1

META ANALYSIS: EFFECT OF OBESITY ON THE PSYCHOOSIAL OF

ADOLESCENTS

Nurqaulan Karima Gustari1, Demsa Simbolon2*

1
Department of Nutrition, Health Polytechnic of Bengkulu Ministry of Health
2
Jl. Indra Giri, No. 03, Padang Harapan, Bengkulu

*Correspondence : E-mail: demsa_ui03@yahoo.com Tel/Hp : 081398908917

ABSTARCT

Introduction: Adolescence is a period of rapid growth and development, both

physically, psychologically and intellectually which has an age range of 10-19 years.

Over the past 40 years, the number of obese children and adolescents (5-19 years) has

increased from 11 million in 1975 to 12 million in 2016. Obese adolescents show

negative psychosocial symptoms such as depression, bulimia, social discrimination,

decreased self-esteem and self-satisfaction, thereby reducing their quality of life.

Objective: This study aims to analyze the influence of obesity on psychosocial

adolescents.

Methods: This research design uses a meta-analysis method. Article taken from

Pubmed and Google Scholar. The articles analyzed were articles published in 2011-

2022, free, full text with a case control study, cross sectional, cohort, and included OR

(Odds Ratio). Articles were collected using the PRISMA diagram and analyzed using

the Review Manager application 5.4 with a random effects analysis model.

Results: The results of the study of 5 articles with the results of the analysis using a

random-effect model resulted in a pooled odds ratio of 0.20 (95% CI 0.05-0.87). The

results above can be concluded that there is a significant relationship between obesity
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and adolescent psychosocial, this is evidenced by the value of p<0.05, namely p=0.03.

The variation between studies is heterogeneous, it can be seen from the p value in the

heterogeneity test is 0.00001 <0.05 and the value of I2=100% (I2>50%). So this

analysis uses a random effect model.

Conckusion: There is a significant relationship between obesity and psychosocial

events in adolescents.

Keywords : Obesity, psychosocial, adolescent, meta analysis, mental health, depression

INTRODUCTION

Adolescence is a period of rapid growth and development, both physically,

psychologically and intellectually.(1) The age range of adolescents according to the

World Health Organization (WHO) is a population aged 10-19 years, according to the

Law of the Ministry of Health of the Republic of Indonesia Number 25 In 2014,

adolescents were residents aged 10-18 years, and according to the Population and

Family Planning Agency (BKKBN) the age range for adolescents was 10-24 years and

unmarried.(2)

Over the past 40 years, the number of obese children and adolescents (5-19 years)

has increased from 11 million in 1975 to 12 million in 2016. If this trend continues, by

2022, there will be more children. adolescents are fatter in the world than children with

average weight or very thin.(3) The 2013 Basic Health Research (Riskesdas) data shows

that the prevalence of obese adolescents aged 13-15 years has increased from 2.5% in

2010 to 10.8% in 2013 consisting of 8.3% overweight and 2.5% obese. Riskesdas 2018,

the prevalence of overweight and obesity at the age of 13-15 years is 16.0% and the age

of 16-18 years is 13.5%. The number of adolescents who are obese in Indonesia is
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increasing every year.(4) Obesity in adolescence increases the risk of obesity in

adulthood, and can cause a variety of cardiovascular and metabolic disorders. Obese

adolescents are vulnerable to social prejudice, and discrimination, not only from the

general public but also from medical professionals, and may be hesitant to seek medical

care.(1)

Psychosocial factors have been strongly associated with obesity in adolescents. It

is characterized by the fact that obese adolescents are more sensitive to external hunger

nerves such as taste and smell of food and diet. Obese people tend to eat when they

want, and not on an empty stomach. Obese adolescents show negative psychosocial

symptoms such as depression, bulimia, social discrimination, decreased self-esteem and

self-satisfaction, thereby reducing their quality of life. Psychological effects will prevent

successful weight loss in obese adolescents. Studies show that obese adolescents do not

adhere to nutritional therapy because of their emotional diet behavior.(5)

The results showed that obese adolescent girls had a high risk of experiencing

psychosocial disorders 6.395 times than girls with normal nutritional status, because

obese adolescents received a lot of bullying.(6) The results of detailed interviews with

psychosocial problems in five obese subjects showed that the subjects suffered from

stress due to guilt and were "bullied" or ridiculed by friends. Feeling fat is one of the

negative images of adolescence associated with psychological stress.(5)

Meta-analyses are easier to perform because they are quantitative and focus on

effect sizes. The meta-analysis allows the results of different studies to be combined and

takes into account relative sample sizes and effect sizes. The results of this review are

based on the very broad and focused scope of this analysis. The meta-analysis also

provides answers to questions that are required by inconsistencies in the conclusions of

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different similar studies.(7) This study aims to determine whether there is an influence of

obesity on adolescent psychosocial.

METHODS

Figure 1. PRISMA chart (Revman 5.4.1)

This research is a meta-analysis research. The articles used in this study are

articles published from 2011 to 2022. The articles were obtained from the Pubmed and

Google Scholar databases, as well as Crossref using the Publish Or Perish application.

The keywords used in finding the article are Obesity, Psychosocial, Adolescent. This

research strategy uses PICOTS according to inclusion criteria, population used by

adolescents, obesity intervention, obesity adolescent comparators, outcomes of

psychosocial disorders, publication in 2011-2022, language using Indonesian and

English, case control research study, cross sectional, cohort.

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Data analysis using Review Manager (RevMan 5.4) with random effects model

method, calculates the difference in results between variables (odds ratio) and provides

estimates of combined effects and variations or heterogeneity of all studies. The process

of searching for articles using a journal search database is shown in Figure 1. The meta-

analysis process begins with journal identification, namely searching for journals from

the database with predetermined keywords. The results obtained 3092 articles. The next

step is to eliminate the same articles followed by a filtration process so that 9 articles are

eligible for meta-analysis.

RESULTS

Occurrence of Obesity in Adolescents

A total of 5 selected research articles, it can be seen the incidence of obesity in

adolescents as follows;

Table 1. Incidence of Adolescent Obesity

No Researcher Name n % Teen Location
Obesity
1 Andrie, Elisabeth K. 2021 104 25,1% Athena, Yunani
2 Utami, Anggita Putri 2018 46 50% Semarang
3 Masdar, Huriatul 2016 33 25% Pekan Baru
4 Azwa, Ismail, Abdullah 2021 71 50% Banda Aceh
5 Moonajilin, Rahman dan Islam 31 5% Bangladesh
Average 57
Percentage 5% – 50%

Table 1 shows the percentage of obesity in adolescents from various sources

taken from the lowest, namely 1.6% to the highest, which is 50%, and has an average

number of 57 adolescents with obesity.

Psychosocial Incidents of Obese Teenagers

A total of 5 selected research articles, it can be seen that psychosocial events in

adolescents are as follows;

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Table 2. Psychosocial Incidence of Obese Adolescents

No Researcher Name psychosocial Location
n= %
1 Andrie, Elisabeth K. 2021 129 Kecemasan : 81,1% Athena,
63 Depresi Melankolik : 41,2% Yunani
12 Perlaku Bunuh Diri : 7,8%
9 Rendah Diri : 5,8%
34 Penindasan : 22,8%
2 Utami, Anggita Putri 2018 28 60,9% Semarang
3 Masdar, Huriatul 2016 5 Depresi : 7,6% Pekan Baru
40 Ansietas : 60,6%
17 Stress : 25,8%
4 Azwa, Ismail, Abdullah 48 67% Banda Aceh
2021
5 Moonajilin, Rahman, dan 27 Depresi : 33,3% Bangladesh
Islam 15 Kecemasan 18,5%
Average 36
Percentage 7,6% – 81,1%

Table 2 shows the percentage of psychosocial events in adolescents from various

sources taken from the lowest, namely 7.6% to the highest, namely 81.1%, and has an

average of 36 adolescents with psychosocial disorders.

The Effect of Obesity on Adolescent Psychosocial

There are 5 research articles used for the meta-analysis. These articles are with

Case control, Cohort, and Cross Sectional study designs. The following results were

obtained.

Gambar 2. Forest Plot Meta Analisis Pengaruh Obesitas Terhadap Psikososial

Remaja (Revman 5.4.1)
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Captions: the blue square ( ) represents the OR of each study, (---) represents the 95%

CI, and the black diamond ( ) represents the poled odds ratio.

In Figure 2 above, it can be seen that the analysis using the random-effect model

resulted in a pooled odds ratio of 0.20 (95% CI 0.05-0.87). The results above can be

concluded that there is a significant relationship between obesity and adolescent

psychosocial, this is evidenced by the value of p <0.05, namely p = 0.03. The variation

between studies is heterogeneous, this can be seen from the p value in the heterogeneity

test is 0.00001 <0.05 and the I2 value = 100% (I2>50%). So this analysis uses a random

effect model

Figure 3. Funnel Plot Meta Analysis of the Effect of Obesity on Adolescent

Psychosocial (Revman 5.4.1)
Image caption: SE= Standard Error, o = represents the article, the vertical dotted
line (---) is the center line to see the symmetry of the plot.

Figure 4.3 Funnel Plot of the Effect of Obesity on Psychosocial Adolescents

shows that the left plot has an SE (Standard Error) between 0.14 – 0.27 while the right

plot has a standard error of 0.23 – 0.28. The funnel plot above shows an asymmetric
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distribution of research, where the distribution is not balanced between the left and right

of the center line, which means that there is publication bias.

DISCUSSION

Occurrence of Obesity in Adolescents

In table 1 there are 5 research articles that look at the number of obesity

incidents in adolescents. As many as 5 research articles, the lowest sample of adolescent

obesity is n = 31 with a 5% incidence of obese adolescents from a total of 622 samples

of adolescents according to research by Moonajilin, Rahman and Islam (2020) in

Bangladesh. The highest sample of adolescent obesity n = 104 obese adolescents with a

percentage of 25.1% of the total 414 samples according to Andrie's research (2021) in

Athens, Greece.

The prevalence of obesity in adolescents is mostly in developing countries,

where the rate of increase is 30% higher than in more developed countries. In the last 40

years, the number of obese adolescents (5-19 years) has increased from 11 million in

1975 to 12 million in 2016.(3) The 2013 Basic Health Research (Riskesdas) data shows

that the prevalence of obese adolescents aged 13-15 years increased from 2.5% in 2010

to 10.8% in 2013 consisting of 8.3% overweight and 2.5% obesity. Riskesdas 2018, the

prevalence of overweight and obesity at the age of 13-15 years is 16.0% and the age of

16-18 years is 13.5%.(4)

The incidence of obesity in adolescents increases rapidly in childhood

worldwide and is recognized as a threat to public health. The statistical differences

between overweight/obese cases and controls were seen from gender, relationship,

mother's occupation, parents' marital status, anxiety, melancholic depression, low self-

esteem, sex, physical activity, and school activities.(8)

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Factors that influence the incidence of adolescent obesity today, most of them

often eat fast food, consume too many carbohydrates and lack of daily physical activity,

over time it will become their daily habit or culture. If teenagers are already overweight

or obese, you should change your diet, and if obesity has genetic factors, you should

pay attention to your daily diet.(9)

Psychosocial Events in Obese Adolescents

In table 2 there are 5 research articles that can be seen the number of

psychosocial events in obese adolescents. From the 5 articles it was said that most of the

obese adolescents with psychosocial disorders experienced anxiety, which was 81.1%.

Anxiety is a symptom of psychosocial disorders that can lead to depression.

Psychosocial events in obese adolescents often occur in developing countries such as

Indonesia.

Riskesdas (2018) shows the prevalence of emotional mental disorders as

indicated by symptoms of depression and anxiety for ages 15 years and over reaching

around 6.1% of the total population of Indonesia or equivalent to 11 million people.(4)

Teenagers (15-24 years) have a depression percentage of 6.2%. Severe depression will

have a tendency to hurt yourself (self harm) to suicide. 80-90% of suicides are the result

of depression and anxiety. Suicide cases in Indonesia can reach 10,000 or the equivalent

of every hour there is a suicide case. According to a holy ophthalmologist, 4.2% of

students in Indonesia have thought of committing suicide. Among students, 6.9% had

suicidal intentions while another 3% had attempted suicide. Depression in adolescents

can be caused by several things such as pressure in the academic field, bullying, family

factors, and economic problems.

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The Effect of Obesity on Adolescent Psychosocial

Meta-analysis results from 5 research articles related to obesity on adolescent

psychosocial and have been selected according to the picots then the data is processed

using the Revman application (Review Manager) 5.4.1. The research articles mentioned

above used a case control, cross sectional, and cohort study design.

The results of the 5 research articles obtained that the lowest odds ratio was 0.02

and the highest was 1.00. This difference occurs due to the different number of samples

in each research article. The results of Moha's research (2017) say that when viewed

from the results of the OR (odds ratio) 63.3% of respondents with grade 1 obesity have

a 7.4 times greater chance of high self-esteem than respondents with grade 2 obesity.

Grade 2 has low self-esteem, so it can reduce the self-confidence of adolescents and

psychologically interfere.

Research conducted by Flores (2019) in the US and Mexico stated that

overweight/obese adolescents were more likely to report dissatisfaction with their

bodies. The results of the standard odss ratio show that psychosocial and social

environmental factors are the most significant things related to overweight/obesity.(3)

Obese adolescents who experience depression are more experienced by female

adolescents than male adolescents, this is in line with Utami's research (2018) in

Semarang. The results of the study stated that obese adolescent girls had a risk of

experiencing psychosocial disorders 6.395 times compared to normal nutritional girls.

Obese adolescent girls have a risk of depression 1.994 times than normal nutritional

girls. Obese adolescent girls tend to have a negative body image, and tend to be victims

of bullying at school.(6) Obesity or being overweight in adolescents is directly related to

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depression and poor body image. Obesity or being overweight is indirectly associated

with negative self-esteem, eating disorders, and a poorer quality of life.(1)

Research by Azwa, Ismail, & Abdullah, (2021) results of statistical tests

showing that adolescents with obesity are 2 times more likely to experience mental

disorders (psychological) compared to adolescents who are not obese. Statistically

reached the level of significant. Obese adolescents tend to withdraw from the

environment they hang out in, feel less confident, and often lock themselves up at home.

The problem of obesity can be a psychological burden for teenagers, because nowadays

they want to look better / perfect in terms of body weight.(9)

However, this does not apply in Bangladesh, research by Moonajilin, Rahman,

and Islam (2020) states that there is no significant relationship between

overweight/obese adolescents on depression and anxiety disorders in adolescents in

Bangladesh who were tested using the Chi Square test and regression analysis. This

situation occurs because of the Bangladeshi culture which views overweight/obesity

positively.(10)

Another study which also said that obesity affects adolescent psychosocial

factors is Andrie's (2021) study where study participants in the obese group suffered

from anxiety and experienced melancholic depression, had suicidal behavior, reported

low self-esteem, and they had also been victims of bullying at least once in a year. their

life.(8) The statement is in line with Van Vuuren's research (2019) that overweight/obese

adolescents report psychosocial problems more often than normal-weight adolescents

and are more often victims of being bullied. Victim is a significant mediator in the

relationship between obesity and psychosocial. Adolescents with obesity have suicidal

thoughts more often than normal weight adolescents.(11)

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In this study, the results from a meta-analysis of 5 research articles showed a

significant influence between obesity and psychosocial behavior (p = 0.03). The results

of the study are in line with the theory and the results of other studies which say that

obesity has an influence on adolescent psychosocial or vice versa. However, it should

be realized that the psychosocial factors in adolescents are not only obesity, but there

are many other risk factors that contribute to adolescent psychosocial events. According

to research by Rendra Zola (2021) that factors that can cause psychosocial adolescents

include factors in the state of the living environment, school environment, family

economic status, relationships with other people (peers), unplanned events (a person's

death) and adolescent life habits.(12)

CONCLUSION

The incidence of obesity in adolescents increases every year, the incidence of

obesity is more common in developing countries than in developed countries. Obese

adolescents with psychosocial experience a lot of anxiety, psychosocial adolescents are

also commonly found in developing countries, such as Indonesia. The results of the

meta-analysis of 5 research articles there is a significant relationship between obesity

and adolescent psychosocial, where the results are in line with the theory. There is a

publication bias, this could happen because this study only publishes the effect of

obesity on adolescent psychosocial, while research that does not discuss the effect of

obesity on adolescent psychosocial behavior is not published.

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