Differences in adolescent cerebral perfusion as a function of obesity: Results from the FLEX-Brain study.

OBJECTIVE: Children and adolescents have greater resting cerebral blood flow (rCBF) during periods of rapid brain growth. Overweight and obesity have a global impact on brain cerebrovascular health in adults, but whether these effects are discernable in adolescents with overweight and obesity remains unknown. This study examined differences in rCBF between adolescents with a healthy weight (HW) and adolescents with overweight or obesity (OW). METHODS: The current study focused on analyzing data from 58 participants (mean age = 15.43 [SD 1.37] years). Participants were classified into OW (n = 38) and HW groups (n = 20) according to the Centers for Disease Control and Prevention's guidelines for children. Voxelwise t tests between the HW and OW groups were conducted to test for regional group differences in rCBF, controlling for age and sex. Mean rCBF was extracted from a gray matter mask to compare global rCBF between the HW and OW groups. RESULTS: The HW group had greater rCBF compared with the OW group in five clusters, with peaks in the cerebellum, precentral gyrus, and supplementary motor area. No clusters survived correction for the OW > HW contrast. Global rCBF did not significantly differ between the groups (p = 0.09). CONCLUSIONS: These results suggest that overweight and obesity in adolescence are associated with discernable reductions in blood flow to specific brain regions rather than having a global impact on rCBF.

A Social Affective Neuroscience Model of Risk and Resilience in Adolescent Depression: Preliminary Evidence and Application to Sexual and Gender Minority Adolescents.

Depression is a disorder of dysregulated affective and social functioning, with attenuated response to reward, heightened response to threat (perhaps especially social threat), excessive focus on negative aspects of the self, ineffective engagement with other people, and difficulty modulating all of these responses. Known risk factors provide a starting point for a model of developmental pathways to resilience, and we propose that the interplay of social threat experiences and neural social-affective systems is critical to those pathways. We describe a model of risk and resilience, review supporting evidence, and apply the model to sexual and gender minority adolescents, a population with high disparities in depression and unique social risk factors. This approach illustrates the fundamental role of a socially and developmentally informed clinical neuroscience model for understanding a population disproportionately affected by risk factors and psychopathology outcomes. We consider it a public health imperative to apply conceptual models to high-need populations to elucidate targets for effective interventions to promote healthy development and enhance resilience.

Cluster Randomized Trial of a College Health Center Sexual Violence Intervention.

INTRODUCTION: Sexual violence, particularly in the context of drinking, is prevalent on college campuses. This study tested a brief intervention to prevent sexual violence among students receiving care from college health centers. STUDY DESIGN: This study was a two-arm, unblinded cluster RCT. SETTING/PARTICIPANTS: On 28 campuses with health/counseling centers (1:1 randomization allocation; 12 intervention and 16 control), from September 2015 to March 2018, a total of 2,291 students seeking care at college health centers completed surveys before the appointment, immediately after, 4 months later, and 12 months later. INTERVENTION: Intervention college health center staff received training on delivering sexual violence education to all students seeking care. Control sites provided information about drinking responsibly. MAIN OUTCOME MEASURES: The primary outcome was students' change in recognition of sexual violence. Additional outcomes included sexual violence disclosure and use of services among students with a history of sexual violence at baseline. Generalized linear mixed models accounting for campus-level clustering assessed intervention effects. Data were analyzed from September 2018 to June 2019. RESULTS: Half (55%) of students seeking care at college health centers reported any history of sexual violence exposure. No between-group differences in primary (ß=0.001, 95% CI= -0.04, 0.04) or secondary outcomes emerged between intervention and control students. Post-hoc analyses adjusting for the intensity of intervention delivery (intensity-adjusted) revealed an increase in self-efficacy to use harm reduction strategies (ß=0.09, 95% CI=0.01, 0.18) among intervention participants. Among those who reported sexual violence at baseline, intervention students had increased odds of disclosing violence during the visit (AOR=4.47, 95% CI=2.25, 8.89) in intensity-adjusted analyses compared with control. No between-group differences emerged for remaining outcomes. CONCLUSIONS: Sexual violence exposure is high among students seeking care in college health centers. A brief provider-delivered sexual violence intervention, when implemented with fidelity, was associated with improved self-efficacy to use harm reduction and increased disclosure of sexual violence during clinical encounters but no increased use of services. More interventions that are stronger in intensity are needed to connect students to sexual violence services. TRIAL REGISTRATION: This study is registered at www.clinicaltrials.gov NCT02355470.

Sexual Assault, Alcohol Use, and Gender of Sexual Partners Among Cisgender Women Seeking Care at US College Health Centers, 2015-2018.

Objectives. To assess differences by gender of sexual partner in the association between sexual assault and alcohol use among women seeking care in college health centers.Methods. This longitudinal study comprised 1578 women aged 18 to 24 years visiting 28 college health centers in Pennsylvania and West Virginia from 2015 to 2018. We used multilevel logistic regression and negative binomial regression, testing for interactions of gender of sexual partners, sexual assault, and prevalence and frequency of alcohol use and binge drinking.Results. Sexual assault was reported by 87.3% of women who had sex with women or with women and men (WSWM), 68.2% of women who had sex with men only (WSM), and 47.5% of women with no penetrative sexual partners. The relative associations between sexual assault and alcohol outcomes were smaller for WSWM (prevalence: odds ratios from 0.04 to 0.06; frequency: incidence rate ratios [IRRs] from 0.24 to 0.43) and larger for women who had no penetrative sexual partners (IRRs from 1.55 to 2.63), compared with WSM.Conclusions. Alcohol use patterns among women who have experienced sexual assault differ by gender of sexual partners.

Suicidal thoughts and behaviors in adolescents who underwent bariatric surgery.

BACKGROUND: Extant literature warns of elevated suicide risks in adults postbariatric surgery, making understanding risks for adolescent patients imperative. OBJECTIVES: To examine prevalence and predictors/correlates of suicidal thoughts and behaviors (STBs) in adolescents with severe obesity who did/did not undergo bariatric surgery from presurgery/baseline to 4 years postsurgery. SETTING: Five academic medical centers. METHODS: Using a prospective observational design, surgical adolescents (n = 153; 79% female, 65% white, mean [M]age = 17 yr, Mbody mass index[BMI] = 52 kg/m2) and nonsurgical comparators (n = 70; 80% female, 54% white, Mage = 16 yr, MBMI = 47 kg/m2) completed psychometrically sound assessments at presurgery/baseline and postsurgery years 2 and 4 (year 4: n = 117 surgical [MBMI = 38 kg/m2], n = 56 nonsurgical [MBMI = 48 kg/m2]). RESULTS: For the surgical group, rates of STBs were low (year 2 [1.3%-4.6%]; year 4 [2.6%-7.9%], similar to national base rates. Groups did not differ on a year 4 postsurgical STBs (post-STBs) composite (post-STBs: ideation/plan/attempt; n = 18 surgical [16%], n = 10 nonsurgical [18%]; odds ratio = .95, P = .90). For the surgical group, predictors/correlates identified within the broader suicide literature (e.g., psychopathology [P < .01], victimization [P < .05], dysregulation [P < .001], drug use [P < .05], and knowing an attemptor/completer [P < .001]) were significantly associated with post-STBs. Surgery-specific factors (e.g., percent weight loss, weight satisfaction) were nonsignificant. Of those reporting a lifetime attempt history at year 4, only a minority (4/13 surgical, 3/9 nonsurgical) reported a first attempt during the study period. Of 3 decedents (2 surgical, 1 nonsurgical), none were confirmed suicides. CONCLUSIONS: The present study indicates that undergoing bariatric surgery in adolescence does not heighten (or lower) risk of STB engagement across the initial 4 years after surgery. Suicide risks present before surgery persisted, and also newly emerged in a subgroup with poorer psychosocial health.

Change, predictors and correlates of weight- and health-related quality of life in adolescents 2-years following bariatric surgery.

BACKGROUND/OBJECTIVES: Weight-related quality of life (WRQOL) and generic health-related quality of life (HRQOL) have been identified as important patient-reported outcomes for obesity treatment and outcome research. This study evaluated patterns of WRQOL and HRQOL outcomes for adolescents at 24-months post-bariatric surgery relative to a nonsurgical comparator sample of youth with severe obesity, and examined potential weight-based (e.g., BMI, weight dissatisfaction) and psychosocial predictors and correlates of these outcomes. SUBJECTS/METHODS: Multi-site data from 139 adolescents undergoing bariatric surgery (Mage = 16.9; 79.9% female, 66.2% White; MBody Mass Index [BMI] = 51.5 kg/m2) and 83 comparators (Mage = 16.1; 81.9 % female, 54.2% White; MBMI = 46.9 kg/m2) were collected at pre-surgery/baseline, 6-, 12-, and 24-months post-surgery/baseline with high participation rates across time points (>85%). Self-reports with standardized measures of WRQOL/HRQOL as well as predictors/covariates (e.g., weight dissatisfaction, social support, peer victimization, family dysfunction, loss of control eating, self-worth, and internalizing symptoms) were obtained. Growth curve models using structural equation modeling examined WRQOL/HRQOL over time and linear regressions examined predictors and correlates of WRQOL/HRQOL outcomes. RESULTS: Significant improvement in WRQOL and Physical HRQOL, particularly in the first postoperative year with a leveling off subsequently, was found for the surgical group relative to comparators, but with no significant Mental HRQOL change. At 24 months, the surgical group had significantly greater WRQOL/HRQOL across most subscales. Within the surgical group at 24 months, weight-based variables were significantly associated with WRQOL and Physical HRQOL, but not Mental HRQOL. Mental HRQOL was associated with greater internalizing symptoms and loss of control eating. CONCLUSIONS: For adolescents undergoing bariatric surgery, most clinically meaningful changes in WRQOL and Physical HRQOL occurred early postoperatively, with weight-based variables as the primary drivers of 24-month levels. In contrast, expectations for Mental HRQOL improvement following surgery should be tempered, with 24-month levels significantly associated with psychosocial rather than weight-based correlates.

Young adolescent sleep is associated with parental monitoring.

OBJECTIVES: Insufficient sleep can increase risk for adverse psychological and physical outcomes. Parental monitoring of daily activities is associated with youth health behaviors. We examined parental monitoring of waking and bedtime behaviors and sleep in a community sample of high-risk youth. METHODS: One-hundred sixty-five 10- to 14-year-olds from low-socioeconomic status families participated (11.8 years ±1.16, 52% female; 78% Black/African American). Parents and youth evaluated parental monitoring of waking activities. Parent expectations about bedtime and parent knowledge about adolescent's bedtime and sleep routine were independently rated. Youth sleep was assessed via parent report and actigraphy over 7 days. RESULTS: More parental knowledge about bedtime was associated with longer parent-reported sleep duration (ß = .18, P < .05). Parental monitoring of waking activities (youth reported) was associated with more actigraph-assessed sleep over 7 days (B = 2.73, SE = .91), weekdays (B = 2.44, SE = .01), and weekends (B = 3.88, SE = .1.41, all Ps < .05), whereas parent reported monitoring was associated with more sleep on weekdays only (B = 2.10, SE = .87, P < .05). Parental knowledge and expectations about bedtime behaviors were not associated with actigraph-assessed sleep (P values > .05). Parental monitoring of waking and bedtime behaviors was not associated with sleep duration variability (P values > .05). CONCLUSIONS: Parental monitoring of waking activities may indirectly influence adolescent sleep via increased structure and felt security in the parent-adolescent relationship. Youth perception of monitoring may be particularly relevant for youth sleep duration.

Weight Loss Trajectories and Adverse Childhood Experience among Obese Adolescents with Polycystic Ovary Syndrome.

STUDY OBJECTIVE: To examine the effect of childhood trauma and family history of psychiatric illness on weight loss trajectories of obese, female adolescents with polycystic ovary syndrome (PCOS). DESIGN: Prospective study. SETTING: PCOS and adolescent medicine outpatient clinics. PARTICIPANTS: Participants were, on average, 15.8 years of age, 80% Caucasian (39/49 participants), and had a body mass index of 36.8 ± 8.8. INTERVENTIONS: Healthy Bodies, Healthy Minds is an evidence-based one-on-one intervention consisting of 4 weekly sessions, 4 biweekly sessions, and 3 monthly booster sessions. Each session was 45-60 minutes long with 15-30 minutes of physical activity with a lifestyle coach. MAIN OUTCOME MEASURES: Paired sample t tests were used to assess group differences in pre- and post-treatment weight between participants reporting childhood trauma and body mass index-matched controls not endorsing trauma. One-way analysis of variance was performed to assess the influence of childhood trauma on weight loss between the 2 groups. RESULTS: Adolescents without a family history of psychiatric illness lost more weight (mean, -1.28 kg; SD, 6.89) than those who had a family history of psychiatric illness (mean, -0.64 kg; SD, 4.7) from baseline to booster session completion (6 months). However, results of independent t tests did not reveal statistically significant group differences in weight loss from baseline to booster session completion (t21 = 0.51; P = .6). CONCLUSION: Obese adolescents with PCOS who have experienced childhood trauma can lose weight and acquire its health benefits when enrolled in an intervention addressing weight, mood, and sleep. Family history of psychiatric illness emerged as a potential predictor of lesser weight loss.

An overview of common psychiatric problems among adolescent and young adult females: Focus on mood and anxiety.

Adolescence is a dynamic period of learning and adaptation. It provides unique opportunities in which adolescents strive to become independent, generative young adults. However, with these strides come increased prevalence in psychiatric symptomatology. Among adolescent girls, anxiety disorders are the most common condition followed by mood disorders. Mood disorders, specifically depression, result in the greatest impairment. Factors such as body mass index and early pubertal onset are associated with poorer mental health such as depression. In addition, depression is a top risk factor for suicide particularly among youth aged 13-17 years. We provide a brief description of the most common mood disorders, along with assessment tools, among teen and young adult females. Then, special considerations for psychiatric presentation among this young population will be presented.

Peer Victimization in Adolescents With Severe Obesity: The Roles of Self-Worth and Social Support in Associations With Psychosocial Adjustment.

Objective: To examine the associations of peer victimization with internalizing symptoms, externalizing symptoms, social competence, and academic performance in a clinical sample of adolescents with severe obesity, and whether self-worth and social support affect these associations. Methods: Multisite cross-sectional data from 139 adolescents before weight loss surgery ( M age = 16.9; 79.9% female, 66.2% White; M Body Mass Index [BMI] = 51.5 kg/m 2 ) and 83 nonsurgical comparisons ( M age = 16.1; 81.9% female, 54.2% White; M BMI = 46.9 kg/m 2 ) were collected using self-reports with standardized measures. Results: As a group, participants did not report high levels of victimization. Self-worth mediated the effects of victimization on a majority of measures of adjustment, and further analyses provided evidence of the buffering effect of social support for some mediational models. Conclusions: Self-worth and social support are important targets for prevention and intervention for both victimization and poor adjustment in adolescent severe obesity.

Loss of control eating and eating disorders in adolescents before bariatric surgery.

OBJECTIVE: This study assessed loss of control (LOC) eating and eating disorders (EDs) in adolescents undergoing bariatric surgery for severe obesity. METHOD: Preoperative baseline data from the Teen Longitudinal Assessment of Bariatric Surgery (Teen-LABS) multisite observational study (n = 242; median BMI = 51 kg/m2 ; mean age= 17; 76% female adolescents; 72% Caucasian) included anthropometric and self-report questionnaires, including the Questionnaire of Eating and Weight Patterns-Revised (QEWP-R), the Night Eating Questionnaire (NEQ), the Beck Depression Inventory (BDI-II), and the Impact of Weight on Quality of Life-Kids (IWQOL-Kids) RESULTS: LOC eating (27%) was common and ED diagnoses included binge-eating disorder (7%), night eating syndrome (5%), and bulimia nervosa (1%). Compared to those without LOC eating, those with LOC eating reported greater depressive symptomatology and greater impairment in weight-related quality of life. DISCUSSION: Before undergoing bariatric surgery, adolescents with severe obesity present with problematic disordered eating behaviors and meet diagnostic criteria for EDs. LOC eating, in particular, was associated with several negative psychosocial factors. Findings highlight targets for assessment and intervention in adolescents before bariatric surgery. © 2016 Wiley Periodicals, Inc.(Int J Eat Disord 2016; 49:947-952).

Brain volume and white matter in youth with type 2 diabetes compared to obese and normal weight, non-diabetic peers: A pilot study.

Type 2 Diabetes Mellitus (T2DM) and obesity are linked to specific patterns of subcortical brain atrophy and decreased microstructural integrity of white matter. Fifteen adolescents (12-21-years-old, 80% Caucasian, 15% African American, mean BMI=32)-five with T2DM confirmed by oral glucose tolerance test, five matched obese adolescent controls without diabetes (OBCN), and five matched (race, sex) normal-weight controls (NWCN)-underwent Magnetic Resonance Imaging (MRI) for the collection of gray matter volume and white matter integrity. Analyses of Variance (ANOVAs) of the neuroimaging data revealed significant differences in caudate nucleus volume [F(2,12)=7.79, p<0.05] such that the normal-weight group had significantly greater volume than the obese and T2DM groups (NWCN>OBCN, p=0.020; OBCN>T2DM, p=0.042; and NWCN>T2DM; p=0.003) after controlling for participant Body Mass Index (BMI). Similarly, there was a main effect for the volume of the thalamus [F(2,12)=4.39, p<0.05] with greater volume for both the NWC and the OBC groups in comparison to the T2DM group (NWC>T2DM, p=0.020; OBC>T2DM; p=0.040). Finally, an examination of white matter integrity among the three groups illustrated a pattern of white matter integrity reduction between normal-weight participants and both obese controls and T2DM participants, with T2DM demonstrating the greatest deficit in functional anisotropy (FA) volume, but these results were not significant after further controlling for BMI. Results from the current pilot study illuminate a host of brain morphology differences between youth with T2DM, obese youth, and normal-weight controls; future research with a larger sample size is critical.

Mood and Ambulatory Monitoring of Physical Activity Patterns in Youth with Polycystic Ovary Syndrome.

STUDY OBJECTIVE: To provide initial insight into physical activity patterns and predictors of moderate to vigorous physical activity (MVPA) in youth with polycystic ovary syndrome (PCOS) by using a multisensor activity monitor. DESIGN: Cross-sectional study analyzing baseline MVPA data using real-time continuous monitoring of physical activity. Body mass index (BMI) and depressive symptoms were examined as predictors of MVPA. SETTING: A large, urban children's hospital in the United States. PARTICIPANTS: Thirty-five youth (aged 12 to 21 years) previously diagnosed with PCOS (mean BMI = 38.0 kg/m(2); mean age = 15.4 years, 79% white) who were participants in a behavioral lifestyle intervention. MAIN OUTCOME MEASURES: Total steps, total MVPA, longest continuous bout of MVPA, and frequency of MVPA bouts lasting for 5 to 9 minutes and 10 or more minutes. RESULTS: Sixty percent of youth averaged at least 1 daily MVPA bout lasting 10 or more minutes, and 14% averaged a daily MVPA bout lasting 30 or more minutes. BMI was negatively correlated with MVPA bout duration (P = .04). Parental ratings of depression, but not self-report ratings, were predictive of participants' total MVPA (ß = -.46; P = .01), number of 5- to 9-minute bouts (ß = -.39; P = .03), and bouts of 10 or more minutes (ß = -.35; P = .05). CONCLUSION: Youth with PCOS may benefit from being prescribed multiple bouts of MVPA lasting less than 30 continuous minutes to meet national recommendations and achieve health benefits. BMI and parental endorsement of child's depression symptoms may be important to consider when assessing and prescribing MVPA to youth with PCOS.

A multisite view of psychosocial risks in patients presenting for bariatric surgery.

OBJECTIVE: The psychosocial health of adolescents with severe obesity (BMI ≥ 120% for age and gender) has only recently been the focus of empirical work. METHODS: This multisite study-an ancillary to a prospective longitudinal observational study documenting health in adolescents having weight loss surgery (WLS)-presents preoperative/baseline data from 141 WLS adolescents and 83 nonsurgical comparisons (NSComps). Self-report data from adolescent and caregiver dyads characterize adolescent psychopathology and potential correlates. RESULTS: One in three adolescents reported internalizing symptoms, and one in five endorsed externalizing symptoms in the clinical range. Generalized linear model analysis demonstrated that increased risk of psychopathology for adolescents with severe obesity was associated with family dysfunction, eating pathology, family composition, and seeking behavioral intervention (versus WLS), whereas better quality of life (QOL) was associated with lower psychopathology. CONCLUSIONS: While psychopathology rates are comparable to national samples, there is a subgroup of youth who present for behavioral weight loss services and are at greater risk for psychopathology relative to national adolescent base rates. Adolescents who achieve candidacy for WLS may be a highly selective population of youth with severe obesity and may have lower base rates of psychopathology compared to NSComps.

Child Maltreatment and the Adolescent Patient With Severe Obesity: Implications for Clinical Care.

OBJECTIVE: To characterize prevalence and correlates of child maltreatment (CM) in a clinical sample of adolescents with severe obesity. METHOD: Multicenter baseline data from 139 adolescents undergoing weight loss surgery (Mage = 16.9; 79.9% female, 66.2% White; Mbody mass index [BMI] = 51.5 kg/m(2)) and 83 nonsurgical comparisons (Mage = 16.1; 81.9% female, 54.2% White; MBMI = 46.9 kg/m(2)) documented self-reported CM (Childhood Trauma Questionnaire) and associations with psychopathology, quality of life, self-esteem and body image, high-risk behaviors, and family dysfunction. RESULTS: CM prevalence (females: 29%; males: 12%) was similar to national adolescent base rates. Emotional abuse was most prevalent. One in 10 females reported sexual abuse. For females, CM rates were higher in comparisons, yet correlates were similar for both cohorts: greater psychopathology, substance use, and family dysfunction, and lower quality of life. CONCLUSION: While a minority of adolescents with severe obesity reported a CM history, they carry greater psychosocial burden into the clinical setting.

Neurodevelopmental assessment after anesthesia in childhood: review of the literature and recommendations.

Preclinical studies have established that anesthesia is toxic to the brain in neonatal animals, but scant research investigates the neurodevelopmental effects of exposure to anesthesia. In this article, we discuss the issue of outcome measurement of children after anesthesia administered between infancy and approximately 4 years of age. Recent studies are reviewed with the goal of understanding the contributions and limitations of the extant literature with respect to neurodevelopmental outcome. A review of school-based information (academic achievement and learning disability characterization), which are most frequently applied to measure cognitive outcome in cohort studies, is provided. The strengths and limitations of this literature is reviewed, followed by a discussion of how future trials investigating neurodevelopmental outcome after anesthesia might be improved by procedures designed specifically to assess the status of the central nervous system. Neuropsychological assessment is described and proposed as a way to increase the validity and sensitivity of forthcoming studies that intend to evaluate the short- and long-term effects of exposure to anesthesia during infancy and early childhood.

Self-regulation of sleep, emotion, and weight during adolescence: implications for translational research and practice.

Self-regulation-the ability to manage motivations, emotions, physiological sensations, and behavior to meet internal and external demands of the environment-is critical to health and development. Adolescence represents a dynamic period of change in both the demand and capacity for self-regulation. As teens mature and become more autonomous, they are confronted with decisions in determining where they spend their time, what they eat, when they go to bed, and how they prioritize and pursue various social, academic, and recreational goals. We highlight opportunities to improve self-regulatory capacities and related health outcomes during this important developmental window. In particular, we focus on emotion regulation, sleep regulation, and weight regulation as three separate but synergistic self-regulatory systems that may provide unique opportunities for intervention to optimize health outcomes. To this end, we begin by describing developmental changes that occur in emotion, sleep and weight regulatory systems during the transitional period of adolescence, as well as how these changes can lead to profound and enduring health consequences. Next, we describe emerging evidence that indicates complex and synergistic interactions among these regulatory systems during adolescence. Last, we end with possible prevention and intervention efforts that capitalize on the interactions among these three regulatory domains.

Depressive symptoms and metabolic markers of risk for type 2 diabetes in obese adolescents.

OBJECTIVE: Although higher rates of depression are found among individuals with type 2 diabetes, it remains unknown if the presence of depressive symptoms is associated with heightened metabolic risk for the development of type 2 diabetes among youth. The objective of this study was to evaluate whether depressive symptoms in obese adolescents are associated with impaired ß-cell function relative to insulin sensitivity [oral disposition index (oDI)] and/or dysglycemia or prediabetes, predictors of type 2 diabetes development. RESEARCH DESIGN AND METHODS: Fasting and oral glucose tolerance test (OGTT)-derived indices of glucose tolerance, insulin sensitivity, secretion, and oDI were evaluated in obese youth (n = 56, age 15.0 ± 1.6 yr, 68% female). The Children's Depression Inventory was utilized to determine depressive symptomatology. RESULTS: Despite no association between depressive symptoms and measures of adiposity, youth with higher depressive symptoms had (i) significantly higher fasting and stimulated glucose levels (13% higher glucose area under the OGTT curve), (ii) ∼50% lower oDI, and (iii) a 50% frequency of prediabetes. CONCLUSIONS: These data point to an important relationship between depressive symptoms and a heightened metabolic risk for type 2 diabetes in obese adolescents, including prediabetes and impairment in ß-cell function relative to insulin sensitivity. While the directionality of these relationships is unknown, it should be determined if treating one disorder improves the other or vice versa.