Weight change and appetite disturbance as symptoms of adolescent depression: Toward an integrative biopsychosocial model
Section snippets
Facts about adolescent weight, appetite, and depression
In the simplest sense, weight and appetite regulation can be conceptualized as a feedback system. The brain receives input signals and then induces output signals to neural and hormonal systems that regulate metabolism and modulate food seeking behavior (Bray & Tartaglia, 2000). A variety of psychological and biological factors, many of which are in flux during adolescence, has the potential to complicate this relation (Schlundt, Hill, Sbrocco, Pope-Cordle, & Kasser, 1990). People consume more
Factors that influence adolescent weight, appetite, and depression
Adolescents clearly face a variety of opposing physiological, behavioral, and psychological forces. In the following section, we review several factors that could affect the apparent relation of weight and appetite disturbance to depression during adolescence, insofar as they (a) affect weight and/or appetite, (b) relate to depression, and (c) change during adolescence. Highlights of this review are summarized in Table 1.
A developmental model
Clearly many factors that influence weight, appetite, and depression undergo change during adolescence. These factors include psychological and behavioral variables (e.g., exercise, body dissatisfaction, dieting, eating disorders, stress), secretion of gonadal and peripheral hormones (e.g., cortisol, testosterone, estradiol, progestin, pituitary growth hormone, leptin), hypothalamic activation and neuropeptide levels (e.g., neuropeptide Y, melanocortins), and regulation of the reward system
Studies on the relation of weight change and appetite disturbance to depression
As a first step toward understanding the effect of development on the relation of appetite disturbance and weight change to depression, we reviewed empirical studies of these relations in child, adolescent, and adult samples. Three key questions guided this review. First, how prevalent are weight gain, weight loss, appetite increase, and appetite decrease in depressed children, adolescents, and adults? Second, are there developmental differences in these rates? Third, are the rates of weight
Discussion
Six major conclusions emerged from this review. First, many of the factors that control appetite and weight change during adolescence are also associated with depression (see Table 1). Second, these factors are in flux especially during puberty, creating a need for a developmental model in order to understand the relation of weight and appetite to depression to change during this period (see Fig. 1). Third, as anticipated by our developmental model, the prevalence of appetite and weight loss in
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Melissa A. Maxwell was supported in part by a National Institute of Mental Health Training Grant (T32-MH18921).