Abstract
A number of studies have reported significant associations between obesity and poor psychological wellbeing in children but findings have been inconsistent. Methods: This study utilised data from 3,898 children aged 5-16 years obtained from the Health Survey for England 2007. Information was available on Body Mass Index (BMI), parental ratings of child emotional and behavioural health (Strengths and Difficulties Questionnaire), self-reported physical activity levels and sociodemographic variables. A multilevel modelling approach was used to allow for the clustering of children within households. Results: Curvilinear relationships between both internalising (emotional) and externalising (behavioural) symptoms and adjusted BMI were observed. After adjusting for potential confounders the relationships between obesity and psychological adjustment (reported externalising and internalising symptoms) remained statistically significant. Being overweight, rather than obese, had no impact on overall reported mental health. 17% of children with obesity were above the suggested screening threshold for emotional problems, compared to 9% of non-obese children. Allowing for clustering and potential confounding variables children classified as obese had an odds ratio (OR) of 2.13 (95% CI 1.39 to 3.26) for being above the screening threshold for an emotional disorder compared to non-obese young people. No cross-level interactions between household income and the relationships between obesity and internalising or externalising symptoms were observed. Conclusions: In this large, representative, UK-based community sample a curvilinear association with emotional wellbeing was observed for adjusted BMI suggesting the possibility of a threshold effect. Further research could focus on exploring causal relationships and developing targeted interventions.
Highlights
Childhood obesity is a serious health problem in the Western world with evidence of continued high rates [1,2]
The Health Survey for England conducted in 2007 (HSE 2007) was designed to place a special emphasis on information related to childhood obesity and included estimates of psychological adjustment in those under 16 years [31]. This data presented an opportunity to explore the cross-sectional relationship between excess adiposity and mental wellbeing in children and model any association in a more sophisticated way than has previously been reported
It may be that socio-cultural factors are the predominant influence, with children who obviously exceed the normative range of adiposity being at an exponentially increasing risk of adverse experiences, such as peer rejection. In this large and nationally representative cohort there was evidence of a threshold effect of obesity on reported mental wellbeing in children
Summary
Childhood obesity is a serious health problem in the Western world with evidence of continued high rates [1,2]. There are many plausible reasons why excess adiposity may be associated with poor psychological adjustment These include: the impact of obesity on self-esteem and social confidence; the direct effect of hormonal and metabolic changes on brain function [12,13]; the result of changes in dietary behaviour and physical activity levels that can be a consequence of depressed mood [14] or; weight gain secondary to the use of psychiatric medications [15]. The meta-analysis included four studies where the average age at baseline assessment was below 18 years (with follow-up in adulthood). In these cases there was no observed association between overweight at baseline and risk of depression at follow-up. Such studies provide evidence that those experiencing depression during adolescence may be at increased risk of obesity in adulthood [17]
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