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Are balance and quality of life impaired in children who are obese?
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Abstracts / Appetite 76 (2014) 197–215
Early psychopathology of obesity. A study with preschoolers and their parents. A. EK a, J. HEDMAN b, C. MARCUS a, P. NOWICKA a,c. a Division of Pediatrics, Department of Clinical Sciences, Intervention and Technology (CLINTEC), Karolinska Institutet Huddinge, B62, 141 86 Stockholm, Sweden, b Department of Public Health Sciences, Karolinska Institute, Stockholm, Sweden, c Unit for Biocultural Variation and Obesity, School of Anthropology and Museum Ethnography, University of Oxford, Oxford, UK. [email protected] While increased levels of depression and symptoms of ADHD have been reported in older children with obesity, not much is known on the prevalence of early psychopathology in obese children as young as four. Parents’ to 4–6 year old children (n = 28, mean age 4.9 yrs, 50% boys) with obesity (mean BMI SDS 3.0), participating in a treatment study, filled out the Child Behaviour Checklist for ages 1.5–5, measuring the child’s emotional, social and behavioural problems. The parents also filled out the Beck Depression Inventory Second Edition (BDI-II), measuring parents’ degree of depression. Children’s levels of problematic behaviour symptoms were compared to Swedish and Danish reference populations. The total score of problem behaviours in this clinical sample was 30.6 (SD 20.3), compared to 22.3 (15.4) for Sweden and 16.1 (15.0) for Denmark. Obese children had higher scores on the following subscales: externalizing, internalizing, affective problems, anxiety, attention and depression. They were more withdrawn and had more sleep problems than their normal weight peers. Mothers’ scores on BDI-II were positively correlated with the children’s scores on the total problem scale and on the externalizing problem subscale (p > 0.000). The results were adjusted for child’s age at the onset of obesity as well as parent’s ethnicity. The high prevalence of psychological problems as early in life needs to be confirmed in larger samples. http://dx.doi.org/10.1016/j.appet.2014.01.017
Restrictive feeding and child weight. Evidence for a bi-directional association in preschool children. P.W. JANSEN a,b, V.W.V. JADDOE a, A. HOFMAN a, F.C. VERHULST a, H. TIEMEIER a. a Erasmus Medical Centre, PO Box 2060, 3000 CB Rotterdam, The Netherlands, b Murdoch Children’s Research Institute, Melbourne, Australia. [email protected] Parents’ restriction of food intake has consistently been associated with a higher body mass index (BMI) in children. It is assumed that parental restriction weakens children’s self-regulation, but restriction may also be a parent’s response to child overweight. With few exceptions, studies have not examined this possibility. In longitudinal analyses, we aimed to identify directionality in the restrictive feeding–BMI relationship among preschoolers. BMI was measured among 3478 children in the population-based Generation R Study. Restriction (Child Feeding Questionnaire) was self-reported by parents. Bi-directionality was examined in a path analysis with
Restriction and BMI expressed in standard deviation (SD) scores. Path analysis jointly estimating Restriction–BMI associations in both directions and accounting for continuity in BMI over time indicated that a higher BMI at age 2 years was associated with more restriction at age 4 years, which in turn was positively related with child BMI two years later. However, associations were modest, e.g. for each SD increase in Restriction, child BMIz increased by 0.07 (95% CI: 0.04, 0.10). The relation from BMI to parenting was stronger than reverse (Wald test for comparison: p-value = 0.03). Our results imply a bi-directional relation between restrictive feeding and child BMI. This suggests that, in contrast to school-age children, among preschoolers a cyclical relationship may appear: the main direction of effect was parents responding to high child weight by restriction of food intake, while excessive restriction may also have a small counterproductive effect resulting in overeating and adiposity. http://dx.doi.org/10.1016/j.appet.2014.01.018
Are balance and quality of life impaired in children who are obese? G. O’MALLEY, S. KILLEEEN, S. MURPHY. Weight Management Service, Temple Street Children’s University Hospital, Dublin 1, Ireland. [email protected] Children who are obese have impaired physical fitness. Balance and coordination are key parameters of fitness and when impaired can lead to falls and musculoskeletal injury. The aim was to investigate whether children who are obese have impaired balance and to explore whether balance impairment is associated with quality of life. Children were recruited from an obesity clinic and were classified as Class 1 (C1) obese (BMI SDS 2.0–2.49) or Class 2 (C2) obese (BMI SDS > 2.5). Balance was measured using the BOT-II. Based on age-adjusted norms, children were classified as having a balance impairment. Quality of life was assessed using the PedsQL. A general linear model compared the differences in balance between C1 and C2 with correction for age, gender and musculokeletal injury. A t-test compared quality of life between children with and without balance impairment. Eighty-seven children (11.15 ± 2.7 years) who were obese (mean BMI SDS = 2.36 ± 0.32; C1: n = 57) were recruited. Mean balance was 26.52 ± 5.2 out of a maximum of 37. 71.26% Of children had impaired balance (C1 70.18% C1; C2 73.33%). C2 obese children had lower balance scores compared to C1 obese children (F = 5.27; p = 0.02). Mean quality of life was 59.0% ± 19.8% (C1 60.7% ± 19.1; C2 57.44 ± 19.8) and children with balance impairment had lower quality of life (56.43 ± 18.35 versus 66.88 ± 20.68, p = 0.04). Results of our study indicate that balance was impaired in children who were obese and that children with such impairment had a lower quality of life. Results highlight the importance of conducting a physiotherapy assessment in children who are obese. http://dx.doi.org/10.1016/j.appet.2014.01.019
Abstracts / Appetite 76 (2014) 197–215
Early psychopathology of obesity. A study with preschoolers and their parents. A. EK a, J. HEDMAN b, C. MARCUS a, P. NOWICKA a,c. a Division of Pediatrics, Department of Clinical Sciences, Intervention and Technology (CLINTEC), Karolinska Institutet Huddinge, B62, 141 86 Stockholm, Sweden, b Department of Public Health Sciences, Karolinska Institute, Stockholm, Sweden, c Unit for Biocultural Variation and Obesity, School of Anthropology and Museum Ethnography, University of Oxford, Oxford, UK. [email protected] While increased levels of depression and symptoms of ADHD have been reported in older children with obesity, not much is known on the prevalence of early psychopathology in obese children as young as four. Parents’ to 4–6 year old children (n = 28, mean age 4.9 yrs, 50% boys) with obesity (mean BMI SDS 3.0), participating in a treatment study, filled out the Child Behaviour Checklist for ages 1.5–5, measuring the child’s emotional, social and behavioural problems. The parents also filled out the Beck Depression Inventory Second Edition (BDI-II), measuring parents’ degree of depression. Children’s levels of problematic behaviour symptoms were compared to Swedish and Danish reference populations. The total score of problem behaviours in this clinical sample was 30.6 (SD 20.3), compared to 22.3 (15.4) for Sweden and 16.1 (15.0) for Denmark. Obese children had higher scores on the following subscales: externalizing, internalizing, affective problems, anxiety, attention and depression. They were more withdrawn and had more sleep problems than their normal weight peers. Mothers’ scores on BDI-II were positively correlated with the children’s scores on the total problem scale and on the externalizing problem subscale (p > 0.000). The results were adjusted for child’s age at the onset of obesity as well as parent’s ethnicity. The high prevalence of psychological problems as early in life needs to be confirmed in larger samples. http://dx.doi.org/10.1016/j.appet.2014.01.017
Restrictive feeding and child weight. Evidence for a bi-directional association in preschool children. P.W. JANSEN a,b, V.W.V. JADDOE a, A. HOFMAN a, F.C. VERHULST a, H. TIEMEIER a. a Erasmus Medical Centre, PO Box 2060, 3000 CB Rotterdam, The Netherlands, b Murdoch Children’s Research Institute, Melbourne, Australia. [email protected] Parents’ restriction of food intake has consistently been associated with a higher body mass index (BMI) in children. It is assumed that parental restriction weakens children’s self-regulation, but restriction may also be a parent’s response to child overweight. With few exceptions, studies have not examined this possibility. In longitudinal analyses, we aimed to identify directionality in the restrictive feeding–BMI relationship among preschoolers. BMI was measured among 3478 children in the population-based Generation R Study. Restriction (Child Feeding Questionnaire) was self-reported by parents. Bi-directionality was examined in a path analysis with
Restriction and BMI expressed in standard deviation (SD) scores. Path analysis jointly estimating Restriction–BMI associations in both directions and accounting for continuity in BMI over time indicated that a higher BMI at age 2 years was associated with more restriction at age 4 years, which in turn was positively related with child BMI two years later. However, associations were modest, e.g. for each SD increase in Restriction, child BMIz increased by 0.07 (95% CI: 0.04, 0.10). The relation from BMI to parenting was stronger than reverse (Wald test for comparison: p-value = 0.03). Our results imply a bi-directional relation between restrictive feeding and child BMI. This suggests that, in contrast to school-age children, among preschoolers a cyclical relationship may appear: the main direction of effect was parents responding to high child weight by restriction of food intake, while excessive restriction may also have a small counterproductive effect resulting in overeating and adiposity. http://dx.doi.org/10.1016/j.appet.2014.01.018
Are balance and quality of life impaired in children who are obese? G. O’MALLEY, S. KILLEEEN, S. MURPHY. Weight Management Service, Temple Street Children’s University Hospital, Dublin 1, Ireland. [email protected] Children who are obese have impaired physical fitness. Balance and coordination are key parameters of fitness and when impaired can lead to falls and musculoskeletal injury. The aim was to investigate whether children who are obese have impaired balance and to explore whether balance impairment is associated with quality of life. Children were recruited from an obesity clinic and were classified as Class 1 (C1) obese (BMI SDS 2.0–2.49) or Class 2 (C2) obese (BMI SDS > 2.5). Balance was measured using the BOT-II. Based on age-adjusted norms, children were classified as having a balance impairment. Quality of life was assessed using the PedsQL. A general linear model compared the differences in balance between C1 and C2 with correction for age, gender and musculokeletal injury. A t-test compared quality of life between children with and without balance impairment. Eighty-seven children (11.15 ± 2.7 years) who were obese (mean BMI SDS = 2.36 ± 0.32; C1: n = 57) were recruited. Mean balance was 26.52 ± 5.2 out of a maximum of 37. 71.26% Of children had impaired balance (C1 70.18% C1; C2 73.33%). C2 obese children had lower balance scores compared to C1 obese children (F = 5.27; p = 0.02). Mean quality of life was 59.0% ± 19.8% (C1 60.7% ± 19.1; C2 57.44 ± 19.8) and children with balance impairment had lower quality of life (56.43 ± 18.35 versus 66.88 ± 20.68, p = 0.04). Results of our study indicate that balance was impaired in children who were obese and that children with such impairment had a lower quality of life. Results highlight the importance of conducting a physiotherapy assessment in children who are obese. http://dx.doi.org/10.1016/j.appet.2014.01.019