https://imcjms.com Ibrahim Medical College Journal of Medical Science https://imcjms.com/registration/journal_full_text/408 Wed, 23 Feb 2022 12:09:31 +0000 Abstract Background and objectives: Obesity among adolescents is a significant public health concern in the United States. The prevalence of obesity has increased from 13.0% in 2011 to 15.5% in 2019. The association between breakfast skipping and obesity is still controversial, and a mediator role of depression in this association is limited. The purpose of this study was to investigate the independent association between breakfast skipping and obesity and to investigate the mediator role of depressive symptomology between breakfast skipping and obesity prevalence. Materials and methods: In this cross-sectional study, data were extracted from the CDC's Youth Risk Behavior Surveillance System (YRBSS) for 9th to 12th graders from 2011 through 2020. SAS version 9.4 was used to analyze the data using proc survey frequency and proc survey logistic regression models. The adjusted odds ratios (aORs) with 95% confidence intervals (CI) were estimated. The Sobel test also was performed to test the mediator role of self-reported depression. Results: Of the 56,320 adolescents, 13.7% did not eat breakfast, 14.1% were obese, and 15.1% had depressive symptomology. Breakfast non-eaters was associated with a 24% increased odds of obesity (aOR: 1.24; 95% CI: 1.14 to 1.36) after adjusting for race/ethnicity, gender, grade level, and behavioral risk factors. A mediator role of self-reported depression was noted using the regression model and Sobel test (z = 3.90, S.E. = 0.02, p< 0.0001) between breakfast skipping and obesity. Conclusions: Breakfast skipping was independently associated with obesity. Self-reported depression was identified as a mediator factor. Therefore, the mental health condition also needs to be addressed in the prevention of obesity among adolescents. IMC J Med Sci 2022; 16(2): 001. DOI: https://doi.org/10.55010/imcjms.16.11 *Correspondence: Azad R. Bhuiyan, Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences, Jackson State University, Jackson, MS 39213, USA. Email:  azad.r.bhuiyan@jsums.edu   Introduction Breakfast is an important first meal of the day that impacts behavior, academic performance, and physical and mental well-being [7-11]. Adolescence is a critical transition period from childhood to adulthood as it represents the vulnerable phase of human development to physical, mental, and social maturity [12]. Although breakfast impacts both short- and long-term health and wellbeing of adolescents, the barrier to eating breakfast prevail among adolescents, especially in minority population having several risk factors such as lower family income, lower education, physical inactivity, watching television, and alcohol consumption [6,12-15]. However, controversy remains in the relationship between breakfast skipping and obesity prevalence among adolescents in the U.S., mainly because of inadequate adjustment of confounding variables. For example, conflicting results within four U.S. studies are notable –breakfast skipping was associated with obesity among adolescents in study of Kentucky adolescents and in a national study [15,16]. On the other hand, the National Heart, Lung, and Blood Institute Growth and Health Study found no association of breakfast skipping with obesity measures used after controlling for race, age, parental education, energy intake [13,14]. According to the Centers for Disease Control and Prevention (CDC), the rate of breakfast non-eaters increased from 13.1% to 16.7% and obesity rates increased from 13.0% to 15.5% among adolescents during the 2011-2012 survey period to the 2019-2020 survey period [17]. 2026 Ibrahim Medical College. All rights reserved.