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PEDIATRICS Vol. 111 No. 4 April 2003, pp. 851-859

Obesity and Psychiatric Disorder: Developmental Trajectories

Sarah Mustillo, PhD*, Carol Worthman, PhD{ddagger}, Alaattin Erkanli, PhD*, Gordon Keeler, MS*, Adrian Angold, MRCPsych* and E. Jane Costello, PhD*

* Center for Developmental Epidemiology, Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina
{ddagger} Department of Anthropology, Emory University, Atlanta, Georgia

--> Objectives. To identify age-related trajectories of obesity from childhood into adolescence, and to test the association of these trajectories with the development of psychiatric disorders (conduct disorder, oppositional defiant disorder, attention-deficit/hyperactivity disorder, substance abuse, depression, and anxiety).

Methods. White children (N = 991) 9 to 16 years old from the Great Smoky Mountains Study, a representative sample of rural youth, were evaluated annually over an 8-year period for height, weight, psychiatric disorder, and vulnerabilities for psychiatric disorder. Longitudinal analyses on the repeated measures data were conducted using developmental trajectory models and generalized estimating equation models.

Results. Obesity was 3 to 4 times more common than expected from national rates using Centers for Disease Control and Prevention 2000 criteria. Four developmental trajectories of obesity were found: no obesity (73%), chronic obesity (15%), childhood obesity (5%), and adolescent obesity (7%). Only chronic obesity was associated with psychiatric disorder: oppositional defiant disorder in boys and girls and depressive disorders in boys.

Conclusions. In a general population sample studied longitudinally, chronic obesity was associated with psychopathology.

Key Words: obesity • psychopathology • developmental trajectories • depression • conduct disorder

Abbreviations: GSMS, Great Smoky Mountains Study • BMI, body mass index • NHANES, National Health Interview Survey • CAPA, Child and Adolescent Psychiatric Assessment • ADHD, attention-deficit/hyperactivity disorder • SPMM, semiparametric mixture model • GEE, Generalized Estimation Equation • CDC, Centers for Disease Control and Prevention

Received for publication May 22, 2002; Accepted Oct 3, 2002.




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