Preview

Meditsinskiy sovet = Medical Council

Advanced search

Diversity of sleep quality, eating behavior, emotional and behavioral characteristics in adolescent boys with obesity

https://doi.org/10.21518/ms2025-206

Abstract

Introduction. Obesity is a pressing public health issue. An important task is the study of individual clinical variants of obesity in specific patient groups, including adolescent boys.

Aim. To study the heterogeneity of sleep quality indicators, emotional and behavioral characteristics, and eating behavior in adolescent boys with obesity.

Materials and methods. The study included 164 adolescents aged 14–17, comprising 137 with obesity (E66.0, ICD-10) and 27 healthy controls. Sleep quality was assessed using the Adolescent Sleep-Wake Scale (ASWS). Behavioral and emotional disorders were evaluated using the Achenbach questionnaire (Youth Self Report, YSR 11-18). Eating behavior was assessed using the Dutch Eating Behavior Questionnaire (DEBQ).

Results. Six distinct clusters were identified: (1) adolescents with thought problems and high aggression; (2) children with sleep and eating disorders, low social adaptation, and high aggression; (3) adolescents without significant issues; (4) socially adapted adolescents with internalized problems and emotional eating; (5) adolescents with eating disorders, deviant behavior, and aggression; and (6) socially adapted adolescents with restrictive eating behavior. Healthy adolescents predominantly belonged to the third cluster, while adolescents with obesity showed diverse cluster representation. Assignment to any cluster other than the third was a significant predictor of increased BMI z-score.

Conclusion. The study revealed significant differences in emotional and behavioral characteristics among adolescents with obesity, emphasizing the importance of considering these factors when selecting treatment approaches.

About the Authors

N. I. Vtornikova
Almazov National Medical Research Centre
Russian Federation

Natalia I. Vtornikova - Assistant of the Department of Children’s Diseases with Clinics of the Institute for Medical Education, Almazov National Medical Research Centre.

2, Akkuratov St., St Petersburg, 197341



I. L. Nikitina
Almazov National Medical Research Centre
Russian Federation

Irina L. Nikitina - Dr. Sci. (Med.), Professor, Head of the Department of Children’s Diseases with Clinics of the Institute for Medical Education, Almazov National Medical Research Centre.

2, Akkuratov St., St Petersburg, 197341



I. A. Leonova
Almazov National Medical Research Centre
Russian Federation

Irina A. Leonova - Cand. Sci. (Med.), Assistant Professor of the Department of Children’s Diseases with Clinics of the Institute for Medical Education, Almazov National Medical Research Centre.

2, Akkuratov St., St Petersburg, 197341



I. A. Kelmanson
Almazov National Medical Research Centre
Russian Federation

Igor A. Kelmanson - Dr. Sci. (Med.), Professor, Professor of Department of Children’s Diseases with Clinics of the Institute for Medical Education, Almazov National Medical Research Centre.

2, Akkuratov St., St Petersburg, 197341



References

1. Di Cesare M, Sorić M, Bovet P, Miranda JJ, Bhutta Z, Stevens GA et al. The epidemiological burden of obesity in childhood: a worldwide epidemic requiring urgent action. BMC Med. 2019;17(1):212. https://doi.org/10.1186/s12916-019-1449-8.

2. O’Brien M, Nader PR, Houts RM, Bradley R, Friedman SL, Belsky J, Susman E. The ecology of childhood overweight: a 12-year longitudinal analysis. Int J Obes. 2007;31(9):1469–1478. https://doi.org/10.1038/sj.ijo.0803611.

3. Boswell N, Byrne R, Davies PSW. Aetiology of eating behaviours: A possible mechanism to understand obesity development in early childhood. Neurosci Biobehav Rev. 2018;95:438–448. https://doi.org/10.1016/j.neubiorev.2018.10.020.

4. Kansra AR, Lakkunarajah S, Jay MS. Childhood and Adolescent Obesity: A Review. Front Pediatr. 2021;8:581461. https://doi.org/10.3389/fped.2020.581461.

5. Hales CM, Carroll MD, Fryar CD, Ogden CL. Prevalence of Obesity Among Adults and Youth: United States, 2015-2016. NCHS Data Brief. 2017;(288):1–8. Available at: https://pubmed.ncbi.nlm.nih.gov/29155689.

6. Qasim A, Turcotte M, de Souza RJ, Samaan MC, Champredon D, Dushoff J et al. On the origin of obesity: identifying the biological, environmental and cultural drivers of genetic risk among human populations. Obes Rev. 2018;19(2):121–149. https://doi.org/10.1111/obr.12625.

7. Han JC, Weiss R. Obesity, metabolic syndrome and disorders of energy balance. In: Sperling MA, Majzoub JA, Menon RK, Stratakis CA (eds.). Sperling Pediatric Endocrinology. 5th ed. Philadelphia, PA: Elsevier; 2021. https://doi.org/10.1016/B978-0-323-62520-3.00024-5.

8. Russell CG, Russell A. A biopsychosocial approach to processes and pathways in the development of overweight and obesity in childhood: Insights from developmental theory and research. Obes Rev. 2019;20(5):725–749. https://doi.org/10.1111/obr.12838.

9. Moya M. Pediatric Overweight and Obesity: Comorbidities, Trajectories, Prevention and Treatments. Cham: Springer Nature; 2023. 306 p. https://doi.org/10.1007/978-3-031-26727-7.

10. van Strien T, Cebolla A, Etchemendy E, Gutiérrez-Maldonado J, Ferrer-García M, Botella C, Baños R. Emotional eating and food intake after sadness and joy. Appetite. 2013;66:20–25. https://doi.org/10.1016/j.appet.2013.02.016.

11. Cracco E, Goossens L, Braet C. Emotion regulation across childhood and adolescence: evidence for a maladaptive shift in adolescence. Eur Child Adolesc Psychiatry. 2017;26(8):909–921. https://doi.org/10.1007/s00787-017-0952-8.

12. Ganley RM. Emotion and eating in obesity: A review of the literature. Int J Eat Disord. 1989;8(3):343–361.

13. Gouveia MJ, Canavarro MC, Moreira H. Associations between Mindfulness, Self-Compassion, Difficulties in Emotion Regulation, and Emotional Eating among Adolescents with Overweight/Obesity. J Child Fam Stud. 2019;28(1):273–285. https://doi.org/10.1007/s10826-018-1239-5.

14. Debeuf T, Verbeken S, Boelens E, Volkaert B, Van Malderen E, Michels N, Braet C. Emotion regulation training in the treatment of obesity in young adolescents: protocol for a randomized controlled trial. Trials. 2020;21(1):153. https://doi.org/10.1186/s13063-019-4020-1.

15. Stroebe W. The goal conflict model: a theory of the hedonic regulation of eating behavior. Cur Opin Behav Sci. 2022;48:101203. https://doi.org/10.1016/j.cobeha.2022.101203.

16. Ouwens MA, van Strien T, van Leeuwe JFJ. Possible pathways between depression, emotional and external eating. A structural equation model. Appetite. 2009;53(2):245–248. https://doi.org/10.1016/j.appet.2009.06.001.

17. Herman CP, Polivy J, Pliner P, Vartanian LR. Social influences on eating. Cham: Springer; 2019. 234 р. https://doi.org/10.1007/978-3-030-28817-4.

18. Anic GM, Titus-Ernstoff L, Newcomb PA, Trentham-Dietz A, Egan KM. Sleep duration and obesity in a population-based study. Sleep Medicine. 2010;11(5):447–451. https://doi.org/10.1016/j.sleep.2009.11.013.

19. Kelmanson IA. Sleep quality, emotional and behavioral disturbances, and eating behavior in adolescents with obesity: a structural equation modeling. Somnologie. 2023;27(2):90–101. https://doi.org/10.1007/s11818-023-00405-8.

20. Garaulet M, Ortega FB, Ruiz JR, Rey-López JP, Béghin L, Manios et al. Short sleep duration is associated with increased obesity markers in European adolescents: effect of physical activity and dietary habits. The HELENA study. Int J Obes. 2011;35(10):1308–1317. https://doi.org/10.1038/ijo.2011.149.

21. Spaeth AM, Dinges DF, Goel N. Effects of Experimental Sleep Restriction on Weight Gain, Caloric Intake, and Meal Timing in Healthy Adults. Sleep. 2013;36(7):981–990. https://doi.org/10.5665/sleep.2792.

22. Van Cauter E, Knutson KL. Sleep and the epidemic of obesity in children and adults. Eur J Endocrinol. 2008;159(Suppl. 1):S59–S66. https://doi.org/10.1530/EJE-08-0298.

23. Theorell-Haglöw J, Berglund L, Janson C, Lindberg E. Sleep duration and central obesity in women – differences between short sleepers and long sleepers. Sleep Med. 2012;13(8):1079–1085. https://doi.org/10.1016/j.sleep.2012.06.013.

24. Soares MJ, Macedo A. Chapter 6 – Sleep Disturbances, Body Mass Index, and Eating Behavior. In: Watson RR (ed.). Modulation of Sleep by Obesity, Diabetes, Age, and Diet. San Diego: Academic Press; 2015. Available at: https://pages.ucsd.edu/~mboyle/COGS163/pdf-files/Sleep%20Disturbances,%20Body%20Mass%20Index,%20and%20Eating%20Behavior.pdf.

25. Soares MJ, Macedo A, Azevedo MH. Sleep disturbances and eating behaviours in undergraduate students. In: Preedy VR, Patel VB, Le L-A (eds.). Handbook of nutrition, diet and sleep. Wageningen: Wageningen Academic Publishers; 2013. https://doi.org/10.3920/978-90-8686-763-9_9.

26. Pronk NP, Anderson LH, Crain AL, Martinson BC, O’Connor PJ, Sherwood NE, Whitebird RR. Meeting recommendations for multiple healthy lifestyle factors. Prevalence, clustering, and predictors among adolescent, adult, and senior health plan members. Am J Prev Med. 2004;27(Suppl. 2):25–33. https://doi.org/10.1016/j.amepre.2004.04.022.

27. Prochaska JJ, Spring B, Nigg CR. Multiple health behavior change research: an introduction and overview. Prev Med. 2008;46(3):181–188. https://doi.org/10.1016/j.ypmed.2008.02.001.

28. Boone-Heinonen J, Gordon-Larsen P, Adair LS. Obesogenic clusters: multidimensional adolescent obesity-related behaviors in the U.S. Ann Behav Med. 2008;36(3):217–230. https://doi.org/10.1007/s12160-008-9074-3.

29. Huh J, Riggs NR, Spruijt-Metz D, Chou CP, Huang Z, Pentz M. Identifying patterns of eating and physical activity in children: a latent class analysis of obesity risk. Obesity. 2011;19(3):652–658. https://doi.org/10.1038/oby.2010.228.

30. Vervoort L, Naets T, Goossens L, Verbeken S, Claes L, Tanghe A, Braet C. Subtyping youngsters with obesity: A theory-based cluster analysis. Appetite. 2022;168:105723. https://doi.org/10.1016/j.appet.2021.105723.

31. Faul F, Erdfelder E, Lang AG, Buchner A. G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods. 2007;39(2):175–191. https://doi.org/10.3758/bf03193146.

32. LeBourgeois MK, Giannotti F, Cortesi F, Wolfson AR, Harsh J. The relationship between reported sleep quality and sleep hygiene in Italian and American adolescents. Pediatrics. 2005;115(Suppl. 1):257–265. https://doi.org/10.1542/peds.2004-0815H.

33. Achenbach TM, Rescorla LA. Manual for the ASEBA School-age Forms & Profiles: An Integrated System of Multi-informant Assessment. Burlington: ASEBA; 2001. 238 p.

34. Kolmagorova AV, Slobodskaya ER, Kinscht IA. Mental health assessment in early childhood. Byulletenʹ Sibirskogo Otdeleniya Rossiyskoy Akademii Meditsinskikh Nauk. 2007;(3):46–52. (In Russ.) Available at: https://cyberleninka.ru/article/n/otsenka-psihicheskogo-zdorovya-v-rannem-vozraste.

35. van Strien T, Frijters JER, Bergers GPA, Defares PB. The Dutch Eating Behavior Questionnaire (DEBQ) for assessment of restrained, emotional, and external eating behavior. Int J Eat Disord. 1986;5(2):295–315.

36. Borisenkov MF, Popov SV, Pecherkina AA, Dorogina OI, Martinson EA, Vetosheva VI et al. Food addiction in young adult residents of Russia: Associations with emotional and anthropometric characteristics. Eur Eat Disord Rev. 2020;28(4):465–472. https://doi.org/10.1002/erv.2731.

37. Qiu W, Joe H. Random Cluster Generation (with Specified Degree of Separation). Version 1.3.8. 2023. Available at: https://cran.r-project.org/web/packages/clusterGeneration/clusterGeneration.pdf.

38. Van der Maaten L, Hinton G. Visualizing data using t-SNE. J Mach Learn Res. 2008;9(11):2579–605. Available at: https://www.jmlr.org/papers/volume9/vandermaaten08a/vandermaaten08a.pdf.

39. Tibshirani R, Walther G, Hastie T. Estimating the number of clusters in a data set via the gap statistic. Journal of the Royal Statistical Society: Series B (Statistical Methodology). 2001;63(2):411–423. https://doi.org/10.1111/1467-9868.00293.

40. Dalmaijer ES, Nord CL, Astle DE. Statistical power for cluster analysis. BMC Bioinformatics. 2022;23(1):205. https://doi.org/10.1186/s12859-022-04675-1.

41. Ellis PD. The Essential Guide to Effect Sizes: Statistical Power, Meta-Analysis, and the Interpretation of Research Results. Cambridge: Cambridge University Press; 2010. 173 р.

42. Aparicio E, Canals J, Arija V, De Henauw S, Michels N. The role of emotion regulation in childhood obesity: implications for prevention and treatment. Nutr Res Rev. 2016;29(1):17–29. https://doi.org/10.1017/S0954422415000153.

43. Rao W-W, Zong Q-Q, Zhang J-W, An F-R, Jackson T, Ungvari GS et al. Obesity increases the risk of depression in children and adolescents: Results from a systematic review and meta-analysis. J Affect Disord. 2020;267:78–85. https://doi.org/10.1016/j.jad.2020.01.154.

44. Nikitina IL, Vtornikova NI, Kelmanson IA. Clinical heterogeneity of sleep quality, emotional and behavioral characteristics, and eating habits in adolescents with obesity: A cluster analysis. Eur J Pediatr. 2024;183(4):1571–1584. https://doi.org/10.1007/s00431-023-05406-1.

45. Shah B, Tombeau Cost K, Fuller A, Birken CS, Anderson LN. Sex and gender differences in childhood obesity: contributing to the research agenda. BMJ Nutr Prev Health. 2020;3(2):387–390. https://doi.org/10.1136/bmjnph-2020-000074.

46. Braet C, Beyers W, Goossens L, Verbeken S, Moens E. Subtyping children and adolescents who are overweight based on eating pathology and psychopathology. Eur Eat Disord Rev. 2012;20(4):279–286. https://doi.org/10.1002/erv.1151.

47. Quek YH, Tam WWS, Zhang MWB, Ho RCM. Exploring the association between childhood and adolescent obesity and depression: a meta-analysis. Obes Rev. 2017;18(7):742–754. https://doi.org/10.1111/obr.12535.

48. Van Malderen E, Goossens L, Verbeken S, Kemps E. Multi-method evidence for a dual-pathway perspective of self-regulation in loss of control over eating among adolescents. Appetite. 2020;153:104729. https://doi.org/10.1016/j.appet.2020.104729.

49. Tull MT, Gratz KL, Latzman RD, Kimbrel NA, Lejuez CW. Reinforcement Sensitivity Theory and emotion regulation difficulties: A multimodal investigation. Pers Individ Dif. 2010;49(8):989–994. https://doi.org/10.1016/j.paid.2010.08.010.

50. Halahakoon DC, Kieslich K, O’Driscoll C, Nair A, Lewis G, Roiser JP. Reward-Processing Behavior in Depressed Participants Relative to Healthy Volunteers: A Systematic Review and Meta-analysis. JAMA Psychiatry. 2020;77(12):1286–1295. https://doi.org/10.1001/jamapsychiatry.2020.2139.

51. Braet C, Beyers W. Subtyping children and adolescents who are over-weight: Different symptomatology and treatment outcomes. J Consult Clin Psychol. 2009;77(5):814–824. https://doi.org/10.1037/a0016304.

52. Tevie J, Shaya FT. Association between mental health and comorbid obesity and hypertension among children and adolescents in the US. Eur Child Adolesc Psychiatry. 2015;24(5):497–502. https://doi.org/10.1007/s00787-014-0598-8.

53. Luppino FS, de Wit LM, Bouvy PF, Stijnen T, Cuijpers P, Penninx BW, Zitman FG. Overweight, obesity, and depression: a systematic review and meta-analysis of longitudinal studies. Arch Gen Psychiatry. 2010;67(3):220–229. https://doi.org/10.1001/archgenpsychiatry.2010.2.

54. Fulton S, Décarie-Spain L, Fioramonti X, Guiard B, Nakajima S. The menace of obesity to depression and anxiety prevalence. Trends Endocrinol Metab. 2022;33(1):18–35. https://doi.org/10.1016/j.tem.2021.10.005.

55. Everitt BS, Landau S, Leese M, Stah D. Cluster analysis. 5th ed. Chichester, UK: John Wiley & Sons, Ltd; 2011. 348 р. Available at: https://cicerocq.wordpress.com/wp-content/uploads/2019/05/cluster-analysis_5ed_everitt.pdf.

56. Barrett LF, Barrett DJ. An Introduction to Computerized Experience Sampling in Psychology. Social Science Computer Review. 2001;19(2):175–185. https://doi.org/10.1177/089443930101900204.

57. Al‐Khudairy L, Loveman E, Colquitt JL, Mead E, Johnson RE, Fraser H et al. Diet, physical activity and behavioural interventions for the treatment of overweight or obese adolescents aged 12 to 17 years. Cochrane Database Syst Rev. 2017;6(6):CD012691. https://doi.org/10.1002/14651858.CD012691.

58. Vervoort L, Naets T, De Guchtenaere A, Tanghe A, Braet C. Using confidence interval-based estimation of relevance to explore bottom-up and top-down determinants of problematic eating behavior in children and adolescents with obesity from a dual pathway perspective. Appetite. 2020;150:104676. https://doi.org/10.1016/j.appet.2020.104676.


Review

For citations:


Vtornikova NI, Nikitina IL, Leonova IA, Kelmanson IA. Diversity of sleep quality, eating behavior, emotional and behavioral characteristics in adolescent boys with obesity. Meditsinskiy sovet = Medical Council. 2025;(11):80-92. (In Russ.) https://doi.org/10.21518/ms2025-206

Views: 17


Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.


ISSN 2079-701X (Print)
ISSN 2658-5790 (Online)