Original article
Obesity in Adolescents: Understanding the Combined Role of Food Security and Emotional and Behavioral Disorders

https://doi.org/10.1016/j.jadohealth.2022.05.004Get rights and content

Abstract

Purpose

To examine the associations and interactions between levels of food security and emotional and behavioral disorders with obesity in adolescents.

Methods

Multiple logistic regression modeling was used to analyze the association of adolescent obesity with levels of food security and emotional and behavior disorders in children aged 12–17 years using data from National Health Interview Survey 2016–2018 combined years. Presence of emotional and behavioral disorders within food security categories was added to logistic regression modeling to examine interactions.

Results

When added individually to multiple logistic regression models, marginal and low food security, Attention Deficit Hyperactivity Disorder (ADHD) and anxiety were associated with increased odds of obesity, but very low food security and depression were not. Within the group of adolescents with very low food security, those with anxiety, depression, or ADHD had a nearly two to three-fold increase in odds of obesity compared to adolescents with very low food security and no emotional and behavioral disorders. A similar increase in the odds of obesity with the presence of anxiety, depression, or ADHD was not seen in the adolescents with high food security.

Discussion

This study finds a significant interaction between food security level and emotional and behavioral disorders. The distinction that very low food security in adolescents is only associated with obesity when either anxiety, depression or ADHD are present, but not independently, is an important contribution to understanding complex interactions contributing to obesity.

Section snippets

National health interview survey

The National Health Interview Survey (NHIS), a cross-sectional household interview survey, is the principal source of health information of the civilian, noninstitutionalized population in the United States. Data on a broad range of health topics are collected annually since 1957 by the National Center for Health Statistics. Data are collected via personal, face to face interviews by trained personnel from the U.S. Census Bureau continuously throughout the year. In order to obtain a

Results

A total of 9,982 adolescents representing a weighted population of 71,361,230 from the 2016–2018 combined NHIS survey were included. The response rates for the child component of 2016, 2017, and 2018 NHIS surveys were 60.1%, 60.6%, and 59.2%, respectively. Surveys regarding an adolescent were completed by a parent for 91.1% of surveys, a grandparent for 4.0%, and others completed 4.1%. About half (50.2%) of the adolescents were male.

Table 1 shows the characteristics of the sample and weighted

Discussion

Obesity in adolescents is multifactorial and influenced by external factors, such as food security and internal factors, such as emotional and behavioral disorders. This research further explored how these factors individually and combined affect the odds of obesity in adolescents, while controlling for the effect of family poverty status, education, race/ethnicity, sex, and age in a nationally representative sample of American adolescents aged 12–17 years. The obesity rate of 20.3% (95% CI

Acknowledgments

Dr. Vish conceptualized and designed the study, participated in data analysis and drafted the initial manuscript, and reviewed and revised the manuscript. Jenna Braun participated in drafting the initial manuscript and reviewed and revised the manuscript. Melissa King participated in drafting the initial manuscript and reviewed and revised the manuscript. Adrienne Stolfi carried out the analysis of data and reviewed and revised the manuscript. All authors approved the final manuscript as

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    Conflicts of interest: The authors have no conflicts of interest to disclose.

    Financial Disclosure: The authors have no financial relationships relevant to this article to disclose.

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