Comanagement of Pediatric Depression and Obesity: A Clear Need for Evidence

Mihalopoulos, Nicole L.; Spigarelli, Michael G.

doi:10.1016/j.clinthera.2015.08.009

Cited by 5 publications

(4 citation statements)

References 22 publications

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“…In this cross‐sectional study, we demonstrated that more than one‐third of overweight and obese children with elevated blood pressure had concurrent evidence of a MDO, a finding that is well above the overall lifetime prevalence of MDOs in US adolescents (14.3%) . While it is recognized that children with overweight/obesity suffer more from depression and anxiety that is multifactorial in etiology, what was particularly striking in our study was the finding that overweight/obese children with MDOs had 6.3 times greater odds of having hypertension than those without a MDO. Conversely, hypertensive children with overweight/obesity were 2.8 times more likely to have a MDO than normotensive children with overweight/obesity.…”

Section: Discussionsupporting

confidence: 45%

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Association of mood disorders with cardiovascular disease risk factors in overweight and obese youth with elevated blood pressure

Medrano

Amatya

Vizthum

et al. 2018

J of Clinical Hypertension

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In 2015, the American Heart Association released a statement describing mood disorders (MDO) in youth, specifically major depressive disorder (MDD) and bipolar disorder (BPD), as tier-II moderate-risk conditions predisposing to cardiovascular disease (CVD). We therefore sought to determine the prevalence of MDO among a high-risk population of children with overweight/obesity and a history of at least one elevated blood pressure (BP). We also aimed to determine if, among children with overweight and obesity, the presence of MDO was associated with modifiable risk factors such as macro and micronutrient intake, and if MDO could predict comorbid CVD risk factors, specifically hypertension and LVH. ; OR 1.13, P = .88). Overall, the prevalence of MDOs in this group of overweight/obese children with elevated blood pressure was well above national averages, suggesting that at-risk youth, particularly those with confirmed hypertension, should be regularly screened for MDOs.

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Section: Discussionsupporting

confidence: 45%

“…Several factors linking MDOs and CVD have been proposed, including unhealthy eating behaviors and macro‐/micro‐nutrient intake, demographic factors, and obesity . However, literature regarding the association of MDO with CVD risk factors and the comanagement of these conditions in youth is limited …”

Section: Introductionmentioning

confidence: 99%

Association of mood disorders with cardiovascular disease risk factors in overweight and obese youth with elevated blood pressure

Medrano

Amatya

Vizthum

et al. 2018

J of Clinical Hypertension

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“…They concluded that priority should be given to correcting this deficiency. 6 The third article, by Mihalopoulos and Spigarelli, 7 reviews the disappointingly scarce literature on comorbid depression in obese adolescents. In many ways adolescents pharmacologically resemble adults more than they do children.…”

mentioning

confidence: 99%

“…Although one of our reviewers of this study felt that adult data for comorbid obesity and depression should have been relied on more for treatment of adolescents, in my view there are many reasons to suspect that adolescents could differ in their response to obesity, to its psychosocial effects, and, perhaps also, to its treatment. It is unfortunate that, as shown by Mihalopoulos and Spigarelli, 7 so little has been done to investigate these questions.…”

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confidence: 99%

Pediatric Obesity

Walson

2015

Clinical Therapeutics

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The divide between those who have and those who do not is most often discussed in terms of personal wealth, but access to food and clean water is equally disparate. Currently, millions of children routinely go to bed hungry. Most of these children live in the developing world, but in the United States "over 15 million children live in food insecure households." 1 Although undernutrition is equally or perhaps even more important, the focus of this issue of Clinical Therapeutics is on the effects of overnutrition, that is, pediatric obesity. Although millions of children in the world are starving, the number of obese and morbidly obese US children continues to increase at epidemic rates. 2 There are more than twice as many children and up to 4 times as many obese adolescents than there were 30 years ago, and in 2012 as many as 1 in 3 children and adolescents was overweight or obese. Although somewhat less rapidly, this increase is also occurring in many other "developed" countries. 3 The causes, consequences, prevention, and treatment of pediatric obesity are the subject of numerous studies, interventions, and publications. For example, a recent PubMed search that used the terms "obesity AND pediatric OR paediatric" yielded 353,167 hits. The first 2 articles in this issue discuss the implications of obesity on dosing medications in children. The first, by Kendrick et al, 4 is an update of a review of medication dosing in obese children. Such an update seemed desirable on the basis of the increase in interest in this topic, including an article by Le et al, 5 also published in the journal, that used Bayesian estimation to show that actual weight and allometric weight (weight to the 0.75 power) can both be used to estimate V d and CL of vancomycin in obese children. Both V d and CL were slightly lower than found in nonobese control children, and the authors felt the estimates "were unlikely to be clinically relevant." 5 As Kendrick et al 4 describe, this is not true for the effects of obesity on dosing of some medications, especially medications for which, unlike vancomycin, dosing is not routinely adjusted on the basis of therapeutic drug-monitoring results. The review by Kendrick et al 4 concluded that there is limited, often suboptimal, data available on dosing of obese pediatric patients, making it necessary to extrapolate from data in obese adults. The second article, by Rowe et al, 6 suggests that this approach is seldom likely to be useful. The article by Rowe et al 6 focuses on the gaps in knowledge about dosing of acute care medications in obese children. These authors selected 25 acute care drugs from the Strategic National Stockpile and the Acute Care Supportive Drugs List. They found a major difference (8% vs 88%, respectively) of these drugs had information in their labels on dosing of obese children versus obese adults. They were also able to find sufficient published PK data to dose obese adults with only 3 of 25 drugs (12%), but published PK data adequate to dose obese children was unavailable to all ...

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