Mental health, loss of control eating, and cognitive functioning in adolescents undergoing bariatric surgery.

Bariatric surgery is an effective treatment for severe obesity in adolescence. Nevertheless, much remains to be understood regarding the impact of surgery on mental health, eating behaviors, and cognition. We review the findings related to mental health both before and after surgery as well as long-term changes in psychopathology, including suicide risk. Overall, adolescents with and without a history of psychopathology lose weight at similar rates. At the same time, there is an increased risk for suicide that requires further study. Regarding alcohol and substance use, this population reports lower rates of consumption than age related non-obese cohorts. Nevertheless the impact of altered anatomy and metabolism on alcohol ingestion in a population at risk for substance use is concerning. Eating behaviors, specifically loss of control eating, are discussed. Finally, we include discussion of the cognitive changes occurring perioperatively and considerations for adolescents with cognitive impairments. Clinical recommendations and suggestions for future research are discussed.

Teens with Type 1 Diabetes: How Does Their Nutrition Measure Up?

OBJECTIVE: To characterize the intake of macronutrient and fiber in adolescents with type 1 diabetes (T1D) and examine their association with health indicators. METHODS: Baseline data from an RCT were examined. Adolescent-parent dyads (n = 257, mean age 12 ± 1.2 years, 49.4% girls) reported dietary intake via two separate 24-hour recall interviews during a two-week period. Demographic and medical variables were abstracted from questionnaires and medical charts. RESULTS: Controlling for demographic and diet variables, a higher percentage of daily energy intake from fats was associated with poorer HbA1c. In contrast, an association between higher percent of energy intake from proteins and carbohydrates was found with higher systolic and diastolic BP, respectively. CONCLUSIONS: Many early adolescents with T1D did not meet diabetes nutritional guidelines. Lower adherence to nutritional guidelines, specifically more than recommended energy intake from fats, was associated with poorer HbA1c. Addressing nutritional guidelines and increasing adherence as part of treatment may improve health outcomes for youth with T1D.

Perceived Social Support for Exercise and Weight Loss in Adolescents Undergoing Sleeve Gastrectomy.

OBJECTIVES: Bariatric surgery is an effective treatment for youth with severe obesity. However, outcomes are variable and there remains sparse understanding of predictors of weight loss following surgery. The current study examines the role of adolescent-reported pre-operative social support around exercise, binge eating, and exercise to predict excess body mass index (EBMI) loss from 3 to 12 months post-surgery. METHOD: Participants were 101 adolescents ages 12-21 (M age = 16.6, SD = 1.8). Pre-operative body mass index (BMI) ranged from 35 to 87 (M = 50.3, SD = 8.6). Structural equation modeling (SEM) was used to evaluate a model of the association of adolescent report of perceived social support for exercise with less binge eating (items from the Eating Disorder Diagnostic Scale) and more self-reported exercise (items from the Youth Risk Behavior Surveillance System). The model was used to predict EBMI loss at 3, 6, 9, and 12 months post-surgery. RESULTS: Social support significantly predicted exercise and demonstrated a trend for predicting binge eating, such that more social support was associated with more exercise and a trend for less binge eating. Binge eating was associated with less EBMI loss. However, there was no association of exercise with EBMI loss. CONCLUSIONS: Pre-operative binge eating should be a target for identification and treatment prior to sleeve gastrectomy in adolescents. Although not directly or indirectly associated with EBMI loss, perceived social support around exercise was associated with increased exercise, which may make it a consideration for a target for intervention as well.

The Feasibility of a Pilot Intervention for Parents of Young Children Newly Diagnosed with Type 1 Diabetes.

OBJECTIVE: Evaluate the feasibility, acceptability, and indicators of preliminary efficacy of the pilot of a parent-focused, phone-based intervention to improve glycemic control and parental and child well-being in young children newly diagnosed with type 1 diabetes (T1D). METHODS: Thirty mothers of young children ages 1-6 diagnosed with T1D for less than 6 months were randomized to either a phone-based intervention or physical activity education comparison program. Child HbA1c and parent report of depressive symptoms, stress, social support, and child quality of life were assessed at baseline, 1, 6, and 12 months post intervention. RESULTS: The program was feasible, as the majority of participants completed more than 80% of the intervention or comparison education sessions and reported high levels of satisfaction. Overall, there was a significant time by treatment intervention where the intervention group demonstrated improved social support and quality of life over time as compared to the comparison education group. The intervention demonstrated a trend towards moderating the association between baseline maternal depressive symptoms and prospective worsening of HbA1c. CONCLUSIONS: Parents of young children newly diagnosed with T1D can be engaged in a phone-based program to provide support during this vulnerable period.

Family and youth factors associated with health beliefs and health outcomes in youth with type 1 diabetes.

OBJECTIVE: To examine the association of family organization with metabolic control in adolescents with type 1 diabetes through the mechanisms of family self-efficacy for diabetes and disease management. METHOD: Data from the baseline assessment of a longitudinal RCT were used, wherein 257 adolescent-parent dyads (adolescents aged 11-14) each completed the family organization subscale of the Family Environment Scale, the self-efficacy for Diabetes Self-Management Scale, the Diabetes Behavior Rating Scale, and 2 24-hr diabetes interviews. RESULTS: Structural equation modeling showed greater family organization was associated indirectly with better disease management behaviors via greater family self-efficacy (ß = .38, p < .001). Greater self-efficacy was indirectly associated with better metabolic control via better disease management both concurrently (ß = -.37, p < .001) and prospectively (ß = -.26, p < .001). The full model indicates more family organization is indirectly associated with better metabolic control concurrently and prospectively through greater self-efficacy and better disease management (ß = -.13, p < .001). CONCLUSIONS: Understanding the mechanisms by which family organization is associated with metabolic control provides insight into possible avenues of prevention/intervention for better diabetes management.

Parenting behavior, child functioning, and health behaviors in preadolescents with type 1 diabetes.

OBJECTIVE: To examine the association of critical parenting behaviors with preadolescent reported depressive symptoms, self-efficacy, and self-care behaviors in youth with type 1 diabetes (T1D). METHOD: A total of 84 youth with T1D, ages 9-11 years, completed the Diabetes Family Behavior Checklist, Child Depression Inventory, Self-Efficacy for Diabetes scale, and Self-Care Inventory during a baseline assessment for a randomized controlled trial of an intervention to promote adherence. RESULTS: Preadolescents who reported more critical parenting behaviors reported more depressive symptoms and lower self-efficacy. The relationship between critical parenting and self-efficacy was partially mediated by depressive symptoms. In a second model, depressive symptoms were associated with lower self-efficacy and fewer self-care behaviors. The relationship between depressive symptoms and self-care was fully mediated by self-efficacy. CONCLUSIONS: Critical parenting behaviors are associated with preadolescents' psychological well-being, which has implications for self-care. Clinical implications include decreasing critical parenting behaviors and monitoring preadolescents with T1D for depressive symptoms.

Correlates of self-worth and body size dissatisfaction among obese Latino youth.

The current study examined self-worth and body size dissatisfaction, and their association with maternal acculturation among obese Latino youth enrolled in a community-based obesity intervention program. Upon entry to the program, a sample of 113 participants reported global self-worth comparable to general population norms, but lower athletic competence and perception of physical appearance. Interestingly, body size dissatisfaction was more prevalent among younger respondents. Youth body size dissatisfaction was associated with less acculturated mothers and higher maternal dissatisfaction with their child's body size. By contrast, although global self-worth was significantly related to body dissatisfaction, it was not influenced by mothers' acculturation or dissatisfaction with their own or their child's body size. Obesity intervention programs targeted to Latino youth need to address self-worth concerns among the youth as well as addressing maternal dissatisfaction with their children's body size.

Individual and family strengths: an examination of the relation to disease management and metabolic control in youth with type 1 diabetes.

We examined the association of youths' positive qualities, family cohesion, disease management, and metabolic control in Type 1 diabetes. Two-hundred fifty-seven youth-parent dyads completed the Family Cohesion subscale of the Family Environment Scale, the Diabetes Behavior Rating Scale, 24-hour diabetes interview, and youth completed the Positive Qualities subscale of the Youth Self Report (YSR-PQ). Structural equation modeling demonstrated that YSR-PQ scores were associated with metabolic control mediated by associations with more family cohesion and better disease management. That is, youth with higher YSR-PQ scores had more cohesive families, better disease management, and, indirectly, better metabolic control. Family cohesion was indirectly associated with better metabolic control mediated by its association with better disease management, but not mediated by its association with YSR-PQ scores. Youth who reported more positive qualities, as measured by the YSR-PQ subscale, had better disease management and metabolic control through the association with more family cohesion. However, the current results did not support an alternative hypothesis that cohesive families display better diabetes management mediated by higher YSR-PQ scores.

Associations of parent coping, stress, and well-being in mothers of children with diabetes: examination of data from a national sample.

Caring for a child with diabetes is associated with parental stress and difficulties with psychological and physical functioning. Although small samples of children and parents have been studied to examine the relationship of parental stress and coping with well-being, little has been done looking at broader, national samples. The current study examined data on parental demographics, stress, coping, psychological well-being, and physical well-being from a national dataset (NSCH). A subset of 278 mothers who had children diagnosed with diabetes (either type 1 or type 2; M age = 12.1; 46% female children; 78% white) were included in the analyses for the current study. Results suggested that mothers of non-white children and mothers from single parent households experience poorer psychological and physical well-being than mothers of white children or mothers with a partner. Further, more stress was related to less positive psychological well-being, and poorer maternal coping was related to decreases in psychological and physical well-being. Findings support previous research with smaller, local samples and indicate the importance of addressing maternal stress and coping and providing interventions when needed for mothers of children with diabetes.

Brief report: The relationship of parental support and conflict to physical activity in preadolescents with type 1 diabetes.

OBJECTIVE: To use structural equation modeling to provide a preliminary examination of the relationship between parental support and conflict regarding physical activity behaviors in preadolescents with type 1 diabetes. METHOD: Parent-child dyads (n = 85, M child age = 10.8) completed physical activity items from the Diabetes Family Behavior Scale, Diabetes Related Conflict Scale, and Self-Care Inventory. Children completed physical activity items from the Center for Disease Control's Youth Risk Behavior Surveillance System, and activity was further measured via 24 hr recall interviews assessing physical activity behavior on a typical day. RESULTS: Parental conflict was related to less frequent physical activity, whereas parental support was related to more frequent physical activity. CONCLUSIONS: In this exploratory study, parental conflict and support for physical activity were related to physical activity in preadolescents with type 1 diabetes. Further research and development of interventions aimed at improving parental support and decreasing conflict around physical activity are warranted.

Adolescents' anxiety in dating situations: the potential role of friends and romantic partners.

This study examined adolescents' interpersonal functioning, including the qualities of their closest friendships and romantic relationships, as predictors of dating/heterosocial anxiety. An ethnically diverse sample of 781 adolescents (57% girls; ages 15-19 years) completed measures that assessed the number and type of close friends, the presence of a romantic relationship, the qualities of their best same-sex friendship and their romantic relationship (using the Network of Relationships Inventory-Revised), and levels of dating or heterosocial anxiety (using the Dating Anxiety Scale for Adolescents). Most adolescents were romantically involved, and girls were more likely to have a romantic partner than boys. Adolescents with fewer other-sex friends and those with less positive and more negative interactions with their best friends reported high levels of dating anxiety. In addition, adolescents who reported never having a romantic relationship, who did not have a current romantic partner, and who had less positive and more negative interactions with their romantic partners reported higher levels of dating anxiety. Variations were noted for different aspects of dating anxiety. The findings indicate that multiple aspects of adolescents' social relations may be independently and uniquely related to feelings of distress in dating or heterosocial situations. Adolescents' social relationships have the potential to support or interfere with the development of successful romantic relationships.

Adolescents' eating, exercise, and weight control behaviors: does peer crowd affiliation play a role?

OBJECTIVE: To examine the association between peer crowd affiliation (e.g., Jocks, Populars, Burnouts, Brains) and adolescents' eating, exercise, and weight control behaviors. The roles of gender and ethnicity were also examined. METHOD: Ethnically diverse adolescents (N = 705; 66% girls) completed the Peer Crowd Questionnaire, eating and exercise items from the Youth Risk Behavior Surveillance System, and weight control behaviors from the Eating Attitudes Test-12. RESULTS: Controlling for gender and ethnicity, adolescents affiliating with the Burnouts reported more unhealthful eating and more bulimic behaviors than others; adolescents affiliating with the Brains reported more healthful eating, less unhealthful eating, and more dieting; those affiliating with Jocks and Populars reported engaging in more exercise; and Populars also reported more unhealthful eating. In addition, boys exercised more than girls; girls reported more dieting and bulimic behaviors. Black adolescents reported more unhealthful eating and less dieting than other adolescents. CONCLUSIONS: Along with gender and ethnicity, peer crowd affiliation is related to adolescents' eating, exercise, and weight control behaviors. Prevention programs should consider adolescent peer crowds in developing health promotion and obesity prevention programs.