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

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.

Stress Management as an Effective Complementary Therapeutic Strategy for Weight Loss in Children and Adolescents with Obesity: A Systematic Review of Randomized Controlled Trials

“…Cognitive behavioral therapy (CBT) is a theoretically based treatment approach that emphasizes the process of changing habits and attitudes that maintain psychological disorders and could be an appropriate treatment approach to obesity [49]. More specifically, CBT recognizes that cognition, feelings, and behaviors are interrelated and utilizes techniques involving motivational enhancement, goal setting, problem solving, and knowledge/skill acquisition that can facilitate sustainable behavior changes [50]. Mindfulness-based cognitive therapy (MBCT) is an adaptation that incorporates elements of CBT with mindfulness-based stress reduction, aiming to teach those at high risk of depressive relapse to stay well through learned skills [21,51].…”

Treatment of Pediatric Overweight and Obesity: Position of the Academy of Nutrition and Dietetics Based on an Umbrella Review of Systematic Reviews

“…Mental health screening and tracking. Mental health concerns among children and adolescents with overweight and obesity, such as depression, anxiety, disordered eating behaviors, body shape concerns, and low self-esteem, [77][78][79][80][81] underscore the need to screen for and address psychological comorbidities when providing overweight and obesity treatment. An SR and meta-analysis representing more than 143,000 children and adolescents found 10.4% of youth with obesity had depression.…”

A novel model of obesity prediction: Neurobehaviors as targets for treatment.

“…Our lab has successfully utilized episodic future thinking, which directly targets DD through the vivid imagining of positive future events, to decrease the demand for food in a hypothetical food purchasing task (Sze et al, 2017), and we are currently using this strategy to improve health behaviors in individuals with type 2 diabetes. Additionally, cognitive-behavioral therapy, which targets mood regulation and self-evaluation, has been recommended as a treatment for obesity and has been shown effective for improving eating behaviors, sustained weight loss, and psychological improvement in individuals with obesity (Braet et al, 2004; Cheroutre et al, 2020; Cooper et al, 2003; Kang & Kwack, 2020; Pekkarinen et al, 1996). We hypothesize that an interventional approach combining episodic future thinking with cognitive-behavioral therapy or other strategies known to improve mood and self-image may be excellent strategies for tackling obesity.…”