Date of Award

January 2013

Document Type

Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

Karen Dorsey

Subject Area(s)

Medicine, Mental health, Public health

Abstract

Recognizing that obesity and depression tend to be refractory chronic diseases, this paper explores the comorbid development of the conditions in childhood by asking: 1) what are the characteristics of youth at high risk for co-occurrence of obesity/overweight and elevated depressive symptoms and 2) through which mechanisms do obesity/overweight and depressive symptoms co-develop in youth.

It was hypothesized that youth with comorbidity have characteristic demographic, social, and psychological profiles. It was f further hypothesized that there are multiple mechanistic pathways between obesity and depression including childhood depression associated with later onset obesity and childhood obesity associated with later onset depression.

This study used a systematic review of the literature through electronic databases to identify three broad study types useful in addressing the two questions: longitudinal cohort studies, cross-sectional studies of cohorts identified on the basis of one disease state, and intervention studies designed to target one disease state with measurements of treatment-associated changes in the second disease. Both qualitative comparisons and meta-analysis were conducted.

74 studies were identified for qualitative analyses and 18 for meta-analyses. Studies of obese populations showed evidence to support an association between the development of depression and seeking weight-loss treatment, self-perception of being overweight, anxiety, bulimic symptoms, maternal depression, peer victimization and decreased social support. Sex, race, and obesity severity were not associated with comorbidity. Longitudinal studies showed an association between childhood depression and later onset

childhood obesity. Childhood obesity and subsequent adult depression was significant for females only as was childhood depression and subsequent onset adult obesity. Male sex was protective against development of disease in adulthood. Intervention studies showed significant reductions in depressive symptoms

associated with multidisciplinary weight loss interventions and bariatric surgery.

The study findings can be used primarily to screen for obese youth at increased risk of having elevated depressive symptoms. Additionally, the new understanding of multidirectional temporal relationships should be used to develop novel prevention strategies.

Comments

This thesis is restricted to Yale network users only. This thesis is permanently embargoed from public release.

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