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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