Creese Hanna, Saxena Sonia, Nicholls Dasha, Pascual Sanchez Ana, Hargreaves Dougal
School of Public Health, Imperial College London, London, UK.
Department of Brain Sciences, Imperial College London, UK.
EClinicalMedicine. 2023 May 22;60:101992. doi: 10.1016/j.eclinm.2023.101992. eCollection 2023 Jun.
Mental illness and obesity are among the biggest challenges to population health, they are linked, and may be modifiable during adolescence. We aimed to determine intervening pathways between mental health and BMI z-score symptoms across adolescence.
In this longitudinal cohort study, we used path models to examine self-reported dieting, happiness with appearance, self-esteem and bullying at 14 years as potential mediators of the cross-lagged relationship between mental health (via the Strengths and Difficulties Questionnaire) and Body Mass Index (BMI) z-score at 11 and 17 years by sex in the UK Millennium Cohort Study, a prospective cohort study of 18,818 children born in the UK between September 1st, 2000, and January 31st, 2002. Full, incomplete data on all singleton children still participating in the study by age 11 years were analysed in GSEM via maximum likelihood estimation (N = 12,450).
We found happiness with appearance and self-esteem, but not dieting or bullying, mediated the relationship between BMI age 11 and mental health age 17. Each increase in BMI z-score at 11 years was associated with 0.12 increase for boys and a 0.19 increase for girls in scores of unhappiness with appearance (boys: 0.12, 95% C.I.; girls 0.19, C.I. 0.14 to 0.23) and a 16% increase for boys and a 22% increase for girls in odds of low self-esteem (boys OR 1.16, 95% C.I. 1.07 to 1.26; girls: OR 1.22, 95% C.I. 1.15 to 1.30) at 14 years. In turn, for both boys and girls, being unhappy with appearance and low self-esteem at 14 years were associated with a greater likelihood of emotional and externalizing symptoms at 17 years.
Early prevention strategies to encourage healthy physical and mental development of children need to focus on the promotion of positive body-mage and self-esteem.
The National Institute for Health and Care Research (NIHR) School for Public Health Research (SPHR).
精神疾病和肥胖是影响人群健康的两大挑战，二者相互关联，且在青春期可能是可改变的。我们旨在确定整个青春期心理健康与体重指数（BMI）z评分症状之间的干预途径。
在这项纵向队列研究中，我们使用路径模型来检验14岁时自我报告的节食、对外表的满意度、自尊和受欺负情况，作为英国千禧队列研究中11岁和17岁时心理健康（通过优势与困难问卷）与体重指数（BMI）z评分之间交叉滞后关系的潜在中介因素。该前瞻性队列研究对2000年9月1日至2002年1月31日在英国出生的18818名儿童进行了研究。通过最大似然估计，在广义结构方程模型（GSEM）中分析了所有在11岁时仍参与研究的单胎儿童的完整和不完整数据（N = 12450）。
我们发现对外表的满意度和自尊，而非节食或受欺负情况，介导了11岁时的BMI与17岁时的心理健康之间的关系。11岁时BMI z评分每增加一个单位，男孩对外表不满意程度的得分增加0.12，女孩增加0.19（男孩：0.12，95%置信区间；女孩：0.19，置信区间0.14至0.23），14岁时男孩自尊低下的几率增加16%，女孩增加22%（男孩比值比1.16，95%置信区间1.07至1.26；女孩：比值比1.22，95%置信区间1.15至1.30）。反过来，对于男孩和女孩来说，14岁时对外表不满意和自尊低下与17岁时出现情绪和外化症状的可能性更大有关。
鼓励儿童身心健康发展的早期预防策略需要注重促进积极的身体形象和自尊。
国家卫生与保健研究机构（NIHR）公共卫生研究学院（SPHR）。
