Association of Food Insecurity with Mental Health Outcomes in Parents and Children.

BACKGROUND: Food insecurity affects 13.7 million US households and is linked to poor mental health. Families shield children from food insecurity by sacrificing their nutritional needs, suggesting parents and children experience food insecurity differentially. OBJECTIVE: To identify the associations of food insecurity and mental health outcomes in parents and children DATA SOURCES: PubMed, Embase, Web of Science, and PsycInfo STUDY ELIGIBILITY CRITERIA: We included original research published in English from January 1990 to June 2020 that examined associations between food insecurity and mental health in children or parents/guardians in the United States. STUDY APPRAISAL AND SYNTHESIS METHODS: Two reviewers screened studies for inclusion. Data extraction was completed by one reviewer and checked by a second. Bias and confounding were assessed using the Agency for Healthcare Research and Quality RTI Item Bank. Studies were synthesized qualitatively, grouped by mental health outcome, and patterns were assessed. Meta-analyses were not performed due to high variability between studies. RESULTS: We included 108 studies, assessing 250,553 parents and 203,822 children in total. Most studies showed a significant association between food insecurity and parental depression, anxiety, and stress, and between food insecurity and child depression, externalizing/internalizing behaviors, and hyperactivity. LIMITATIONS: Most studies were cross-sectional and many were medium- or high-risk for bias or confounding. CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS: Food insecurity is significantly associated with various mental health outcomes in both parents and children. The rising prevalence of food insecurity and mental health problems make it imperative that effective public health and policy interventions address both problems.

Unremitting Pain and Fever in a 15-Year-Old Boy With Osteomyelitis.

A previously healthy 15-year-old boy from a rural county in the southeastern United States was evaluated in the emergency department with fever and worsening toe pain in the absence of trauma. He initially presented to his primary care physician 4 weeks before with upper respiratory symptoms and was treated with corticosteroids for presumed reactive airway disease. His respiratory symptoms resolved. One week after this presentation, he developed fever and right great toe pain and presented to an outside hospital. Inflammatory markers were elevated. MRI confirmed a diagnosis of osteomyelitis with associated periosteal abscess. He was treated with intravenous antibiotics and drainage of the abscess. Ten days after his discharge from the outside hospital, he developed fever and had increasing drainage of the toe and pain refractory to oral pain medications. He presented to our facility for further evaluation. Repeat MRI and inflammatory markers corroborated his worsening disease, and he was admitted to the hospital for intravenous antibiotics and underwent serial surgical debridement. He developed painful subcutaneous nodules on his lower extremities and was found to have lung abnormalities on chest radiograph. A multispecialty team collaborated in the management of this patient and unveiled a surprising diagnosis.

Internalized Weight Bias, Teasing, and Self-Esteem in Children with Overweight or Obesity.

Background: Although 2/3 of US adults and nearly 1/3 of US children have overweight or obesity, weight stigma is common. Many with overweight or obesity ascribe negative ideas to themselves, resulting in internalized weight bias (IWB). In adults, IWB has been associated with psychosocial problems; however, this relationship has been studied little in children. This study aims to describe IWB in children with overweight and obesity and to study the association of children's IWB with experienced weight bias, self-esteem, and their parents' IWB. Methods: Children ages 9-18 with overweight or obesity completed the Weight Bias Internalization Scale (WBIS), Rosenberg Self-Esteem Scale, and Perception of Teasing Scale; parents completed the Weight Bias Internalization Scale-Modified and the Perceived Weight Discrimination Scale. Descriptive statistics were used to assess IWB, self-esteem, and experienced weight stigma. Chi-square and t-tests were used to examine associations between categorical and continuous variables, respectively. Multivariate linear regression was used to identify correlates of IWB in children. Results: Of 111 child participants, the median WBIS score was 2.8 out of 7. Higher IWB was associated with more peer teasing (p < 0.001) and lower self-esteem (p < 0.001). IWB in children was not associated with child BMI z-score (p = 0.590) or higher parent IWB (p = 0.287). Conclusions: Children with overweight and obesity who have experienced more teasing by peers or who have lower self-esteem are more likely to have a higher IWB. However, increasing child BMI z-score and parent IWB are not associated with higher child IWB.

Assessing Parents' Communication of Weight and Weight Management from Clinic to Home.

Background: Family-oriented therapies are the gold standard of childhood obesity treatment, yet little is known about if or how information gathered by one parent from a health care provider is translated to the home. We assessed how families of children and adolescents with overweight and obesity communicate weight-related information received from their provider to family members not present at the visit. Methods: Parents and children (9-18 years old, N = 112) completed the McMaster's Family Assessment Device Communication Subscale (FADc) and investigator-derived questions describing weight-related communication practices with family members. We used descriptive statistics to describe communication practices and separate logistic regression models to assess associations of communication practices with parent-reported FADc, child BMI z-score, child sex, parent BMI, household income, and site. Results: Most parents discuss with other family members: their child's weight (60.4%) or weight management discussions with the child's provider (57.9%). Median parent FADc score was 2.0 (IQR 0.5). The most common facilitator to weight-related conversations was understanding what the provider said (95.1%). Higher FADc score (worse communication) was associated with whether parents ask other family members' opinions about weight information received from their child's provider [odds ratio 0.22 (95% confidence interval 0.05-0.99)]. Higher income was associated with many healthy communication practices. Conclusions: Slightly more than half of parents discuss with family members what their provider said regarding their child's weight. More effort must be placed on aiding parents in relaying information from the provider to other family members in the home to encourage family lifestyle changes and alleviate childhood obesity.