Which Came First, and Who Has it Worse?

Kovalam Beach

“Which came first, the chicken or the egg?” is an age-old question that capsulizes the mystery of causation. One of the areas where it applies is childhood obesity. Do kids start by being in emotional pain and adopt comfort eating as a palliative measure? Or do the excessive eating and consequent weight gain start first, resulting in teen years filled with misery?

Britain’s National Obesity Obervatory (NOO) sought answers and found that “depression can predict obesity in adolescents and young adults.” This information comes from longitudinal studies conducted by the National Child Measurement Programme, which follows the progress of kids for years. Their report adds:

The authors of one study on adolescent girls conclude that this could be because depressed individuals eat more to provide comfort or distraction from negative emotions, or that serotonin dysregulation could lead them to eat more carbohydrate-rich foods.

So there are cases where the depression predates the obesity; but the NOO also mentions studies indicating that “obesity in adolescence may lead to depression in adulthood.” Clearly there’s a vicious-cycle effect going on here, and it’s also certain that many children are already obese in their very young years, before they have a chance to learn what depression is all about.

There are as many scenarios and life paths as there are people, and even in the aggregate — as shown by cohort studies — the same demographic group can show up differently. These mysteries inspire experts to stress the importance of covering a lot of ground. Here are two excerpts from an article by Traci Pedersen:

“[O]besity prevention and treatment efforts [ought] to address the broad spectrum of psychosocial implications of being obese as a teenager.”
— Bamini Gopinath, Ph.D., senior research fellow at the University of Sydney in Australia.

“[P]arents, health care providers and teenagers need to understand the far-reaching effects that being overweight can have on a teen’s enjoyment of life.
— Lawrence J. Cheskin, M.D., director of the Johns Hopkins Weight Management Center

In the 2004-2005 school year, Australian researchers started studying about 2,000 kids of both sexes starting at about age 12, and followed up five years later. In that part of the world, scientists also use the word “adiposity” for obesity, and what they wanted to find out was how obesity impacted the quality of life of these 17- and 18-year-olds. How was their physical health, and how well did they function emotionally and socially?

In some ways, girls and boys were the same. In the kids who had been obese during their teen years, physical functioning was of course impaired. Kids whose weight status had changed over the five-year period from overweight/obese into the normal range, reported improved Quality of Life (QOL) scores.

The surprise

Pedersen’s article is titled “Obesity Reduces Quality of Life in Boys,” and here is the type of situation for which the word “counterintuitive” was invented. Probably most people would assume that overweight girls have a tougher time of it, because of society’s higher expectations for female appearance. But Dr. Gopinath says, “Adiposity in boys was associated with poorer quality of life during adolescence. This association was not observed among girls.”

This fits in with one of the details of the NOO report:

Recent findings from the Millennium Cohort Study … suggest that childhood obesity may in fact be associated with emotional and behavioral problems from a very young age, with obese boys at particular risk.

But wait! It also mentions another study saying the opposite, that the mental-health impact of obesity is worse in girls.

Research points to a stronger relationship between common mental health disorders among girls than boys…. Increases in BMI and decreases in physical activity over time have also been found to be significantly associated with depressive symptoms in young women. For girls, the effects of obesity on self-esteem are often detectable before puberty. One study even found that the impact of overweight on self-competence may start as young as five years old. For boys, it is only during early teenage years that self-competence is impaired.

Your responses and feedback are welcome!

Source: “Obesity and mental health – National Obesity Observatory,” National Obesity Observatory, March 2011
Source: “Obesity Reduces Quality of Life in Boys,” PsychCentral.com, 02/23/13
Image by Stan Dalone & Miran Rijavec


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About Dr. Robert A. Pretlow

Dr. Robert A. Pretlow is a pediatrician and childhood obesity specialist. He has been researching and spreading awareness on the childhood obesity epidemic in the US for more than a decade.
You can contact Dr. Pretlow at:


Dr. Pretlow’s invited presentation at the American Society of Animal Science 2020 Conference
What’s Causing Obesity in Companion Animals and What Can We Do About It

Dr. Pretlow’s invited presentation at the World Obesity Federation 2019 Conference:
Food/Eating Addiction and the Displacement Mechanism

Dr. Pretlow’s Multi-Center Clinical Trial Kick-off Speech 2018:
Obesity: Tackling the Root Cause

Dr. Pretlow’s 2017 Workshop on
Treatment of Obesity Using the Addiction Model

Dr. Pretlow’s invited presentation for
TEC and UNC 2016

Dr. Pretlow’s invited presentation at the 2015 Obesity Summit in London, UK.

Dr. Pretlow’s invited keynote at the 2014 European Childhood Obesity Group Congress in Salzburg, Austria.

Dr. Pretlow’s presentation at the 2013 European Congress on Obesity in Liverpool, UK.

Dr. Pretlow’s presentation at the 2011 International Conference on Childhood Obesity in Lisbon, Portugal.

Dr. Pretlow’s presentation at the 2010 Uniting Against Childhood Obesity Conference in Houston, TX.

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