Study: Childhood obesity associated with more depressive symptoms over time
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Key takeaways:
- A higher baseline BMI was associated with more depressive symptoms over time.
- Lower cognitive performance and greater psychopathology at baseline were also associated with increased weight gain.
A higher baseline BMI in children was associated with more depressive symptoms into adolescence, according to research published in JAMA Pediatrics.
“Obesity has been associated with less optimal cognitive performance and more mental health problems in youth,” Tamara S. Hershey, PhD, director of the McDonnell Center for Systems Neuroscience at Washington University School of Medicine in St. Louis, and co-author of the study, told Healio.
“However,” Hershey said, “we do not have a good understanding of which comes first during development. Knowing how obesity, cognition and mental health change over time in children might help identify early intervention targets or explore mechanisms.”
Hershey and colleagues assessed data from the Adolescent Brain Cognitive Development (ABCD) study, an ongoing, NIH-funded, 21-site project that tracks the development of over 12,000 U.S. children over 10 years, beginning at ages 9 to 11 years. Participants receive annual physical and sociocultural, cognitive and psychiatric assessments and undergo brain imaging every 2 years.
“We analyzed ABCD data from the first three time points, excluding those with history of serious medical conditions, diabetes or eating disorders,” Hershey said.
The researchers focused on two questions: How was BMI and waist circumference at age 9 to 11 years associated with cognition and mental health changes over the next 2 years, and how are cognition and mental health at age 9 to 11 years associated with BMI and waist circumference changes over the next 2 years.
“We used rigorous statistical methods to ensure that any results were not due to other variables such as medications, family history of mental health problems, socioeconomic background, etc.,” Hershey said.
The researchers included 5,269 children who had valid cognitive tests, psychiatric surveys and imaging data. They found that although baseline BMI was not associated with longitudinal changes in cognition, lower baseline cognition was overall associated with greater longitudinal BMI gain, with each baseline endorsement of externalizing problems corresponding to 0.015 (2.2%) more annual BMI increases compared with no endorsement.
“At baseline, children who scored lower on cognitive tests and who had more mental health issues, regardless of type, gained more weight over time than those with higher cognition and fewer mental health issues,” Hershey said.
Children who had overweight or obesity at baseline developed significantly more depressive symptoms and depression over time than children with normal weight, with each 1-point BMI increase corresponding to 0.010 (22%) and 0.011 (15%) more problems annually beyond changes at median BMI, the researchers found.
Hershey noted that no relationship was seen between having obesity or overweight at baseline and cognition or other types of mental health issues over time.
“The finding that general mental health and lower cognitive scores were associated with weight gain over time, but overweight/obesity at baseline was associated with greater depression only over time was an interesting contrast,” Hershey said. “These findings may suggest that overweight/obesity presents a risk for depression during development. In contrast, good mental health and cognition may be protective for the development of overweight/obesity.”
Hershey cautioned that the findings were from a large, heterogenous population without significant psychiatric diagnoses.
“We thus were looking at subclinical mental health issues, and we only looked at weight gain, not transition to obesity, over time,” Hershey said. “Thus, we are not saying that children with obesity will eventually have major depressive disorder, or that children who scored lower on a cognitive test will develop obesity. Nevertheless, our findings are still meaningful.”
She said the results highlight the need for adults to monitor mental health — specifically depressive symptoms — in children who already have overweight or obesity, and to be aware that cognition and mental health are important for children's healthy weight development.
Hershey also said she is interested in examining a longer time frame, rather than the three time points across 2 years of this investigation, as well as efforts to understand the “mediating mechanisms.”
“Why is obesity associated with more depressive symptoms over time?” Hershey said. “We mentioned two possible pathways in our article, namely weight-related discrimination and inflammation, but these would need to be investigated further. Understanding modifiable factors that contribute to obesity and mental health issues can help us better intervene and prevent.
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