Clinical heterogeneity of sleep quality, emotional and behavioral characteristics, and eating habits in adolescents with obesity: A cluster analysis

This study aims to examine the role of sleep quality, emotional and behavioral characteristics, and eating behavior in adolescents with obesity by means of cluster analysis. One hundred ninety-four adolescents (78 girls, 116 boys) aged 12–17 (mean 14.3 ± 2.7) with obesity (ICD-10 code E 66.0) entered the study. The Adolescent Sleep Wake Scale was used to evaluate sleep quality. The Achenbach Youth Self-Report for Ages 11–18 questionnaire was used to evaluate emotional and behavioral disturbances. The Dutch Eating Behavior Questionnaire was used to assess maladaptive eating. k-Means cluster analysis was used to clarify heterogeneity. Four clusters were identified: the first included anxious, depressed, socially withdrawn adolescents with thought problems and somatic complaints, non-aggressive, obedient, and having mean values on the sleep quality scale, inclined to restrict their food consumption. The second consisted of rule-breaking youngsters with poor sleep quality, reluctant to restrict their food consumption. The third comprised subjects with the highest values on the sleep quality and lowest values on emotional and behavioral problems, aimed at restricting food consumption. The fourth comprised adolescents with obvious signs of emotional disorders, poorest sleep quality, disinhibited behavior, and emotional and external eating. No statistically significant difference was found between the clusters in sex distribution. Patient allocation to the second or fourth cluster was associated with significantly higher body mass index values, as opposed to the reference third cluster.