Insufficient sleep may be a significant contributing factor to the increase in pediatric obesity and thus may also contribute to adult obesity and chronic illness. Previous research has been based on large survey studies with consideration of demographics and lifestyle factors (e.g., snacking and TV watching) but not of child psychological/behavioral functioning and parenting factors. This study investigated the relationship of sleep duration to obesity status in 819 children ages 8 to 11 years old, with consideration of demographics, clinical elevations in child psychological/behavioral functioning, and parenting stress. In unadjusted and adjusted analyses, parent-reported child sleep duration was significantly associated with the odds of obesity with an increase of 41% for each 1-hour reduction in sleep duration. In addition to sleep duration, only median neighborhood income was significantly related to obesity status. Indices of child psychological/behavioral functioning and parenting stress were associated with sleep duration but not with obesity, and adjusting for these behavioral and parenting characteristics did not appreciably alter the relationship between sleep duration and obesity status. Exploratory gender-specific analyses found that mean sleep duration was significantly associated with the odds of obesity for boys but not for girls. These results show that the relationship of shorter sleep duration to a greater likelihood of being obese persists even after adjusting for potential confounders of child psychological/behavioral functioning and parenting stress. Gender-specific associations are similar to findings reported in samples that include adolescents.

Objective: The objective of this study was to offer a practical demonstration of the use of bootstrapping in structural equation modeling (SEM) with smaller samples by evaluating family dinnertime rituals at the intersection between the family social environment and pediatric type 1 diabetes mellitus management. Method: Participants were 77 children and adolescents aged 6 to 18 years and their mothers from a larger study of child and parental challenges related to managing the treatment regimen and correlates of adherence. SEM was used to test a model of maternal reports of the family social environment as exogenous variables with mealtime rituals and child hemoglobin A1c levels as endogenous variables. The bootstrapping procedure and the Bollen-Stine bootstrapped χ² test were then applied to test the stability and appropriateness of this model. Results: Using SEM, the final model had robust goodness-of-fit indicators and revealed that the family social environment characteristics of control and cohesion were related to mealtime rituals, which was associated with hemoglobin A1c levels. The bootstrapping procedure indicated that the parameter estimates were very stable, thus lending greater credence to the model. The Bollen-Stine approach provided evidence that the entire hypothesized model was not significantly different from the model derived from bootstrapping. Conclusions: This investigation offers a practical demonstration of the bootstrapping technique and the Bollen-Stine approach for testing models on smaller samples in SEM. These techniques may be used with relatively small samples, which are common in developmental/behavioral pediatrics and pediatric psychology research.

Objective To examine associations of sleep duration and regularity with dietary intake and eating-related cognitions among adolescents who are overweight/obese. Methods Participants were 315 adolescents being evaluated through Healthy Kids, Healthy Weight. Outcomes were reported sleep duration and regularity (bedtime shift, wake-time shift, sleep duration shift). Major predictors were dietary intake (e.g., consumption of calories and sugar-sweetened beverages) and eating-related cognitions (food preoccupation, eating self-efficacy). Results Findings were that staying up (i.e., bedtime shift) and sleeping in later (i.e., wake-time shift) on weekends compared with weekdays significantly relates to drinking more sugar-sweetened beverages, the latter for males. Sleeping in on weekends was related to greater food preoccupation. Conclusions Sleep regularity was the most important variable in its relationships with dietary intake. Evaluating sleep patterns and improving them with behavioral interventions should be considered as an additional weight loss strategy to promote dietary adherence.

Adolescents who are obese are at risk for being teased about their appearance with the concomitant negative psychological sequelae. Identifying modifiable variables associated with teasing could inform pediatric weight-management interventions. Characterizing society’s role in the victimization of these at-risk individuals could guide anti-bullying programs for schools and broader public health efforts. This study aims to examine novel societal and cognitive factors associated with weight-related teasing frequency. Participants were adolescents (N = 334) being evaluated for a hospital-affiliated weight-management program. The outcome was perceived weight-related teasing frequency. Predictors were sociocultural awareness and internalization of appearance-related attitudes, physical activity self-efficacy, and psychological functioning. Multivariate regressions controlled for demographics and body mass index (BMI) z-scores with separate regressions testing interactions of BMI z-scores with all predictors. In adjusted analyses, higher physical activity self-efficacy and fewer depressive symptoms related to lower teasing frequency. Interactions indicated that less awareness/internalization of sociocultural attitudes towards appearance, more positive body image, and higher self-esteem related to lower teasing frequency regardless of BMI. Targeted interventions and public health campaigns should be developed and tested for adolescents that improve body image with promotion of diverse views about attractiveness, bolster confidence in overcoming physical activity barriers, and identify and treat mood symptoms.