Page 42 - Go4it

Chapter 3
(28-30). This underscores that obesity affects not only health but also psychological well-being. This is in line with previous studies outside the Netherlands that found that obese adolescents have a higher prevalence of psychopathology (behavioural and emotional problems) than normal-weight adolescents (6,8,9).
Erermis et al. (2004) studied the presence of psychopathology with the CBCL between clinically obese adolescents (obese adolescents seeking treatment in an outpatient clinic), non-clinical obese adolescents, and normal weight adolescents. The clinical obese adolescents scored significantly higher on behavioural and emotional problems than the other 2 groups (31). In both the study of Erermis et al. and in our study, the question remains whether the higher scores on the CBCL resulted from the children’s behaviour or parent’s concern about their children’s behaviour because the CBCL scores were based on parental reports. In our study, the self-reported YSR scores were significantly lower than the parent-reported CBCL scores in contrast to 2 other studies in obese adolescents which found that the amount of behavioural and emotional problems were almost equal between parent and child report (6,14). These study samples had comparable mean BMI or BMIsds to our study sample. A possible explanation could be that the referral to a hospital influenced the parent-youth (dis)agreement. We noticed that parents’ perceptions of problems regarding the level of obesity were often the reason for referral to a hospital rather than the adolescents’ perception. The explanation for these differences is that the child perspective reflects the individual’s perception, judgement, and tolerance of his/her behaviour and their feelings, thoughts, and fantasies across different situations. Parent-reports are mainly based on the observable behaviour of their child at home compared with other children, and verbal reports by their child and others. Especially adolescents are indispensable informants about their problem behaviour, because many of the problems they experience remain unnoticed by their parents (14). Furthermore, the observed discrepancies might be a response shift or adaptation of the adolescents according to their amount of overweight. Several studies showed a correlation between BMI and psychopathology. Bogt et al., demonstrated that BMI was correlated with internalizing and externalizing problem behaviour, as well as social, attention and thought problems (32). Britz et al., found a higher prevalence of psychiatric disorders (mood, anxiety, eating disorders) in extremely obese adolescents (BMI=42.4 kg/m2) compared to obese adolescents (BMI=29.8 kg/m2) (33). In our study we did not find a correlation between reported problems and BMI or BMIsds, which may be due to the finding that our study sample was rather homogeneous with respect to both BMI and reported psychiatric problems. The increased prevalence of behaviour and emotional problems in obese adolescents advocates for an interdisciplinary approach in the treatment of obesity in a clinical setting. We recommend not only to provide
42