MH Problems Common In Obese Youngsters
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
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Published online: 1 October 2004
Published in print: October 1, 2004
Notes
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.
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