion
There is a clear association between children with obesity/overweight and poor psychosocial health that is exacerbated by negative experiences from family and peers. Being obese or overweight in childhood can contribute to depression. This in turn can worsen obesity and it can increase the risk of development of depression in adult life.

There is a clear benefit on gained from physical activity, which improves psychosocial health, particularly if the family is involved. It is also correlated with a significant improvement in quality of life.
References

  1. Psychological consequences of childhood obesity: psychiatric comorbidity and prevention. Rankin J, Matthews L, Cobley S, Han A, Soanders R, Wiltshire H, Baker J.
  2. Psychological consequences of childhood obesity: psychiatric comorbidity and prevention. Rankin J, Matthews L, Cobley S, Han A, Soanders R, Wiltshire H, Baker J.
  3. Systematic Review of the Relationships between Physical Activity and Health Indicators in the Early Years (0-4 years). Carson V, Lee EY, Hewitt L, Jennings C, Hunter S, Kuzik N, Stearns J, Powley Unrau S, Poitras V, Gray C, Adamo K, Janssen I, Okely A, Spence J, Timmons B, Sampson M, Tremblay M.
  4. Systematic Review of Physical Activity and Exercise Interventions on Body Mass Indices, subsequent Physical Activity and Psychological Symptoms in Overweight and Obese Adolescents. Ruotsalainen H, Kyngas H, Tammelin T, Kaariainen M.
  5. A Pilot Study of Iyengar Yoga for Paediatric Obesity: Effects on Gait and Emotional Functioning. Hainsworth KR, Liu XC, Simpson PM, Swartz AM, Linneman N, Tran ST, Medrano GR, Mascarenhas B, Zhang L, Weisman SJ.
  6. Paediatric Obesity – Assessment, Treatment and Prevention: An Endocrine Society Clinical Practice Guidelines. Styne DM, Arslanian SA, Connor EL, Farooqi IS, Murad MH, Silverstein JH, Yanovski JA.
  7. The Impact of Multicomponent weight management programs on quality of life in adolescents affected by overweight or obesity: a meta-analysis of randomised controlled trials. Murray M, Pearson JL, Dordevic AL, Bonham MP.
  8. Change in health-related Quality of Life in the context of paediatric obesity interventions:a meta-analytic review. Steele RG, Gayes LA, Dalton WT, Smith C, Maphis L, Conway-Williams E.

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