Psychological complications of pediatric obesity

Psychological complications associated with pediatric obesity include low self-esteem, depression, body dissatisfaction, loss-of-control eating, unhealthy and extreme weight control behaviors, impaired social relationships, obesity stigma, and decreased health-related quality of life. Bioecological models offer a framework for understanding the interaction between pediatric obesity and psychological complications and illustrate system-level approaches for prevention and intervention. As the medical setting is often the first point of contact for families, pediatricians are instrumental in the identification and referral of children with psychological complications. Motivational interviewing, patient talking points, brief screening measures, and referral resources are important tools in this process.     

Psychosocial predictors of adolescent sexual behavior

Objective  To find out the psychosocial factors associated with adolescent sexual behavior. Methods  A cross sectional study was carried out in Chandigarh Union Territory of India by enrolling 11^th class students from six randomly selected schools. A pre-tested questionnaire containing 83 items was administered after ensuring privacy and confidentiality. Socio-economic status, residence, gender, grade in the class, religion, acculturation level, self esteem, social support and coping behavior were considered as independent explanatory variables and physical sexual contact (which included kissing, hugging and sexual intercourse) was taken as dependent variable. Results  Two hundred and fifty seven students enrolled for the study had mean age of 17 yr. The prevalence of sexual activity was 20% (95% CI: 13.6%–28.1%) among males and 6% (95% CI: 1.3%–18.8%) among females. Four percent of males and 1% of females reported sexual intercourse. The main reason for not having sexual physical contact was societal norms. After adjusting for confounders in multivariate analysis, male gender (OR: 3.5; 95%CI: 1.5–8.1) and modern attitudes (OR: 0.77; 95%CI: 0.6–0.98) were found to be the risk factors for initiation of sexual activity in adolescence. Conclusion  Cultural norms rather than the individual/psychological factors tend to govern adolescent sexual behavior in Indian society.     

青少年心理病理症状及应对方式与童年期反复躯体和情感虐待经历的相关性研究

目的分析青少年心理问题、应对方式与童年期反复严重躯体虐待、中度躯体虐待及情感虐待经历的关联强度。方法5141名中学生以自愿、无记名方式填写调查表的形式调查童年期经历父母或其他监护人的严重和中度躯体虐待及情感虐待情况。以在小学年龄阶段,3类共24项虐待行为中至少1项平均1年发生3次以上,界定为有该项童年期反复虐待经历。用症状自评量表（SCLOO）评定总心理问题、心理病理症状阳性项目数和9种心理病理症状,运用特质性应对方式问卷评定青少年积极和消极应对方式。结果青少年总心理问题检出率为9．1％,其中躯体化、强迫、人际关系敏感、抑郁、焦虑、敌对、恐惧、偏执、精神病性症状检出率分别为1．3％、3．6％、3．6％、2．8％、2．2％、4．0％、2．1％、2．8％、1．6％。总心理问题检出率、9种心理病理症状检出率和阳性项目数与3类童年期反复虐待经历的数量呈剂量-反应趋势。有童年期反复虐待经历的青少年,消极应对评分高于无童年期反复虐待经历者,且消极评分越高,其总心理问题检出率和阳性项目数增加。以青少年和父母的人口统计学变量为协变量,多项式Logistic回归分析表明,积极应对评分不影响3类童年期反复虐待经历与总心理问题的比值比（OR）,但消极应对降低童年期反复虐待经历与总心理问题及9种心理病理症状的OR值。结论不同种类和数量的童年期反复躯体虐待、情感虐待经历对青少年心理健康产生负面影响,消极应对方式可能参与调节了童年期虐待经历与青少年心理问题的联系。     

Psychosocial aspects of chronic illness in adolescence

Success in the survival of children with significant medical conditions has resulted in a dramatic increase in the prevalence of adolescents with chronic illness. Unfortunatelly, the traditional biomedical approach does not prepare practitioners for the complexities of managing chronic illness, because numerous psychosocial factors are involved. This article will address the need for integrating psychosocial issues into the assessment and treatment of the chronically ill adolescent. Assessment of the teen should incorporate an understanding of the developmental stages of adolescence, a review of how these developmental tasks are being accomplished, a discernment of individual characteristics, and knowledge of the family and community to which they belong. Management should take into account the phases of illness (acute, chronic or terminal) and encourage empowerment of the adolescent and family in decision making. A team approach that is community—based, comprehensive, and culturally appropriate is ideal.     

Psychosocial aspects of childhood obesity

Rates of childhood obesity are increasing at alarming rates worldwide. This is especially alarming as obesity is associated with many physical and psychological consequences. A great number of studies indicate that obese children have an impaired psychological well-being (e.g., depression, self-esteem, and quality of life) compared to their non-overweight peers. There has been an overwhelming amount of research conducted in this area over the past few decades, and as such, this paper provides a summarized overview of the vast trove of available information on the psychosocial aspects of childhood obesity. In this paper we provide a summarized overview of: 1) psychosocial aspects that contribute to the onset of childhood obesity; 2) psychosocial consequences of childhood obesity; and 3) familial-based lifestyle behavior modification interventions for treating childhood obesity and its treatment success. Although it seems obvious that obese children and adolescents would likely be at higher risk for psychological problems, the mediating factors in the relationship between psychological problems and obesity are still not well established. Obesity is a complex disorder with an equally complex etiology, and is thus associated with complex behaviors and outcomes that make it difficult to study in children. It has been indicated that family-based lifestyle interventions can improve psychological well-being in obese children; however, not all children profit from these interventions. Interventions aimed at improving treatment results need further investigation. For example, interventions targeted specifically at groups that tend to be less successful in weight-loss programs and interventions providing long-term support to these individuals are recommended.     

1986～1996年儿童期单纯肥胖症研究

介绍我国部分儿科工作者１９８６－１９９６年在儿童期单纯肥胖症领域内的研究进展。方法流行学，生理学，心理－行为，分子生物学研究。结果学龄前期单纯肥胖症检出率长期居高不下，年增长率失控。     

The interface of child mental health and juvenile diabetes mellitus

Diabetes mellitus is a common childhood illness, and its management is often complicated by mental health challenges. Psychiatric comorbidities are common, including anxiety, depression, and eating disorders. The illness can profoundly affect the developing brain and family functioning and have lifelong consequences. The child mental health provider can provide valuable assistance to support the child and family and assessment and treatment of comorbid mental health problems and to promote positive family functioning and normal developmental progress.     

地中海贫血患儿父母心理社会状况调查

目的：了解地中海贫血患儿父母心理社会健康状况。方法：采用晤谈方式,结合自编“地中海贫血患儿父母调查问卷表”和“临床症状自评量表(SCL-90)”对3组地中海贫血患儿父母212例,其中轻型贫血组46对父母,92人;中间型贫血组35对父母,70人;重型贫血组25对父母,50人。进行调查,并将其SCL-90的评定结果与健康儿童父母对照组比较。结果：132例(62.3%)缺乏本病基本知识,对贫血现象存在许多误解;189例(89.2%)担心患病子女的生长发育受影响,甚至会过早夭折;176例(83.0%)对子女患病表示内疚、自责;126例(59.4%)不愿公开病情,害怕受到社会歧视;重型贫血组30例(60.0%)父母工作深受影响,48例(96.0%)缺乏足够经济支持,治疗信心不足。与对照组比较,SCL-90总均分及焦虑和抑郁两因子分值在3组中均明显升高(P<0.05);另外,在重型组除偏执和精神病症因子外,大部分因子分值升高,其中以总均分及躯体化、强迫症状、人际关系、敌对、恐怖等因子明显高于另外两组(P<0.05)。结论：地中海贫血患儿父母存在广泛的心理社会健康问题。     

Childhood overweight and obesity management: A national perspective of primary health care providers' views, practices, perceived barriers and needs

BACKGROUND:

Obesity and overweight in children are an escalating problem in Canada and worldwide. Currently, little is known about the manner in which primary health care providers are responding to Canada’s obesity epidemic.

OBJECTIVE:

To determine the views, practices, challenges/barriers, and needs of a national sample of family physicians (FPs) and community paediatricians (CPs) with respect to paediatric obesity identification and management.

METHODS:

A self-administered questionnaire was mailed to a random sample of 1200 FPs and 1200 CPs across Canada between 2005 and 2006.

RESULTS:

A total of 464 FPs and 396 CPs participated. The majority of practitioners viewed paediatric obesity as an ‘important’/‘very important’ issue. Although the majority reported providing dietary (more than 85%) and exercise (98%) advice to their overweight/obese patients, practitioners’ perceived success rate in treating paediatric obesity was limited (less than 22%). Approximately 30% of FPs and 60% of CPs (P<0.05) used the recommended method to identify paediatric obesity. At least 50% of practitioners indicated that too few government-funded dietitians, a lack of success in controlling paediatric patients’ weight, time constraints and limited training were key barriers to their success. To support efforts to identify or manage paediatric obesity, practitioners identified the need for office tools, patient educational materials and system-level changes.

DISCUSSION:

Canadian primary health care providers are not adequately equipped to deal with the paediatric obesity epidemic. Effective assessment tools and treatment resources, dissemination of clinical practice guidelines, enhanced undergraduate medical education and postgraduate continuing medical education, and system-level changes are urgently needed to address this health problem.     

Effectiveness and safety of interventions to manage childhood overweight and obesity: An Overview of Cochrane systematic reviews

BackgroundChildhood overweight and obesity are associated with adverse physical, social, and psychological outcomes.ObjectivesWe conducted an overview of Cochrane systematic reviews on the effectiveness and risks of interventions to treat overweight and obesity in children and adolescents.MethodsIn June 2019, we searched the Cochrane Database of Systematic Reviews for eligible reviews. The primary outcomes were change in adiposity (body mass and body mass index [BMI] z-score) and adverse events. Two reviewers screened studies and one reviewer extracted and another verified data. Two reviewers assessed methodological quality and reached consensus. Data were synthesized narratively.ResultsWe included seven Cochrane reviews published between 2011 and 2017 containing evidence from 167 randomized controlled trials with 21,050 participants. Lifestyle and behavioural interventions more effectively reduced weight compared with no intervention, usual care, or another behavioural treatment (three reviews, low-to-moderate certainty). Parent–child lifestyle and behavioural interventions more effectively reduced BMI z-score compared with no intervention (one review, low certainty). Decision support tools for healthcare providers more effectively limited increases in BMI z-score compared with usual care (one review, moderate certainty). Pharmacologic treatments combined with behavioural modification more effectively reduced adiposity compared with placebo or usual care (one review, low certainty), but the risk of adverse events was greater than non-pharmacologic therapy. Surgical interventions (e.g., LAP-BAND) combined with behavioural modification more effectively reduced adiposity compared with behavioural modification alone (one review, low certainty). Those who underwent surgery reported a higher number of adverse events compared with those treated with lifestyle modification.ConclusionsThere is low-certainty evidence that lifestyle and behavioural interventions, pharmacologic interventions, and surgical interventions are effective in weight management for children with overweight and obesity. Safety data remain lacking across all intervention modalities. Future research should focus on implementation strategies. Further, a focus on overall well-being may be more beneficial than weight management specifically.     

儿童肥胖症与肠道菌群相关性的研究进展

近年越来越多的研究发现肠道菌群与肥胖症的发生发展密切相关。肠道菌群可能通过增加能量摄取、影响肠道激素分泌、引起慢性系统炎症、产生胰岛素抵抗等对儿童肥胖症产生作用。该文对儿童肥胖症与肠道菌群相关性和可能的机制进行综述,以期为儿童肥胖症的病因和防治提供参考依据。     

Assessment of child and adolescent overweight and obesity

Accurate appropriate assessment of overweight and obesity in children and adolescents is a critical aspect of contemporary medical care. However, physicians and other health care professionals may find this a somewhat thorny field to enter. The BMI has become the standard as a reliable indicator of overweight and obesity. The BMI is incomplete, however, without consideration of the complex behavioral factors that influence obesity. Because of limited time and resources, clinicians need to have quick, evidence-based interventions that can help patients and their families recognize the importance of reducing overweight and obesity and take action. In an era of fast food, computers, and DVDs, it is not easy to persuade patients to modify their diets and to become more physically active. Because research concerning effective assessment of childhood obesity contains many gaps, this report is intended to provide a comprehensive approach to assessment and to present the evidence available to support key aspects of assessment. The discussion and recommendations are based on >300 studies published since 1995, which examined an array of assessment tools. With this information, clinicians should find themselves better equipped to face the challenges of assessing childhood overweight and obesity accurately.     

The outcome of childhood obesity management depends highly upon patient compliance

Over the last 20 years, obesity in childhood and adolescence has become a major public health concern due to dramatically increasing prevalence rates. We evaluated the outcome of 294 children (135 girls, 159 boys) aged 6–16 years (median 10.9 years) enrolled in a single centre outpatient obesity intervention programme consisting of periodical visits to the outpatient unit with regular medical and dietetic counselling aiming at a modification of dietary and activity patterns of patients and parents. The average number of visits to the outpatient unit was 3.6 (SD 2.7) with a mean visit interval of 62.1 days. A mean drop-out rate of 27.5% between each scheduled appointment occurred. In a stepwise regression model, neither reduction of the standard deviation score of patients body mass index (BMI-SDS) nor dietary counselling contributed to the total number of visits. The only significant contributor was the patients initial BMI-SDS explaining 4.6% of the variance of attended visits adjusted for age and sex. Segregation of the patients into an obesity (initial BMI-SDS 90th percentile, at least three visits attended, n =59) and an excessive obesity (initial BMI-SDS 99th percentile, at least four visits attended, n =75) subgroup showed a mean reduction of BMI-SDS in the obesity group at visit three of 0.14 (SD 0.21, P <0.0001), and in the excessive obese group at visit four of 0.17 (SD 0.22, P <0.001). In a stepwise regression model, the mean interval between visits and regular dietary counselling explained 11.7% of the variance of BMI-SDS reduction at visit three in both subgroups. Conclusion: there is an urgent need for efficient strategies to improve adherence of outpatients to obesity treatment since, in terms of reduction in body mass index standard deviation score, a beneficial outcome can be achieved for compliant obese children and adolescents.Abbreviations BMI body mass index - BMI-SDS body mass index standard deviation score     

Regional, socioeconomic and urban-rural disparities in child and adolescent obesity in China: a multilevel analysis

Aim: To study socio‐demographic patterns of obesity in Chinese children and adolescents. Methods: Data came from the 2005 cycle of the Chinese National Survey on Student’s Constitution and Health. In all, 231 326 subjects aged 7–18 years, distributed across 622 schools and 30 provinces, were analysed. Multilevel modelling was used to estimate variations at individual, school area and province levels. Results: The prevalence of obesity varied enormously across different areas. Young people living in high socioeconomic and urban areas had higher body mass index (BMI) and higher odds of overweight and obesity than those living in lower socioeconomic and rural areas. Subjects living in provinces with a higher standard of living, as indicated by less perinatal mortality, lower Engel coefficient, and higher personal expenditure on health had higher BMI and higher odds of overweight and obesity than those living in less affluent provinces. An interaction between gender and urbanicity revealed that boys in urban areas were especially prone to obesity. Conclusion: In contrast to most present‐day high income countries, obesity among young people in China is associated with affluence and urban residence. Intervention and strategy for obesity prevention should be targeting high socioeconomic families in urban areas, perhaps with particular focus on boys.