The Hyperactivity/Inattention Subscale of the Strengths and Difficulties Questionnaire Predicts Short- and Long-Term Weight Loss in Overweight Children and Adolescents Treated as Outpatients

Abstract

Objective: The success of treatment for pediatric obesity is variable and often unsatisfactory. This study elucidates the influence of inattention and hyperactivity/impulsivity on short- and long-term weight loss and maintenance after outpatient treatment. Methods: We included 8- to 16-year-old overweight and obese participants treated in 17 multidisciplinary outpatient treatment centers in a nationwide observational study. All treatment centers that reported long-term (1-year) follow-up weight data of at least 60% of the participants were included. At the beginning and end of treatment and at 1 year follow-up weight and height were measured at the center. Inattention and hyperactivity/impulsivity were assessed with the hyperactivity/inattention subscale (HI) of the parent-rated Strengths and Difficulty Questionnaire (SDQ). General linear models were used with the standard deviation scores of the BMI (BMI-SDS) as dependent variable and HI scores as main independent variable adjusting for age, sex, baseline BMI-SDS, and center. Results: 394 participants were included (57% female, age: 11.7± 2.0 years, baseline BMI-SDS 2.32 ±.46 kg/m²). HI scores were significantly associated with short- and long-term BMI-SDS (p < 0.0005), with higher baseline HI scores predicting less weight loss. Conclusions: Our results indicate that inattention and hyperactivity/impulsivity are linearly associated with reduced short- and long-term weight loss. Implications for treatment are discussed.

Neurocognitive correlates of obesity and obesity-related behaviors in children and adolescents

“…18 Greater inattention predicted less short- and long-term weight loss for children and adolescents in weight-loss treatment. 49,50 On the contrary, Gunstad et al 21 found no relationship between BMI and digit span backward performance in children and adolescents, whereas Krombholz 22 also found no relationship among weight and concentration ability in a sample of kindergarteners.…”

The Burden of Psychosocial Stressors and Urgent Mental Health Problems in a Pediatric Weight Management Program

“…While it is unclear whether BMI, independent of other risk factors, is associated with suicidal ideation, both actual and perceived adolescent overweight and obesity are associated with suicidal ideation. 30 Furthermore, weight-based teasing, which is associated with lower self-esteem, lower body image, and higher depressive symptoms, may be a causative factor. 3 We also identified 12 patients with homicidal ideation, but none expressed imminent threat of harm, and therefore did not require crisis intervention.…”

“…29 Accordingly, in our study, we found that patients aged 8 to 10 and 11 to 14 years had a greater proportion of borderline/abnormal hyperactivity-inattention symptoms scores compared with US norms. These symptoms have treatment implications as a recent study showed that weight loss success was negatively predicted by inattention and hyperactivity/impulsivity as measured using the SDQ-P. 30 Given the known associations between school difficulties, 2 weight-based teasing, 3 and bullying, 4 it was not surprising that nearly one-quarter (21.9%) of patients in our sample endorsed difficulties at school and 6% felt unsafe due to emotional, verbal, or physical threats and/or assaults. Similarly, patients in our sample had a greater proportion of borderline/abnormal SDQ-P peer problems scores, which includes specific questions about bullying and social isolation, compared with the normative US data.…”

The moderating role of body dissatisfaction in the relationship between ADHD symptoms and disordered eating in pediatric overweight and obesity

“…In addition, inattentiveness has also been uniquely linked to children with obesity with suggested negative influence on attentiveness to hunger and satiety cues (Agranat-Meged et al, 2005; Davis, Levitan, Smith, Tweed, & Curtis, 2006). Furthermore, greater inattention, hyperactivity, and/or impulsivity in youth with obesity predicts poorer short- and long-term weight-related treatment outcomes (Nederkoorn, Braet, Van Eijs, Tanghe, & Jansen, 2006; van Egmond-Froehlich et al, 2012). Although the literature linking pediatric OV/OB and ADHD has grown, further investigation into the exact nature of the association and identification of contributing factors are still needed.…”