Pediatric Gastroenterology, Hepatology & Nutrition

The Korean Society of Pediatric Gastroenterology, Hepatology and Nutrition (대한소아소화기영양학회)
권호 표지
DOI QR코드

DOI QR Code

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

  • Kang, Na Ri (Department of Psychiatry, Jeju National University School of Medicine) ;
  • Kwack, Young Sook (Department of Psychiatry, Jeju National University School of Medicine)
  • Received : 2019.12.20
  • Accepted : 2019.12.26
  • Published : 2020.01.15
Download PDF
⟨ Previous Next ⟩

Abstract

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.

Keywords

References

  1. Ogden CL, Carroll MD, Kit BK, Flegal KM. Prevalence of childhood and adult obesity in the United States, 2011-2012. JAMA 2014;311:806-14. https://doi.org/10.1001/jama.2014.732
  2. Shan XY, Xi B, Cheng H, Hou DQ, Wang Y, Mi J. Prevalence and behavioral risk factors of overweight and obesity among children aged 2-18 in Beijing, China. Int J Pediatr Obes 2010;5:383-9. https://doi.org/10.3109/17477160903572001
  3. Kang KS. Nutritional counseling for obese children with obesity-related metabolic abnormalities in Korea. Pediatr Gastroenterol Hepatol Nutr 2017;20:71-8. https://doi.org/10.5223/pghn.2017.20.2.71
  4. Sharma V, Coleman S, Nixon J, Sharples L, Hamilton-Shield J, Rutter H, et al. A systematic review and meta-analysis estimating the population prevalence of comorbidities in children and adolescents aged 5 to 18 years. Obes Rev 2019;20:1341-9. https://doi.org/10.1111/obr.12904
  5. Sagar R, Gupta T. Psychological aspects of obesity in children and adolescents. Indian J Pediatr 2018;85:554-9. https://doi.org/10.1007/s12098-017-2539-2
  6. Mustillo S, Worthman C, Erkanli A, Keeler G, Angold A, Costello EJ. Obesity and psychiatric disorder: developmental trajectories. Pediatrics 2003;111 (4 Pt 1):851-9. https://doi.org/10.1542/peds.111.4.851
  7. Sawyer MG, Harchak T, Wake M, Lynch J. Four-year prospective study of BMI and mental health problems in young children. Pediatrics 2011;128:677-84. https://doi.org/10.1542/peds.2010-3132
  8. Yi DY, Kim SC, Lee JH, Lee EH, Kim JY, Kim YJ, et al. Clinical practice guideline for the diagnosis and treatment of pediatric obesity: recommendations from the Committee on Pediatric Obesity of the Korean Society of Pediatric Gastroenterology Hepatology and Nutrition. Korean J Pediatr 2019;62:3-21. https://doi.org/10.3345/kjp.2018.07360
  9. Luppino FS, de Wit LM, Bouvy PF, Stijnen T, Cuijpers P, Penninx BW, et al. Overweight, obesity, and depression: a systematic review and meta-analysis of longitudinal studies. Arch Gen Psychiatry 2010;67:220-9. https://doi.org/10.1001/archgenpsychiatry.2010.2
  10. Abou Abbas L, Salameh P, Nasser W, Nasser Z, Godin I. Obesity and symptoms of depression among adults in selected countries of the Middle East: a systematic review and meta-analysis. Clin Obes 2015;5:2-11. https://doi.org/10.1111/cob.12082
  11. Roberts RE, Duong HT. Obese youths are not more likely to become depressed, but depressed youths are more likely to become obese. Psychol Med 2013;43:2143-51. https://doi.org/10.1017/S0033291712002991
  12. Burke NL, Storch EA. A meta-analysis of weight status and anxiety in children and adolescents. J Dev Behav Pediatr 2015;36:133-45. https://doi.org/10.1097/dbp.0000000000000143
  13. Roohafza H, Kelishadi R, Sadeghi M, Hashemipour M, Pourmoghaddas A, Khani A. Are obese adolescents more depressed? J Educ Health Promot 2014;3:74.
  14. Whitaker BN, Fisher PL, Jambhekar S, Com G, Razzaq S, Thompson JE, et al. Impact of degree of obesity on sleep, quality of life, and depression in youth. J Pediatr Health Care 2018;32:e37-44. https://doi.org/10.1016/j.pedhc.2017.09.008
  15. Lamertz CM, Jacobi C, Yassouridis A, Arnold K, Henkel AW. Are obese adolescents and young adults at higher risk for mental disorders? A community survey. Obes Res 2002;10:1152-60. https://doi.org/10.1038/oby.2002.156
  16. Mannan M, Mamun A, Doi S, Clavarino A. Prospective associations between depression and obesity for adolescent males and females- a systematic review and meta-analysis of longitudinal studies. PLoS One 2016;11:e0157240. https://doi.org/10.1371/journal.pone.0157240
  17. Quek YH, Tam WWS, Zhang MWB, Ho RCM. Exploring the association between childhood and adolescent obesity and depression: a meta-analysis. Obes Rev 2017;18:742-54. https://doi.org/10.1111/obr.12535
  18. Esposito M, Gallai B, Roccella M, Marotta R, Lavano F, Lavano SM, et al. Anxiety and depression levels in prepubertal obese children: a case-control study. Neuropsychiatr Dis Treat 2014;10:1897-902. https://doi.org/10.2147/ndt.s69795
  19. Sheinbein DH, Stein RI, Hayes JF, Brown ML, Balantekin KN, Conlon RPK, et al. Factors associated with depression and anxiety symptoms among children seeking treatment for obesity: a social-ecological approach. Pediatr Obes 2019;14:e12518.
  20. Wang S, Sun Q, Zhai L, Bai Y, Wei W, Jia L. 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. Int J Environ Res Public Health 2019;16:E340.
  21. Reeves GM, Postolache TT, Snitker S. Childhood obesity and depression: connection between these growing problems in growing children. Int J Child Health Hum Dev 2008;1:103-14.
  22. Anderson SE, Cohen P, Naumova EN, Jacques PF, Must A. Adolescent obesity and risk for subsequent major depressive disorder and anxiety disorder: prospective evidence. Psychosom Med 2007;69:740-7. https://doi.org/10.1097/PSY.0b013e31815580b4
  23. Sanderson K, Patton GC, McKercher C, Dwyer T, Venn AJ. Overweight and obesity in childhood and risk of mental disorder: a 20-year cohort study. Aust N Z J Psychiatry 2011;45:384-92. https://doi.org/10.3109/00048674.2011.570309
  24. Rancourt D, McCullough MB. Overlap in eating disorders and obesity in adolescence. Curr Diab Rep 2015;15:78. https://doi.org/10.1007/s11892-015-0645-y
  25. Smink FR, van Hoeken D, Hoek HW. Epidemiology of eating disorders: incidence, prevalence and mortality rates. Curr Psychiatry Rep 2012;14:406-14. https://doi.org/10.1007/s11920-012-0282-y
  26. Veses AM, Martinez-Gomez D, Gomez-Martinez S, Vicente-Rodriguez G, Castillo R, Ortega FB, et al.; AVENA; AFINOS Study Groups. Physical fitness, overweight and the risk of eating disorders in adolescents. The AVENA and AFINOS studies. Pediatr Obes 2014;9:1-9. https://doi.org/10.1111/j.2047-6310.2012.00138.x
  27. Pasold TL, McCracken A, Ward-Begnoche WL. Binge eating in obese adolescents: emotional and behavioral characteristics and impact on health-related quality of life. Clin Child Psychol Psychiatry 2014;19:299-312. https://doi.org/10.1177/1359104513488605
  28. Carriere C, Michel G, Feart C, Pellay H, Onorato O, Barat P, et al. Relationships between emotional disorders, personality dimensions, and binge eating disorder in French obese adolescents. Arch Pediatr 2019;26:138-44. https://doi.org/10.1016/j.arcped.2019.02.008
  29. Decaluwe V, Braet C, Fairburn CG. Binge eating in obese children and adolescents. Int J Eat Disord 2003;33:78-84. https://doi.org/10.1002/eat.10110
  30. Brechan I, Kvalem IL. Relationship between body dissatisfaction and disordered eating: mediating role of self-esteem and depression. Eat Behav 2015;17:49-58. https://doi.org/10.1016/j.eatbeh.2014.12.008
  31. Byrne ME, LeMay-Russell S, Tanofsky-Kraff M. Loss-of-control eating and obesity among children and adolescents. Curr Obes Rep 2019;8:33-42. https://doi.org/10.1007/s13679-019-0327-1
  32. Barlow SE; Expert Committee. Expert committee recommendations regarding the prevention, assessment, and treatment of child and adolescent overweight and obesity: summary report. Pediatrics 2007;120 Suppl 4:S164-92. https://doi.org/10.1542/peds.2007-2329C
  33. Sonmez AO, Yavuz BG, Aka S, Semiz S. Attention-deficit hyperactivity disorder symptoms and conduct problems in children and adolescents with obesity. The Medical Bulletin of SISLI ETFAL Hospital 2019;53:300-05.
  34. Cortese S, Moreira-Maia CR, St Fleur D, Morcillo-Penalver C, Rohde LA, Faraone SV. Association between ADHD and obesity: a systematic review and meta-analysis. Am J Psychiatry 2016;173:34-43. https://doi.org/10.1176/appi.ajp.2015.15020266
  35. Erhart M, Herpertz-Dahlmann B, Wille N, Sawitzky-Rose B, Holling H, Ravens-Sieberer U. Examining the relationship between attention-deficit/hyperactivity disorder and overweight in children and adolescents. Eur Child Adolesc Psychiatry 2012;21:39-49. https://doi.org/10.1007/s00787-011-0230-0
  36. Leib S, Gilon Mann T, Stein D, Vusiker I, Tokatly Latzer I, Ben-Ami M, et al. High prevalence of attention-deficit/hyperactivity disorder in adolescents with severe obesity seeking bariatric surgery. Acta Paediatr 2019. doi: 10.1111/apa.15039. [Epub ahead of print].
  37. Martins-Silva T, Vaz JDS, Hutz MH, Salatino-Oliveira A, Genro JP, Hartwig FP, et al. Assessing causality in the association between attention-deficit/hyperactivity disorder and obesity: a Mendelian randomization study. Int J Obes (Lond) 2019;43:2500-8. https://doi.org/10.1038/s41366-019-0346-8
  38. Kalarchian MA, Marcus MD. Psychiatric comorbidity of childhood obesity. Int Rev Psychiatry 2012;24:241-6. https://doi.org/10.3109/09540261.2012.678818
  39. Halfon N, Larson K, Slusser W. Associations between obesity and comorbid mental health, developmental, and physical health conditions in a nationally representative sample of US children aged 10 to 17. Acad Pediatr 2013;13:6-13. https://doi.org/10.1016/j.acap.2012.10.007
  40. Rupp K, McCoy SM. Bullying perpetration and victimization among adolescents with overweight and obesity in a nationally representative sample. Child Obes 2019;15:323-30. https://doi.org/10.1089/chi.2018.0233
  41. Koyanagi A, Veronese N, Vancampfort D, Stickley A, Jackson SE, Oh H, et al. Association of bullying victimization with overweight and obesity among adolescents from 41 low- and middle-income countries. Pediatr Obes 2020;15:e12571.
  42. Pont SJ, Puhl R, Cook SR, Slusser W. Section on Obesity; Obesity Society. Stigma experienced by children and adolescents with obesity. Pediatrics 2017;140:e20173034. https://doi.org/10.1542/peds.2017-3034
  43. Amaya-Hernandez A, Ortega-Luyando M, Bautista-Diaz ML, Alvarez-Rayon GL, Mancilla-Diaz JM. Children with obesity: peer influence as a predictor of body dissatisfaction. Eat Weight Disord 2019;24:121-7. https://doi.org/10.1007/s40519-017-0374-0
  44. Gouveia MJ, Frontini R, Canavarro MC, Moreira H. Quality of life and psychological functioning in pediatric obesity: the role of body image dissatisfaction between girls and boys of different ages. Qual Life Res 2014;23:2629-38. https://doi.org/10.1007/s11136-014-0711-y
  45. Phan TT, Chen FF, Pinto AT, Cox C, Robbins J, Kazak AE. Impact of psychosocial risk on outcomes among families seeking treatment for obesity. J Pediatr 2018;198:110-6. https://doi.org/10.1016/j.jpeds.2018.02.071
  46. World Health Organization. Report of the commission on ending childhood obesity. Geneva: World Health Organization, 2016.
  47. Peirson L, Fitzpatrick-Lewis D, Morrison K, Warren R, Usman Ali M, Raina P. Treatment of overweight and obesity in children and youth: a systematic review and meta-analysis. CMAJ Open 2015;3:E35-46. https://doi.org/10.9778/cmajo.20140047
  48. Kamath CC, Vickers KS, Ehrlich A, McGovern L, Johnson J, Singhal V, et al. Clinical review: behavioral interventions to prevent childhood obesity: a systematic review and metaanalyses of randomized trials. J Clin Endocrinol Metab 2008;93:4606-15. https://doi.org/10.1210/jc.2006-2411
  49. Shaw K, O'Rourke P, Del Mar C, Kenardy J. Psychological interventions for overweight or obesity. Cochrane Database Syst Rev 2005;(2):CD003818.
  50. Chu DT, Minh Nguyet NT, Nga VT, Thai Lien NV, Vo DD, Lien N, et al. An update on obesity: Mental consequences and psychological interventions. Diabetes Metab Syndr 2019;13:155-60. https://doi.org/10.1016/j.dsx.2018.07.015
  51. Brennan L, Walkley J, Fraser SF, Greenway K, Wilks R. Motivational interviewing and cognitive behaviour therapy in the treatment of adolescent overweight and obesity: study design and methodology. Contemp Clin Trials 2008;29:359-75. https://doi.org/10.1016/j.cct.2007.09.001
  52. Brennan L, Walkley J, Wilks R, Fraser SF, Greenway K. Physiological and behavioural outcomes of a randomised controlled trial of a cognitive behavioural lifestyle intervention for overweight and obese adolescents. Obes Res Clin Pract 2013;7:e23-41.
  53. Miri SF, Javadi M, Lin CY, Griffiths MD, Bjork M, Pakpour AH. Effectiveness of cognitive-behavioral therapy on nutrition improvement and weight of overweight and obese adolescents: a randomized controlled trial. Diabetes Metab Syndr 2019;13:2190-7. https://doi.org/10.1016/j.dsx.2019.05.010
  54. Banos RM, Oliver E, Navarro J, Vara MD, Cebolla A, Lurbe E, et al. Efficacy of a cognitive and behavioral treatment for childhood obesity supported by the ETIOBE web platform. Psychol Health Med 2019;24:703-13. https://doi.org/10.1080/13548506.2019.1566622
  55. Karbasi Amel A, Karbasi Amel S, Erfan A. Effectiveness of parents-focused cognitive-behavioral therapy on attention deficit hyperactivity disorder symptoms, obesity and self-esteem of overweight children with attention deficient hyperactivity disorder. Adv Biomed Res 2018;7:73. https://doi.org/10.4103/abr.abr_170_17
  56. Jelalian E, Jandasek B, Wolff JC, Seaboyer LM, Jones RN, Spirito A. Cognitive-behavioral therapy plus healthy lifestyle enhancement for depressed, overweight/obese adolescents: results of a pilot trial. J Clin Child Adolesc Psychol 2019;48(sup1):S24-33. https://doi.org/10.1080/15374416.2016.1163705