Controlled study of critical parent and family factors in the obesigenic environment. Obesity. 2007;15:126 -136. Objective: Critical gaps remain in our understanding of the obesigenic family environment. This study examines parent and family characteristics among obese youth presenting for treatment in a clinic setting. Research Methods and Procedures: Families of 78 obese youth (BMI z-score ϭ 2.4; age, 8 to 16 years; 59% girls; 49% African-American) were compared with 71 non-overweight (BMI z-score ϭ Ϫ0.02) demographically matched comparisons. Parents completed measures assessing family demographics, psychological distress (Symptom Checklist 90-Revised), and family functioning both broadly (Family Environment Scale: Conflicted, Support, Control) and at mealtimes (About Your Child's Eating-Revised: Mealtime Challenges, Positive Mealtime Interaction). Height and weight were obtained from all participants. Results: Compared with mothers and fathers of non-overweight youth, parents of obese youth had significantly higher BMIs (p Ͻ 0.001). Mothers of obese youth reported significantly greater psychological distress (p Ͻ 0.01), higher family conflict (p Ͻ 0.05), and more mealtime challenges (p Ͻ 0.01). Less positive family mealtime interactions were reported by both mothers (p Ͻ 0.01) and fathers (p Ͻ 0.05) of obese youth. These group differences did not vary by child sex or race. Logistic regression analyses indicated that maternal distress and mealtime challenges discriminated between obese and non-overweight youth after controlling for maternal BMI. Family conflict was explained, in part, by maternal distress. Discussion: Obese youth who present for treatment in a clinic setting are characterized by psychosocial factors at the parent and family level that differ from non-overweight youth. These data are critical because they identify factors that may be serving as barriers to a family's or youth's ability to implement healthy lifestyle behaviors but that are potentially modifiable.

Children with neurofibromatosis type 1 (NF1) can have varying degrees of cognitive impairment, and are at risk for social, emotional, and behavioral dysfunction. We undertook an evaluation of social, emotional, and behavioral functioning of youth with NF1 and peers from multiple perspectives. We hypothesized that children with NF1 would have more psychosocial difficulties, which would be positively associated with neurological involvement. We compared 58 children with NF1, ages 7-15, with comparison classroom peers, classmates who were same race/gender and closest date of birth. Peer relationships, emotional well-being, and behavior were evaluated from multiple perspectives in multiple settings. Results showed that teachers perceived children with NF1 as more prosocial (i.e., polite, helpful to others). Teachers and peers viewed children with NF1 as displaying less leadership behavior and as more socially sensitive-isolated (i.e., often left out, trouble making friends). Children with NF1 had fewer friendships and were less well liked by peers. Mothers and fathers reported more problems with social functioning among children with NF1. Few group differences in emotional well-being and behavior were identified according to child and father report. However, mothers perceived children with NF1 to have more emotional problems relative to comparison peers, predominantly among older children. Neurological involvement was significantly related to psychosocial problems. We conclude that children with NF1 are frequently socially isolated and rejected by peers; and that greater neurological involvement is associated with more emotional problems. Central nervous system involvement appears to play a key role in identifying children at risk for problems with friendships, social acceptance, and emotional functioning (i.e., depression).

Background Comprehensive studies of adolescent bariatric surgery outcomes are in their infancy and are critically needed. The present study examined the rate of change in the body mass index (BMI), health-related quality of life (HRQOL), depressive symptoms, and self-concept in adolescents undergoing Roux-en-Y gastric bypass (RYGB) during the first 24 postoperative months using a prospective longitudinal design at a pediatric medical center. Methods A total of 16 adolescents (mean age 16.2 yr; 62.5% female, mean BMI 59.9 kg/m2; 97% of eligible, consecutive patients) completed the Impact of Weight on Quality of Life-Kids, Pediatric Quality of Life Inventory, Beck Depression Inventory, Self-Perception Profile for Adolescents, and height and weight measurements at baseline and 6, 12, 18, and 24 months after RYGB. A total of 75% participated at all follow-up points. Results Before RYGB, global psychosocial impairments were documented. Hierarchical linear modeling was used to examine the growth trajectories. Several quadratic (nonlinear) trends were revealed. A substantial reduction in weight and depressive symptoms, as well as improved HRQOL and self-concept were identified across the first postoperative year, followed by decelerations in year 2, including weight regain (P < .0001) and slight increases in depressive symptoms (P = .004) and decreases in HRQOL (Social, P = .002; Body Esteem, P = .0007; Physical Comfort, P < .0001; and Total, P < .0001), and self-concept (Social, P = .02; Appearance, P = .002; and Close Friendship, P = .008). Conclusion During the first 24 months after RYGB, preliminary evidence suggests adolescents experience significant weight loss as well as psychosocial and HRQOL improvements. A deceleration in these gains occurred in the second postoperative year. Longer term follow-up with larger samples is critical to determine the weight and psychosocial trajectories, and what role psychosocial status plays in adolescents’ weight change and maintenance.