DETERMINING CAUSAL PATHWAYS OF THE BIDIRECTIONAL

RELATIONSHIP BETWEEN OBESITY AND DEPRESSION IN CALIFORNIA

CHILDREN Sarah Poblete, Liki Porotesano, Breah Smith, and

Hannah Summers

San Diego State University

Significance

Obesity

• Increases the risk of heart disease, high blood pressure, stroke, type II diabetes, metabolic syndrome, cancer, and more.

• In the last 30 years, childhood obesity has increased from 7% to 18%, and adolescent obesity has increased from 5% to 21%

• Once seen only as an adult problem, now seen more frequently in children

Depression

• Depression is the leading cause of disability in Americans 15-44 years old, with over half of these cases beginning at age 14

• Once seen only as an adult problem, now seen more frequently in children

Innovation

• Longitudinal cohort study

• Examines both aspects of the bidirectional relationship between obesity and depression:• Obesity Depression• Depression Obesity

• Looks for biologic gradient between each of the bidirectional relationships between obesity and depression

• Includes a variety of potential mediating and moderating factors• Biopsychosocial variables

SPECIFIC AIMS

Aim 1

Aim 1: To determine the bidirectional temporal associations between obesity and depression in California children.

Obesity Depression

Time

Aim 2

Aim 2: To prove a biologic gradient between obesity and depression.

Obesity

Dep

ress

ion

Aim 3

Aim 3: To determine the mediating and moderating factors which influence the relationship between obesity and depression in California children.

ObesityDepressio

n

Moderating Factors

MediatingFactors

APPROACH

Population

• California children age 7 at start of study

• Randomly select 200 public schools

• Select 25 children from each school

• (5000 total participants)

12-Year Timeline

Jan – Feb Hire research staff

Mar - MayTrain staff on measurement

protocol

Jun – Aug Recruit participantsAnnually

in Septemb

er (10 years)

Staff measurement protocol refresher

Participant Measurement

Final year Data analysis

Aim 1

Obesity

• Measure using digital weight scale and digital stadiometer

• Obese is defined as BMI percentile greater than 95% using CDC growth charts

To determine the bidirectional temporal associations between obesity and depression in California children.

Aim 1

Depression

• Measure using the Children’s Depression Inventory (CDI)

• Defined as score greater than 60 on the CDI

• Calculate association between depression and obesity using odds ratio

To determine the bidirectional temporal associations between obesity and depression in California children.

Aim 2To prove a biologic gradient between obesity and depression.

Obesity(BMI)

Dep

ress

ion

(CD

I)

Threshold

Linear

• Obesity plotted according to BMI calculations

• Depression plotted according to CDI score

• Graphs plotted to represent population-wide as well as within sub-sectors to identify regions or populations in which the dose-response relationship is stronger

Mediating Factors

• Body dissatisfaction • Weight stigma • Dieting • Binge eating • Physical activity/sedentary

level • Various psychological

characteristics

Moderating Factors

• Gender• Genetics

Aim 3To determine the mediating and moderating factors which influence the relationship between obesity and depression in California children

Body Dissatisfaction and Weight Stigma

• How much a person likes or dislikes their body

• Measurement tool: Children’s Figure Rating Scale

Body Dissatisfaction • Verbal teasing,

physical bullying, and relational victimization

• Measurement tool: Perception of Teasing Scale

Weight Stigma

Dieting and Binge Eating

Self-imposed dieting, not diets enforced by parents

Measurement tool: Restraint Scale

Dieting Categorized as

Bulimia Nervosa or Binge Eating Disorder

Measurement tool: Eating Disorder Examination Child Version

Binge Eatin

g

Gender

Female gender is a strong moderating

factor among adults

Obese adolescent females are

more at risk for future

depression

Depressed adolescent females are

more at risk for future obesity

Genetics

• Genetic testing administered at first measurement• Simple cheek swab

• Chromosome 3p25-26• Genetic linkage analysis• Identify relationship with depression

• FTO gene and MC4R gene (Chromosome 2q14.1)• Genetic linkage analysis• Identify relationship with obesity

• Single Nucleotide Polymorphisms (SNPs)• Genetic sequencing• Map SNPs to identify associations between

depression chromosome and obesity chromosome

Physical Activity & Sedentary Level• Measurement tools:

• Physical Activity Questionnaire for Children (PAQ)

• Physical Activity Questionnaire for Older-Children (PAQ-C)

• Adolescent Sedentary Activity Questionnaire (ASAQ)

• Parents will respond to questionnaires for children under the age of 10.

Psychological Characteristics

• Self-Esteem• Rosenberg Self-Esteem Scale

• Anxiety• Spence Children’s Anxiety Scale

• Hostility• Anger Regulation and

Expression Scale Short

• Loneliness• Loneliness & Social

Dissatisfaction Questionnaire

Measuring Mediation and Moderation

Mediator and Moderator Analysis:

• Linear Regression

• Correlation Coefficient

ObesityDepressio

nModerating

Factors

MediatingFactors

Limitations and Other ConsiderationsPotential Errors

• Self-report bias

• Recall bias

• Respondent fatigue bias

• Social desirability bias

Potential Risks

• Obesity and depression are sensitive subjects• Referral to trained medical

physicians and psychologists must be available

• Ethics of genetic testing

QUESTIONS?

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