A longitudinal study of overweight during childhood : etiology, mental health outcomes and mediating factors

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(29) 7DEOHRI&RQWHQWV Résumé .................................................................................................................................................................. i Summary ............................................................................................................................................................ iii List of Tables...................................................................................................................................................... ix List of Figures ..................................................................................................................................................... x List of Abbreviations ...................................................................................................................................... xi Acknowledgments ..........................................................................................................................................xv CHAPTER 1. INTRODUCTION ...................................................................................................................... 1 1.1.. The inextricable link between mental and physical health ............................................ 3. 1.2.. Child obesity: a pervasive problem .......................................................................................... 3. 1.3. Are child overweight and obesity associated with mental health problems? Which mental health problems? ............................................................................................................ 5 1.4.. The social context of obesity prevention research ............................................................ 7. 1.5. Determinants of overweight and obesity in early childhood: Conceptual and theoretical frameworks ............................................................................................................................. 8 1.6. Quebec Longitudinal Study of Child Development (QLSCD): Data collection and key definitions ............................................................................................................................................ 11 1.6.1.. Developmental periods ..................................................................................................... 13. 1.6.2.. Overweight and obesity .................................................................................................... 13. CHAPTER 2. LITERATURE REVIEW ....................................................................................................... 15 2.1.. Stability and heterogeneity of childhood weight status development .................... 17. 2.2.. Early life risk and protective factors for overweight development ......................... 23. 2.3.. Perinatal and infancy factors ................................................................................................... 24. 2.4.. Childhood behavioural characteristics ................................................................................ 25. 2.5.. Family environment and socioeconomic status ............................................................... 26. 2.6.. Associations between childhood internalizing symptoms and overweight ......... 27. 2.7.. Causal sequence ............................................................................................................................ 28. 2.8.. Sex as potential moderator of the overweight-internalizing relationship ............ 29. 2.9.. Potential mediators of the overweight-internalizing symptoms association ...... 29. 2.10.. Peer victimization .................................................................................................................... 29. 2.11.. Body dissatisfaction ................................................................................................................ 31. 2.12.. Potential common etiology for overweight and mental health problems ......... 31 v.

(30) 2.13.. Summary of literature review............................................................................................. 32. 2.14.. Specific aims and hypotheses of the present dissertation ....................................... 33. CHAPTER 3: METHODS ............................................................................................................................... 35 3.1.. Measuring overweight and obesity using BMI ................................................................. 37. 3.2.. Modelling BMI longitudinally .................................................................................................. 40. 3.3.. Group based developmental trajectories vs. growth curve methods ...................... 41. 3.4.. Moderation and mediation models ....................................................................................... 45. 3.5.. Study design and participants ................................................................................................. 47. 3.6.. Measures.......................................................................................................................................... 49. 3.6.1.. Main variables of interest................................................................................................. 49. 3.7.. Analyses ........................................................................................................................................... 52. 3.8.. Additional Analyses ..................................................................................................................... 57. 3.8.1.. Measures ................................................................................................................................. 58. CHAPTER 4: RESULTS.................................................................................................................................. 59 Article 1 ............................................................................................................................................................. 61 ABSTRACT ................................................................................................................................................... 66 INTRODUCTION ........................................................................................................................................ 68 METHODS .................................................................................................................................................... 69 Participants ............................................................................................................................................ 69 Measures.................................................................................................................................................. 69 ANALYSES .................................................................................................................................................... 71 Weighting ................................................................................................................................................ 74 RESULTS ....................................................................................................................................................... 74 BMI Trajectory Models....................................................................................................................... 74 Early-life Predictors of BMI Trajectory Group Membership ............................................... 75 COMMENT ................................................................................................................................................... 77 Comparison with Other Studies ..................................................................................................... 77 Limitations .............................................................................................................................................. 79 REFERENCES .............................................................................................................................................. 81 Article 2 ............................................................................................................................................................. 85 ABSTRACT ................................................................................................................................................... 89 INTRODUCTION ........................................................................................................................................ 90 METHODS .................................................................................................................................................... 91. vi.

(31) Measures.................................................................................................................................................. 92 ANALYSES .................................................................................................................................................... 95 RESULTS ....................................................................................................................................................... 95 DISCUSSION ................................................................................................................................................ 97 Strengths and Limitations ................................................................................................................ 99 CONCLUSION .............................................................................................................................................. 99 ACKNOWLEDGEMENTS ...................................................................................................................... 100 REFERENCES ........................................................................................................................................... 101 Article 3 .......................................................................................................................................................... 113 ABSTRACT ................................................................................................................................................ 117 INTRODUCTION ..................................................................................................................................... 119 METHODS ................................................................................................................................................. 120 Participants ......................................................................................................................................... 120 Measures............................................................................................................................................... 121 ANALYSES ................................................................................................................................................. 125 RESULTS .................................................................................................................................................... 125 DISCUSSION ............................................................................................................................................. 127 Strengths and Limitations ............................................................................................................. 129 CONCLUSION ........................................................................................................................................... 130 ACKNOWLEDGEMENTS ...................................................................................................................... 130 REFERENCES ........................................................................................................................................... 131 Results From Additional Analyses ....................................................................................................... 143 CHAPTER 5: DISCUSSION ........................................................................................................................ 149 5.1.. Summary of results .................................................................................................................. 151. 5.1.1.. Developmental trajectories of adiposity during childhood ............................. 151. 5.1.2.. Early-life predictors of trajectory group membership ...................................... 152. 5.1.3. Associations between overweight and internalizing symptoms in early adolescence ......................................................................................................................................... 154 5.2.. Scientific contributions ........................................................................................................... 154. 5.3.. Emerging issues ......................................................................................................................... 155. 5.3.1.. Identifying the best target for overweight and obesity prevention ............. 155. 5.3.2.. Determining how early obesity prevention should begin ................................ 162. 5.3.3.. The role of socioeconomic status, food insufficiency and overweight ........ 165. vii.

(32) 5.3.4.. Overweight and child mental health ......................................................................... 167. 5.3.5.. Ethical considerations for obesity prevention research ................................... 170. 5.4.. Strengths and limitations of this research ...................................................................... 172. 5.4.1. 5.5.. Specific limitations with regards to the Mediation Analyses .......................... 174. Future directions ....................................................................................................................... 177. CHAPTER 6: CONCLUSION ...................................................................................................................... 179 BIBLIOGRAPHY ........................................................................................................................................... 183 APPENDICES .................................................................................................................................................. xvii Appendix I: Ethics Approval ................................................................................................................ xix Appendix II: Sample Letter to Parents, Informed Consent and Authorization Forms: at 5 months (1998). .................................................................................................................................... xxii Consent Forms for Parents, Principal and Teacher at 6 years (2004) .......................... xxv Appendix III: Sociodemographic Characteristics (QLSCD phase 1) ............................... xxxvii Appendix IV: Operational Definitions of Variables...................................................................... xxxix Appendix IV-A: Main Variables of Interest ................................................................................... xl Appendix IV-B: Perinatal and Infancy Risk Factors (0 – 1.5 years) ................................ xliii Appendix IV-C: Child Characteristics (1.5 – 5 years) ........................................................... xliv Appendix IV-D: Family and Social Environment Risk Factors. ......................................... xlvi Appendix V: Alternate Trajectory Models (6 to 12 years) ........................................................ liii BMI (raw score) .................................................................................................................................... liii BMI z-score (3 group model) ........................................................................................................... liv BMI z-score (4 group model) ........................................................................................................... liv Appendix VI: Curriculum Vitae ..............................................................................................................lv . . viii.

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