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Objective: To explore how chronic stress, reactivity to acute stress, and obesogenic eating are linked in adolescent females predisposed to obesity., Methods: Participants included 21 adolescent females (m age  = 14.57 years) and their biological mothers with obesity (body mass index [BMI] ≥ 30 kg/m 2 ). The pilot and feasibility study involved adolescent self-report of chronic stress, an acute stress-induction paradigm (Trier Social Stress Task, TSST), salivary cortisol collection to assess stress reactivity, and both subjective (self-report) and objective (snack buffet) measures of obesogenic eating., Results: Adolescent females reporting high chronic stress were significantly more likely to engage in self-reported emotional and external eating and to have higher food cravings (p's < .05) compared to adolescents with low chronic stress. Effect size estimates suggested a blunting effect of cortisol in the high chronic stress group. Blunted cortisol reactivity significantly predicted higher self-reported food cravings for the high chronic stress group (p = .04). Associations among chronic stress, cortisol, and self-reported and objective obesogenic eating reflected medium to large effect sizes., Conclusions: This study built on limited extant research on stress and eating to demonstrate that chronic stress was associated with self-reported obesogenic eating patterns in adolescent females predisposed to obesity. Different patterns of cortisol reactivity and eating emerged depending on chronic stress group (low versus high). Understanding these eating patterns in the context of chronic stress can inform interventions to reduce obesity risks in adolescence., Competing Interests: Declaration of competing interest The authors have no conflicts of interest to disclose., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Understanding the contribution of caregiver feeding practices to adolescent diet and weight is important to refining caregiver roles within the context of adolescent obesity prevention and treatment. This secondary data analysis examined whether feeding practices of female caregivers differentiated persistently non-overweight (n = 29) from persistently obese (n = 47) adolescents. Families who previously participated in a cross-sectional study on correlates of obesity were recruited for this follow-up study. At the time of the follow-up study, anthropometric measures were taken for all female caregivers and adolescents, and caregivers completed the Child Feeding Questionnaire-Adolescent version. Socioeconomic, demographic, female caregiver anthropometric, and psychological (caregiver perceived self-weight and concern for adolescent overweight) variables were examined as predictors of feeding practices found to differentiate the two groups. Female caregivers of persistently obese adolescents reported significantly greater use of restriction and monitoring compared to female caregivers of persistently non-overweight adolescents. Restriction was predicted by female caregiver age and concern for adolescent overweight whereas monitoring was predicted by concern for adolescent overweight only. Caregiver feeding strategies may be an important target for adolescent obesity prevention and intervention efforts particularly among those with heightened concern about their teen's weight status., (Copyright © 2014. Published by Elsevier Ltd.)

Objective: Relative suicidal behavioral risks (ideation, attempts) for overweight, obese, and extremely obese adolescents (vs. healthy weight) and who did/did not accurately perceive themselves as overweight were examined in this study., Design and Methods: A new variable (weight status/accuracy) was computed that combined actual weight status (based on BMI) with weight perception accuracy. To evaluate the effect of weight status/accuracy on each suicidal risk behavior, logistic regression was performed to calculate odds-ratios and 95% confidence intervals (CI). Potential model covariates included gender, age, race, survey year, and whether they had felt sad/hopeless., Results: Weight perception accuracy increased as the degree of excess weight increased. Relative to healthy weight, being obese or extremely obese (but not overweight) was associated with significantly greater risk for adolescent engagement in suicidal ideation, but was unrelated to suicide attempts. Adolescents in all excess weight categories who were accurate in their weight perception were at significantly greater odds of suicidal ideation, whereas those who were inaccurate were of no greater odds of suicidal ideation than healthy weight youth who accurately perceived their weight. Findings regarding suicide attempts varied based on actual weight/weight perception accuracy and race/ethnicity., Conclusion: The present findings are both important and clinically relevant. While widely accepted that there are multiple pathways to suicide, our understanding of adolescent suicidal behavior risks and accordingly, prevention efforts, will be informed by comprehensive prospective studies that should also, from here forward, consider categorization of the entire weight spectrum (e.g., extreme obesity)., (Copyright © 2012 The Obesity Society.)

Objective: To examine female caregiver and adolescent dyad characteristics that predict the female caregiver's concern about their adolescent's weight and the degree to which caregiver concern predicts desire for physician intervention., Method: Fifty-three caregivers of adolescents with persistent obesity were asked to report on their adolescent's quality of life (QOL), weight status, concern about their adolescent's weight, and desire for physician intervention., Results: Results indicated that only caregiver-reported QOL was a meaningful predictor of caregiver concern for African-American adolescents with persistent obesity accounting for 51% of the variance and that caregiver concern predicted desire for physician intervention accounting for 46% of the variance., Conclusion: Based on these findings, it is recommended that practitioners assess caregiver perception of obesity-specific QOL in their adolescent patients with persistent obesity, particularly those who are African-American.

Background: The present study examined the psychological distress, parenting stress, and family functioning in female caregivers of adolescents undergoing bariatric surgery compared to that of caregivers of adolescents with extreme obesity not undergoing surgery across the first postoperative year., Methods: The female caregivers of 16 adolescents undergoing Roux-en-Y gastric bypass (mean age 16.6 years, mean body mass index 66.2 kg/m(2); 94% recruitment) and those of 28 comparison adolescents who had sought behavioral weight management (mean age 16.2 years, mean body mass index 46.3 kg/m(2); 90% recruitment) were included in the study. The caregivers completed measures of psychological distress (Symptom Checklist-90-Revised), parenting stress (Stress Index for Parents of Adolescents), and family functioning (Family Assessment Device) at baseline (before surgery) and at 6 and 12 months after surgery. Caregiver and adolescent anthropometric data were also obtained., Results: At baseline, clinical cutoffs were exceeded by 29.5% of the caregivers for psychological distress, 31.8% for family dysfunction, and 13.2% for parenting stress. Linear mixed modeling indicated that bariatric adolescents had a significantly greater body mass index at baseline than the comparison adolescents (t = -7.79, P <.001), with a substantial reduction by 12 months relative to the near-flat trajectory of the comparison group (t = 20.32, P <.001). No significant group differences at baseline or group trajectory differences were identified for any caregiver or family variable., Conclusion: Our initial findings suggest that caregivers of adolescents with extreme obesity present with limited dysfunction and that bariatric surgery has no effect on caregiver distress, parenting stress, or family functioning across the first postoperative year. Larger samples and longer term follow-up will allow examination of what role caregiver/family factors play in the adolescent postoperative outcomes., (Copyright © 2011 American Society for Metabolic and Bariatric Surgery. Published by Elsevier Inc. All rights reserved.)

Within the United States, minority youth are at greater risk of becoming overweight/obese and are less likely to receive preventive health care. The authors examined several domains of preventive health care perceptions among persistently overweight/obese white and black adolescents. A total of 55 youth (29 white, 26 black) who had previously sought weight management treatment participated in a follow-up study 4 years later (M (years) = 4.2 ± 0.8). All participants remained overweight (5% at the 85th- 94th BMI percentiles) or obese (95% ≥ 95th BMI percentile), with no significant difference in weight by race. Relative to whites, blacks perceived greater physician concern about and counseling regarding weight (P (concern) < .01; P (counsel) < .01), eating habits(P (concern) < .001; P (counsel) < .01), and physical activity (P (concern) < .001; P (counsel) < .05). Although whites reported knowing more weight-related comorbidities than blacks, there were no group differences in number of weight loss methods attempted (M (methods) = 7.5 ± 2.7). Overall, there were no group differences in perceptions of risk. Physicians may be appropriately focusing efforts on educating black youth, but knowledge and behavior gaps persist.

Background: The preoperative psychological evaluation (including the assessment of depressive symptoms) is an important component in determining adolescent bariatric candidacy. The adult bariatric data have suggested that candidates can engage in "impression management" and underreport depressive symptoms during their preoperative evaluation. The present study examined whether adolescent depressive symptoms among bariatric candidates change during preoperative preparation compared with adolescents with extreme obesity who were not seeking surgery., Methods: Adolescent candidates for bariatric surgery (n = 30; 60% female; mean age 16.5 ± 1.4 years) completed the Beck Depression Inventory-II (BDI-II) at initial consultation (time 1, mean body mass index [BMI] 64.5 ± 11.5 kg/m(2)) and again immediately preoperatively (time 2, mean interval 4.7 ± 2.9 months; mean BMI 64.4 ± 10.4 kg/m(2)). Comparators (n = 25; 64% female; mean age 16.2 ± 1.2 years; mean BMI 46.5 ± 4.8 kg/m(2)) were studied at enrollment in a research protocol and again 6 months later (mean interval 6.2 ± 0.4 months; mean BMI 46.8 ± 5.0 kg/m(2)). The height and weight were also taken., Results: We found a small, but statistically significant, difference in the BDI-II scores at time 1, with bariatric candidates reporting greater depressive symptoms (mean 16.6 ± 12.9) than the comparators (mean 10.6 ± 9.0; P < .05). No difference was seen in the BDI-II scores between the bariatric candidates (mean 14.4 ± 12.1) and the comparators (mean 10.4 ± 8.2) at time 2 (P = .17). The change in BDI-II scores for the bariatric candidates showed a trend toward significance (P = .09)., Conclusion: These results reinforce the position that the adult bariatric literature does not necessarily generalize to the adolescent bariatric population. They further suggest that impression management might not be a significant concern in the assessment of adolescent bariatric candidates. Future research should examine whether preoperative changes in psychological functioning predict the postoperative outcomes., (Copyright © 2011 American Society for Metabolic and Bariatric Surgery. Published by Elsevier Inc. All rights reserved.)

Objective: The current study examined the attributes of the reciprocated friends (RF) of a group of clinically referred obese children and the impact of these friendships on emotional well-being., Methods: Classroom visits for 87 obese youth [body mass index (BMI) >95th percentile; 8- to 16-years old) were completed to obtain peer reports of social functioning, including reciprocated friendships, and to identify a demographically similar non-overweight comparison peer (CPO, n = 76). Subsequently, data regarding self-reported emotional well-being were collected from 84 obese children and 74 CPOs., Results: Most obese children (68%) had at least one RF in their classroom. RFs were similar socially to CPOs and functioned more adaptively in the peer environment relative to obese children. Among obese youth, having at least one reciprocated friendship moderated the effect of sensitive-isolated behavior on loneliness., Conclusion: Friendships may be a source of support for better psychosocial outcomes for obese youth.

Objective: To examine maternal parenting behaviors, child temperament and their potential interactions in families of obese children and demographically similar families of nonoverweight children., Design: A total of 77 obese youth (M body mass index (BMI) z-score values, zBMI=2.4; ages 8-16, 59% female, 50% African American) and their parents were recruited from a pediatric weight management clinic and compared to 69 families of nonoverweight youth (M zBMI=-0.03). Comparison youth were classmates of each obese participant matched on gender, race and age., Measurements: Maternal report of child temperament, parenting style and anthropometric assessments were obtained., Results: Compared to nonoverweight youth, mothers of obese youth described their child as having a more difficult temperament and their parenting style as lower in behavioral control. A logistic regression model indicated that difficult temperament, lower behavioral control and the interaction of low maternal warmth and difficult child temperament were associated with increased odds of a child being classified as obese., Conclusions: Treatment-seeking obese youth and their parents are characterized by different parent and child factors when compared to nonoverweight comparison families. These findings direct investigators to test more complex models of the relation between parent and child characteristics and their mutual role in the weight-related behavior change process.

Objective: It is asserted that the more immediate and observable consequences of pediatric obesity are psychosocial in nature. This study examines the peer relations of clinically referred obese youth compared to demographically comparable nonoverweight peers within the classroom environment., Methods and Procedures: Peer-, teacher-, and self-reports of behavioral reputation (Revised Class Play (RCP)), and peer reports of social acceptance, nonsocial attributes (attractiveness, athleticism, academic competence), and health interference (school absence, illness, fatigue) were obtained regarding 90 obese youth (BMI > 95th percentile; 8-16 years, 57% girls, 50% African American) and 76 nonoverweight demographically similar comparison classmates., Results: Relative to comparison peers, obese children were nominated significantly less often as a best friend and rated lower in peer acceptance, although the two groups did not differ in the number of reciprocated friendships. Obese youth were described by peer, teacher, and self-report as more socially withdrawn and by peers as displaying less leadership and greater aggressive-disruptive behavior. Peers also described obese youth as less physically attractive, less athletic, more sick, tired, and absent from school. Being seen as less attractive and less athletic by peers helped to explain differences in obese and nonoverweight youth's levels of peer acceptance., Discussion: Clinically referred obese youth are characterized by peer relations that differ from those of nonoverweight youth. The peer environment provides a rich context to understand the social consequences of pediatric obesity as well as factors that could be targeted in intervention to promote more positive health and psychosocial outcomes.

Objective: Critical gaps remain in our understanding of the obesigenic family environment. This study examines parent and family characteristics among obese youth presenting for treatment in a clinic setting., Research Methods and Procedures: Families of 78 obese youth (BMI z-score = 2.4; age, 8 to 16 years; 59% girls; 49% African-American) were compared with 71 non-overweight (BMI z-score = -0.02) demographically matched comparisons. Parents completed measures assessing family demographics, psychological distress (Symptom Checklist 90-Revised), and family functioning both broadly (Family Environment Scale: Conflicted, Support, Control) and at mealtimes (About Your Child's Eating-Revised: Mealtime Challenges, Positive Mealtime Interaction). Height and weight were obtained from all participants., Results: Compared with mothers and fathers of non-overweight youth, parents of obese youth had significantly higher BMIs (p < 0.001). Mothers of obese youth reported significantly greater psychological distress (p < 0.01), higher family conflict (p < 0.05), and more mealtime challenges (p < 0.01). Less positive family mealtime interactions were reported by both mothers (p < 0.01) and fathers (p < 0.05) of obese youth. These group differences did not vary by child sex or race. Logistic regression analyses indicated that maternal distress and mealtime challenges discriminated between obese and non-overweight youth after controlling for maternal BMI. Family conflict was explained, in part, by maternal distress., Discussion: Obese youth who present for treatment in a clinic setting are characterized by psychosocial factors at the parent and family level that differ from non-overweight youth. These data are critical because they identify factors that may be serving as barriers to a family's or youth's ability to implement healthy lifestyle behaviors but that are potentially modifiable.