Elsevier

Journal of Affective Disorders

Volume 202, 15 September 2016, Pages 203-209
Journal of Affective Disorders

Research paper
Overweight during childhood and internalizing symptoms in early adolescence: The mediating role of peer victimization and the desire to be thinner

https://doi.org/10.1016/j.jad.2016.05.022Get rights and content

Highlights

  • Child overweight development is associated with adolescent internalizing symptoms.

  • Peer victimization and body dissatisfaction partly mediate this link.

  • Mechanisms may differ depending in part on overweight developmental trajectory.

Abstract

Background

Overweight is associated with depression and anxiety among adults. It is unclear whether this association begins in childhood. Overweight among children is associated with a higher risk of peer victimization, and may mediate an association between overweight and internalizing symptoms. No study has tested this hypothesis in a longitudinal population-based sample using developmental trajectories of overweight in middle childhood.

Methods

Data was drawn from the population-based Quebec Longitudinal Study of Child Development. A three-group trajectory model of overweight development (6–12 years) was previously identified using a semi-parametric group-based approach (n=1678): “early-onset” (11.0%), “late-onset” (16.6%) and “never overweight” (72.5%). Mediation models tested the link between overweight status and child-reported depression and anxiety at 13 years via peer victimization and body dissatisfaction.

Results

Children on an early-onset overweight trajectory were at increased risk for both depression (B=.318, 95% CI=.141;.496) and anxiety (B=.262, 95% CI=.09;.44) at 13 years. These direct associations were mediated by peer victimization and subsequent desire to be thinner. Children on a late-onset childhood overweight trajectory were at increased risk for both depression (B=.332, 95% CI=.187;.477) and anxiety (B=.215; 95% CI=.072;.358) at 13 years, mediated by the desire to be thinner.

Limitations

We were unable to control for previous levels of body dissatisfaction. Our measure of peer victimization was not specific to weight-based teasing.

Conclusions

Overweight during middle childhood increases risk of early adolescence internalizing symptoms. Peer victimization and body dissatisfaction are partly responsible for this link.

Introduction

Childhood overweight and obesity1 has become a national public health priority for several countries worldwide, and research and intervention efforts have risen sharply in an attempt to counteract what is now documented as an extremely complex phenomenon. A large proportion of work has been aimed at the physical health problems associated with child overweight and we still lack information on its mental health impact. While several studies have shown that overweight adolescents and adults are at higher risk for depression and anxiety (Atlantis and Baker, 2008, Goldfield et al., 2010, Luppino et al., 2010, Mustillo et al., 2003, ter Bogt et al., 2006), studies examining this question in childhood have thus far elicited modest or mixed results, particularly among community samples (Bradley et al., 2008, Datar and Sturm, 2004, Drukker et al., 2009, Harriger and Thompson, 2012, Luppino et al., 2010, Wardle and Cooke, 2005). One potential reason behind the inconsistent findings is that studies have not often been able to evaluate the longitudinal development of weight status across childhood. There exist differential trajectories of weight status development during childhood and it is plausible that only certain overweight experiences lead to internalizing symptoms (e.g: depression and anxiety). For example, a child who becomes overweight early and persistently may be at a greater risk for negative psychosocial outcomes than a child who experiences weight problems more transiently (Mustillo et al., 2003).

Alternately, the inconclusive or modest associations identified in the literature thus far could be indicative of the existence of indirect (or mediating) pathways. That is, overweight and internalizing symptoms may be associated via a third factor, such as peer victimization. Indeed, weight-based peer victimization has been identified as one of the most prominent forms of bullying in the school setting (Bradshaw et al., 2011, Puhl et al., 2011). It is documented as a source of major distress in the lives of those who experience it (Cramer and Steinwert, 1998, MacLean et al., 2009, Puhl and Latner, 2007), with negative scars that may last into adulthood (Puhl and Latner, 2007). However, given a lack of longitudinal studies, it is still unclear whether peer victimization mediates the predictive association between childhood overweight development and subsequent internalizing symptoms among youth in community samples.

Past research informs us that it is likely not a child's weight status per se, but rather the extent to which they are dissatisfied with their weight status, that is linked to negative psychological outcomes (Mond et al., 2011). Children as young as 9 years of age with a history of being at-risk for overweight have been identified as showing signs of body dissatisfaction (Shunk and Birch, 2004). Overweight youth may exhibit such dissatisfaction because at some level the outside world has informed them their body shape or size does not fit the ideal. They may internalize societal norms and ideals of beauty, attractiveness, and health directly; or indirectly, such as when faced by teasing, bullying or other forms of rejection by peers (Bearman et al., 2006).

Our aim for the present study was to test the predictive association between various weight status trajectories during middle childhood (assessed objectively between 6 and 12 years) and internalizing symptoms in early adolescence (13 years), and whether these associations occurred via peer victimization and/or the child's desire to be thinner. We relied on a large population-based sample (n=1221) assessed 11 times over the first 13 years of the child's life.

Section snippets

Participants

Participants were from the Québec Longitudinal Study of Child Development (QLSCD; 1998–2011). A random population sample of 2940 families with a 5-month-old singleton infant in 1998 was identified through the provincial master list of birth registries. Participants were selected if they spoke English or French (official languages of Canada). The sample was reduced to 2120 due to non-response, inability to contact, or not meeting study criteria. Trained research assistants conducted home visits

Results

We report the results in 4 sections: 1) Variables selected as confounders; 2) Direct associations between IVs and DVs, without mediators; 3) Results from full mediation models; 4) Results of a supplementary analysis examining the victimization patterns of the overweight trajectories.

  • 1.

    Variables Selected as Confounders

    The following variables were selected as control variables due to their significant association with at least two main variables: Child Sex, Early Peer Victimization (3-5 yrs),

Discussion

Controlling for several potential confounders, we found children characterized by an early-onset overweight trajectory between 6 and 12 years were at increased risk for both anxiety and depression at 13 years. Increased levels of peer victimization and the desire to be thinner mediated these associations. Children on a late-onset childhood overweight trajectory were also at increased risk for both anxiety and depression at 13 years. These associations were mediated by the desire to be thinner.

Acknowledgments

The authors have no potential conflicts of interest to disclose. The first author had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

We thank the children and families whose ongoing participation made this study possible, as well as the Québec Institute of Statistics and the GRIP staff for data collection and management.

This research, as part of the Quebec Longitudinal Study of Child Development (QLSCD),

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