Psychiatric Assessment of Children with Constitutional Obesity

Psychiatric assessment of Children with constitutional obesity

Nasreldin M*, Abdou AA*, El Shinnawy H*, Goueli T*, Enaba D*, Atef A**

*Department of Psychiatry, Faculty of Medicine Cairo University

** Department of Pediatrics, Faculty of Medicine Cairo University

Abstract:

Objectives: To find out psychiatric disorders that accompany pediatric obesity and to compare between boys and girls regarding these disorders. Method: This is a descriptive cross sectional outpatient study. The study sample consisted of 52 overweight youngsters (26 girls; 26 boys) presented to the endocrinology clinic in Abo-elrish pediatric hospital complaining of increased body weight. Endocrinal profile revealed no abnormality and it was proved to be a constitutional obesity. The following tools were applied: Weight and height were measured and the adjusted BMI was calculated, the Anxiety Scale for Children, the Depression Scale for Children, the Self-Concept Scale and Behavioral Checklist for Children were applied. Results: Eight (15.4%) of the children were depressed, 16 (30.8%) of them were moderately anxious and 10 (19.2%) were highly anxious. Twenty four (46.2%) of the children had a low self-concept and 28 (53.8%) of them had a positive self-concept. The whole sample of children had an eating disorder. Comparative results between males and females showed that all females were in the primary stage, while the males were distributed throughout the stages of education. Four (15.4%) of both boys and girls were depressed.  Half of the males were not anxious, 10 (38.5%) of the other half were moderately anxious and 4(15.4%) of them were highly anxious. There were 6 (23.1%) of the girls with moderate anxiety and another 6 (23.1%) were highly anxious. Sixteen (61.5%) of girls had low self-concept while only 8 (30.8%) of boys had low self-concept with a statistical significance (p = 0.050). Eight (30.8%) of boys and girls had a withdrawal problem. There were 8 (30.8%) boys with anxiety/depression and only 4 (15.4%) girls with anxiety/depression. Conclusions:  low self concept and eating disorders compensated for the absence of other psychiatric comorbidities especially depression and anxiety.

Key Words: Pediatric obesity, psychiatric disorders, depression, eating disorder, self concept

Abbreviations: Body Mass Index (BMI), Intelligence Quotient (IQ), Standard Deviation (SD), Centers for Disease Control and Prevention (CDC), Eating Disorder Test (EDT)

Declaration of interest: None

Corresponding Author:

Mohamed Nasreldin

Assistant Professor of Psychiatry faculty of medicine Cairo University

Email:mohnas@hotmail.com    Mobile: +201223267788

Introduction:

Obesity is being recognized as a serious public health concern due to its rising prevalence in children and its many adverse health effects. Pediatric obesity is a condition where excess body fat negatively affects a child's health or wellbeing. The diagnosis of obesity is often based on BMI (Peter, 2005), however, the term overweight rather than obese is often used in children as it is less stigmatizing. (Bessesen, 2008).

Concerns about body dissatisfaction and low self-esteem in obese children and adolescents, especially girls, focus on their distance from societal body shape ideals and experience of social marginalization that reflects a broader stigmatizing view of obesity (Friedman, 1995). These have been accompanied by research looking at depression, (Erickson et al., 2000), psychiatric disorder, (Lamertz et al., 2002 and Mustillo et al., 2003) and quality of life (Schwimmer et al., 2003 and Williams et al., 2005). However, as with biomedical risk, the psychological distress associated with childhood obesity shows variation within and between studies. Any deficit in low self-esteem, for example, depends on children’s gender, age, degree of obesity, and whether they are drawn from clinical or community samples (French et al., 1995).

Aim of the study:

The present study aims to find out psychiatric disorders that accompany paediatric obesity, comparing males and females as regards these disorders, and suggesting areas for future study.

Method

Ethical considerations:

Approval of the ethical and research committees of the Department of Psychiatry Kasr EL Aini Hospital was obtained in accordance with the provisions of the world medical association's declaration of Helsinki. The consent of the participant was taken after describing the steps of assessment. Informed consent of the study procedure was signed by the parents of the children.

Study design:

This is a descriptive cross sectional outpatient study.

Study population:

The study sample consisted of 52 overweight youngsters (26 girls; 26 boys) who presented to the endocrinology clinic in Abo-elrish paediatric hospital complaining of increased body weight. Endocrinal profile proved no abnormality and it was proved to be a constitutional obesity.  The male group was with a mean age of 9.77 years (SD = 2.46; range 5–13), and a mean intelligence quotient (IQ) of 89.62 (SD = 11.08; range 65-100). The females group was with a mean age of 9.54 (SD = 1.75; range 6-12), and a mean (IQ) of 91.38 (SD = 6.46; range 77-99). Both groups were matched regarding the educational level.

Study tools:

1-Weight and height were measured. The BMI was calculated and then matched to the (CDC) charts and was found to be in the range from 85th to less than the 95th percentile.

2-Wechsler Intelligence Scale for Children (Weiss et al., 1993), which measures the child's IQ (intelligence quotient), general abilities, attention, and speech development.

3-The Anxiety Scale for Children (Viola, 1987), a 42 questions scale measuring the child's anxiety manifestations: (score < 18 normal, 19-28 moderate anxiety and > 29 high anxiety). The manifest behavior, e.g.: avoidance of specific situations, physiological responses to anxiety and verbalization of anxiety experience.