Risk-Taking Behaviors of Adolescents With Extreme Obesity: Normative or Not?

Abstract

OBJECTIVE: Present first published data detailing high-risk behaviors of adolescent high school students (HSS) with extreme obesity (BMI ≥ 99th percentile for age and gender) compared with healthy weight peers (5th–84th percentile). METHODS: The 2007 Youth Risk Behavior Survey was used to compare HSS with extreme obesity (N = 410) and healthy weight peers (N = 8669) in their engagement in (1) tobacco use, (2) alcohol/other drug use, (3) high-risk sexual behaviors, and (4) suicidal behaviors. Logistic regression was used to calculate gender-stratified odds ratios (OR) and 95% confidence intervals (CI), controlling for age and race. RESULTS: HSS with extreme obesity were similar to healthy weight peers in the prevalence of most behaviors related to alcohol/drug use, high-risk sexual activities, and suicide, with the following exceptions: relative to healthy weight HSS, both male and female students with extreme obesity more frequently reported ever trying cigarettes (female students, adjusted OR: 2.0 [95% CI: 1.3–3.2]; male students, OR: 1.5 [CI: 1.2–2.0]). Compared with healthy weight female students, female students with extreme obesity had lower odds of ever having sex (OR: 0.5 [CI: 0.3–0.9]), but greater odds of drinking alcohol/using drugs before their last sexual encounter (OR: 4.6 [CI: 1.2–17.6]), currently smoking (OR: 2.3 [CI: 1.2–4.4]), and using smokeless tobacco (OR: 4.6 [CI: 1.2–17.2]). Compared with healthy weight male students, male students with extreme obesity had greater odds of smoking before age 13 (OR: 1.4 [CI: 1.0–2.0]). CONCLUSIONS: With few exceptions, HSS with extreme obesity engage in high-risk behaviors at rates comparable with healthy weight peers, sometimes in even more dangerous ways. Health care providers should assess risk-taking behaviors in this cohort.

Prevalence and predictors of alcohol and tobacco consumption in adolescence. [Preval y factores de predic. de los comport. de riesgo en la adolesc.: el papel de la condición de peso, condic. clínica y dimensiones psicosoc.]

“…Although some investigators have found positive associations between these risk behaviors and obesity (Sansone, Sansone & Fine, 1995;Shan, et al 2010), other studies found no such association. As Ratcliff, Jenkins, Reiter-Purtill, Noll and Zeller (2011) recently observed, the rates obtained by obese adolescents for the majority of risk behaviors, were similar to those of their normal weight peers.…”

Obesity and Weight Regulation

“…This is the first large study to demonstrate an even greater burden of poor weight-related beliefs and unhealthy dieting behaviors for young people with severe obesity, compared to overweight and obese young people. Among severely obese young people, an increased risk of smoking was also found in previous studies [72]. The reasons are still unclear -possible reasons are 'smoking for weight loss' or being 'in'.…”

Completeness and accuracy of anthropometric measurements in electronic medical records for children attending primary care

“…In the WHO computer program, weight-for-age is not calculated beyond 10 years of age, making it harder to determine which outliers for zBMI data are from weight data in adolescents. The BIV cut-offs suggested by the WHO for calculation of zBMI may be too conservative and be incorrectly excluding those patients with extremely high zBMIs 29. One previous study demonstrated the BIV cut-offs from the WHO underestimated obesity prevalence30 and recently, the Center for Disease Control (CDC) changed their upper limit for BIVs from >+5 to >+8 31.…”