Child obesity and depression

Can the increasing condition of obesity in children and adolescence negatively affected their social relations? If so, would it be safe to assume that the stigma of being obese would lead to overweight children having a greater tendency towards depression? It is my intent to describe this growing epidemic as well as to understand the relationship between obesity, social interactions, and depression in children. It is my theory that obesity leads to stigmatized children which in turn increase the predisposition towards depression.
Obesity among children is on the rise. It threatens children’s physical and emotional wellbeing. The Centers for disease control and prevention (2009) show that over the past 20 years, obesity has more than doubled in children age six to 11 from 6.5% in 1980 to 17% in 2006. In children ages 12 to19 this number has more than tripled. This increase is from 5% to 17.6%. Calculations of child obesity were done by figuring body mass index (also known as BMI) which measures weight in relation to height. A child is considered overweight when belonging at or above the 85th percentile and obese when BMI is at or above 95th percentile for children at the same age and height.
What has caused this alarming increase of this epidemic in children? Among the usual reasons as to weight gain include lack of physical activity and poor genetics. Yet, another substantial concern is today’s society is that of deteriorating eating habits. According to the National Health Review (2008) family income affects a child’s inclination to gain weight. Also, low income families tend to eat more filling starchy foods such as rice, bread, cakes (Echwald, 1999). Families with higher income tend to eat more vegetables.According to recent meta-analysis, individuals of low socioeconomic statuses are prone to depression (Johnston, Johnson, McLeod, and Johnston, 2004). Other culprits to consider are the readily available food choices out there that are high in sugar, salt, and fat contents. These foods are accessible everywhere including vending machines, restaurants, and grocery stores. Many unhealthy food products today are also heavily marketed to target young and impressionable minds. With unhealthy family choices and negative food industry influences affecting children’s eating habits, unhealthy eating is common and has become natural to children (Nutrition Health Review, 2008). These conditions, aggravated by the fact that parents often use food as reward, all contribute to this increasing problem of child obesity.
Obesity is not only detrimental to our children’s physical well being; it is also detrimental to their emotional wellbeing. There is a stigma in being obese. This is especially true in industrialized countries where thinness is considered beautiful and the opposite is not (Myers, 2008). Another study found an association between obesity and self esteem in children as well as adolescence (Cited in Lowry et al., 2007). A study conducted in Australia by Hesketh and colleagues (2004) confirmed this. They conducted a three year longitudinal study of children and found that seven year olds with higher BMIs modestly predicted lower self esteem than other peers their age. In children age 11, higher BMIs became a stronger predictor of low self esteem.Yet, self esteem in obese preschool children remain unaffected (Strauss and Pollack, 2003).It is not surprising that overweight female adolescents are more impacted emotionally than their male counterparts. Overweight females often expect to be rejected and go into withdrawal (Monello and Mayer, 1963). Overall, they have found, both sexes experience more occurrence of depressive symptoms than their normal weight peers.
Depression is a mood disorder that goes beyond temporary feelings of sadness ( Papalia, Olds. and Feldman, 2008). Depression affects self esteem and one’s sense of self efficacy. Some of the characteristics of depression are lack of concentration, fatigue, indifference to physical activity, and feelings of worthlessness and friendlessness. Dr. William L. Coleman, a professor of pediatrics at the Center for Development and Learning at the University of North Carolina in Chapel Hill, states that there has been an increase of 15 percent in depression among school-age children over the last five years (Cited in Colino, 2004).
There are other factors that are influencing this negative outlook when it comes to obesity in children. For one there are Ethnic influences involved. For example, 13 to 14 year old White and Hispanic females who are overweight convey lower self esteem issues than their normal weight counterpart. However, 13 to 14 year old African American females regardless of weight did not show a difference in self esteem. This indicates that American Africans may be more accepting of larger body sizes than Whites or Hispanic whose negative view regarding larger set weights explain for the declined self esteem and tendency towards depression of their young children (Lowry et al., 2007).
A link has been found on low self esteem in relation to peer victimization and the lack of social support (Sweeting, Wright, and Minnis, 2005). Peer victimization focuses on appearances and body weight. Obese children are more prone to be negatively affected by negative peer comments and remarks. Overweight kids are seen by other kids as the least desirable of friends. It may be for also this reason why obese children may be prone to be isolated socially and be on the sidelines of social networks. Peer victimization is also one of the causes of depression in obese children and adolescents. It is easy to see how peer victimization on obese children can lead to both self esteem issues as well as depression. Alarmingly, there is a positive correlation between depressive symptoms at age six to nine years of age and being overweight later on in life. (Liem, Sauer, Oldehinkel, and Stolk, 2008).
A study conducted by Strauss and Pollack (2004) investigated the social networks of overweight and normal weight adolescents. Although overweight adolescent listed the same number of friends as their normal weight counterparts, the results of the study does not show in support of this.
In the study mentioned above, an impressively large sample of 90,118 was taken from the National Longitudinal Study of Adolescent Health. It included 13 to 18 year old kids who were both of normal and overweight weights. In the study, overweight was defined as having a body mass index (BMI) of 95> percentile for age and sex. The method used was of friendship nominations each adolescent received from others. Each participant was allowed 5 best female and 5 best male friends. In and out degree measurements were made. This means that it measured the number of nominations each individual received from other students and the number of nominations that participant made to identify as friends. It also took into consideration extended networks such as friends and friends of friends. Calculations of connections and degree of relationships were then made by matrix programs.
Results show that overweight participants were significantly less popular than normal weight participants with a significant level of p<.001. Overweight participants are less likely to receive 5 friendship nominations and less likely to receive 2 or best friend nominations. On the other hand, those who were nominated by overweight participants as friends were less likely to return the nominations. Results also show that normal weight participants had about the same mean number of nominated friendship ties as others reported about them (means of 4.58; 4.79). In contrast, overweight participants nominated more friendship ties with others than they actually received from others (means of 4.29; 3.39).
Myers (2008) states that establishing of friendship relationships is an essential part of social development. It enables children to learn how to communicate, cooperate, and learn about intimacy. It also gives children the opportunity to learn how to resolve differences and conflicts. Because of the stigma that overweight children receive, overweight children have lesser opportunities to establish and build these relationships thus damaging their self efficacy on their ability on making friends.
Being rejected by peers and friendlessness has long term effects. Bagwell, Newcomb, and Bukowski (1998) conducted a longitudinal study that showed fifth graders who were friendless had a greater tendency to show depressive symptoms and low self-esteem long way into adulthood (Cited in Myers, 2008). Social isolation from peers as well as peer victimization can lead to feelings of loneliness. According to Myers (2008) lonely people tend to view others and oneself negatively. They experience a loss of confidence in their socialization skills and blame themselves for their poor social relationships. These negative thinking brings about depressive moods (Myers, 2008).
The Endocrine Society (2009) reports a study on how elevated levels of cortisol relates to depression. Cortisol is a steroid that is released in response to stress. It is also responsible for converting fat into energy. The sample size in this study is a total of 50 obese children and teenagers of which 20 were boys and 30 were girls with ages ranging from eight to 15 years of age. Prior to the study, they were not diagnosed with depression. These children were patients at Athens University pediatric clinic. A questionnaire assessed their symptoms of depression.
Cortisol normally is elevated during mornings, tapers off late morning, and is low at night. In this study, Pervanidou and colleagues took saliva and blood samples from the participants to check their cortisol levels. Results are summarized by lead researcher and author, Dr. Panagiota Pervanidou of Athens University Medical School in Athens, Greece as he states, “There is evidence in adults that abnormal regulation of cortisol plays a role in both obesity and depression. ”
The fact that obese individuals produce higher levels of cortisol which is also the hormone responsible for depression indicates that depression is not only induced by external influences but is internal as well. It further indicates that with external factors and internal hormonal balances such with that that is associated with obesity; there is a more increased tendency for these individuals to show symptoms of depression.
In another article by Carol Hilton (2002) cites a study conducted by endocrinologist Dr. Ronnie Aronson who conducted a study that examined the effectiveness of different approaches to weight loss. The sample consisted of 141 overweight patients. 86 of these patients were successful at losing weight and were able to maintain (with some further losing more weight) after a nine month follow up. Within this study it was found that with weight loss, participants reported to be less depressed. Another interesting fact about this study is that elevation of mood and depression from weight loss is actually better than results from antidepressants. Yet, Dr. Aronson cautions that this elevation of depression should not be correlated to weight loss since it could be the frustration of the attempts and the failure thereof that may be the stronger indicator of mood elevation.
Wilson Lawson (2003) writes an article entitled, “The puzzle of obese children and depression.” This article basically expresses the “chicken and egg dilemma”. Mainly, which comes first, depression or obesity? It cites a study in Pediatric that followed almost 1,000 children in North Carolina over a period of eight years. Respondents were from ages nine to 16. They found that the more the child is overweight, the more likely the child is at risk for depression. Yet, Dr. Sarah Mustillo, a researcher in psychiatry and behavioral sciences at Duke Medical Center, that depression causes obesity when a child becomes too depressed to do any physical activity.
Conclusion
Obesity and depression has become an increasing health risk to children and adolescents. Many factors contributing to obesity is the convenience and trend of unhealthy food and food choices. Unfortunately, this may be tied in with other factors such as low socio-economic statuses and ethnic backgrounds. The social stigma of being obese affects and leads to the deterioration of both self esteem and social efficacy. Without these two beliefs, children do not develop the necessary skills for social interaction. Peer victimization compounds this problem. Peer rejection brings about social isolation and depression. As demonstrated in Strauss and Pollack’s study, social isolation occurs frequently in obese children. Yet, depression in obese children is not affected by behavioral and environmental influences alone. The study conducted by the Endocrine Society indicates that hormonal influences may be partly to blame. The elevated levels of the hormone cortisol were found to be associated with obesity and depression. The study done by Hilton does not believe in the correlation of weight loss and the elevation of depressive symptoms. Instead, it cautions on looking into other factors such as the frustration of unsuccessful attempts of weight loss.


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