Rates of psychiatric disorders in a clinical study group of adolescents with extreme obesity and in obese adolescents ascertained via a population based study

Abstract

OBJECTIVE: To compare rates of DSM-IV psychiatric disorders between (1) a clinical study group of extremely obese adolescents and young adults, (2) gender-matched population-based obese controls and (3) a population-based control group of the same age range. DESIGN: Rates of psychiatric disorders were assessed in (1) the clinical study group of obese adolescents and (2) the population based sample of obese adolescents, and compared to (3) a large population-based control group using a standardized psychiatric interview. SUBJECTS: (1) Clinical study group: 30 female and 17 male extremely obese adolescents and young adults (age range: 15 ± 21 y; mean BMI : 42.4 kgam 2 ). (2) Thirty females and 17 males with the highest BMI (age range 15 ± 21 y; mean BMI : 29.8 kgam 2 ) of a population-based control group encompassing 1655 (805 males) adolescents and young adults. (3) The population based control group excluding the 30 females and 17 males with the highest BMI (n 1608; 788 males). MEASUREMENTS: Munich-Composite International Diagnostic Interview (M-CIDI) allowing for DSM-IV diagnoses. RESULTS: High rates of mood, anxiety, somatoform and eating disorders were detected in the clinical sample of obese adolescents which exceeded those observed in population controls (all P-values`0.01). Rates between populationbased obese adolescents and young adults and population controls did not differ. In most patients the psychiatric disorders set in after onset of obesity. 57% and 35% of the female and male patients, respectively, reported eating binges with lack of control. However, less than one-half of these patients quali®ed for a DSM-IV diagnosis of an eating disorder. CONCLUSIONS: Extremely obese adolescents and young adults who seek long-term inpatient treatment have a high lifetime prevalence for affective, anxiety, somatoform and eating disorders. Because the mean BMI of the clinical study group was considerably higher than that of the obese population controls, we were not able to clarify whether the high rate of psychopathology in the study group was related to the extreme obesity or to their treatment-seeking behavior.

Efficacy of exercise for treating overweight in children and adolescents: a systematic review

“…Future studies will contribute to the urgently needed empirical knowledge base in this field if they: (1) use precise techniques in the assessment of body composition, (2) choose well-defined, robust, single modality exercise treatments, (3) measure changes in energy balance (i.e., caloric intake and caloric expenditure), (4) monitor intervention compliance (both attendance and dose), (5) follow the CONSORT guidelines for reporting RCTs, 103 (6) include long-term interventions and follow-up (at least 12 months), (7) use stratified randomization procedures to minimize between-group differences in age, pubertal status, gender and overweight outcomes at baseline, (8) include factorial studies of exercise alone and in combination with multimodal treatments (individual and family behavioral/dietary/ physical activity interventions), (9) measure clinical correlates associated with obesity during exercise treatments (e.g., components of the 'metabolic syndrome,' C-reactive protein, self-efficacy for physical activity, sleep apnea), and (10) conduct cost-effectiveness analyses to compare economic benefits of exercise treatments with other therapeutic modalities.…”

“…For example, between-group differences at baseline were substantial in most studies, such as 3.2 and 7.5% in two DXA studies for percent body fat, 29,65 6.3% in one hydrodensitometry study for percent body fat, 68 12.2 and 15.3% in two studies for percent over ideal body weight, 64 while differences of 2.8 and 1.5 kg/m 2 were found in two studies for body mass index, 64,70 and there was a mean (7s.d.) difference between groups of 7.5 (73.1) kg across six studies for body weight.…”

“…[1][2][3][4][5] In adults, the morbidity and mortality burden of obesity is well documented. Of major concern is the growing body of evidence reporting overweight-related morbidity in childhood and adolescence, both in the psychosocial [6][7][8] and physiological domain. [9][10][11][12][13][14] Recently, the prevalence of 'metabolic syndrome' was reported to be 39 and 50% in moderate and severely obese children and adolescents, respectively, indicating higher morbidity burden with greater obesity severity.…”

Psychiatric disorders and symptom severity in referred versus non-referred overweight children and adolescents

“…However, in research on overweight in youth, structured clinical interviews, currently seen as the Ôgold standard' for the assessment of psychiatric disorders [9], are rarely included. With the M-CIDI, Britz and colleagues [7] obtained lifetime psychiatric diagnoses in 33 out of 47 obese adolescents (15-21 years) referred for overweight treatment. Vila et al [46] interviewed 155 referred obese youngsters (5-17 years) using the K-SADS-R and demonstrated current mental disorders in 56.77% of the sample.…”

“…Parents of overweight youngsters referred to an obesity clinic report more symptoms of internalizing and externalizing problems in their children as compared to parents of non-referred overweight youngsters [5,14]. In the Britz et al study [7] a gender-matched sample of non-referred obese youngsters was composed by selecting the 47 heaviest adolescents from a large population-based control group. Referred obese youngsters displayed significantly more diagnoses of mood (42.55% vs. 17.02%), anxiety (40.43% vs. 21.28%) and somatoform (14.89% vs. 0.00%) disorders.…”