Emotional Health Predicts Changes in Body Mass Index (BMI-z) Among Black and Latino Youth

Childhood obesity is a complex and multifaceted health problem linked to elevated risk for chronic diseases, such as diabetes, cancer, hypertension, and cardiovascular disease.1,2 Although research has increased dramatically in the past 2 decades, questions regarding factors driving overweight and obesity remain, particularly among youth of color who experience disproportionate rates of obesity and comorbid health conditions.3 Adolescence is a critical period in the developmental trajectory,4 in part because overweight and obese adolescents are more likely to remain overweight and/or obese in adulthood.3 Overweight and obesity have been associated with adverse symptoms and intra- and interpersonal psychological, social, and emotional issues that continue into adulthood, including depression and anxiety, social withdrawal, feeling worthless, lower self-esteem, and behavioral problems.5–7 Poor mental health may lead to increases in weight due to fluctuations in appetite, obesogenic behaviors (eg, overeating) to cope with negative mood, sedentary behavior, and increased isolation.8 Chronic stress or experiences of discrimination may also influence physiology and behaviors that affect weight gain.9 On the other hand, increased body mass index (BMI) could result in adverse emotional outcomes over time due to weight-based stigma, bullying, or poor self-esteem.5,6 The few longitudinal studies that have examined the association between emotional health and physical health outcomes have primarily taken a narrow focus of mental health symptoms (e.g., only examining depression)10 or behavioral concerns (e.g., conduct).11 Physical outcomes, including BMI, were often collected by self-report12 and/or retrospectively.13 Furthermore, they have been limited to predominantly White samples of older adolescents or adults.12,13 Persistent racial and ethnic disparities in overweight and obesity further complicate research as well as clinical prevention and intervention efforts. Black and Latino youth experience disproportionate levels of overweight and obesity beginning as early as preschool and are more likely to remain obese as adults compared with Whites.14 Blacks and Latinos also are at disproportionate risk for multiple negative health conditions associated with overweight and obesity, such as diabetes.14,15 Reasons for such disparities remain poorly understood and understudied. Although emotional health has been associated with weight in both adults and youth,16 prior research has been limited to cross-sectional studies.17 Longitudinal, prospective designs are critical to explicate the association between emotional health and BMI among Black and Latino youth. The primary objective of this study is to examine whether negative emotional symptoms prospectively predict increases in BMI z-scores (BMI-z) across 2 years among a sample of predominantly Black and Latino, urban youth. We hypothesize that more negative emotional symptoms measured at baseline (grades 5 and 6) would predict increases in BMI-z scores 2 years later. Results can inform programs and interventions aimed at reducing obesity in youth of color.