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Joshua Ikwuagwu

Professor Nolen

ENGL 1301

November 4 2021

Can you trust Depressed Teens?

As rates of obesity increase in America, so does a decline in mental wellness. Studies

have shown for decades that obesity leads to issues such as heart problems, type 2 diabetes, and

joint. Mental isn’t far behind on the scale of severity as it can lead to loss of motivation and

destructive relationships. Five highly qualified researchers at the University of Minnesota wrote

a peer reviewed study titled “Depression, Anxiety and Severity of Obesity in Adolescents: Is

Emotional Eating the Link?” In it they study the behavior of adolescents who are overweight and

facing mental troubles, such as depression and anxiety. All except 2 of the researchers involved

in this study are Associate Professors at The University of Minnesota, and that person is a

Professor in the Department of Pediatrics at The University of Minnesota. 4 of them work in the

Pediatrics Department of the university, and the person that isn’t belongs to the Division of

Biostatistics. Allison Foy is a major in Clinical Behavioral Neuroscience, with a focus on

pediatrics. Kyle Rudser is a Professor in the Division of Biostatistics at The University of

Minnesota. Aaron Kelly and Claudia Fox are the Co-Directors for Minnesota Universities’

Center for Pediatric Obesity Medicine (CPOM). Amy Gross is the Associate Director for

Clinical Care in the Center for Pediatric Obesity Medicine at the University of Minnesota, and is

a member of the Association for Behavior Analysis and The Obesity Society (Medical School -

University of Minnesota). While the researchers are following the rules of the scientific method,
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they made a large mistake in trusting the words of children openly talking about their

insecurities, which in could invalidate this entire study.

The purpose of this research study was to “characterize the impact of depression and

anxiety on the severity of obesity among youth seeking weight management treatment and to

determine the extent to which emotional eating mediates the relationship between depression

and/or anxiety and degree of obesity” (Fox, Claudia K, et al. “Depression, Anxiety, and Severity

of Obesity in Adolescents: Is Emotional Eating the Link?” Clinical Pediatrics, U.S. National

Library of Medicine, Oct. 2016,). The researchers’ initial hypothesis was that the bridge between

obesity and depression would be emotional eating. They found this through clinical trials

conducted on obese teenagers between the ages of 12-18 during January 2012 through October

2013. Their expertise in these areas, due to their PhDs, is an example of Arete.

On the first page of the article there is a disclaimer at the bottom of the page, stating “Dr.

Kelly serves as a consultant for Takeda Pharmaceuticals and Novo Nordisk Pharmaceuticals and

is the signatory author for a pediatric obesity clinical trial sponsored by Novo Nordisk

Pharmaceuticals; he does not accept personal or professional income for his services. Dr. Kelly

also receives research support from Astra Zeneca Pharmaceuticals in the form of drug/placebo.

Dr. Fox is a site principal investigator for a pediatric obesity clinical trial sponsored by Novo

Nordisk Pharmaceuticals. None of the other authors have disclosures” (Pg.1). Takeda

Pharmaceuticals is a Japanese pharmaceutical company. It is the largest pharmaceutical company

in Asia and one of the top 20 largest pharmaceutical companies in the world by revenue. In 2014,

just 1 year after this study was published, they released a drug called Contrave. One of the

ingredients for that drug is bupropion, which is known as an anti-depressant. This study is about

proving the link between depression, anxiety, and obesity, and one of its 5 PhD’s also happened
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to be working for Takeda during his time researching the study. It could be possible that his

purpose in assisting this study was to perform the research for Takeda and sell them the

information before it was published. After all the study concluded in 2013, but this research was

published 3 years later. Their acknowledgement of this possible conflict of interest transparency.

This gives a comfort that their research is unbiased in anyway.

On page 5 the researchers conclude the paper with “In conclusion, depression and anxiety

are associated with more severe obesity among treatment-seeking youth. Although emotional

eating did not mediate the relationship between depression/anxiety and obesity severity in the

current study, longitudinal studies will be valuable in identifying other mechanisms that explain

the relationships between mental illness and obesity in this population, which in turn could serve

as targets for intervention.” The came to this conclusion through their data in, “There were a total

of 102 adolescents, mean age 15.3±1.9 years, included in this study (Table 1). [34%] were boys,

33% were non-white, 17% were classified as Fox et al. Page 3 Clin Pediatr (Phila). Author

manuscript; available in PMC 2018 May 18[….] (mean BMI 30.3 ± 1.9 kg/m2 ), and 83% as

having severe obesity (mean BMI 41.2 ± 7.2 kg/m2 ). In the overall sample, 34% endorsed

symptoms consistent with depression and 32% endorsed symptoms of anxiety. Among patients

with and without depression, 91% and 79% had severe obesity [….] Among patients with and

without anxiety, 94% and 78% had severe obesity, respectively (p=0.088) [….] severe obesity

versus obesity, and with BMI as a continuous variable. After adjusting for sex, race, age, and

emotional eating, the odds of having severe obesity versus obesity was [3.5] higher for patients

with depression [Odds Ratio 3.5 95% CI: (1.1, 11.3), p=0.038] and nearly five times higher for

patients with anxiety [….] Emotional eating, however, was not significantly associated after

adjusting for the other covariates (p=0.201 and 0.205 respectively) (Table 2a and 2b). Also, the
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odds ratios of depression and anxiety were attenuated when emotional eating was not adjusted

for. In the adjusted analysis of associations with BMI treated as a continuous variable, depression

was not significantly associated with BMI [difference of 1.74, (−1.25, 4.73), p=0.255]. However,

anxiety was significantly associated with greater BMI [3.49, (0.41, 6.57), p=0.026] (Table 3a and

3b). Additionally, the association of depression and anxiety were slightly higher when emotional

eating was not adjusted for (1.94 and 3.57 respectively).”

On page 3 of the study, under the measures section, they mention how they came to

receive the data. “Depression was assessed with the Patient Health Questionnaire (PHQ-9), a 9-

item, self-report survey on a 4-point Likert scale (0=’not at all’ to 3=’nearly every day’). Anxiety

was assessed with the Generalized Anxiety Disorder Scale (GAD-7), a 7-item self-report survey

on a 4-point Likert scale (0=’not at all’ to 3=’nearly every day’). A PHQ-9 score cut point of ≥11

was considered positive for detecting depression15 and a GAD-7 score cut point of ≥ 10 was

considered positive for detecting anxiety. […] Emotional eating was measured by patient self-

report on the Child Eating Behavior Questionnaire (CEBQ), Emotional Over-Eating subscale.18

The CEBQ was originally designed as a parent report of child eating behavior, yet precedent has

been made for using a modified version of the CEBQ as an adolescent self-report measure.19 As

such, prefix statements were modified from ‘My child…’ to ‘I…’ The four items comprising the

Emotional Over-Eating subscale are: ‘eat more when anxious,’ ‘eat more when annoyed,’ ‘eat

more when worried,’ and ‘eat more when nothing else to do.’ Each item was rated on a 5-point

Likert scale (1=never to 5=always). The mean of the four items was used as the emotional eating

score”. Seeing as this is a self-report, a question can be brought up to the researchers. How can

they trust their reports? It is no secret that teenagers lie to cover their tracks, but this study

ranged from 12-18, with a mean of 15. A study conducted by the Victoria W. Dykstra, Teena
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Willoughby, Angela D. Evans for The Journal of Adolescence, titled “Lying to friends:

Examining lie-telling, friendship quality, and depressive symptoms over time during late

childhood and adolescence”, lie telling in proportionate with having poor mental health, which

we know the majority of their experiment base has. Dolores Garcia-Arocena wrote an article title

“Happy or Sad: The Chemistry behind Depression”. In in she states “During the last decade,

increased access to brain imaging technology has allowed neuroscientists and hospital clinicians

to view the brain in detail, measure neural activity, and quantify neurotransmitter levels. Such

studies have revealed many clues regarding the underlying contributing factors of depression and

the pathophysiology of this disease.” This means that there is a more reliable way to measure

depression without using a questionnaire. Even with the researcher’s credibility, how can users

of their research trust children to speak the truth of their situation.

Most of the researcher’s involved in this study each had a specialization in pediatrics and

mental wellness. They well all professors at The University of Minnesota, both co-directors of

the Center for Pediatric Obesity Medicine were on this team. There was even a large chance that

this research was used in the production of antidepressant-based diet pill. Yet, the downfall of

this study was their reliance on the words of children to be the bridge between reality and their

hypothesis. It is possible the children told the truth, but other researchers cannot rely on the

possibility of the truth. A peer reviewed study is supposed to be thoroughly done in order to

guarantee its data can be trusted, and with that being said, this study cannot be trusted.
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Citations

“Aaron Kelly, Phd.” Medical School - University of Minnesota,

https://med.umn.edu/bio/pediatrics-a-z/aaron-kelly. Accessed November, 4

Fox, Claudia K, et al. “Depression, Anxiety, and Severity of Obesity in Adolescents: Is

Emotional Eating the Link?” Clinical Pediatrics, U.S. National Library of Medicine, Oct. 2016,

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5958895/. Accessed November, 4

https://directory.sph.umn.edu/bio/sph-a-z/kyle-rudser Accessed November, 4

https://experts.umn.edu/en/persons/allison-foy/publications/ Accessed November, 4

Dolores Garcia-Arocena, Ph.D. “Happy or SAD: The Chemistry behind Depression.” The

Jackson Laboratory, https://www.jax.org/news-and-insights/jax-blog/2015/december/happy-or-

sad-the-chemistry-behind-depression#., Accessed November, 14

https://med.umn.edu/bio/pediatrics-a-z/amy-gross Accessed November, 4

https://med.umn.edu/bio/pediatrics-by-division/claudia-fox Accessed November, 4

Lying to friends: Examining lie-telling, friendship quality, and depressive symptoms over

time during late childhood and adolescence Dykstra, Victoria W;Willoughby, Teena;Evans,

Angela D Journal of Adolescence 84:123 Academic Press 2020-10-01 01401971, Accessed

November, 14

“Takeda and Orexigen Announce FDA Approval of Contrave® (Naltrexone HCI and

Bupropion HCI) Extended-Release Tablets for Chronic Weight Management.” Takeda and

Orexigen Announce FDA Approval of Contrave® (Naltrexone HCI and Bupropion HCI)

Extended-Release Tablets for Chronic Weight Management,

https://www.takeda.com/newsroom/newsreleases/2014/takeda-and-orexigen-announce-fda-
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approval-of-contrave-naltrexone-hci-and-bupropion-hci-extended-release-tablets-for-chronic-

weight-management/. , Accessed November, 14