Professional Documents
Culture Documents
Joshua Ikwuagwu
Professor Nolen
ENGL 1301
November 4 2021
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
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,
Ikwuagwu 2
they made a large mistake in trusting the words of children openly talking about their
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.
The researchers are very transparent about their team, this establishes eunoia with the
audience as it displays they are most likely doing this because they care about the children
involved, as one would expect seeing as they are pediatricians. 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
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
Ikwuagwu 3
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 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
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
Ikwuagwu 4
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
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).” In the quote they display the data
they’ve collected regarding the children’s physical and mental health. In the data they include
margins of error as to indicate these numbers may not be exact. This data establishes phronesis,
While this essay does have a lot of data collected, their method of collection raises issues.
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
Ikwuagwu 5
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
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. This is a betrayal of the logos
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
Ikwuagwu 6
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.
Ikwuagwu 7
Citations
Emotional Eating the Link?” Clinical Pediatrics, U.S. National Library of Medicine, Oct. 2016,
Dolores Garcia-Arocena, Ph.D. “Happy or SAD: The Chemistry behind Depression.” The
Lying to friends: Examining lie-telling, friendship quality, and depressive symptoms over
time during late childhood and adolescence Dykstra, Victoria W;Willoughby, Teena;Evans,
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)
https://www.takeda.com/newsroom/newsreleases/2014/takeda-and-orexigen-announce-fda-
Ikwuagwu 8
approval-of-contrave-naltrexone-hci-and-bupropion-hci-extended-release-tablets-for-chronic-