1. DETERMINING CAUSAL PATHWAYS OF THE BIDIRECTIONAL RELATIONSHIP BETWEEN OBESITY AND DEPRESSION IN CALIFORNIA CHILDREN Sarah Poblete, Liki Porotesano, Breah Smith, and Hannah Summers San Diego State University

2. Significance Obesity Increases the risk of heart disease, high blood pressure, stroke, type II diabetes, metabolic syndrome, cancer, and more. In the last 30 years, childhood obesity has increased from 7% to 18%, and adolescent obesity has increased from 5% to 21% Once seen only as an adult problem, now seen more frequently in children Depression Depression is the leading cause of disability in Americans 15-44 years old, with over half of these cases beginning at age 14 Once seen only as an adult problem, now seen more frequently in children

3. Innovation Longitudinal cohort study Examines both aspects of the bidirectional relationship between obesity and depression: Obesity  Depression Depression  Obesity Looks for biologic gradient between each of the bidirectional relationships between obesity and depression Includes a variety of potential mediating and moderating factors Biopsychosocial variables

4. SPECIFIC AIMS

5. Aim 1 Aim 1: To determine the bidirectional temporal associations between obesity and depression in California children. ObesityDepression Time

6. Aim 2 Aim 2: To prove a biologic gradient between obesity and depression. Obesity Depression

7. Aim 3 Aim 3: To determine the mediating and moderating factors which influence the relationship between obesity and depression in California children. ObesityDepression Moderating Factors Mediating Factors

8. APPROACH

9. Population California children age 7 at start of study Randomly select 200 public schools Select 25 children from each school (5000 total participants)

10. 12-Year Timeline Jan – Feb Hire research staff Mar - May Train staff on measurement protocol Jun – Aug Recruit participants Annually in September (10 years) Staff measurement protocol refresher Participant Measurement Final year Data analysis

11. Aim 1 Obesity Measure using digital weight scale and digital stadiometer Obese is defined as BMI percentile greater than 95% using CDC growth charts To determine the bidirectional temporal associations between obesity and depression in California children.

12. Aim 1 Depression Measure using the Children’s Depression Inventory (CDI) Defined as score greater than 60 on the CDI Calculate association between depression and obesity using odds ratio To determine the bidirectional temporal associations between obesity and depression in California children.

13. Aim 2 To prove a biologic gradient between obesity and depression. Obesity (BMI) Depression (CDI) Threshold Linear Obesity plotted according to BMI calculations Depression plotted according to CDI score Graphs plotted to represent population-wide as well as within sub-sectors to identify regions or populations in which the dose- response relationship is stronger

14. Mediating Factors Body dissatisfaction Weight stigma Dieting Binge eating Physical activity/sedentary level Various psychological characteristics Moderating Factors Gender Genetics Aim 3 To determine the mediating and moderating factors which influence the relationship between obesity and depression in California children

15. Body Dissatisfaction and Weight Stigma How much a person likes or dislikes their body Measurement tool: Children’s Figure Rating Scale Body Dissatisfaction Verbal teasing, physical bullying, and relational victimization Measurement tool: Perception of Teasing Scale Weight Stigma

16. Dieting and Binge Eating Self-imposed dieting, not diets enforced by parents Measurement tool: Restraint Scale Dieting Categorized as Bulimia Nervosa or Binge Eating Disorder Measurement tool: Eating Disorder Examination Child Version Binge Eating

17. Gender Female gender is a strong moderating factor among adults Obese adolescent females are more at risk for future depression Depressed adolescent females are more at risk for future obesity

18. Genetics Genetic testing administered at first measurement Simple cheek swab Chromosome 3p25-26 Genetic linkage analysis Identify relationship with depression FTO gene and MC4R gene (Chromosome 2q14.1) Genetic linkage analysis Identify relationship with obesity Single Nucleotide Polymorphisms (SNPs) Genetic sequencing Map SNPs to identify associations between depression chromosome and obesity chromosome

19. Physical Activity & Sedentary Level Measurement tools: Physical Activity Questionnaire for Children (PAQ) Physical Activity Questionnaire for Older-Children (PAQ-C) Adolescent Sedentary Activity Questionnaire (ASAQ) Parents will respond to questionnaires for children under the age of 10.

20. Psychological Characteristics Self-Esteem Rosenberg Self-Esteem Scale Anxiety Spence Children’s Anxiety Scale Hostility Anger Regulation and Expression Scale Short Loneliness Loneliness & Social Dissatisfaction Questionnaire

21. Measuring Mediation and Moderation Mediator and Moderator Analysis: Linear Regression Correlation Coefficient ObesityDepression Moderating Factors Mediating Factors

22. Limitations and Other Considerations Potential Errors Self-report bias Recall bias Respondent fatigue bias Social desirability bias Potential Risks Obesity and depression are sensitive subjects Referral to trained medical physicians and psychologists must be available Ethics of genetic testing

23. QUESTIONS?

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