What is a significant psychological effect of pediatric obesity?

Depression and Suicidality: The Most Significant Psychological Effects of Pediatric Obesity

Weight stigma in pediatric obesity significantly increases the risk of depression and suicidality, with research showing the odds of thinking about and attempting suicide are approximately 2 times higher among children who are teased about their weight compared to those who are not teased. 1

Depression and Mental Health Consequences

Weight stigma poses numerous emotional and psychological consequences for children and adolescents with obesity:

• Depression and anxiety are significantly more prevalent among obese children, with evidence showing increased vulnerability that persists even after accounting for factors such as age, sex, BMI, and age of obesity onset 1
• Studies demonstrate that obese children show significantly higher levels of depressive symptoms compared to normal-weight peers, with a positive correlation between BMI z-score and depression scores 2
• Self-harm behaviors and suicidality are markedly higher among youth who have been teased or bullied about their weight compared with same-weight peers who have not been teased 1

Social Isolation and Academic Impact

The psychological effects extend beyond internal emotional states to social functioning:

• Adolescents with obesity are significantly more likely to experience social isolation and are less likely to be nominated as friends by peers 1
• More than two-thirds of 9- to 11-year-old children who perceived themselves as having excess weight believed they would have more friends if they could lose weight 1
• Weight-based teasing mediates the relationship between higher BMI and poorer school performance, with affected students reporting:
  • Harm to their grades due to weight-based bullying 1
  • School avoidance to escape weight-based teasing and bullying 1
  • The likelihood of reporting these negative academic reactions increased by 5% per teasing incident, even after controlling for sex, race, age, grades, and weight status 1

Self-Esteem and Body Image

Obesity significantly impacts children's self-perception and self-worth:

• Obese children demonstrate lower self-esteem that correlates inversely with depression levels - as depression increases, self-esteem decreases 3
• Poor body image is common among youth who are teased or bullied about their weight 1
• Overall health-related quality of life, including emotional, social, and school functioning, is significantly lower among severely obese children compared to healthy-weight children 1

Disordered Eating Behaviors

Weight stigma can trigger unhealthy eating patterns that worsen obesity:

• Weight-based victimization reinforces unhealthy eating behaviors that contribute to increased body weight 1
• Children who report weight-based teasing are more likely to engage in emotional eating, binge eating, and other disordered eating behaviors 1
• Longitudinal research demonstrates associations between early experiences of weight-based teasing and later development of disordered eating behaviors 1

Clinical Implications

The psychological effects of pediatric obesity require specific attention in clinical settings:

• Language matters - terms like "fat," "obese," and "extremely obese" are rated as the most undesirable, stigmatizing, and blaming by parents 1
• When parents perceive a doctor using stigmatizing language about their child's weight, 34% report they would switch doctors, and 24% would avoid future medical appointments 1
• Screening for depression and anxiety should be incorporated into the standard care for children with obesity 2, 4
• Cognitive Behavioral Therapy (CBT) has shown effectiveness for addressing the mental health problems that coexist with pediatric obesity 5

Treatment Considerations

Evidence suggests that properly structured obesity interventions can help improve psychological outcomes:

• Structured, professionally run pediatric obesity treatment is not associated with increased risk of depression or anxiety and may result in a mild reduction in symptoms 6
• Longer intervention duration is associated with greater reduction in anxiety symptoms 6
• Higher baseline BMI z-score is associated with greater reduction in depression following intervention 6

The psychological effects of pediatric obesity, particularly depression and suicidality, represent serious health concerns that can significantly impact quality of life and even mortality. Addressing weight stigma and incorporating mental health screening and support into obesity treatment programs is essential for comprehensive care.