Psychiatric News October 1, 2004
Volume 39 Number 19
© 2004 American Psychiatric Association
p. 33
MH Problems Common In Obese Youngsters
Joan Arehart-Treichel
Childhood and adolescent obesity is one of America's most serious health
crises. In recent years there has been an upsurge in research on the
psychological problems associated with it.
American youth are getting heavier, according to a spate of media reports.
And French youngsters are developing weight problems as well, French
television has pointed out.
And a new French study suggests that being obese has an adverse
psychological impact on young people. Obese youth suffer especially from
anxiety disorders including separation anxiety and social phobia, the study
found.
The study was headed by Gilbert Vila, M.D., Ph.D., a child psychiatrist
affiliated with the Hôpital Necker-Enfants Malades in Paris and
published in the May/June Psychosomatic Medicine.
Scientific interest in the psyches of overweight children and teens harks
back to at least 1940. Since then, various studies have come up with different
insights into the subject. A study conducted at the University of Medicine and
Dentistry of New Jersey, for example, found that obese girls aged 13 and 14
are four times more likely to experience low self-esteem than nonobese girls
are. A University of Minnesota investigation revealed that children who were
teased about being overweight were likely to have a poor body image, low
self-esteem, and symptoms of depression.
Standardized Tools Rarely Used
However, few investigators exploring the psychology of overweight youth
have used standardized diagnostic tools or control groups. So Vila and his
colleagues used a validated diagnostic interview instrument and
DSM-IV criteria. They also decided to compare the psychological
status of overweight youngsters with that of young people who have
insulin-dependent diabetes, a somatic illness that produces considerable
stress.
Their study included 155 obese youngsters aged 5 to 17 (average age was
11), as well as 171 insulin-dependent diabetic children aged 5 to 18 (average
age was 13).
Obesity was defined by comparing subjects' body mass index with the ideal
body mass index of the general population, matched for gender and age.
The obese youngsters were consecutively recruited outpatients in the
department of pediatric nutrition at Hôpital Necker-Enfants Malades in
Paris. The diabetic children were serially recruited from the pediatric
diabetes unit at the hospital. Obese subjects were assessed psychologically
with a semistructured interview, the Kiddie Schedule for Affective Disorders
and Schizophrenia (K-SADS R), and with two self-reports—the State and
Trait Anxiety Inventory for Children and the Child Depression Inventory.
Diabetic subjects were assessed with the two self-reports.
Majority Have Psychiatric Diagnosis
The K-SADS R revealed that 58 percent of the obese subjects had a
DSM-IV psychiatric diagnosis. (In contrast, French epidemiological
data based on a community sample of school-aged children indicated a
prevalence of mental disorders of only 5 percent in the general
population.)
The most common DSM-IV psychiatric diagnosis the obese subjects
received was an anxiety disorder—about one-third had one. The most
prevalent were social phobia, generalized anxiety disorder, and separation
anxiety disorder. In contrast, only 12 percent had a DSM-IV
depressive disorder.
Analysis of the self-report questionnaires also revealed that about 50
percent of obese subjects met DSM-IV criteria for anxiety or
depression.
Diabetics Show Less Anxiety
When the self-report questionnaires of the obese subjects were compared
with those of the diabetic subjects, the former were found to have
significantly higher anxiety scores, but not significantly higher depression
scores.
As for why anxiety emerged as the most serious psychological problem for
obese youth, Vila and his colleagues suggested that since society tends to
look down on overweight young people, such stigma might prompt them to avoid
social contact and fear criticism. Depression may have ranked less serious as
a problem for the obese youth in the study perhaps because they were young and
had not yet experienced multiple failures at losing weight as so many obese
adults do.
The researchers concluded that obesity in youngsters "is a
significant source of stress that may contribute to the development of
psychological disorders and to the maintenance of obesity."
An abstract of the study, "Mental Disorders in Obese Children
and Adolescents," is posted online at
<www.psychosomaticmedicine.org/cgi/content/abstract/66/3/387>.
Psychosom Med 2004 66 387[Abstract/Free Full Text]
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