Self-esteem and obesity in children and adolescents: a literature review

Prospective changes in body image dissatisfaction among adolescent bariatric patients: the importance of body size estimation

BACKGROUND

Body image dissatisfaction (BID) is pervasive among patients presenting for bariatric surgery but improves significantly postoperatively. These findings have been determined primarily from studies of adults. The objective of the present study was to examine the changes in BID among adolescents with extreme obesity from baseline/preoperatively to 6 and 12 months after receiving bariatric surgery at a pediatric medical center using body size estimation.

METHODS

BID was prospectively assessed among 16 adolescent bariatric patients (mean age 16.3 ± 1.2 years, mean body mass index [BMI] 66.2 ± 12.0, 67% female) using a standard visual/perceptual measure (i.e., Stunkard Figure Rating Scale). Participants identified their current and ideal body size, with a discrepancy score (current minus ideal) indicating BID. The body size estimation ratings were compared with attitudinal (i.e., Impact of Weight on Quality Of Life-Kids: Body Esteem and Self-Perception Profile for Adolescents: Physical Appearance) body image scores, BMI, and total weight-related quality of life.

RESULTS

A significant reduction occurred in the current body size (from 7.9 to 6.4, P <.001) from baseline to 6 months but not from 6 to 12 months. The current body size was related to BMI and percentage of excess weight loss but not attitudinal body image at each follow-up point. A smaller discrepancy (current minus ideal) was associated with greater total weight-related quality of life (r = -.68), with a trend toward significance for body esteem (r = -.65) at 12 months.

CONCLUSION

Adolescents undergoing bariatric surgery experience a significantly decreased BID within the first 12 months after surgery, with the most substantial change occurring from baseline to 6 months. The postoperative weight-related quality of life is more closely associated with the body size discrepancy than with the current body size.

Associations of mood and anxiety disorders with obesity: comparisons by ethnicity

OBJECTIVE

The aim of this study is to compare the associations of mood and anxiety disorders (12 months and past diagnosis) with obesity among ethnically diverse adults.

METHODS

Data from Caucasians, African American, and Latinos in the National Comorbidity Survey Replication (NCS-R), National Latino and Asian American Study (NLAAS), and National Study of American Life (NSAL) were analyzed (n=17,445). Multivariate logistic regression models tested the associations between 12 month and past diagnosis of mood and anxiety disorders with obesity (body mass index ≥ 30kg/m²).

RESULTS

Approximately 52% of the sample was female and 24% obese. Among Caucasians, 12-month mood disorder (OR=1.30, 95% CI=1.05, 1.62), past diagnosis of mood disorder (OR=1.37, 95% CI=1.11, 1.69) and 12-month anxiety disorder (OR=1.40, 95% CI=1.02, 1.68) were associated with greater likelihood of obesity. Among African Americans, past year anxiety disorder (OR=1.63, 95% CI=0.92, 1.67) was associated with greater likelihood of obesity, and a trend toward an association between 12 month mood disorder (OR=1.24, 95% CI=0.92, 1.67) and obesity was observed. Similarly among Latinos, past year anxiety disorder (OR=1.45, 95% CI=1.00, 1.99) was associated with greater likelihood of obesity, and a trend toward an association between 12-month mood disorder (OR=1.26, 95% CI=0.94, 2.01) was observed. Tests of statistical interaction to assess heterogeneity of the associations of mood and anxiety disorders with obesity, comparing African Americans and Latinos to Caucasians, suggest differences in the association of past diagnosis of mood disorder with obesity (P<.10 for both groups).

CONCLUSIONS

Results suggest similar associations between 12-month mood and anxiety disorders with obesity across groups.

Relationship of insulin resistance to psychobehavioral characteristics of overweight and obese African American children

OBJECTIVES

The objective of this study was to evaluate the relationships of insulin resistance to positive as well as negative dimensions of the child's emotions, behavior and personality (hereafter referred to as "psychobehavioral characteristics") in a convenience sample of inner-city, overweight and obese, African American children.

METHODS

A secondary analysis was performed on a sample of 127 children ages 9-12 yr old who were participating in a community-based, Type 2 diabetes prevention program. Psychobehavioral characteristics of children were assessed using both child and parent ratings derived from the Behavioral Assessment for Children, 2nd edition (BASC-2). Body fatness was evaluated using anthropometric techniques, and insulin resistance (HOMA-IR) was calculated from fasting glucose and insulin concentrations. Hierarchical multiple linear regression models were employed with BASC scales as dependent variables and HOMA-IR as the independent variable of interest.

RESULTS

After adjusting for child age, pubertal stage, gender, family socioeconomic index, and intervention group assignment, child HOMA-IR was related at p<0.05 to less favorable scores for parent-report of behavioral symptoms and externalizing problems composites, and to content scales for bullying and negative emotionality. Additionally, child HOMA-IR was related at p<0.01 to less favorable scores for child-report inattention/hyperactivity composite. Body fatness suppressed the unfavorable relationship between HOMA-IR and these and other psychobehavioral characteristics as the degree of significance was higher following adjustment for body fatness in this cohort.

CONCLUSION

More than one psychobehavioral characteristic were associated with body fatness and insulin resistance in the overweight children of this study. Whether the associations are due to several, or only one, of these psychobehavioral characteristics could not be determined. A much larger and future study will be needed to determine which, if any, of these psychobehavioral characteristics are independently associated with insulin resistance in overweight children.

Correlates of weight instability across the lifespan in a population-based sample

OBJECTIVE

Research from overweight/obese clinical samples links weight instability to poor health. This study investigated whether negative health outcomes were associated with weight instability in a population-based sample.

METHOD

One thousand five hundred ten women and 1,111 men from the Mid-Atlantic Twin Registry completed questionnaires assessing demographics, body size in childhood, adolescence, and adulthood, health satisfaction, and disordered eating. Noneating disorder psychiatric diagnoses were assessed via clinical interviews.

RESULTS

Weight instability was related to lower health satisfaction and self-esteem, and higher body dissatisfaction, dieting, and binge eating for both sexes. Weight unstable women were more likely to meet criteria for lifetime major depressive disorder, generalized anxiety disorder, and eating disorders. Weight stable women were more likely to abuse alcohol; however, two of these associations [e.g. weight instability and generalized anxiety disorder (GAD) and weight stability and alcohol abuse] became nonsignificant once lifetime binge eating was accounted for, indicating that these forms of psychopathology are more strongly related to binge eating than weight instability itself. No associations between weight stability and psychiatric diagnoses were found in men.

DISCUSSION

Weight instability is related to mental and physical health concerns for both sexes. It was also specifically associated with depression and eating pathology in women.

The intellectual disability version of the very short form of the physical self-inventory (PSI-VS-ID): cross-validation and measurement invariance across gender, weight, age and intellectual disability level

Recently Maïano, Bégarie, Morin, and Ninot (2009) developed and validated an intellectual disability (ID) version of the very short form of the physical self-inventory (PSI-VS-ID). In a recent review of the various physical self-concept instruments Marsh and Cheng (in press) noted that the short and very short versions of the French PSI represent an important contribution to applied research but that further research was needed to investigate the robustness of their psychometric properties in new and diversified samples. Thus, this study is specifically designed to investigate the robustness of the PSI-VS-ID psychometric properties in a new independent sample of 248 adolescents and young adults with ID. In particular, tests of measurement invariance were conducted across the present sample and the original sample from Maïano et al. (2009) study in order to more precisely assess the degree of replication of the results. Overall, results from a series of confirmatory factor analyses of the PSI-VS-ID provided support for its: (i) factorial validity and reliability; (ii) factorial invariance across gender and weight status; (iii) partial (strict or strong) factorial invariance across age, ID level and samples; and (iv) latent mean differences across gender, weight status and ID level groups.

The effect of group-based weight control intervention on adolescent psychosocial outcomes: Perceived peer rejection, social anxiety and self-concept

This paper examines the effectiveness of group-based weight control treatment on adolescent social functioning. Eighty-nine adolescents who were randomized to group-based cognitive behavioral treatment (CBT) with aerobic exercise (CBT+EXER) or peer enhanced adventure therapy (CBT+PEAT) completed measures of social functioning at baseline, end of treatment, and 12-month follow-up. Results demonstrated significant reductions in adolescent perceptions of peer rejection and social anxiety over time with no significant demonstrated group differences. Improvements in social functioning were related to increases in self-concept dimensions. Findings demonstrate benefits of group-based weight control treatment for enhancing adolescent self-perceived social functioning across multiple domains.

Psychological factors and weight problems in adolescents. The role of eating problems, emotional problems, and personality traits: the Young-HUNT study

BACKGROUND

The associations between psychological factors and weight problems in adolescents are not conclusive. We studied associations between psychological factors, including personality and weight problems, in an adolescent population. In addition, we examined the same psychological factors as predictors for change in weight categories during adolescence.

METHOD

From 1995 to 1997, 8,090 adolescents, aged 13-18 years, participated in the Young-HUNT-I study; of those, 1,619 also participated in a follow-up study in 2000-2001. They completed a questionnaire monitoring eating problems, self-esteem, personality, anxiety, and depression, and had their height and weight measured. Weight problems were defined using the international age-and sex-specific BMI-cut-offs defining underweight, overweight, and obesity. Psychological factors at baseline were studied both in relation to weight categories at baseline, and as predictors for weight change between baseline and the follow-up.

RESULTS

Significant sex differences in mean values were found in all psychological factors, with higher scores in girls compared with boys. In the cross-sectional design, eating problems were associated with weight problems, and the two factors of oral control (EAT-A) and food preoccupation (EAT-B) showed an inverse association. Oral control was associated with underweight, while food preoccupation was associated with overweight and obesity in both sexes. Low self-esteem was associated with overweight and obesity in both sexes, but no association was found between emotional problems or personality traits, and weight problems. During the follow-up, oral control was a clear predictor of weight change during adolescence in both sexes. Oral control protected against unhealthy weight gain but also predicted unhealthy weight reduction in both sexes.

CONCLUSIONS

Girls scored higher on all psychological factors compared with boys, but no sex differences were found with regard to the association between psychological factors and weight problems. Eating problems showed the strongest association with weight problems at baseline and were also the strongest predictor of weight change during adolescence.

Overestimation of own body weights in female university students: associations with lifestyles, weight control behaviors and depression

The study aimed to analyze the lifestyles, weight control behavior, dietary habits, and depression of female university students. The subjects were 532 students from 8 universities located in 4 provinces in Korea. According to percent ideal body weight, 33 (6.4%), 181 (34.0%), 283 (53.2%), 22 (4.1%) and 13 (2.5%) were severely underweight, underweight, normal, overweight and obese, respectively, based on self-reported height and weight. As much as 64.1% and only 2.4%, respectively, overestimated and underestimated their body weight status. Six overweight subjects were excluded from overestimation group for the purpose of this study, resulting in overestimation group consisting of only underweight and normal weight subjects. Compared to those from the normal perception group, significantly more subjects from the overestimation group were currently smoking (P = 0.017) and drank more often than once a week (P = 0.015), without any significant differences in dietary habits. Despite similar BMIs, subjects who overestimated their own weight statuses had significantly higher weight dissatisfaction (P = 0.000), obesity stress (P = 0.000), obsession to lose weight (P = 0.007) and depression (P = 0.018). Also, more of them wanted to lose weight (P = 0.000), checked their body weights more often than once a week (P = 0.025) and had dieting experiences using 'reducing meal size' (P = 0.012), 'reducing snacks' (P = 0.042) and 'taking prescribed pills' (P = 0.032), and presented 'for a wider range of clothes selection' as the reason for weight loss (P = 0.039), although none was actually overweight or obese. Unlike the case with overestimating one's own weight, being overweight was associated with less drinking (P = 0.035) and exercising more often (P = 0.001) and for longer (P = 0.001) and healthier reasons for weight control (P = 0.002), despite no differences in frequency of weighing and depression. The results showed that weight overestimation, independent of weight status, is associated with risky lifestyles, weight control behaviors, and mental conditions. Preventive interventions should focus not only on obesity, but also on body weight overestimation.

Is obesity associated with emotional and behavioural problems in children? Findings from the Millennium Cohort Study

Objectives. We examined cross-sectional and longitudinal associations between obesity and emotional and behavioural problems in a nationally representative sample of young children. Methods. Data were available from 11 202 children (50% boys) participating in the UK's Millennium Cohort Study. Height and weight were measured at 3 and 5 years and children defined as obese using IOTF cut-offs for body mass index (BMI). Emotional and behavioural problems were parentally assessed using the Strengths and Difficulties Questionnaire. Adjusted linear and multinomial regression analyses were conducted separately for boys and girls. Results. At age 3, obese boys had more conduct problems, and obese girls had more prosocial behaviours, than their normal weight counterparts. At age 5, obese boys had more conduct problems, hyperactivity and inattention problems, peer relationship problems and total difficulties. Obese girls only had more peer relationship problems. Obese 3-year-olds were not at increased risk of abnormal scores; in contrast, obese 5-year-old boys were significantly more likely to have abnormal scores for conduct problems, hyperactivity and inattention problems, peer relationship problems, prosocial behaviours and total difficulties. Obesity, at age 3, was also predictive of peer relationship problems at age 5 in boys (95% CI: 0.26 [0.01, 0.52]). Conclusions. Childhood obesity is associated with emotional and behavioural problems from a very young age. Obese boys are at particular risk. Further research is required to examine effect modifiers and mediating factors in these associations. Recognition and response to these mental health problems should be a goal of pediatric obesity interventions and policies.

Weight status and depressive symptoms in 18 year-old Greek adolescents

Depressive symptoms in adolescence have been a subject of considerable controversy in terms of their nature, severity and identification. The aim of the study was to investigate the possible association between weight status and depressive symptoms among 18 year-old Greek adolescents. A cross-sectional study design was used. The study population consisted of 200 students of the University of Athens who fulfilled the following criteria: age 18 years, absence of clinical depression, no history of hospitalization in a mental institution, no history of alcohol abuse. Weight status was assessed by Body Mass Index (BMI) (kg/m(2)) and calculated from weight and height measurements. Severity of depressive symptoms was assessed by Centre for Epidemiologic Studies-Depression Scale (CES-D). In univariate analysis, CES-D score was significantly associated with adolescents' gender and BMI. The multivariate analysis showed that CES-D score was negatively related to BMI even after controlling the confounding effect of gender (P=0.018, B=-0.378). Depressive symptoms are related to weight status of adolescents.

Perception of overweight and self-esteem during adolescence

OBJECTIVE

To examine sex- and race/ethnicity-specific relationships between adolescents' self-esteem and weight perception.

METHOD

Descriptive analysis and logistic regression of Wave II of the National Longitudinal Study of Adolescent Health (N = 6,427 males, 6,574 females; ages 11-21) examined associations between low self-esteem and perceived overweight within body mass index (BMI) percentile categories, controlling for sociodemographics and stratified by sex and race/ethnicity.

RESULTS

25.1% and 8% of normal weight females and males, respectively, perceived themselves as overweight, with variation by race/ethnicity. Low self-esteem was most strongly associated with misperceived overweight in moderate BMI percentile categories (males: OR = 2.34; 95% CI: 1.60-3.41; females: OR = 2.39; 95% CI: 1.82, 3.16). Odds of correctly perceived overweight were higher for low (versus high) self-esteem in white and black females but not males of any race/ethnicity.

DISCUSSION

Understanding subgroup differences by race/ethnicity in perceived overweight-self-esteem relationships may inform eating disorders' prevention strategies.

Prevalence of overweight and obesity in Saudi children and adolescents

BACKGROUND AND OBJECTIVE

There is limited information on overweight and obesity in Saudi children and adolescents. The objective of this study was to establish the national prevalence of overweight and obesity in Saudi children and adolescents.

METHODS

The 2005 Saudi reference data set was used to calculate the body mass index (BMI) for children aged 5 to 18 years. Using the 2007 WHO reference, the prevalence of overweight, obesity and severe obesity were defined as the proportion of children with a BMI standard deviation score more than +1, +2 and +3, respectively. The 2000 CDC reference was also used for comparison.

RESULTS

There were 19 317 healthy children and adolescents from 5 to 18 years of age, 50.8% of whom were boys. The overall prevalence of overweight, obesity and severe obesity in all age groups was 23.1%, 9.3% and 2%, respectively. A significantly lower prevalence of overweight (23.8 vs 20.4; P<.001) and obesity (9.5 vs 5.7; P<.001) was found when the CDC reference was used.

CONCLUSIONS

This report establishes baseline national prevalence rates for overweight, obesity and severe obesity in Saudi children and adolescents, indicating intermediate levels between developing and industrialized countries. Measures should be implemented to prevent further increases in the numbers of overweight school-age children and adolescents and the associated health hazards.

Weight status and emotional well-being: longitudinal findings from Project EAT

OBJECTIVES

To learn more about how overweight is associated with emotional well-being in adolescents and examine change in associations over time.

METHODS

A prospective study was conducted with a sample of 2,516 adolescents who participated in Project EAT-I (1999) and Project EAT-II (2004).

RESULTS

At baseline, overweight participants had lower body satisfaction and decreased self-esteem as compared to normal weight participants. Additionally, an association was found between overweight and depressive symptoms among males during middle adolescence. Longitudinal findings suggest that the adverse impact of overweight on emotional well-being persists into young adulthood, including a marked increase in depressive mood among overweight males between early and middle adolescence.

CONCLUSIONS

The persistent nature of the association between overweight and emotional well-being suggests that the normal developmental process of adolescence will not "take care" of this association. Instead, clinicians should regularly screen overweight adolescents for markers of poor emotional well-being and consider intervention when appropriate.

Antenatal and postpartum depressive symptoms are differentially associated with early childhood weight and adiposity

Antenatal depression is associated with small-for-gestational age, but few studies have examined associations with weight during childhood. Similarly, few studies address whether antenatal and postpartum depression differentially affect child weight. Among 838 mother-child dyads in Project Viva, a prospective cohort study, we examined relationships of antenatal and postpartum depression with child weight and adiposity. We assessed maternal depression at mid-pregnancy and 6 months postpartum with the Edinburgh Postnatal Depression Scale (score > or =13 indicating probable depression). We assessed child outcomes at age 3 years: body mass index (BMI) z-score, weight-for-height z-score, sum of subscapular (SS) and triceps (TR) skinfold thickness (SS + TR) for overall adiposity, and SS : TR ratio for central adiposity. Sixty-nine (8.2%) women experienced antenatal depression and 59 (7.0%) postpartum depression. Mean (SD) outcomes at age 3 were: BMI z-score, 0.45 (1.01); SS + TR, 16.72 (4.03) mm; SS : TR, 0.64 (0.15). In multivariable models, antenatal depression was associated with lower child BMI z-score (-0.24 [95% confidence interval: -0.49, 0.00]), but higher SS : TR (0.05 [0.01, 0.09]). There was no evidence of a dose-response relationship between antenatal depression and these outcomes. Postpartum depression was associated with higher SS + TR (1.14 [0.11, 2.18]). In conclusion, whereas antenatal depression was associated with smaller size and central adiposity at age 3 years, postpartum depression was associated with higher overall adiposity.

Characteristics associated with low self-esteem among US adolescents

OBJECTIVE

Low self-esteem in adolescents has been associated with a number of risk and protective factors in previous studies, but results have been mixed. Our objective was to examine characteristics associated with low self-esteem in a large national sample of young adolescents.

METHODS

We conducted a population-based correlational study. A sample of 6522 adolescents aged 12 to 16 years was surveyed by phone as part of a national study of media and substance use. Self-esteem was measured with 3 questions that assessed global self-worth and physical appearance. Multivariate logistic regression was used to examine the relationship between self-esteem and sociodemographics, child personality characteristics,weight status, daily TV time, parenting style, school performance,and team sports participation. Interactions among gender, race, and weight status were examined.

RESULTS

In multivariate analysis, female gender, Hispanic race, overweight and obesity, sensation seeking, rebelliousness, and daily TV time were each independently associated with lower self-esteem. Teens of black race, with higher parental responsiveness and demandingness, better school performance, or involvement in team sports were less likely to report low self-esteem. Black females were at lower risk and Hispanic males were at higher risk for low esteem than peers of similar gender of other races.

CONCLUSIONS

Low self-esteem was associated with a number of modifiable risk factors, including obesity, TV time, team sports participation, school performance, and parenting style, that should be discussed with teens and parents at health supervision visits. Further research examining race and gender-specific factors that serve to moderate risk for poor self-esteem in adolescents is warranted.

Body Size and Social Self-Image among Adolescent African American Girls: The Moderating Influence of Family Racial Socialization

Social psychologists have amassed a large body of work demonstrating that overweight African American adolescent girls have generally positive self-images, particularly when compared with overweight females from other racial and ethnic groups. Some scholars have proposed that elements of African American social experience may contribute to the maintenance of these positive self-views. In this paper, we evaluate these arguments using data drawn from a panel study of socio-economically diverse African American adolescent girls living in Iowa and Georgia. We analyze the relationship between body size and social self-image over three waves of data, starting when the girls were 10 years of age and concluding when they were approximately 14. We find that heavier respondents hold less positive social self-images but also find that being raised in a family that practices racial socialization moderates this relationship.

Exploring the relationship among weight, race, and sexual behaviors among girls

OBJECTIVE

The relationship between weight and sexual behavior among adolescents is poorly understood. We examined this relationship in a nationally representative sample of high school girls.

METHODS

We performed a cross-sectional analysis of self-reported data from 7193 high school girls who completed the 2005 Youth Risk Behavior Surveillance survey. We used multivariate logistic regression to examine associations among 3 weight indices (BMI calculated from self-reported weight and height, perceived weight, and weight misperception) and 6 sexual behaviors (ever had vaginal sex; sex before age 13; >or=4 sexual partners; and alcohol, condom, and oral contraceptive use at last sex) adjusting for age, race/ethnicity, and a history of intimate partner violence.

RESULTS

There were no differences in the likelihood of ever having sex on the basis of BMI or weight perception accuracy; however, girls who perceived themselves as overweight were less likely to have ever had sex. Among sexually active girls, those who had low BMI and perceived themselves as overweight or had overweight misperceptions were less likely to report condom use at last sex. Sexually active girls who perceived themselves as overweight were also more likely to have had sex before age 13. Associations between the 3 weight indices and sexual risk behaviors varied across racial/ethnic groups.

CONCLUSIONS

Sexual risk behaviors may be more common among girls who are underweight or perceive themselves (accurately or not) to be overweight and vary by racial/ethnic group. This suggests that girls at weight extremes and those from different racial backgrounds may have unique sexual health education and prevention needs.

Unterschiede im physischen Selbstkonzept bei normalgewichtigen und adipösen Personen

Zusammenfassung. Der vorliegende Beitrag befasst sich mit Besonderheiten des physischen Selbstkonzepts von Personen mit Adipositas. Theoretische Grundlage bildet dabei das Modell zum Selbstkonzept von Shavelson, Hubner und Stanton, (1976) , das für Modelle zum physischen Selbstkonzept übernommen und weiterentwickelt wurde. Der auf Basis dieser Modelle entwickelte Physical Self Description Questionnaire (PSDQ; Marsh, Richards, Johnson, Roche & Tremayne, 1994 ) wird dabei als Messinstrument verwendet. Im ersten Teil der Studie werden zum einen Besonderheiten des physischen Selbstkonzepts adipöser Personen verglichen mit normalgewichtigen Kontrollprobanden und zum anderen wird die Bedeutung sportlicher Aktivität für das Selbstkonzept adipöser Personen untersucht. Der zweite Teil der Studie beschäftigt sich mit der Erklärung des globalen physischen Selbstwerts durch verschiedene Komponenten des physischen Selbstkonzepts bei adipösen und normalgewichtigen Probanden. Die Ergebnisse deuten daraufhin, dass sich das physische Selbstkonzept adipöser Personen in verschiedener Hinsicht von dem Normalgewichtiger unterscheidet. Abschließend erfolgt die Ableitung von Implikationen, die sich aus diesen Ergebnissen für Forschung und Praxis ergeben.

Childhood emotional problems and self-perceptions predict weight gain in a longitudinal regression model

BACKGROUND

Obesity and weight gain are correlated with psychological ill health. We predicted that childhood emotional problems and self-perceptions predict weight gain into adulthood.

METHODS

Data on around 6,500 individuals was taken from the 1970 Birth Cohort Study. This sample was a representative sample of individuals born in the UK in one week in 1970. Body mass index was measured by a trained nurse at the age of 10 years, and self-reported at age 30 years. Childhood emotional problems were indexed using the Rutter B scale and self-report. Self-esteem was measured using the LAWSEQ questionnaire, whilst the CARALOC scale was used to measure locus of control.

RESULTS

Controlling for childhood body mass index, parental body mass index, and social class, childhood emotional problems as measured by the Rutter scale predicted weight gain in women only (least squares regression N = 3,359; coefficient 0.004; P = 0.032). Using the same methods, childhood self-esteem predicted weight gain in both men and women (N = 6,526; coefficient 0.023; P < 0.001), although the effect was stronger in women. An external locus of control predicted weight gain in both men and women (N = 6,522; coefficient 0.022; P < 0.001).

CONCLUSION

Emotional problems, low self-esteem and an external locus of control in childhood predict weight gain into adulthood. This has important clinical implications as it highlights a direction for early intervention strategies that may contribute to efforts to combat the current obesity epidemic.

Obesity and mental health

Mental health factors contribute to the onset and maintenance of overweight and obese status in children, adolescents, and adults. Binge eating disorder (BED), body image, self-esteem, mood disorders, and social and family factors affect individuals in different ways and contribute to weight gain and failure in weight loss management. Assessment of these mental health factors and treatment by 1 of several mental health treatment models may not only improve self-worth but also weight loss and maintenance.

Early child care and adiposity at ages 1 and 3 years

BACKGROUND

The majority of infants in the United States are in nonparental child care, yet little is known about the effect of child care on development of obesity.

OBJECTIVE

To examine the relationship between child care attendance from birth to 6 months and adiposity at 1 and 3 years of age.

METHODS

We studied 1138 children from a prospective cohort of pregnant women and their offspring. The main exposure was time in child care from birth to 6 months of age, overall and by type of care: (1) child care center; (2) someone else's home; and (3) child's own home by nonparent. The main outcomes were weight-for-length (WFL) z score at 1 year and BMI z score at 3 years of age.

RESULTS

A total of 649 (57%) infants attended child care; 17% were cared for in a center, 27% in someone else's home, and 21% in their own home by a nonparent. After adjustment for confounders, overall time in child care was associated with an increased WFL z score at 1 year and BMI z score at 3 years of age but not skinfold thicknesses. Center and own home care were not associated with the outcomes, but care in someone else's home was associated with an increase in both the 1- and 3-year outcomes.

CONCLUSION

Child care in the first 6 months of life, especially in someone else's home, was associated with an increased WFL z score at 1 year and BMI z score at 3 years of age.

The interpersonal basis of stereotype-relevant self-views

Recent research examining the interpersonal basis of self-stereotyping is considered from the perspective of Cognitive-Affective Personality System (CAPS) theory. The reviewed work shows that individuals tend to see themselves in a stereotypic manner when interacting with someone who engenders affiliative motivation and is thought to hold stereotypic views of their group. Evidence suggesting that this context-dependent self-stereotyping is extended temporally through future psychologically similar interactions and the invocation of significant others thought to endorse stereotypes is also discussed. These findings and the theoretical framework that stimulated them strongly resonate with the notion of if...then contingencies of the self articulated in CAPS theory. The implications of each viewpoint for the other are discussed.

The epidemiology of overweight and obesity among Australian children and adolescents, 1995-97

OBJECTIVES

To determine the population prevalence of overweight and obesity among Australian children and adolescents, based on measured body mass index (BMI). To determine if overweight and obesity are distributed differentially across the population of young Australians.

METHODS

Data from three independent surveys were analysed. In each, height and weight were measured by trained surveyors using valid, comparable methods. BMI (kg/m2) was used as the index of adiposity and recently published international BMI cut-off values used to categorise each subject as non-overweight, overweight or obese.

RESULTS

The population prevalence and distribution of overweight, obesity and overweight/obesity combined were generally consistent across datasets. The ranges of the prevalence of non-overweight, overweight, obesity and overweight/obesity combined were 79-81%, 14-16%, 5% and 19-21% (boys) respectively and 76-79%, 16-18%, 5-6% and 21-24% (girls). There were no consistent relationships between the prevalence of overweight/obesity and sex, age or SES. Their prevalence was up to 4% higher in urban than rural areas among boys, but there were no differences between urban and rural girls. The data suggest a higher prevalence of overweight/ obesity among students from European or Middle-Eastern cultural backgrounds.

CONCLUSIONS

Some 19-23% of Australian children and adolescents are either overweight or obese. Although urban/rural, SES and cultural background differentials were noted, only the last warrants a targeted health promotion response.

IMPLICATIONS

Overweight/obesity is a prevalent health risk factor among Australian children and adolescents. More information is needed to understand whether targeted approaches are required for specific ethnic groups in addition to broad, population-based approaches.

The impact of school-based prevention of overweight on psychosocial well-being of children

This review aimed to gain insight in the extent to which psychosocial effects of obesity prevention programmes have been studied, to give an overview of the methods used to measure the particular psychosocial aspects and - if possible - to quantify the effects found. Intervention studies (n = 267) covering the period 1990-October 2005 were derived from seven reviews about childhood obesity interventions. An additional search identified 2754 studies covering the period January 2005-February 2008. In total, 2901 papers (excluding 120 duplicates) were screened for inclusion. Sixty-nine papers covering 53 interventions were included and screened on measuring psychosocial variables. All original authors were contacted. Seven of the selected interventions measured psychosocial variables, five of which evaluated a net intervention effect as compared with a control condition. Only two interventions reported a statistically significant net intervention effect (a decrease in use of purging or diet pills and a decrease in peer ratings of aggression and observed verbal aggression). We conclude that a minority of childhood obesity interventions investigate the effects of their programmes on psychosocial well-being of children and adolescents. It is recommended that in the future, these programmes will be evaluated in a uniform way on a broad range of psychosocial aspects.

Is there a clear link between overweight/obesity and sleep disordered breathing in children?

The proportion of children who are overweight or obese has risen steadily in recent decades and approaches a quarter of all children in Western countries. This global epidemic of excess weight and adiposity in humans is associated with increased morbidity and mortality, especially related to diabetes and poor cardiovascular health. It would appear that obesity is also generally accepted to be an important risk factor in the development of sleep disordered breathing (SDB), in children as well as adults. The article, "The prevalence, anatomical correlates and treatment of sleep-disordered breathing in obese children and adolescents", by Verhulst et al., also in this issue, reviews evidence supporting the view that obese children are at higher risk of developing SDB. We believe, however, that the available studies do not support a straightforward association of overweight or obesity with increased prevalence of SDB. Rather, the available data is clearly equivocal mainly due to methodological differences between the previous studies. This review nonetheless examines the factors which may modulate the relationship between overweight or obesity and prevalence of SDB, particularly ethnicity and age.

Exercise effects on depressive symptoms and self-worth in overweight children: a randomized controlled trial

OBJECTIVE

To test the dose-response effects of an exercise program on depressive symptoms and self-worth in children.

METHOD

Overweight, sedentary children (N = 207, 7-11 years, 58% male, 59% Black) were randomly assigned to low or high dose (20 or 40 min/day) aerobic exercise programs (13 +/- 1.6 weeks), or control group. Children completed the Reynolds Child Depression Scale and Self-Perception Profile for Children at baseline and posttest.

RESULTS

A dose-response benefit of exercise was detected for depressive symptoms. A race x group interaction showed only White children's global self-worth (GSW) improved. There was some evidence that increased self-worth mediated the effect on depressive symptoms.

CONCLUSIONS

This study shows dose-response benefits of exercise on depressive symptoms and self-worth in children. However, Blacks did not show increased GSW in response to the intervention. Results provide some support for mediation of the effect of exercise on depressive symptoms via self-worth.

Consequences of Childhood Obesity

Introduction: The incidence of childhood obesity is rising across the globe, and obesity related co-morbidities are increasing concomitantly in the paediatric population. Materials and Meth- ods: PubMed search for research and review papers on complications of childhood obesity was performed. Results: The consequences of childhood obesity can be broadly classified into medical and psychosocial consequences. Medical consequences include metabolic complications such as diabetes mellitus, hypertension, dyslipidaemia and non-alcoholic fatty liver disease, and me- chanical problems such as obstructive sleep apnoea syndrome and orthopaedic disorders. Psychological and social consequences are prevalent but often overlooked. Local data on these complications were also discussed. Conclusion: Childhood obesity is associated with significant morbidities, which not only have immediate impact on the health of the obese children, but also significantly increase the risk of morbidities in adulthood. Key words: Medical consequence, Psychosocial consequence

Do childhood social circumstances affect overweight and obesity in early adulthood?

Aims: The aim of the study was to examine the association of childhood circumstances with overweight and obesity in early adulthood, to analyse whether the respondent's education and current circumstances mediate these associations, and to explore whether the respondent's health behaviour affects these associations. Design: This was a cross-sectional study with retrospective inquiries. Methods: The study was based on a representative two-stage cluster sample (N= 1894, participation rate 79%) of young adults aged 18—29 years in Finland in 2000. The outcome measure was three-class body mass index (BMI) (normal weight, overweight, and obesity). Multinomial logistic regression was used as the main statistical tool. Results: In women, childhood circumstances (low parental education (relative risk ratio (RRR) = 2.43), parental unemployment (RRR= 2.09) and single-parent family (RRR= 1.99)) increased the risk of overweight (25 ≤ BMI<30), but the effects were largely attenuated by other childhood factors and early adult circumstances. In men, no significant childhood predictors of overweight were found. Single-parent family (RRR=2.32), parental alcohol problem (RRR= 2.71), parental mental health problems (RRR=2.28) and being bullied at school (RRR=3.13) predicted obesity (BMI ≥ 30) in women in the age-adjusted models, and being bullied at school remained a significant predictor after adjusting for all childhood and current determinants. In both genders, the strong association between parental education and obesity remained significant after adjusting for all other determinants (for the lowest educational category, RRR= 3.56 in women, and RRR= 6.55 in men). Conclusions: Childhood factors predict overweight and obesity in early adulthood. This effect is stronger on obesity than on overweight and in women than in men, and it seems to be partly mediated by adult circumstances. The results emphasize the lasting effect of childhood socioeconomic position on adult obesity. When preventive policies are being planned, social circumstances in childhood should be addressed.

Einschätzung kindlichen Essverhaltens durch die Eltern mit einer Kurzform der Anorectic Behaviour Observation Scale

Fragestellung: Eignet sich die für klinische Fragestellungen entwickelte Anorectic Behavior Observation Scale (ABOS) zur Erfassung elterlicher Einschätzungen des Essverhaltens ihrer Kinder auch in epidemiologischen Feldstudien? Methodik: In einer Befragung von 1.057 SchülerInnen im Alter von 10 bis 17 Jahren füllten diese das Eating Disorder Inventory, Child Version (EDI-C) aus, die Eltern von 922 Kindern auch die ABOS. Sie besteht aus 30 Aussagen, die in drei Subskalen unterteilt sind: Auffälliges Essverhalten, Bulimieähnliches Verhalten und Hyperaktivität. Ergebnisse: Die Daten ließen psychometrische Probleme des ABOS wie Varianzeinschränkungen und extreme Verteilungen erkennen. Dies ergibt sich aus der Checklisteneigenschaft der Skala, deren Aussagen von nicht Essgestörten vorwiegend verneint werden. Mit Hilfe von explorativen und konfirmatorischen Faktorenanalysen wurden diejenigen 10 Items ausgewählt, die über bessere psychometrische Eigenschaften als der 30-Item-ABOS verfügen, ohne dass diese Auswahl zu Lasten der Validität ging. Ähnlich wie im Original heißen drei Subskalen mit 4, 2 und 4 Items Essverhalten, bulimieähnliches Verhalten und Aktivitätsniveau/Fitness. Schlussfolgerung: Die Kurzform des ABOS mit dem Namen Eating and Activity Questionnaire for Parents (EAQP) ist ein sparsames Verfahren für das Screening elterlicher Einschätzung des Essverhaltens ihrer Kinder.

Self-esteem in a clinical sample of morbidly obese children and adolescents

AIM

To study self-esteem in clinical sample of obese children and adolescents.

METHODS

Obese children and adolescents aged 8-19 years (n = 107, mean age 13.2 years, mean BMI 32.5 [range 22.3-50.6], mean BMI z-score 3.22 [range 2.19-4.79]; 50 boys and 57 girls) were referred for treatment of primary obesity. Self-esteem was measured with a validated psychological test with five subscales: physical characteristics, talents and skills, psychological well-being, relations with the family and relations with others. A linear mixed effect model used the factors gender and adolescence group, and the continuous covariates: BMI z-scores, and BMI for the parents as fixed effects and subjects as random effects.

RESULTS

Age and gender, but neither the child's BMI z-score nor the BMI of the parents were significant covariates. Self-esteem decreased (p < 0.01) with age on the global scale as well as on the subscales, and was below the normal level in higher ages in both genders. Girls had significantly lower self-esteem on the global scale (p = 0.04) and on the two subscales physical characteristics (p < 0.01) and psychological well-being (p < 0.01).

CONCLUSION

Self-esteem is lower in girls and decreases with age. In treatment settings special attention should be paid to adolescent girls.

Obesity among Scottish 15 year olds 1987-2006: prevalence and associations with socio-economic status, well-being and worries about weight

BACKGROUND

Increases in the prevalence of child and adolescent obesity have accelerated since the mid 1980s. Socio-economic status (SES)-adiposity relationships appear less clear in adolescence than childhood, and evidence on whether increasing obesity is itself patterned according to SES is inconsistent. Increasing prevalence may have increased the tolerance, and reduced recognition of, or concern about, obesity. The aim of this study is to report the prevalence of obesity and its association with SES, well-being and worries about weight among 15-year olds in 1987, 1999 and 2006.

METHODS

Height and weight data obtained from 15-year olds in 1987 (N = 503), 1999 (N = 2,145) and 2006 (N = 3,019), allowed categorisation of obesity (UK90 criteria). SES was represented by parental occupational class and area deprivation; psychological wellbeing by the 12-item General Health Questionnaire (GHQ-12) and self-esteem; weight worries by 'a lot' of worry about weight.

RESULTS

Obesity prevalence was 6.7%, 10.6% and 15.9% (males), and 5.4%, 11.5% and 14.9% (females) in 1987, 1999 and 2006. Among obese males, BMIs increased over time. There was little evidence of differentials in obesity in respect of either SES measure, and none for increased disparities over time. There was no association between obesity and GHQ-12 'caseness' or (except females in 2006) self-esteem. Weight worries were more prevalent among the obese and increased over time overall, but the obesity-weight worry relationship did not change. At each date, large proportions of the obese did not worry 'a lot' about weight, while among the non-obese, up to 18.8% males and 40.1% females (in 2006) did worry.

CONCLUSION

Between 1987 and 2006, prevalence of obesity among Scottish 15 year olds increased around 2.5 times. However, this increasing prevalence did not impact on the obesity-weight-worry relationship. While many obese adolescents appear unconcerned about their weight, a significant minority of the non-obese worry needlessly.

The relationship between body mass index and behavior in children

OBJECTIVE

To examine reciprocal relationships between body mass index (BMI) and internalizing and externalizing problems from infancy through middle childhood, with a focus on sex and history of overweight.

STUDY DESIGN

Data from 1254 children in the National Institute of Child Health and Human Development Study of Early Child Care and Youth Development were used to conduct longitudinal analyses of the relationship between BMI and scores on the Child Behavior Checklist from age 2 years through the 6th grade.

RESULTS

BMI and behavior problems demonstrated stability across the 7 measurement occasions. No consistent relationship between BMI and behavior problems was evident before school entry, but higher BMI was associated with later internalizing problems beginning in the 1st grade for boys and girls. Higher BMI was not associated with increased conduct problems.

CONCLUSIONS

As children move into middle childhood, higher BMI is associated with increased likelihood of developing internalizing problems. Health care providers should monitor BMI as children enter school and provide guidance to parents regarding emerging symptoms of anxiety and depression.

Stigmatization of obese children and adolescents, the importance of gender

To review the literature on stigmatization of overweight girls and boys, with a specific attention to gender differences, a search was performed in the medical as well as the psychological literature. The following databases, Medline, PsycINFO, EMBASE, Scopus, Web of Science and Cochrane as well as Google were used to retrieve information. Finally, chain references were sought. The search was concluded mid-2006. In total, 17 studies were identified. The results from the studies generally indicated that overweight girls seemed to experience a higher degree of stigmatization than overweight boys. The overweight girls were to a larger degree teased about their weight and relationally, verbally and physically bullied. In addition, they were more socially marginalized in respect to friendships and romantic relationships. Stigmatization of overweight children and adolescents indeed occurs, but is more prevalent in overweight girls than overweight boys. There is a need to conduct further studies that are specifically designed to evaluate gender differences in stigmatization of overweight children and adolescents, and for studies focusing on preventing this stigmatization.

Self-esteem and cognitive development in the era of the childhood obesity epidemic

Consequences of obesity for mental health and cognitive development are not established to the same degree as those for chronic diseases. This study aims to document the interrelationships between body weight, self-esteem and school performance in childhood. Height and weight measurements and self-report of self-esteem, diet quality and physical activity of 4945 grade 5 students were linked with standardized literacy test results. Structural equation models were applied to confirm hypothesized relationships between body weight, self-esteem and school performance, and revealed that body weight affected self-esteem negatively and that school performance affected self-esteem positively. Body weight did not affect school performance, and self-esteem did affect neither body weight nor school performance. Subsequent multi-level logistic regression showed that obese students, relative to normal weight students, were more likely (1.44; 95% CI: 1.12-1.84), and students with good school performance, relative to those performing poor, were less likely (0.39; 95% CI: 0.26-0.58), to have low self-esteem. Diet quality and active living had positive effects on both school performance and self-esteem. The study findings further establish obesity as a risk factor for low self-esteem and add to the rationale to promote healthy eating and active living among children and youth as this will prevent chronic diseases and improve mental health and cognitive development.

The association between mothers' psychopathology, childrens' competences and psychological well-being in obese children

BACKGROUND

The prevalence of childhood obesity is rapidly increasing, and many obese children suffer from emotional and behavior problems and mental disorders. Associations with social stigmatization of obesity, maternal psychopathology, socioeconomic status (SES) and resilience factors are discussed.

OBJECTIVE

We hypothesize maternal psychopathology to have an impact on the psychological well-being of an obese child. We further hypothesize that competence factors within the child are important key factors that influence the way a child deals with the psychological burden of obesity.

METHOD

A referred clinical sample of 59 obese children with their mothers was assessed using a structured clinical interview for DSM-IV diagnosis and questionnaires for child and maternal psychopathology, SES, body mass index (BMI), and percent overweight. Correlations, hierarchical linear and logistic regression models were used to analyze associations between mothers and child and the impact of potential predictors.

RESULTS

Mental disorders were found in 37.3% of the obese children in our sample. Maternal anxiety predicted the mother reported child's internalizing problems as well as the child's depression and anxiety self report scores. The mental disorder status of the mother predicted the child's internalizing problems, and maternal binge eating disorder (BED) had an impact on the mental disorder of the child. If the child's total competences were included in the hierarchical regression model they predicted the child's outcome in all three subscales of the Child Behavior Checklist (CBCL), thereby reducing the effect of maternal anxiety to influencing the child's depression score only. Neither SES nor the child's percent overweight accounted for the child's wellbeing.

CONCLUSIONS

Although maternal psychopathology and diagnosis of mental disorder had some impact on the psychological well-being of the child, the child's competences showed a significant negative association with the problem scales. More research on parental and children's skills and competences will highlight the complex interaction of childhood obesity, comorbidity of mental disorders, and resilience factors and will lead to additional approaches for intervention.

Treatment preferences of overweight youth and their parents in Western Canada

The purpose of this study was to examine the family environment and assess treatment preferences among overweight youth and their parents. Data were collected via 41 interviews with parents and children from the wait-list of a weight management clinic and analyzed using grounded theory methodology. Framed around an ecological framework, findings ranged from proximal family issues to more distal policy issues. At the family level, parents attempted to influence their children's lifestyle behaviors by using contradictory and inconsistent strategies that reflected extremes of leniency and control. There was resistance to reducing screen time because participants thought that it was important for the children's social lives. Participants desired better help from health care professionals, requested family-centered treatment, expressed a desire for increased social support, and needed policy/ program-level changes to assist their weight management efforts. These findings offer insight into the complexity of individual, familial, and environmental factors that impact both behavior change and health services delivery in pediatric weight management.

Participation in play activities: a single-case study focusing on a child with obesity experiences

The purpose of this study was to describe how a child with obesity perceived participation in play activities. A single-case study design was chosen to optimize the understanding of the complexities of the research question. A 9-year-old boy diagnosed with obesity was studied. This is a typical case and is studied mainly to provide understanding to the issue. The data were collected from interviews with the boy, his mother and his teacher. Data were also collected through observations and a self-report assessment instrument called Kid Play Profile. The results showed that the boy was ridiculed by his peers and that at times he felt excluded from them, which prevented him from participating in play activities. The boy's experience came from different perceived problems such as lack of friends to play with, his inability to know how to perform in different play activities, and lack of proper support and encouragement from adults. Supporting children to overcome social skills deficits could prevent them from being teased and may have a positive effect on health. To optimize children's participation in play activities, it is important for adults to give them proper support and encouragement. The results were discussed with regard to earlier research, and topics for further research are suggested.

Overweight status and psychological well-being in adolescent boys and girls: a multilevel analysis

Background: Psychological distress and high body mass index (BMI) are linked in adults, especially in females. Effects of social position and behaviour, and whether obesogenic environments affect adolescents and adults equally are unresolved. The aim was to examine associations between psychological distress and being overweight in adolescents, by sex, accounting for social, lifestyle and contextual factors. Correlation of area-level variation in overweight status in adolescents and adults was investigated. Methods: Height, weight, General Health Questionnaire 12 (GHQ12) of psychological distress, physical activity, smoking, alcohol consumption, area deprivation and social class were available on 635 male and 618 female adolescents (13–15 years) from two cross-sectional population health surveys conducted in Scotland in 1998–99/2003–04. Multilevel logistic regression modelled overweight (including obese) status accounting for intraclass correlation of adolescents in households within postcode sector areas in health board regions. Univariable analysis examined effects of high (4 or more) GHQ12 score; multivariable analysis further allowed for covariates. Adult data were used to assess the importance of correlation between adolescent and adult area-level variation. Results: Univariably, there was significantly increased risk of being overweight associated with high GHQ12 score for girls but not boys; adolescent and adult area-level variation correlation did not impact. Results remained significant for girls in multivariable analyses (OR = 2.44, 95% confidence interval (CI): 1.33–4.50) and non-significant for boys (OR = 1.31, 95% CI: 0.56–3.05). Conclusions: Findings indicate being overweight is associated with psychological distress in adolescent girls, but not boys. Effects are not mediated by social, lifestyle or contextual factors.

School performance: the pediatrician's role

When children begin having difficulties in school, the first stop for parents is often the pediatrician's office. Although school performance problems may seem outside the realm of routine primary health care, there are many important roles that the primary care provider may play. These include identifying medical issues that may impact performance, helping the family form an intervention team, and acting as the child's advocate when interacting with the school. In addition, it is important for pediatricians to be familiar with cognitive, emotional, and developmental problems that affect school performance and to assist parents in becoming active participants in their children's education.

Health behavior and academic achievement among adolescents: the relative contribution of dietary habits, physical activity, body mass index, and self-esteem

This study tested a structural equation model to estimate the relationship between health behaviors, body mass index (BMI), and self-esteem and the academic achievement of adolescents. The authors analyzed survey data from the 2000 study of Youth in Iceland , a population-based, cross-sectional sample of 6,346 adolescents in Iceland. The model demonstrated good fit with chi-square of 2685 (n = 5,810, df = 180), p < .001, Comparative Fit Index value of .94, and a root mean square error of approximation of .049. Lower BMI, physical activity, and good dietary habits were all associated with higher academic achievement; however, health behavior was positively and robustly associated with greater self-esteem. Self-esteem was positively influenced both through physical activity (beta = .16) and the consumption of fruits and vegetables (beta = .14). In contrast, poor dietary habits negatively influenced self-esteem and academic achievement, and self-esteem was negatively influenced by increasing levels of BMI (beta = -.05).

Obesity prevention in child care: a review of U.S. state regulations

Objective

To describe and contrast individual state nutrition and physical activity regulations related to childhood obesity for child care centers and family child care homes in the United States.

Methods

We conducted a review of regulations for child care facilities for all 50 states and the District of Columbia. We examined state regulations and recorded key nutrition and physical activity items that may contribute to childhood obesity. Items included in this review were: 1) Water is freely available; 2) Sugar-sweetened beverages are limited; 3) Foods of low nutritional value are limited; 4) Children are not forced to eat; 5) Food is not used as a reward; 6) Support is provided for breastfeeding and provision of breast milk; 7) Screen time is limited; and 8) Physical activity is required daily.

Results

Considerable variation exists among state nutrition and physical activity regulations related to obesity. Tennessee had six of the eight regulations for child care centers, and Delaware, Georgia, Indiana, and Nevada had five of the eight regulations. Conversely, the District of Columbia, Idaho, Nebraska and Washington had none of the eight regulations. For family child care homes, Georgia and Nevada had five of the eight regulations; Arizona, Mississippi, North Carolina, Oregon, Tennessee, Texas, Vermont, and West Virginia had four of the eight regulations. California, the District of Columbia, Idaho, Iowa, Kansas, and Nebraska did not have any of the regulations related to obesity for family child care homes.

Conclusion

Many states lack specific nutrition and physical activity regulations related to childhood obesity for child care facilities. If widely implemented, enhancing state regulations could help address the obesity epidemic in young children in the United States.

Issues in measuring child health

Assessing child health is critical to a variety of child health, educational, and social programs, as well as to clinical research and practice. However, despite the apparent wealth of measures available in health, education, and legal and social welfare systems, little agreement exists as to what are the most important measures and for what domains of health. Development of improved measures may capitalize on advances in conceptualization of child health, including the dynamic nature of the interplay of child health and development over time. The need for enhanced measures can be illustrated by consideration of various aspects of pediatric care: well-child care, acute illness care, and the management of children with special health care needs. In particular, the strong theoretical perspectives on aspects of development such as cognition and behavioral development need to be informed by the experience of various states of health and their developmental implications. If generalist academicians are to further their research and educational mission, they must engage, and urgently, in the development and measurement of child health.

The Relationship between Body Size and Depressed Mood: Findings from a Sample of African American Middle School Girls

The relationship between body weight and depression among adolescent females has been the subject of considerable attention from researchers. The risk of experiencing this distress, however, is not equally distributed across members of all racial groups. African American girls are generally more satisfied with their bodies and thus may be less vulnerable to experiencing depression as a result of weight concerns. Several scholars have suggested that membership in African American culture provides social resources that protect black females from experiencing high levels of weight-based psychological distress. We examine the relationship between body size and depression and the potentially moderating role of African American cultural experiences using data from the Family and Community Health Study (FACHS). Assessing a cohort of 342 African American girls ages 12-14, we found support for a link between weight and depression. There was no evidence, however, that exposure to African American culture moderated this relationship.