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.

Participating in sport and music activities in adolescence: the role of activity participation and motivational beliefs during elementary school.

This investigation examined the precursors of adolescents' participation in sport and music activities in the United States by testing a developmental model across 7 years. Data were drawn from youth questionnaires in the Childhood and Beyond Study (92% European American; N = 594). Findings suggest that patterns of participation across a 3-year period in elementary school predict adolescents' participation through their motivational beliefs. Specifically, children who participated in an activity, children who participated consistently across multiple years, and children who were highly active had higher adolescent motivational beliefs 4 years later than their peers. These motivational beliefs, in turn, positively predicted adolescents' participation 1 year later. Cross-domain analyses suggest that children typically maintain their orientation toward sports and music (e.g., high music-low sport orientation, not oriented toward either domain) as they age. These findings highlight the consistency in children's leisure pursuits and interests from childhood through adolescence.

Using Latent Class Growth Modeling to Examine Longitudinal Patterns of Body Mass Index Change from Adolescence to Adulthood.

BACKGROUND: Few studies use longitudinal designs to assess patterns of body mass index (BMI) change from adolescence to adulthood or incorporate severe obesity as a unique subgroup. OBJECTIVE: To examine patterns of BMI trajectories from adolescence to adulthood and identify demographic characteristics associated with each BMI trajectory pattern. DESIGN: Height, weight, and demographic characteristics were drawn from Waves I to V of the nationally representative school-based sample of the National Longitudinal Study of Adolescent to Adult Health (Add Health) conducted from 1994 to 2018 (data collection is ongoing). PARTICIPANTS/SETTING: Participants included 3,315 (55.5% female) subjects responding to in-home interviews across all five Waves of Add Health. MAIN OUTCOME MEASURES: BMI at each wave modeled over time. STATISTICAL ANALYSES: Latent class growth modeling and logistic regression analysis using population sample weights. RESULTS: Five classes of weight patterns best fit the sample. Twenty-nine percent of the sample had an always healthy BMI (class 1) and 34.9% changed from healthy weight to overweight (class 2). Moving from healthy weight to obese comprised 21.8% of the sample (class 3). BMI patterns increasing from overweight to obese (class 4) and from obese to severely obese (class 5) comprised 7.6% and 7.1% of the sample, respectively. Weight change was similar for males and females with some racial or ethnic minority participants more likely to be severely obese in adulthood. CONCLUSIONS: Results emphasize the importance of tracking weight longitudinally and point to a nationally representative trend of increasing BMI during the transition to adulthood. There was no substantive decreasing trend identified in the sample. Findings highlight the need for effective early and ongoing intervention and prevention strategies and can aid in identification of vulnerable youth who are at the highest risk for moving to problematic weight categories.

A Latent Profile Analysis of Young Adult Lifestyle Behaviors.

Objective: The aim of this study was to identify lifestyle profiles of young adult males and females based on their alcohol, diet, and exercise behaviors and then link these profiles with health. Method: We used the nationally representative 2017 Behavioral Risk Factor Surveillance System (BRFSS; N = 17,286; 47% female; Mage = 23.22; SD = 3.16; 65% white) to examine profiles of alcohol use, daily fruit and vegetable intake, fried potato intake, and exercise per week using latent profile analysis. Participants also reported the days their general, physical, and mental health were poor and BMI. Results: Five distinct profiles for both males and females were identified: Healthy Eaters/Exercisers, Moderates, Unhealthy Eaters, Medium Drinkers, and Heavy Drinkers. Heavy Drinkers and Unhealthy Eaters reported the most days of poor mental and physical health. Conclusions: Heavy drinkers and unhealthy eaters had the highest number of days of poor health, which also places them at risk for a host of health adversities throughout adulthood. Examining motivations behind young adults' patterns of consumption and activity is an important future direction to identify mechanisms for healthy lifestyle promotion during the transition to adulthood.

The mediational role of adolescents' friends in relations between activity breadth and adjustment.

This investigation addresses the mediational role of friends' characteristics between adolescents' activity breadth (i.e., variety in activity participation) and their later adjustment. Data were drawn from 2 longitudinal studies: the Childhood and Beyond (CAB; N = 925) study and the Maryland Adolescent Development in Context Study (MADICS; N = 1,338). Adolescents at Time 2 in each study (8th, 9th, and 11th graders in CAB and 8th graders in MADICS) reported on the breadth of their participation across 5 activity settings: sports, religious, volunteering, community, and school. Friends' characteristics and adolescent adjustment were reported by adolescents at Times 1 and 3. Friends' positive characteristics significantly mediated relations between activity breadth and adolescent depressive affect, self-worth, alcohol use, and problem behavior in both studies. Friends' negative characteristics significantly mediated these relations in CAB, but not in MADICS.

Youth Whose Weight Exceeds Healthy Guidelines Are High-Risk Targets for Tobacco Prevention Messaging and Close Monitoring of Cigarette Use.

BACKGROUND: Adolescents are long-standing tobacco prevention targets, given that smoking patterns typically originate before adulthood. Pediatric overweight/obesity remains at epidemic levels. Links between these two biobehavioral risks are not well understood, yet of keen public health and pediatric care relevance. The aims of the present study were to examine smoking behaviors and attitudes of overweight (OV), obese (OB), and severely obese (SO) adolescents, compared to healthy weight (HW), utilizing the nationally representative sample, Monitoring the Future. METHODS: Smoking behavior prevalence (ever, current, or age of initiation), perceived risk of harm, disapproval of others smoking, and peer smoking were determined for a pooled 2008-2009 sample of 19,678 10th graders (Mage=16.09±0.47 years) by CDC-defined BMI percentile-based categories within race/ethnic group (69.5% white, 14.5% African American, and 16.0% Hispanic). Logistic regression examined the impact of excess weight status on smoking behaviors and attitudes relative to HW. RESULTS: Relative to HW of same race/ethnicity, white or African American OV, OB, and SO had higher odds of recent smoking, with the highest prevalence among SO. For white youth, excess weight increased odds of ever smoking, early daily smoking (before grade 9), perceiving low risk of harm, and not disapproving of others smoking. Findings varied for African American or Hispanic youth. CONCLUSIONS: As we move toward fostering a tobacco-free generation, youth whose weight exceeds healthy guidelines are high-risk targets for tobacco prevention messaging and close monitoring of cigarette use, particularly those who are severely obese as well as white youth of excess weight, starting before adolescence.