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The Obesity/Mental Health Link: A Multidisciplinary Healthcare Challenge

The mental health of children who are obese should be a primary focus of researchers studying childhood obesity, according to Christine Calamaro, PhD, CRNP, an assistant professor at the University of Maryland School of Nursing.

 “My interest in this is not just about the weight of our kids anymore,” explains Calamaro, a research scientist in pediatric nursing. “It is about all the problems associated with obesity. When you start talking about adolescents [emerging] into adulthood, you have to consider comorbidities such as depression and diabetes.”

In the past 40 years, the number of children who are obese has increased fourfold, according to the National Institutes of Health (NIH), now affecting 17% of children and adolescents aged 2 to 19.

Recent research on children who are obese has focused on a link between a lack of sleep duration or quality of sleep.

“We know there is a link, but what are the things causing it?” asks Calamaro.

Her biggest worry is that children and adolescents who stay awake more and sleep less experience impaired physical and mental health. “It only makes sense to me that if they are not sleeping well or have fragmented sleep, then their endocrine balance is screwed up; all their hormones are screwed up; their cortisone levels are higher because they are tired and stressed; they are hungry; they eat more; they get carbohydrate-rich foods to get the instant glucose increase; they can get insulin resistance because of weight gain then eat more carbs to stay awake. It’s a vicious cycle.”

Yet lack of sleep is not the lone culprit. Calamaro led a recent study of 13,568 adolescents aged 12 to 18. Those sleeping no more than six hours per day were not more obese than adolescents sleeping longer. The finding, part of a study published in the Journal of Sleep Research, runs counter to a hypothesis common in adolescent health research, according to Calamaro.

Calamaro says the researchers were disappointed at first because they had expected to easily prove the relationship between a lack of sleep and obesity. but the study revealed that other negative factors were at work.

“In light of other recent analyses that demonstrated a consistent increase in obesity among short sleepers in children and adults, the results of this study raise more questions about the causal pathways that may lead to increased adiposity in adolescents,” Calamaro says.

The study showed an association between sleep duration and depression. Depressed adolescents tended to sleep less than nondepressed adolescents, both in a 12-to-14 age group and in a 15-to-18 age group. Depressed adolescents were almost twice as likely to be obese, whereas, adolescents who watched television excessively were 37% more likely to be obese.

Calamaro and her coauthors also found that younger children who watched more than two hours of TV daily were 36% heavier in later adolescence than those watching less TV. “Television viewing may lead to increased risk of obesity because watching television has been associated with increased dietary intake, leading to an imbalance in energy expenditure,” the authors wrote. Younger children between the ages of 12 and 14 watching TV for roughly two hours per day was predictive of obesity when they were 15 to 18.

“Childhood obesity is a very complex problem we must address,” says Jay A. Perman, MD, a pediatrician and president of the University of Maryland  Baltimore campus. “It is going to take more than healthcare providers to fix. Physicians, nurses, social workers, attorneys, pharmacists, and others need to solve the problem together.”

Last year, the NIH launched $72.5 million in new research funding to examine ways to curtail the nation’s growing childhood obesity epidemic. “Factors behind this increase are believed to include increased consumption of high-calorie food and drinks and less physical activity during and after school. Overweight and obese children are at higher risk of chronic diseases during childhood and adulthood, including heart disease, stroke, asthma, type 2 diabetes, and several cancers,” according to the NIH website.

Despite more funding, experts are not catching up with the problem, says Calamaro. “Preventative care is just not reimbursable from insurance providers as much as it should be. In healthcare, we need to focus more on children. By 2043, half the adult population will be obese in the United States” if trends continue and changes are not made, she says.

“Today, with the current generation of children, by the time the parents capture it, it is too late,” she continues. “It is difficult. So what we do know is start in infancy. A chubby baby is not a healthy baby. To try to get parents to see that is difficult.

“We in the primary care setting need to be reinforcing this message about healthy eating/healthy sleep every time parents and children come into the doctor’s office,” Calamaro adds. “The hardest thing with obesity is to start the minute that baby first comes into your office and to talk about what healthy eating is for that child: Are you feeding that baby properly with that bottle? When does it look like they are finished drinking from the bottle? Are they warm? Are they dry? Are they crying because they are hungry, or are they crying because babies cry? Basic baby knowledge reinforced over and over again.”

— Source: University of Maryland, Baltimore