Psychosocial Risk Factors for the Onset of Adolescent Obesity and Overweight: Findings From the National Longitudinal Study of Adolescent Health

Purpose:  More than a third of adolescents ages 12-19 in the U.S. are overweight (34.3%) and one in five is obese (17.9%). This is a grave concern because obese adolescents are likely to remain obese in adulthood; and obesity is associated with chronic disease, social and economic disadvantage, and stigma. Obesity is difficult to treat and adolescents’ attempts at unsupervised dieting are often ineffective and unsafe, and are paradoxically associated with weight gain. Thus, preventing the onset of adolescent overweight and obesity is one of the nation’s critical public health goals found in Healthy People 2020. Identifying promising targets for prevention requires a clear understanding of risk factors for the development of obesity and overweight in youth, as noted in the latest 2011 NIH Obesity Task Force Report. Gaps persist in our understanding of how psychosocial and behavioral factors influence the development and onset overweight and obesity in adolescence. The purpose of this study was to examine the effects of intrapersonal factors, weight loss behaviors, and interpersonal family factors at W1 on the onset of overweight or obesity one year later at W2, controlling for background factors. 

Method: Data were drawn from waves 1 and 2 of the National Longitudinal Study of Adolescent Health (ages 12-21 at W1), the largest nationally representative sample of adolescents in the U.S.  Our analytic sample (n=13,570) consisted of male and female participants in both waves with non-missing data on height and weight and with valid sampling weights. Logistic regression was conducted in STATA with adjustments for complex survey design. Predictors were measured at W1, including risk factors (body image distortion, depression, dieting, unsafe weight loss behavior); family processes (family support, family mealtimes), and background factors (age, race/ethnicity, SES, family structure). Two outcomes were measured at W2: onset (incidence) of overweight and onset of obesity. The moderating roles of family support and mealtimes processes were also examined. All analyses were stratified by sex.

Results:  Body image distortion (BID), the subjective perception of being heavier than one is, had the strongest impact on risk for onset of overweight and obesity. BID increased the odds of overweight onset by nearly 7 times among both girls (OR=6.53, p<.01) and boys (OR=6.56, p<.01). Dieting increased the odds of obesity onset among girls (OR=1.96, p<.01) and boys (OR=3.10, p<.01). Among girls only, unsafe weight loss at W1 increased the odds of obesity onset at W2 (OR=3.12, p<.01) and depression increased likelihood of obesity onset (OR=1.48, p<.01). Neither family support nor family mealtimes predicted onset of overweight or obesity at W2, and no interaction effects were observed.

Implications: Findings highlight the importance of body image distortion and other psychosocial antecedents to overweight and obesity onset among adolescents. Social Workers should raise awareness among youth about the risks of unsupervised dieting and unsafe weight loss, and seek to promote healthy approaches to body image, eating, managing stress, and monitoring weight. Social Work expertise is urgently needed to develop and test interventions that address the emotional and intrapersonal drivers of obesity.