Relationships Between Executive Dysfunction, Sleep, and BMI in Adolescents in a Pediatric Weight Management Clinic

Background: Childhood obesity affects one in five U.S. children and increases cardiometabolic disease and mortality risks. Executive functions (EF), such as organization, attention, and inhibition are hypothesized to be impaired in children with obesity. This executive dysfunction (ED) is also mediated by sleep behaviors which also influence food appeal and sedentary time. To what degree ED and sleep behaviors affect treatment seeking youth with obesity and their outcomes is not well described. The primary objective of this study was to compare the treatment outcomes as measured by %BMIp95 between children with and without ED. Secondary objectives included: 1) comparing %BMIp95 between children with and without problematic sleep behaviors (duration, timing, variability, and quality), and 2) comparing baseline sleep behaviors of children with and without ED. We hypothesized that ED contributes to worse obesity and outcomes in treatment seeking youth; we now report the interim baseline characteristics of our study population.

Methods: This was a double-blinded prospective study of 11-17 year old patients who were recruited from a comprehensive, multidisciplinary pediatric weight management program. Participants were enrolled in treatment as usual (TAU) that was enhanced by activity and food intake tracking technology utilizing a wearable actigraph and food tracking application. At baseline, %BMIp95 was calculated from weight and height measures, Wisconsin Card Sort Test (WSCT) was administered to determine EF, and actigraph use for 1 week determined their baseline objective sleep metrics (e.g., quality, timing, nighttime wakings). %BMIp95 values were compared utilizing t-tests between groups with ED and those without ED. Linear regression was utilized to determine predictive change in %BMIp95 given problematic sleep patterns.

Results: A total of 23 participants were analyzed; 13 (54%) had ED, 19 (82%) had problematic sleep, and 10 (43%) had both. There were no significant differences in baseline %BMIp95, sleep score, or sleep quantity between groups (Table 2). Linear regression did not demonstrate any relationship between lower sleep quantity or lower sleep quality with higher %BMIp95.

Conclusion: In contrast to our hypothesis, participants with and without ED had similar baseline %BMIp95. Strikingly, over half of the patients had ED in our treatment seeking population, compared to a reported prevalence of approximately 30% among a general school age population. In addition, patient mean sleep duration (6.96 hours/night) was less than the CDC recommended 8-10 hours/night for adolescents, and most of the participants (87%) had sleep duration below 8 hours. Given the high proportion of treatment seeking youth with obesity and ED mediated by problematic sleep patterns, approaches which most effect treatment outcomes will need to be tested.