Roth Binia, Munsch Simone, Meyer Andrea, Winkler Metzke Christa, Isler Emanuel, Steinhausen Hans-Christoph, Schneider Silvia
Kinder- und Jugendpsychiatrischer Dienst Baselland.
Z Kinder Jugendpsychiatr Psychother. 2008 May;36(3):163-76. doi: 10.1024/1422-4917.36.3.163.
Numerous studies based on parent questionnaires reveal that obese children are subject to both physical and psychosocial strains. Children are not included as informants in the assessment procedure, and there is a lack of clinical interview studies assessing DSM-IV-based diagnoses in overweight children.
Emotional and behavioural problems of treatment seeking obese children (N = 59; aged 8-12-years) attending a mental health service were assessed by means of clinical interviews (Kinder-DIPS) that included child and parent reports. In addition, Child Behavior Checklist (CBCL) data (N = 55) available for this clinical sample were compared with data of a representative sample of normal-weight children (N = 1,080). Furthermore, CBCL data of the clinical subsample of 10-12 year-old overweight children (N = 34) were compared with data of a subsample of 10-12 year-old overweight children (N = 33) and of the subsample of normal-weight (N = 386) children from a representative population, both matched by sex.
23 children (39%) met full criteria for a psychiatric disorder according to DSM-IV, and 19 (34.5%), nearly one third, suffered from Binge Eating Disorder (BED). The overweight clinical sample and their normal weight peers differed significantly on 6 of the 8 primary syndrome scales, on the internalizing and the externalizing scores, and on the total problem score of the CBCL. The overweight children in the clinical sample scored significantly higher than the overweight children in the representative sample on the subscale measuring social problems and the total score, with BMI accounting for the difference in total score. Within the representative sample, overweight 10-12 year-old children scored significantly higher than their normal weight peers on two scales measuring delinquency and social problems.
A third of the obese children had mental disorders and behaviour problems. This finding applies to clinically referred obese children and, to a much lesser degree, to nonclinical obese subgroups in the normal population. Clinically obese children constitute a patient group that is in urgent need of multimodal treatment. As a consequence, a major change in treatment and prevention of childhood obesity is warranted, i.e., from the mere treatment of eating and activity behaviours to the inclusion of treatment of co-morbid mental disorder and prevention of chronification.
大量基于家长问卷的研究表明，肥胖儿童面临身体和心理社会方面的压力。在评估过程中未将儿童纳入信息提供者范畴，且缺乏针对超重儿童基于《精神疾病诊断与统计手册》第四版（DSM-IV）诊断的临床访谈研究。
通过临床访谈（儿童抑郁量表简版，Kinder-DIPS）对前往心理健康服务机构就诊的肥胖儿童（N = 59；年龄8 - 12岁）的情绪和行为问题进行评估，该访谈包括儿童和家长报告。此外，将此临床样本的儿童行为量表（CBCL）数据（N = 55）与正常体重儿童的代表性样本（N = 1080）的数据进行比较。此外，还将10 - 12岁超重儿童的临床子样本（N = 34）的CBCL数据与10 - 12岁超重儿童子样本（N = 33）以及来自代表性人群的正常体重儿童子样本（N = 386）的数据进行比较，两组均按性别匹配。
根据DSM-IV，23名儿童（39%）符合精神障碍的全部标准，19名儿童（34.5%），近三分之一，患有暴食症（BED）。超重临床样本及其正常体重同龄人在CBCL的8个主要综合征量表中的6个、内化和外化得分以及总问题得分上存在显著差异。临床样本中的超重儿童在测量社会问题的子量表和总分上的得分显著高于代表性样本中的超重儿童，体重指数（BMI）解释了总分差异。在代表性样本中，10 - 12岁超重儿童在测量违纪和社会问题的两个量表上的得分显著高于其正常体重同龄人。
三分之一的肥胖儿童存在精神障碍和行为问题。这一发现适用于临床转诊的肥胖儿童，在正常人群的非临床肥胖亚组中程度要小得多。临床肥胖儿童构成了一个急需多模式治疗的患者群体。因此，有必要对儿童肥胖的治疗和预防进行重大改变，即从单纯治疗饮食和活动行为转变为纳入共病精神障碍的治疗和预防慢性化。
