|Year : 2020 | Volume
| Issue : 1 | Page : 17-21
Psychological impact of obesity in children
Rania Hussein1, Ragaa A.-E Mohammed2, Inass H Ahmed3
1 Department of Psychiatry, Faculty of Medicine (for girls), Al-Azhar University, Cairo, Egypt
2 Department of Pediatrics, Faculty of Medicine (for girls), Al-Azhar University, Cairo, Egypt
3 Department of Endocrinology, Faculty of Medicine (for girls), Al-Azhar University, Cairo, Egypt
|Date of Submission||13-Nov-2019|
|Date of Decision||25-Nov-2019|
|Date of Acceptance||27-Nov-2019|
|Date of Web Publication||20-Apr-2020|
MD Inass H Ahmed
Lecturer of Endocrinology, Faculty of Medicine for Girls, Al-Azhar University, Cairo, 1356
Source of Support: None, Conflict of Interest: None
Background Obesity is a growing public health problem among both children and adults. Obesity comorbidities are not limited to somatic complications, but extend to involve several psychological consequences. Stigmatization represents a major psychological stress that adversely affects children’s self-esteem.
Aim This study aimed to assess the prevalence of common psychiatric disorders (depression, anxiety, oppositional defiant disorder) in a group of obese children in comparison with those with normal weight.
Participants and methods This case–control study included 60 children with obesity (BMI ≥95th age-specific and sex-specific percentiles) and 60 age-matched and sex-matched normal-weight children (BMI 5th–85th age-specific and sex-specific percentiles) as the control group. Detailed assessments of history and anthropometric indices of central and peripheral obesity, in addition to psychiatric assessment for depression, anxiety, and oppositional defiant disorder, were carried out.
Results 46.7% of children with obesity were victims of bullying. Children with obesity have significantly higher rate of depression and low self-esteem in comparison with healthy peers. Girls were more affected than boys. There is a significant relation between depression and central obesity. The childhood depression inventory score is correlated directly to BMI and waist circumference.
Conclusion Children with obesity are at a higher risk for depression, with the severity of depression correlated positively with BMI and central obesity.
Keywords: children, depression, obesity, self-esteem, waist circumference
|How to cite this article:|
Hussein R, Mohammed RA, Ahmed IH. Psychological impact of obesity in children. Sci J Al-Azhar Med Fac Girls 2020;4:17-21
| Introduction|| |
Obesity is a major public health problem that has been rapidly increasing in prevalence over recent decades among both children and adults. The enduring complications of obesity not only include physical consequences but also remarkable increases in comorbid psychological conditions including mental health problems .
Several physical consequences are linked to obesity including cerebrovascular disorders, diabetes, and fatty liver. Most obesity-related researches have been focused on tackling the physical sequences, whereas little data are known about the impact of obesity on mental health . Obesity adversely affects psychological well-being through weight stigma, poor self-esteem, and/or functional impairment (less movement, and limited ability to engage in activities, causing social withdrawal) .
Children with obesity are frequently exposed to stigmatization, teasing, and bullying that represent psychological stress, which exposes those children to serious emotional and physical consequences adversely affecting their health and performance. It remains unclear as to whether psychiatric disorders and psychological problems are a cause or a consequence of childhood obesity .
Depression is an emerging psychological problem in children that is associated with poor school performance and impaired social functioning, and is strongly linked to substance use disorder, in addition to increased suicidal risk, which is the second leading cause of preventable causes of death among young people . Depression is one, but not the sole complication of obesity in adults; however, its impact on children and adolescents is still underestimated.
The current study aimed to explore the prevalence of common psychiatric disorders including depression, anxiety, and oppositional defiant disorder (ODD) in a group of obese children in comparison with those with normal weight.
| Participants and methods|| |
This case–control study included 60 children with obesity (BMI ≥95th age-specific and sex-specific percentiles) and 60 age-matched and sex-matched normal-weight children (BMI 5th–85th age-specific and sex-specific percentiles) as the control group. They were selected consecutively from the pediatric outpatient clinic of Al-Zahraa University Hospital during the period from January 2016 to March 2017.
Inclusion criteria included children with obesity aged 7–12 years. Obesity was defined as BMI greater than or equal to 95th age-specific and sex-specific percentiles, while those who have BMI in the 5th–85th percentile were considered normal weight .
Informed written consent was obtained from the parents of all the children involved in accordance with the local Ethics Committee of Al-Azhar University.
Children who had any chromosomal or syndromic disorders or those with any chronic medical illness (e.g. cardiac, respiratory, endocrine, liver, or kidney diseases) were excluded from the study.
The control group included age-matched and sex-matched healthy normal-weight children who fulfilled the same exclusion criteria as children with obesity. They were selected from among the relatives of employers at Alzahraa Hospital.
Medical history and examination
Detailed assessment of history was performed for all the children involved including age, sex, medical, dietetic history, lifestyle, and psychiatric history, with a special focus on bullying. A thorough clinical examination including a general and systemic examination was performed. Anthropometric measures including body weight (kg) with the child in light clothes, height (cm) with the child in bare foot and knees straight, hip circumference as an indicator of peripheral obesity, and waist circumference (WC) as an indicator of central obesity were determined using a flexible nonstretchable measuring tape. BMI was calculated as weight in kilograms divided by height squared in meters and was plotted by age and sex on the sex-specific growth chart .
All participants were further subjected to a psychiatric evaluation including the following:
- Arabic version of Mini International Neuropsychiatric Interview for children (Mini-Kid)  for detection of depression, anxiety, and ODD.
- Childhood depression inventory: it is a self-rating scale that consists of 27 items that represent depression symptoms. The total depression score ranges between 0 and 54; higher scores are associated with more severe depression.
Statistical analysis of the data was carried out using the statistical package for the social sciences (version 20.0; SPSS Inc., Chicago, Illinois, USA). Differences between groups were analyzed using an independent Student’s t-test, the χ2-test, and the one-way analysis of variance test. Spearman correlation test was used to determine the correlations between depression severity and anthropometric measurements in the children studied. P value less than 0.05 was considered significant.
| Results|| |
This study included 60 children with obesity (28 males, 32 females); 60 healthy normal-weight children (26 males, 34 females) served as a control group. Their age ranged between 7 and 14 years. Exposure to bullying was significantly higher in obese than normal-weight children (46.7 vs 20%, respectively). Self-esteem was significantly low in obese than in normal-weight children. However, anxiety and ODD were higher in obese children, but this was not statistically significant as shown in [Table 1].
|Table 1 Comparison between groups in terms of sex, age, and psychological data|
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The severity of depression was statistically significantly higher in children with obesity in comparison with normal-weight children (P<0.05) as demonstrated in [Table 2]. In addition, depression severity was significantly higher in female than male obese children as shown in [Table 3].
|Table 2 Distribution of severity of depression among obese-weight and normal-weight children|
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|Table 3 Comparison between male and female in the childhood depression inventory score|
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Correlation between BMI, WC, age of onset, duration of obesity, and severity of depression showed a significant positive correlation between BMI, WC, waist/hip ratio, duration of obesity, and the severity of depression and a significant negative correlation between the age of onset and severity of depression as shown in [Table 4], [Figure 1].
|Table 4 Correlation between anthropometric parameters and the childhood depression inventory score|
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|Figure 1 Correlation between BMI, waist circumference, age of onset, duration of obesity, and severity of depression.|
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| Discussion|| |
Late childhood is a critical developmental period characterized by dramatic physical and psychological changes. Physical changes and appearance are essential preoccupations of adolescents, and therefore, obesity may predispose them to mental health consequences . Depression and obesity are two challenging health issues. Although they have been compartmentalized as separate health conditions, evidence suggests interactions and common pathways. WHO suggests that depression in the year 2020 will be the disease with the highest burden that has intensive cost and a relatively high mortality .
The current study showed that exposure to bulling was significantly higher and self-esteem was significantly lower in children with obesity. This is consistent with Bacchini et al. , who reported that 27% of obese children were victims of bullying. Also, Ozmen et al.  found that obese children suffer from verbal and physical victimization and exclusion from group activities. Weight-based teasing contributes to devastating emotional consequences, academic failure, peer rejection, low self-esteem, and depression.
However, Alvani and Alvani  reported no difference between obese and nonobese participants in terms of self-esteem. This contradiction could be related to social and cultural factors as in some communities, obesity is considered a reflection of beauty and health.
Psychological comorbidities including depression, anxiety, and ODD were higher in obese children, but only the rate of depression was statistically significant. These results are similar to those of Taman and Arafa , who reported a significant association between depression and obesity in children. Anderson et al.  found that depression was prevalent in 40% of obese children with an average age of 14.6 years and Carey et al.  reported a higher frequency of 63.3% among obese persons. However, Flotness et al.  reported a lower prevalence of depression (30%), whereas Sanderson et al.  found a prevalence of depression of 13.2% among obese children. These differences reflect differences in the methodological psychometric tests used to evaluate depression and the different age groups involved.
In our study, we found that girls were more affected than boys. This is consistent with the result of Sutaria et al. , who found that the odds ratio of depression was 1.44% higher among females. In contrast, Anderson et al.  found that the prevalence of depression in obese boys was 40%, whereas in girls, it was 26%. This may be attributed to the fact that girls are more likely to engage in dysfunctional thinking pertaining to body image, self-worth, and well-being. Feelings of guilt and self-blame are more frequent in females, making them more susceptible to depression .
Moreover, we found a significant relation between BMI and the childhood depression inventory score, with a significant association between depression severity and central obesity. This is in agreement with the study of Esposito et al. . Strong evidence has been shown for the association between central obesity and depression in adults, but this association has not been fully explored in the pediatric population. Our findings provide evidence that depression starts early in childhood in the obese population. Zhao et al.  reported that WC or central obesity was associated with increased incidence of depression in adults with obesity. Moreira et al.  clarified that central obesity was an independent predictor of the severity of depressive symptoms and mood disorders in obese women.
Several studies suggest a bidirectional relationship between obesity and depression. It is not clear which of them was the initial trigger. The relation between depression and obesity is not just a coincident sharing of some symptoms such as sleep disturbance, sedentary behavior, and dysregulated food intake, but it seems to be related to shared pathophysiology. The link between both disorders may be partly affected by shared neurobiological mechanisms particularly in terms of serotonin regulation as well as changes to the hypothalamic–pituitary–adrenal (HPA) axis .
Depression is associated with dysregulation of the inflammatory system and increased proinflammatory mediators. Obesity has been identified as a chronic proinflammatory condition; several evidences showed increased expression of proinflammatory cytokines by adipose tissue that is mainly linked to central rather that peripheral obesity. Therefore, the obesity-related inflammatory process has emerged as a hypothesis to explain its relation to depression .
There is no dispute that obesity is undesirable for adolescents as it acts as a damaging obstacle in a society bothering and humiliating obese children. Consequently, obese children and adolescents not only experience low self-esteem as a result of peer taunting but they also show elevated levels of loneliness and sadness. Thus, low self-esteem will lead them to feel doubtful about their worthiness and acceptability. Such feelings lead to low energy and motivation .Children who have poor body images are more prone to developing psychological disturbances. Thus, obese children are unhappy and have physical appearance dissatisfaction that increases with age. Several studies have shown a statistically significant adverse association between self-esteem scores and obesity in children that is significantly correlated with BMI. Loss of weight has been found to be associated with having better self-concept levels and increased self-esteem .
Several studies have clarified a strong relationship between obesity and mood changes that could be related to HPA axis dysregulation. HPA downregulation is associated with increased appetite, dyslipidemia, and increased BMI. This dysregulation may explain the frequent association between obesity, anxiety, and depression . In addition, obesity-related leptin dysregulation (resistance) adversely affects the mood, with a significant association with depressive disorder .
| Conclusion|| |
In conclusion, children with obesity are at a higher risk for depression, with depression severity correlated positively with BMI and central obesity. The younger age of onset, longer duration of obesity, and female sex are associated with more severe depressive symptoms. Screening and early identification of psychological disorders in children with obesity and a multidisciplinary approach including psychological support and weight reduction are required to protect obese children from the psychological hazards of obesity.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4]