Treatment of Children and Adolescents with Obesity and Comorbid Psychiatric Conditions

  • Alan Zametkin
  • Alanna Jacobs
  • Jessica Parrish
Part of the Issues in Clinical Child Psychology book series (ICCP)

The effective treatment of childhood obesity—a challenge in itself— is complicated further when accompanied by comorbid psychiatric disorders. Weight management has become an important concern in the treatment of psychopathology due to the significant weight gain induced by many psychotropic medications. The objectives of this chapter are to review the literature on the relationship between obesity and psychiatric conditions, examine the utility of current obesity treatments for use in these populations, and elucidate the role of psychopharmacology in the weight status of these children. In doing so, we will highlight areas that merit further investigation in the effort to develop more precisely targeted treatments.


Weight Gain Eating Disorder Psychotropic Medication Bulimia Nervosa Adolescent Psychiatry 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. Achenbach, T. M. (1991). Manual for the Child Behavior Checklist/4–18 and 1991 Profile. Burlington, VT: University of VermontGoogle Scholar
  2. Allison, D. B., & Casey, D. E. (2001). Antipsychotic-induced weight gain: A review of the literature. Journal of Clinical Psychiatry, 62(Suppl. 7), 22–31PubMedGoogle Scholar
  3. Allison, D. B., Mentore, J. L., Heo, M., Chandler, L. P., Cappelleri, J. C., Infante, M. C.,et al. (1999). Antipsychotic-induced weight gain: A comprehensive research synthesis.American Journal of Psychiatry, 156, 1686–1696PubMedGoogle Scholar
  4. Archer, L. A., Rosenbaum, P. L., & Streiner, D.L. (1991). The children's eating behavior inventory: Reliability and validity results. Journal of Pediatric Psychology, 16, 629–642PubMedCrossRefGoogle Scholar
  5. Aronne, L. J., & Segal, K. R. (2003). Weight gain in the treatment of mood disorders.Journal of Clinical Psychiatry, 64(Suppl. 8), 22–29PubMedGoogle Scholar
  6. Barlow, S. E., & Dietz, W. H. (1998). Obesity evaluation and treatment: Expert Committee recommendations. The Maternal and Child Health Bureau, Health Resources and Services Administration and the Department of Health and Human Services.Pediatrics, 102, E29PubMedCrossRefGoogle Scholar
  7. Beasley, C. M., Jr., Tollefson, G. D., & Tran, P. V. (1997). Safety of olanzapine. J Clinical Psychiatry 58(Suppl. 10), 13–17Google Scholar
  8. Braet, C., & Van Strien, T. (1997). Assessment of emotional, externally induced and restrained eating behavior in nine to twelve-year-old obese and non-obese children.Behaviour Research and Therapy, 35, 863–873PubMedCrossRefGoogle Scholar
  9. Britz, B., Siegfried, W., Ziegler, A., Lamertz, C., Herpertz-Dahlmann, B. M., Rem-schmidt, H., Wittchen, H. U., & Hebebrand, J. (2000). Rates of psychiatric disorders in a clinical study group of adolescents with extreme obesity and in obese adolescents ascertained via a population based study. International Journal of Obesity and Related Metabolic Disorders, 24, 1707–1714PubMedCrossRefGoogle Scholar
  10. Buddeburg-Fisher B., Klaghofer, R., & Reed, V. (1999). Associations between body weight, psychiatric disorders and body image in female adolescents. Psychotherapy and Psychosomatics, 68, 325–332CrossRefGoogle Scholar
  11. Cavazzoni, P., Tanaka, Y., Roychowdhury, S. M., Breier, A., & Allison, D. B. (2003).Nizatidine for prevention of weight gain with olanzapine: A double-blind placebo-controlled trial. European Neuropsychopharmacology, 13, 81–85PubMedCrossRefGoogle Scholar
  12. Christoffel, K. K., & Forsyth, B. W. (1989). Mirror image of environmental deprivation: Severe childhood obesity of psychosocial origin. Child Abuse and Neglect, 13, 249–256PubMedCrossRefGoogle Scholar
  13. Compton, S. N., March, J. S., Brent, D., Albano, A. M., Weersing, R., & Curry, J. (2004).Cognitive-behavioral psychotherapy for anxiety and depressive disorders in children and adolescents: An evidence-based medicine review. Journal of the American Academy of Child and Adolescent Psychiatry, 43, 930–959PubMedCrossRefGoogle Scholar
  14. Croft, H., Houser, T. L., Jamerson, B. D., Leadbetter, R., Bolden-Watson, C., Donahue,R., et al. (2002). Effect on body weight of bupropion sustained-release in patients with major depression treated for 52 weeks. Clinical Therapeutics, 24, 662–672PubMedCrossRefGoogle Scholar
  15. Croft, J., Houser, T., Leadbetter, R. et al. (2000). Effects of buproprion on weight in the long term treatment of depression. besity Research, 8, 10SGoogle Scholar
  16. Croft, H., Settle, E., Jr., Houser, T., Batey, S. R., Donahue, R. M., & Ascher, J. A.(1999). A placebo-controlled comparison of the antidepressant efficacy and effects on sexual functioning of sustained-release bupropion and sertraline. Clinical Therapeutics, 21, 643–658PubMedCrossRefGoogle Scholar
  17. Daniels, J. (2005). Weight and weight concerns: Are they associated with reported depressive symptoms in adolescents? Journal of Pediatric Health Care, 19, 33–41PubMedGoogle Scholar
  18. Davidson, S., Judd, F., Jolley, D., Hocking, B., Thompson, S., & Hyland, B. (2001). Cardiovascular risk factors for people with mental illness. Australia and New Zealand Journal of Psychiatry, 35, 196–202CrossRefGoogle Scholar
  19. Deberdt, W., Winokur, A., Cavazzoni, P. A., Trzaskoma, Q. N., Carlson, C. D., Bymaster,F. P., et al. (2005). Amantadine for weight gain associated with olanzapine treatment. European Neuropsychopharmacology, 15, 13–21PubMedCrossRefGoogle Scholar
  20. Dimeo, F., Bauer, M., Varahram, I., Proest, G., & Halter, U. (2001). Benefits from aerobic exercise in patients with major depression: A pilot study. British Journal of Sports Medicine, 35, 114–117PubMedCrossRefGoogle Scholar
  21. Epstein, L. H., Klein, K. R., & Wisniewski, L. (1994). Child and parent factors that influence psychological problems in obese children. International Journal of Eating Disorders, 15, 151–158PubMedCrossRefGoogle Scholar
  22. Epstein, L. H., Myers, M. D., & Anderson, K. (1996). The association of maternal psy-chopathology and family socioeconomic status with psychological problems in obese children. Obesity Research, 4, 65–73PubMedGoogle Scholar
  23. Erickson, S. J., Robinson, T. N., Haydel, K. F., & Killen, J. D. (2000). Are overweight children unhappy? Body mass index, depressive symptoms, and overweight concerns in elementary school children. Archives of Pediatric and Adolescent Medicine,154, 931–935Google Scholar
  24. Fairburn, C. G., Welch, S. L., Doll, H. A., Davies, B. A., & O'Connor, M. E. (1997). Risk factors for bulimia nervosa. A community-based case-control study. Archives of General Psychiatry, 54, 509–517PubMedGoogle Scholar
  25. Fava, M. (2000). Weight gain and antidepressants. Journal of Clinical Psychiatry,61(Suppl. 11), 37–41PubMedGoogle Scholar
  26. Fava, M., Judge, R., Hoog, S. L., Nilsson, M. E., & Koke, S. C. (2000). Fluoxetine versus sertraline and paroxetine in major depressive disorder: Changes in weight with long-term treatment. Journal of Clinical Psychiatry, 61, 863–867PubMedGoogle Scholar
  27. Faulkner, G., & Biddle, S. (1999). Exercise as an adjunct treatment for schizophrenia: A review of the literature. Journal of Mental Health, 8, 441–457CrossRefGoogle Scholar
  28. Fellitti, V. J. (1993). Childhood sexual abuse, depression, and family dysfunction in adult obese patients. Southern Medical Journal, 86, 732–736CrossRefGoogle Scholar
  29. Friedman, M. A., & Brownell, K. D. (1995). Psychological correlates of obesity: Moving to the next research generation. Psychological Bulletin, 117, 3–20PubMedCrossRefGoogle Scholar
  30. Goodman, E., & Whitaker, R. C. (2002). A prospective study of the role of depression in the development and persistence of adolescent obesity. Pediatrics, 110, 497–504PubMedCrossRefGoogle Scholar
  31. Gortmaker, S. L. (1993). Social and economic consequences of overweight in adolescence and young adulthood. New England Journal of Medicine, 329, 1008–1012PubMedCrossRefGoogle Scholar
  32. Gracious, B. L., Krysiak, T. E., & Youngstrom, E. A. (2002). Amantadine treatment of psychotropic-induced weight gain in children and adolescents: Case series. Journal of Child and Adolescent Psychopharmacology, 12, 249–257PubMedCrossRefGoogle Scholar
  33. Hasler, G., Pine, D. S., Kleinbaum, D. G., Gamma, A., Luckenbaugh, D., Ajdacic, V.,et al. (2005). Depressive symptoms during childhood and adult obesity: The Zurich cohort study. Molecular Psychiatry, 10, 842–850PubMedCrossRefGoogle Scholar
  34. JKaye, W., Gendall, K., & Strober, M. (1998). Serotonin neuronal function and selective serotonin reuptake inhibitor treatment in anorexia and bulimia nervosa. Biological Psychiatry, 44, 825–838CrossRefGoogle Scholar
  35. Lawlor, D. A., & Hopker, S. W. (2001). The effectiveness of exercise as an intervention in the management of depression: Systematic review and meta-regression analysis of randomized controlled trials. British Medical Journal, 322, 763–767PubMedCrossRefGoogle Scholar
  36. Lieberman, J. A., Stroup, T. S., McEvoy, J. P., Swartz, M. S., Rosenheck, R. A., Perkins,D. O., et al. (2005). Effectiveness of antipsychotic drugs in patients with chronic schizophrenia. New England Journal of Medicine, 353, 1209–1223PubMedCrossRefGoogle Scholar
  37. Lissau, I., & Sorensen, T. I. A. (1994). Parental neglect during childhood and increased risk of obesity in young adulthood. Lancet, 343, 324–327PubMedCrossRefGoogle Scholar
  38. Mackle, M, & Kocsis, J. (1998). Effects on body weight of the SSRI citalopram. Presented at the 27th annual meeting of the Am. College of Neuropsychopharmacology,Las Croabas, Puerto RicoGoogle Scholar
  39. Maloney, M. J., McGuire, J. B., & Daniels, S. R. (1988). Reliability testing of a children's version of the Eating Attitude Test. Journal of the American Academy of Child and Adolescent Psychiatry, 27, 541–543PubMedCrossRefGoogle Scholar
  40. Martinsen, E. (1993). Therapeutic implications of exercise for clinically anxious and depressed patients. International Journal of Sport Psychology, 24, 185–199Google Scholar
  41. Mendlowitz, S. L., Manassis, K., Bradley, S., Scapillato, D., Miezitis, S., & Shaw, B. F.(1999). Cognitive-behavioral group treatments in childhood anxiety disorders: The role of parental involvement. Journal of the American Academy of Child and Adolescent Psychiatry, 38, 1223–1229PubMedCrossRefGoogle Scholar
  42. Michelson, D., Amsterdam, J. D., Quitkin, F. M., Reimherr, F. W., Rosenbaum, J. F.,Zajecka, J., et al. (1999). Changes in weight during a 1-year trial of fluoxetine. American Journal of Psychiatry, 156, 1170–1176PubMedGoogle Scholar
  43. Miller, W. R., & Rollnick, S. (2002) Motivational interviewing: Preparing people for Change,(2nd ed.). New York: Guilford PressGoogle Scholar
  44. Morrison, J. A., Cottingham, E. M., & Barton, B. A. (2002). Metformin for weight loss in pediatric patients taking psychotropic drugs. American Journal of Psychiatry, 159,655–657PubMedCrossRefGoogle Scholar
  45. Neumark-Sztainer, D., Story, M., French, S. A., Hannan, P. J., Resnick, M. D., & Blum,R. W. (1997). Psychosocial concerns and health-compromising behaviors among overweight and nonoverweight adolescents. Obesity Research, 5, 237–249PubMedGoogle Scholar
  46. Neumark-Sztainer, D., Story, M., Hannan, P. J., & Rex, J. (2003). New Moves: A school-based obesity prevention program for adolescent girls. Preventative Medicine, 37, 41–51CrossRefGoogle Scholar
  47. O'Conner P. J., Raglin J. S., & Martinsen E. W. (2000). Physical activity, anxiety, and anxiety disorders. International Journal of Sport Psychology 31, 136–155Google Scholar
  48. Parsons, T. J., Power, C., Logan, S., & Summerbell, C. D. (1999). Childhood predictors of adult obesity: A systematic review. International Journal of Obesity and Related Metabolic Disorders, 23(Suppl. 8), S1–107PubMedGoogle Scholar
  49. Pesa, J. A., Syre, T. S., & Jones, E. (2000). Psychosocial differences associated with body weight among female adolescents: The importance of body image. Journal of Adolescent Health, 26, 330–337PubMedCrossRefGoogle Scholar
  50. Pine, D. S., Cohen, P., Brook, J., & Coplan, J. D. (1997). Psychiatric symptoms in adolescence as predictors of obesity in early adulthood: A longitudinal study. American Journal of Public Health, 87, 1303–1310PubMedCrossRefGoogle Scholar
  51. Pine, D. S., Goldstein, R. B., Wolk S, & Weissman M. M. (2001). The association between childhood depression and adulthood body mass index. Pediatrics, 107,1049–1056PubMedCrossRefGoogle Scholar
  52. Polivy, J. (1996). Psychological consequences of food restriction. Journal of the American Dietetics Association, 96, 589CrossRefGoogle Scholar
  53. Polivy, J., & Herman, C. P. (1985). Dieting and binging: A causal analysis. American Psychologist, 40, 193–201PubMedCrossRefGoogle Scholar
  54. Presnell, K., & Stice, E. (2003). An experimental test of the effect of weight-loss dieting on bulimic pathology: Tipping the scales in a different direction. Journal of Abnormal Psychology,112, 166–170PubMedCrossRefGoogle Scholar
  55. Ratzoni, G., Gothelf, D., Brand-Gothelf, A., Reidman, J., Kikinzon, L., Gal, G., et al.(2002). Weight gain associated with olanzapine and risperidone in adolescent patients: A comparative prospective study. Journal of the American Academy of Child and Adolescent Psychiatry, 41, 337–343PubMedCrossRefGoogle Scholar
  56. Richardson, C. R., Avripas, S. A., Neal, D. L., & Marcus, S. M. (2005). Increasing lifestyle physical activity in patients with depression or other serious mental illness.Journal of Psychiatric Practice, 11, 379–388PubMedCrossRefGoogle Scholar
  57. Shapira, N. A., Goldsmith, T. D., & McElroy, S. L. (2000). Treatment of binge-eating disorder with topiramate: A clinical case series. Journal of Clinical Psychiatry, 61,368–372PubMedGoogle Scholar
  58. Sheslow, D., Hassink, S., Wallace, W., et al. (1993), The relationship between self-esteem and depression in obese children. Annals of the New York Academy of Science, 699, 289–291CrossRefGoogle Scholar
  59. Sikich, L., Hamer, R. M., Bashford, R. A., Sheitman, B. B., & Lieberman, J. A. (2004). A pilot study of risperidone, olanzapine, and haloperidol in psychotic youth: A double-blind, randomized, 8-week trial. Neuropsychopharmacology, 29, 133–145PubMedCrossRefGoogle Scholar
  60. Simansky, K. J. (2005). NIH symposium series: Ingestive mechanisms in obesity, substance abuse and mental disorders. Physiology & Behavior, 86, 1–4CrossRefGoogle Scholar
  61. Spiegel, K., Knutson, K., Leproult, R., Tasali, E., & Van Cauter, E. (2005). Sleep loss:A novel risk factor for insulin resistance and Type 2 diabetes. Journal of Applied Physiology, 99, 2008–2019PubMedCrossRefGoogle Scholar
  62. Spitzer, R. L., Yanovski, S., Wadden, T., Wing, R., Marcus, M. D., Stunkard, A., et al.(1993). Binge eating disorder: Its further validation in a multisite study. International Journal of Eating Disorders, 13, 137–153PubMedCrossRefGoogle Scholar
  63. Stella, S. G., Vilar, A. P., Lacroix, C., Fisberg, M., Santos, R. F., Mello, M. T., et al.(2005). Effects of type of physical exercise and leisure activities on the depression scores of obese Brazilian adolescent girls. Brazilian Journal of Medical and Biological Research, 38, 1683–1689PubMedCrossRefGoogle Scholar
  64. Stice, E., Presnell, K., Groesz, L., & Shaw, H. (2005). Effects of a weight maintenance diet on bulimic symptoms in adolescent girls: An experimental test of the dietary restraint theory. Health Psychology, 24, 402–412PubMedCrossRefGoogle Scholar
  65. Stradmeijer, M., Bosch, J., Koops, W., & Seidell, J. (2000). Family functioning and psychosocial adjustment in overweight youngsters. International Journal of Eating Disorders, 27, 110–114PubMedCrossRefGoogle Scholar
  66. Strauss, R. S. (1999). Childhood obesity. Current Problems in Pediatrics, 29, 1–2PubMedCrossRefGoogle Scholar
  67. Strauss, R. S., & Mir, H. M. (2001). Smoking and weight loss attempts in overweight and normal-weight adolescents. International Journal of Obesity and Related Metabolic Disorders, 25, 1381–1385PubMedCrossRefGoogle Scholar
  68. Sussman, N., Ginsberg, D. L., & Bikoff, J. (2001). Effects of nefazodone on body weight:A pooled analysis of selective serotonin reuptake inhibitor- and imipramine-controlled trials. Journal of Clinical Psychiatry, 62, 256–260PubMedGoogle Scholar
  69. Tanofsky-Kraff, M., Wilfley, D. E., Young, J. F., Mufson, L., Yanovski, S. Z., Glasofer,D. R., et al. (2007). Preventing excessive weight gain in adolescents: interpersonal psychotherapy for binge eating. Obesity, 15, 1345–1355PubMedCrossRefGoogle Scholar
  70. Volkow, N. D., & Wise, R. A. (2005). How can drug addiction help us understand obesity? Natural Neuroscience, 8, 555–560CrossRefGoogle Scholar
  71. Wallace, W. J., Sheslow, D., & Hassink, S. (1993). Obesity in children: A risk for depression. Annals of the New York Academy of Science, 699, 301–303CrossRefGoogle Scholar
  72. Werneke, U., Taylor, D., & Sanders, T. A. (2002). Options for pharmacological management of obesity in patients treated with atypical antipsychotics. International Clinical Psychopharmacology, 17, 145–160PubMedCrossRefGoogle Scholar
  73. Wichstrom, L. (1995). Social, psychological and physical correlates of eating problems.A study of the general adolescent population in Norway. Psychological Medicine, 25,567–579PubMedCrossRefGoogle Scholar
  74. Wilfley, D. E., & Cohen, L. R. (1997). Psychological treatment of bulimia nervosa and binge eating disorder. Psychopharmacological Bulletin, 33, 437–454Google Scholar
  75. Wilfley, D. E., Welch, R. R., Stein, R. I., Spurrell, E. B., Cohen, L. R., Saelens, B. E.,et al. (2002). A randomized comparison of group cognitive-behavioral therapy and group interpersonal psychotherapy for the treatment of overweight individuals with binge-eating disorder. Archives of General Psychiatry, 59, 713–721PubMedCrossRefGoogle Scholar
  76. Yanovski, S. Z., Nelson, J. E., Dubbert, B. K., & Spitzer, R. L. (1993). Association of binge eating disorder and psychiatric comorbidity in obese subjects. American Journal of Psychiatry, 150, 1472–1479PubMedGoogle Scholar
  77. Zametkin, A., Zoon, C. K., Klein, H. W, & Munson, S. (2004). Psychiatric Aspects of Child and Adolescent Obesity: A Review of the Past 10 Years. Journal of the American Academy of Child and Adolescent Psychiatry, 43, 134–150PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science + Business Media, LLC 2008

Authors and Affiliations

  • Alan Zametkin
    • 1
  • Alanna Jacobs
    • 1
  • Jessica Parrish
    • 1
  1. 1.National Institute of Mental HealthBethesda

Personalised recommendations