More than one-quarter to one-third of children who have obesity and enter weight management programs, also have depression, according to 2 recent studies. Depression was more common in children with greater screen time (from watching TV, computers, and phones), who come from lower income homes, have no contact with their fathers, or have a higher percent body fat.
Many children and teenagers won’t talk about their feelings, said Ronald J. Williams, MD, lead author of one of the studies. This makes it important to tell a doctor if your child has signs of depression.
In the study by Dr. Williams and colleagues, depression was found in 31 of 117 children (26.5%) ages 7 to 17 years entering a weight loss program at Penn State. In a study by Katherine Morrison, MD, and colleagues, depression was found in 36.4% of 244 children ages 8 to 17 years entering a weight loss program at McMaster University in Ontario, Canada.
Dr. Morrison said it is important to focus on healthy nutrition as well as increased physical activity, reducing screen time, and making sure that children are getting enough sleep. Her research has shown that poor sleep at 3 years of age is a predictor of being overweight at 7 years of age.
A Family Approach to Change
“The key for children’s obesity programs is that it is not just 1 person who needs to change, it is the whole family. If the parents don’t change, the success rate is going to be low,” said Dr. Williams, who is Director of the Pediatric Multidisciplinary Weight Loss Program at Penn State Hershey Children’s Hospital at Penn State Hershey Medical Center.
“It is really important to focus on changing lifestyle behaviors, including nutrition, physical activity, screen time, and sleep,” said Dr. Morrison, who is Associate Professor in the Department of Pediatrics, Co-chair of the Metabolism And Childhood (MAC) Obesity Research Program, at McMaster University, Hamilton, ON, Canada. She is also Medical Director of the Children’s Metabolism and Obesity Program at McMaster’s Hospital.
“Change is challenging and difficult for all of us, and particularly in this environment when our bodies are fighting against those changes,” Dr. Morrison said. “We are set up to protect the fat that we carry, and I think it is important for people to understand that it is not just a willpower issue,” she said.
Tips for Reducing Screen Time
The American Academy of Pediatrics recommends less than 2 hours of screen time each day. For kids who need to cut back on screen time, Dr. Williams suggests cutting back slowly. He suggests being mindful of those shows that children really want to watch, but shutting off the television when those shows are not on.
“I tell parents that screens are a privilege and not a right, and that sometimes children have to earn that privilege, meaning that they have to do 1 hour of physical activity in order to earn 2 hours of screen time as a form of positive reinforcement,” Dr. Williams said. “If they choose not to do things that they need to, like eating properly and exercising, then they can choose to not have their screen time, but that is their choice,” he noted.
“With iPhones and texting, I tell patients to wait 45 minutes and then answer 4 or 5 texts in a row instead of constantly being on the screen. I say ‘You can still watch TV and eat different foods, but keeping everything in moderation is key,’” Dr. Williams said.
Benson LP, Williams RJ, Novick MB. Pediatric obesity and depression: a cross-sectional analysis of absolute BMI as it relates to children’s depression index scores in obese 7- to 17-year-old children. Clin Pediatr (Phila). 2013;52(1):24-29.
Morrison KM, Shin S, Tarnopolsky M, Taylor VH. Association of depression & health related quality of life with body composition in children and youth with obesity. J Affect Disord. 2014;172C:18-23.