Obesity is a serious and prevalent condition, with grave risks for morbidity and mortality. While the physical consequences of obesity have been well studied, the psychological correlates are less well understood. Theory and research suggest that obesity and depression may be causally linked. We propose a bidirectional theoretical model identifying the behavioral, cognitive, physiological, and social mechanisms that may be responsible for the pathway between obesity and depression, and vice versa. We investigate the research that supports this model, and identify areas of need for future research. In addition, we discuss the clinical implications of this literature, including the need for integrated care in this population.

Understanding the Relation Between Obesity and Depression: Causal Mechanisms and Implications for Treatment

ZELLER, MEG H. AND AVANI C. MODI. Predictors of health-related quality of life in obese youth. Obesity. 2006; 14:122-130. Objective: Recent literature has documented the psychosocial consequences of pediatric obesity, including poor health-related quality of life (HRQOL). The present study examines HRQOL and its association with depressive symptoms and perceived social support in African-American and white youth pursuing weight management treatment. Research Methods and Procedures: Study participants were 166 obese youth (mean = 12.7 years, 70% females, 57% African American, mean BMI = 37.0) referred to a pediatric weight management program. Parents of participants completed a demographics form and the parent-proxy Pediatric Quality of Life Inventory (PedsQL). Youth completed the Children's Depression Inventory, PedsQL, and Perceived Social Support Scale for Children. Results: HRQOL scores were quite impaired relative to published norms on healthy youth (p < 0.001). Approximately 11 % of the sample met criteria for clinically significant depressive symptoms. Simultaneous regression analyses revealed that depressive symptoms, perceived social support from classmates, degree of overweight, and socioeconomic status seem to be strong predictors of HRQOL. Discussion: Obesity has a clear impact on HRQOL regardless of respondent (e.g., parent, youth) or racial group. It is likely that assessing and treating depressive symptoms and fostering social support in the context of pediatric intervention have implications for both improved HRQOL and weight management outcomes.

https://onlinelibrary.wiley.com/doi/pdf/10.1038/oby.2006.15

Predictors of health-related quality of life in obese youth.

Disordered eating attitudes and behaviors appear to be quite common in youth, and overweight youth have been identified as a subset of the population at particularly high risk for endorsing such symptoms. Overweight and eating disorder (ED) symptomatology independently confer significant threats to one's physical and psychosocial health, showing strong links with body weight gain and risk for ED development. When concurrent, the risk for negative health outcomes may be compounded. The purpose of this article is to review the current state of the literature as it concerns disordered eating and its correlates in overweight children and adolescents. Extant literature on the prevalence, distribution, correlates, and etiology of disordered eating attitudes and behaviors (i.e., negative attitudes toward shape and weight, unhealthy weight control behaviors, and binge eating) in overweight youth is reviewed and consolidated in order to make assessment and treatment recommendations for healthcare providers. The current literature suggests that early detection of disordered eating in overweight youth should be a priority to provide appropriate intervention, thereby helping to slow the trajectory of weight gain and prevent or reduce the long-term negative consequences associated with both conditions. Future research should focus on explicating developmental pathways, and on developing novel prevention and treatment interventions for overweight youth exhibiting disordered eating patterns.

https://onlinelibrary.wiley.com/doi/pdf/10.1038/oby.2007.48

Disordered eating attitudes and behaviors in overweight youth.

OBJECTIVE. We sought to document health-related quality of life (HRQoL) impairment and depressive symptomatology in adolescents with extreme obesity considering surgical weight loss. STUDY DESIGN. A retrospective review of clinical data was conducted for 33 consecutive extremely obese adolescents presenting for evaluation at a bariatric surgery program for adolescents. Adolescents completed the PedsQL and the Beck Depression Inventory. Mothers completed the parent-proxy PedsQL and the Child Behavior Checklist. RESULTS. HRQoL scores from both informants were markedly impaired relative to published norms on healthy youth. Moderate agreement was found for self-reported and parent-proxy HRQoL. Approximately 30% of youth met criteria for clinically significant depressive symptoms when based on self-report and 45% of youth when based on mother report. Only 21% of youth were currently engaged in some form of psychological treatment (eg, medication or therapy). CONCLUSIONS. The day-to-day life of adolescents with extreme obesity seeking bariatric surgery is globally and severely impaired. However, only some of these adolescents demonstrate clinically significant levels of depressive symptomatology. These data will be critical to the development of more informed patient selection criteria and more efficacious treatment paradigms for this vulnerable pediatric subgroup.

Health-related quality of life and depressive symptoms in adolescents with extreme obesity presenting for bariatric surgery.

Binge eating disorder (BED), a provisional diagnostic category in DSM-IV-TR (American Psychiatric Association [APA], 2000), is characterized by recurrent binge eating episodes in the absence of inappropriate compensatory behaviors and is often associated with obesity (de Zwaan et al., 1994). When compared with non-binge-eating adults, those with BED suffer from greater eating-disordered cognitions (Crow, Stewart Agras, Halmi, Mitchell, & Kraemer, 2002; Masheb & Grilo, 2000; Striegel-Moore et al., 2001; Wilfley, Schwartz, Spurrell, & Fairburn, 2000), increased general psychopathology (Mussell et al., 1996; Wilfley, Friedman, et al., 2000; Yanovski, Nelson, Dubbert, & Spitzer, 1993), and more health problems (Johnson, Spitzer, & Williams, 2001; de Zwaan et al., 2002).

The DSM-IV-TR description of BED identifies frequency and duration criteria that must be met to receive a diagnosis. The frequency criterion is binge eating (eating an objectively large quantity of food during which a loss of control [LOC] is experienced) on average at least twice per week; the duration criterion is that binge eating occurs consistently over a 6-month period (APA, 2000). However, there are few data demonstrating these thresholds identify the majority of individuals having significant difficulties with binge eating. Investigations comparing adults with BED to those with subthreshold BED (characterized by recurrent episodes of binge eating with an average frequency of once per week during the past 6 months) have found few differences between groups on measures of psychiatric distress, body weight, dieting, weight history, or body image disturbance (Striegel-Moore et al., 2000; Striegel-Moore, Wilson, Wilfley, Elder, & Brownell, 1998). A study employing an even less stringent frequency criterion for subthresh-old BED (binge eating at least once per month during the past 6 months) also found few differences on measures of eating-related and general psychopathology between women with diagnostic and subthreshold BED (Crow et al., 2002). These data suggest that binge eating, even at lower frequencies, is a clinically significant problem. Moreover, the significance of objectively large overeating as an important characteristic of BED in adults has been questioned, suggesting that the experience of LOC may be the most salient factor associated with emotional distress (Niego, Pratt, & Agras, 1997; Pratt, Niego, & Agras, 1998).

Although few adolescents meet the criteria for full-syndrome BED (Johnson, Grieve, Adams, & Sandy, 1999; Stice, Killen, Hayward, & Taylor, 1998; Stice, Presnell, & Bearman, 2001), the prevalence of sub-threshold binge eating, particularly among overweight adolescents, appears to be substantial (Johnson, Rohan, & Kirk, 2002), with estimates ranging from 20% (Isnard et al., 2003) to ~30% (Decaluwe, Braet, & Fairburn, 2003) in weight loss treatment-seeking samples. Consistent with the adult literature (Striegel-Moore et al., 1998, 2000), studies in adolescents seeking weight loss treatment have found that those who report subthresh-old binge eating have greater eating-related distress and depressive symptomatology than those who do not report any binge eating (Berkowitz, Stunkard, & Stallings, 1993; Decaluwe et al., 2003; Isnard et al., 2003; Johnson et al., 1999). Nevertheless, the implications of sub-threshold binge eating as compared with full-syndrome BED in adolescents are unclear. In a community sample of 10- to 18-year-olds, Johnson et al. (1999) found that children meeting full diagnostic criteria for BED by questionnaire reported significantly more depressive symptomatology and greater disturbed eating-related cognitions than children describing subthreshold binge eating. By contrast, another study of middle and high school students with BED and subthreshold BED found no substantial differences in depressed mood, self-esteem, or body dissatisfaction (Ackard, Neumark-Sztainer, Story, & Perry, 2003). Although full-syndrome BED in childhood is rare, children reporting LOC episodes regardless of the amount of food eaten have greater adiposity and psychological distress than those with no LOC episodes (Morgan et al., 2002; Tanofsky-Kraff et al., 2004). In a study using structured clinical interviews, overweight children (6–13 years) who endorsed experiencing as few as one episode of LOC eating in their lifetime reported greater eating-disordered and general psychopathology compared with overweight children who reported no such episodes (Tanofsky-Kraff, Faden, Yanovski, Wilfley, & Yanovski, 2005).

A notable limitation of most prior studies examining binge eating among adolescents is the lack of interview methodology to assess eating-disordered behaviors and cognitions (Ackard et al., 2003; Decaluwe et al., 2003; Isnard et al., 2003; Johnson et al., 1999; Morgan et al., 2002). To investigate the potential association of frequency and recency of binge eating episodes with eating-related cognitions and general psychopathology, we used an interview method to assess eating-disordered pathology in a cohort of overweight, treatment-seeking adolescents. We posited that the frequency and recency of binge eating would be related to higher levels of depressive and anxious symptomatology. Specifically, we hypothesized that (a) teens meeting DSM-IV-TR criteria for BED (high frequency and high recency) would report the highest levels of eating-related and general psychopathology and that (b) participants endorsing recent subthreshold binge eating in the 3 months before assessment (low frequency but high recency) would report more emotional disturbance than adolescents who reportedly had never experienced binge or LOC eating. Given the findings of Tanofsky-Kraff et al. (2005), we also expected adolescents who reported the experience of LOC eating ever in the past (low frequency and low recency) would report higher levels of eating-related, depressive and anxious symptomatology than adolescents who reportedly had never experienced binge or LOC eating.

/pdf/binge-eating-in-overweight-treatment-seeking-adolescents-6ihysp60ht.pdf

Binge Eating in Overweight Treatment-Seeking Adolescents

Objective

The authors describe binge eating and psychopathology in severely obese adolescents who are seeking treatment for obesity and search for specific psychological features that may be associated with binge eating.



Method

Obese adolescents (n = 102) were assessed with the Binge Eating Scale (BES), the State–Trait Anxiety Inventory for Children (STAIC), the Beck Depression Inventory (BDI), Coopersmith's Self-Esteem Inventory (SEI), and the Body-Esteem subscale from the Piers–Harris Children's Self-Concept Scale (PHCSS). They were also evaluated with the Montgomery and Asberg Depression Rating Scale (MADRS) and the Brief Scale for Anxiety (BSA). Two subgroups (i.e., binge eaters and non-binge eaters) were then established according to the BES score.



Results

Binge eating symptoms were frequent in this population and the binge eating dimension was related to high levels of anxiety and depression, as well as to low levels of self-esteem and body-esteem. The dimensions of anxiety and depression were associated specifically with binge eaters.



Discussion

As observed in the obese adult population, binge eating symptoms were found frequently in severely obese adolescents seeking treatment and were related strongly to studied parameters. Obese adolescents who binge eat are a subgroup with high psychopathologic distress. © 2003 by Wiley Periodicals, Inc. Int J Eat Disord 34: 235–243, 2003.

Wadih Naja

Papers

Binge eating and psychopathology in severely obese adolescents