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

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.

Feeling fat rather than being fat may be associated with psychological well-being in young dutch adolescents

PURPOSE

To contribute to a further exploration of the association of psychosocial well-being with overweight and weight perception among young Dutch adolescents.

METHODS

Data from the ongoing Rotterdam Youth Health Monitor were used from 1,923 9-10-year-olds and 3,841 12-13-year-olds. The association of mental health indicators with weight status based on self-report and measured height and weight was studied with logistic regression analyses in both age groups cross-sectionally. Additional longitudinal analyses were conducted among the 787 pupils for whom follow-up data were available. Interactions with gender and ethnic background were explored. Among the 12-13-year-olds, the role of weight perception was also studied.

RESULTS

We found that 9-10-year-old obese boys scored more favourably on social anxiety than nonoverweight boys. Among 12-13-year-olds body weight perception, rather than self-reported or measured weight status was associated with mental health indicators. Mental health indicators at age 9-10 years did not predict self-reported weight status at age 12-13 or change in weight status between 9-10 and 12-13 years, nor did weight status at age 9-10 years predict later mental health indicators or change in these indicators.

CONCLUSIONS

This study provides no evidence that overweight does coincide with less favorable psychological well-being in young adolescents. In 12-13-year-old adolescents, feeling overweight, rather than being overweight, appears to be important.

Clustering of psychosocial symptoms in overweight children

OBJECTIVE

The aims of the present study were to (i) examine the relationship between children's degree of adiposity and psychosocial functioning; and (ii) compare patterns of clustering of psychosocial measures between healthy weight and overweight/obese children.

METHOD

Cross-sectional data from a population-based cohort of 158 healthy weight, 77 overweight, and 27 obese children aged 8-13 years were analysed. Height, weight depression, quality of life, self-esteem, body dissatisfaction, eating disorder symptoms, peer relationships and behavioural and emotional problems were measured.

RESULTS

Multi-level analysis showed significant linear associations between child body mass index z-scores and the psychosocial variables, with increasing adiposity associated with increasing levels of psychosocial distress. Principal components analyses indicated subtle differences between the healthy weight and overweight/obese groups with regards to the clustering of psychosocial measures. In particular, in overweight/obese, but not in healthy weight children, global self-worth clustered with body image and eating disorder symptoms.

CONCLUSIONS

The psychosocial burden of excess weight is significant and broad reaching, with overweight/obese children showing multiple significant psychosocial problems.

Gendered dimensions of obesity in childhood and adolescence

Background

The literature on childhood and adolescent obesity is vast. In addition to producing a general overview, this paper aims to highlight gender differences or similarities, an area which has tended not to be the principal focus of this literature.

Methods

Databases were searched using the terms 'obesity' and 'child', 'adolescent', 'teenager', 'youth', 'young people', 'sex', 'gender', 'masculine', 'feminine', 'male', 'female', 'boy' and 'girl' (or variations on these terms). In order to limit the potential literature, the main focus is on other reviews, both general and relating to specific aspects of obesity.

Results

The findings of genetic studies are similar for males and females, and differences in obesity rates as defined by body mass index are generally small and inconsistent. However, differences between males and females due to biology are evident in the patterning of body fat, the fat levels at which health risks become apparent, levels of resting energy expenditure and energy requirements, ability to engage in certain physical activities and the consequences of obesity for the female reproductive system. Differences due to society or culture include food choices and dietary concerns, overall physical activity levels, body satisfaction and the long-term psychosocial consequences of childhood and adolescent obesity.

Conclusion

This review suggests differences between males and females in exposure and vulnerability to obesogenic environments, the consequences of child and adolescent obesity, and responses to interventions for the condition. A clearer focus on gender differences is required among both researchers and policy makers within this field.

Treatment of adolescent overweight and obesity

Adolescence is a vulnerable period for the development of obesity, and adolescent weight tracks strongly into adulthood. Previous reviews of treatment strategies have failed to discriminate between adolescents and children, thereby, disregarding the uniqueness of this population. Hence, this review aims to summarise the evidence for treatment approaches for adolescent obesity. Pubmed, OVID, EBSCOhost and Google Scholar were searched for randomised controlled trials, meta-analyses and systematic reviews testing treatments for overweight/obese adolescents (aged 12-19 years), published from 1982-2006 in English. Eligible studies had to assess either weight, percentage overweight, body mass index (BMI) or body fat. Thirty-four randomised controlled trials were eligible. The results of this review indicate that the safety and efficacy of surgical and pharmacotherapy treatments for adolescent obesity is uncertain. Diet and physical activity approaches may improve obese status in the short term. However, obesity interventions appear more effective when strategies are combined, rather than when used in isolation. Psychological interventions, such as behavioural and cognitive behavioural therapy, show promise in achieving the necessary lifestyle changes for obesity reduction; however, long-term follow-up studies are needed. There were multiple limitations in appraising the literature. Inconsistent definitions of overweight/obesity make comparisons between studies difficult. Many studies have not used direct adiposity measures, have failed to assess pubertal status or have not used an exclusive adolescent sample. We conclude that, despite these limitations, current evidence indicates that behavioural and cognitive behavioural strategies combined with diet and physical activity approaches may assist in reducing adolescent obesity,although long-term follow-up studies are needed.

The Adolescent Adjustment Profile (AAP) in comparisons of patients with obesity, phenylketonuria or neurobehavioural disorders

Psychosocial development in children with chronic disease is a key issue in paediatrics. This study investigated whether psychosocial adjustment could be reliably assessed with the 42-item Adolescent Adjustment Profile (AAP) instrument. The study mainly focused on adjustment-to-obesity measurement, although it compared three patient groups with chronic conditions. All phenylketonuria (PKU) patients in Sweden between ages 9 and 18 and their parents and teachers were invited to participate. Patients with neurobehavioural syndromes and obesity were age- and gender-matched with PKU patients. Healthy children constituted a reference group. Psychosocial adjustment was measured using the AAP, which is a multi-informant questionnaire that contains four domains. Information concerning parents' socio-economic and civil status was requested separately. Respondents to the three questionnaires judged the PKU patients to be normal in all four domains. Patients with neurobehavioural syndromes demonstrated less competence and the most problems compared with the other three groups. According to the self-rating, the parent rating and the teacher rating questionnaires, obese patients had internalizing problems. The parent rating and the teacher rating questionnaire scored obese patients as having a lower work capacity than the reference group. Compared with the reference group, not only families with obese children but also families with children with neurobehavioural syndromes had significantly higher divorce rates. Obese patients were also investigated with the Strength and Difficulties Questionnaire (SDQ), another instrument that enables comparison between two measures of adjustment. The AAP had good psychometric properties; it was judged a useful instrument in research on adolescents with chronic diseases.

Methods for the assessment of adolescent obesity in epidemiological studies

Az elhízás előfordulási gyakorisága nemcsak felnőtt-, de gyermekkorban is drámaian nő. Célkitűzés: Különböző antropometriai módszerek összehasonlítása. Módszerek: A vizsgálatban 654 fiú és 584 lány (életkor: 15–19 év) adatait értékelték. Az antropometriai adatok közül a testmagasságot és a derékkörfogatot mérték, a testtömeget és a testösszetételt InBody3.0 bioimpedancia-mérővel határozták meg. A testtömegindexet és a testzsír százalékos arányát a készülék számította ki. Eredmények: A testtömegindexre vonatkozó, nemre, korra specifikus diagnosztikus kritériumok szerint sovány a fiúk 6,7%-a, túlsúlyos 15,9%-a és elhízott 4,1%-a; a lányok 7,2%-a sovány; 7,9%-a túlsúlyos és 1,9%-a elhízott. Elhízott volt a testzsírszázalék alapján a fiúk 5,1%-a, a lányok 16,2%-a, míg a derékkörfogat alapján a fiúk 10,5%-a, a lányok 7,9%-a. Elhízott volt a túlsúlyosnak ítélt fiúk 10,5%-a és a lányok 77%-a a zsírszázalék szerint, míg 38%-a, illetve 55%-a a derékkörfogat alapján. Következtetés: Az epidemiológiai vizsgálatokban az elhízottak kiszűrésére, valamint a fogyókúrás dietoterápia nyomon követésére a testösszetétel meghatározásának kiemelt jelentősége van. Mindemellett az olcsó és könnyen kivitelezhető derékkörfogat mérését minden esetben el kell elvégezni.

The extended relationship between child cardiovascular risks and academic performance measures

OBJECTIVE

To examine the relationship between children's overweight status and other cardiovascular risk fitness factors and academic performance among fifth-grade students.

RESEARCH METHODS AND PROCEDURES

Using a sample of 968 fifth-grade students (50.7% boys; mean age = 10.6 years), children's cardiovascular risks (BMI, blood pressure, acanthosis nigricans) and fitness measures were compared with their mean group performance scores across four subscales (mathematics, reading/language arts, science, and social studies) of a statewide standardized academic performance test.

RESULTS

Of this sample, 39% were either at risk for being overweight or were already overweight; slightly over one half were of normal weight. Initial findings revealed a significant relationship between children's weight category and their reading/language arts, mathematics, and science test scores even after controlling for a proxy of socioeconomic status. When additional cardiovascular risk and fitness measures were included in the model, however, children's BMI status had no association. Instead, a composite fitness index, children's blood pressure, sex, and proxy of socioeconomic status were significantly associated with children's academic test scores.

DISCUSSION

This study expanded our understanding of the connection between children's overweight risks and academic performance by examining the impact of other cardiovascular risk factors such as high blood pressure and measures of fitness. These findings support the development and implementation of childhood cardiovascular risk surveillance programs that evaluate not only children's overweight risks but also their fitness, risk for type 2 diabetes, and/or high blood pressure by showing a relationship between some of these risks and children's academic test performance.

Comparing child-feeding practices of Dominican mothers

The purpose of this study was to compare similarities and differences between two samples - mothers of children under the age of 6 years living in the Dominican Republic (D.R.) and recent immigrants from the D.R. to the United States - on their (a) feeding practices for infants and young children, (b) knowledge regarding healthy size and weight and ideal diet for young children, and (c) knowledge regarding the causes and health implications of childhood obesity. An exploratory descriptive design was used, and qualitative data were collected through focus groups.

[Breastfeeding and obesity in school-age children from families of high socioeconomic status]

OBJECTIVE

To examine the association between breastfeeding and obesity in school-age children from Brazilian families of high socioeconomic status.

METHODS

A cross-sectional study was conducted including 555 students aged six to 14 years from a private school in the city of Sao Paulo. Obesity - the outcome variable - was defined as body mass index at or above the 85th centile plus sub scapular and triceps skin folds at or above the 90th centile using the sex and age specific standards of the US National Center for Health Statistics. Exposure was the frequency and duration of breastfeeding. Potential confounders, controlled for using multiple logistic regression, included child sex, age, birthweight, and dietary and physical activity patterns, and maternal age, body mass index, schooling, and practice of sports or physical exercise.

RESULTS

Prevalence of obesity in the studied population was 26%. After confounder adjustment, the risk of obesity in children that had never been breastfed was twice that of other children (OR=2.06; 95% CI: 1.02; 4.16). There was no dose-response effect of duration of breastfeeding on prevalence of child obesity.

CONCLUSIONS

Children who were never breastfed showed greater prevalence of obesity at school age. The absence of a dose-response effect in the relationship between duration of breastfeeding and prevalence of obesity and the still controversial findings regarding this association reported by other authors indicate a need for further studies on the subject, in particular studies with longitudinal design.

The Effects of Weight Management Programs on Self-Esteem in Pediatric Overweight Populations

OBJECTIVE

Review published findings on self-esteem and pediatric overweight, and changes in self-esteem subsequent to weight management programs.

METHODS

We used PsycInfo and MedLine searches to identify peer-reviewed journal articles examining self-esteem changes following participation in weight management programs.

RESULTS

Data regarding the relationship between self-esteem and obesity is mixed. Factors that place overweight children "at-risk" for low self-esteem include early adolescence, female gender, identification with majority cultural standards of body shape, exposure to teasing and peer victimization, a history of greater parental control over feeding, and internal attributions about weight status. Data from intervention studies suggest positive effects on self-esteem across settings. Components related to self-esteem improvements include weight change, parent involvement, and group intervention format.

CONCLUSIONS

Well-designed, longitudinal studies using multidimensional measures of self-esteem, and following CONSORT guidelines are needed to confirm and expand these findings. Emphasis should be placed on examining mediators and moderators of self-esteem change.

Understanding the relationship between obesity and positive and negative affect: the role of psychosocial mechanisms

We examined the relationship between body mass index (BMI) and positive and negative affect, and evaluated whether this relationship is mediated (or suppressed) by physical health, intrusiveness of weight on physical functioning, and distressing interpersonal interactions. Analyses were based on a national sample of more than 3,000 adults ages 25 to 74. Class II (BMI 35-39.9) and Class III (BMI> or =40) obesity were associated with more frequent negative affect and less frequent positive affect, even after demographic and socioeconomic status characteristics were controlled. After the purported pathway variables were controlled, however, obese I persons reported significantly more frequent positive affect, while overweight, obese I, and obese II persons reported significantly less frequent negative affect, compared to normal weight persons. These patterns did not differ significantly by race or gender. Our findings suggest that excessive body weight is not necessarily distressing, yet the physical and interpersonal strains associated with obesity may impair one's mood. We discuss the implications for policy and practice.

The association of self-esteem, depression and body satisfaction with obesity among Turkish adolescents

BACKGROUND

The purpose of this study was to determine the prevalence of overweight and obesity and to examine the effects of actual weight status, perceived weight status and body satisfaction on self-esteem and depression in a high school population in Turkey.

METHODS

A cross-sectional survey of 2101 tenth-grade Turkish adolescents aged 15-18 was conducted. Body mass index (BMI) was calculated using weight and height measures. The overweight and obesity were based on the age- and gender-specific BMI cut-off points of the International Obesity Task Force values. Self-esteem was measured using the Rosenberg Self-Esteem Scale, and depression was measured using Children's Depression Inventory. Logistic regression analysis was used to examine relationships among the variables.

RESULTS

Based on BMI cut-off points, 9.0% of the students were overweight and 1.1% were obese. Logistic regression analysis indicated that (1) being male and being from a higher socio-economical level were important in the prediction of overweight based on BMI; (2) being female and being from a higher socio-economical level were important in the prediction of perceived overweight; (3) being female was important in the prediction of body dissatisfaction; (4) body dissatisfaction was related to low self-esteem and depression, perceived overweight was related only to low self-esteem but actual overweight was not related to low self-esteem and depression in adolescents.

CONCLUSION

The results of this study suggest that school-based adolescents in urban Turkey have a lower risk of overweight and obesity than adolescents in developed countries. The findings of this study suggest that psychological well-being of adolescents is more related to body satisfaction than actual and perceived weight status is.

Obesity in adolescence: Implications in orthodontic treatment

The incidence of obesity is increasing in the United States and around the world, and it is likely that obese patients will present for orthodontic therapy in greater numbers in the future. The implications of obesity for psychosocial well-being, bone metabolism, craniofacial growth, and pubertal growth must be assessed in treating obese orthodontic patients. This review article focuses on the relevant issues concerning obesity in regard to orthodontic therapy.

Validity of self-reported anthropometric values used to assess body mass index and estimate obesity in Greek school children

PURPOSE

To examine the validity of self-reported values of body height and weight, used for the estimation of body mass index (BMI), as a diagnostic method for the evaluation of overweight and obesity in Greek school children.

METHOD

Self-reported height and weight was recorded and then measured in 378 primary (mean age 11.4 +/- .4 years) and 298 high school students (mean age 12.5 +/- .3 years). The BMI cutoff points adopted by the International Obesity Task Force were used to compare prevalence estimates of overweight and obesity obtained from self-reported and actual measures.

RESULTS

Significant differences were found between self-reported and measured anthropometric indices in all subgroups, except for height in elementary school girls. The degree of self-report bias did not differ between genders; however, it was higher for high school students and heavier children, compared to elementary school pupils and lighter children, respectively. Based on self-reports, prevalence estimates were 23.1% for overweight and 4.3% for obesity, but according to measured data the corresponding rates were 28.8% and 9.5%, respectively.

CONCLUSIONS

The present findings imply that the observed discrepancy between self-reported and measured anthropometric data in Greek children and adolescents might lead to erroneous estimating rates of overweight and obesity. Although self-reported data are easy to obtain, health surveys of overweight and obesity in youth need valid and accurate procedures.

Weight loss treatment and psychological well-being: a review and meta-analysis

Research suggests that weight loss treatment generally benefits psychological well-being but these effects have never been quantitatively reviewed. A meta-analysis of 117 weight loss treatment tests showed that weight loss treatment was associated with lowered depression and increased self-esteem. Treatment type moderated treatment effects on depression and self-esteem. Actual weight loss moderated treatment effects on self-esteem but not depression; only treatments that produced actual weight loss predicted increased self-esteem whereas improvements in depression were independent of weight loss. The clinical implications of the findings and the possible causal relationships among weight, depression and self-esteem are discussed.

Correlates of adherence to a physical activity program in young African-American girls

OBJECTIVE

The goal was to identify correlates of adherence to a structured physical activity (PA) program.

RESEARCH METHODS AND PROCEDURES

Subjects were 136 8- to 12-year-old African-American girls. Potential correlates at baseline were: 1) fitness index (FI: % body fat from DXA and cardiovascular fitness from treadmill test), and 2) self-esteem, anxiety, attitude to school and teachers, relationship with parents, and interpersonal relations (Behavioral Assessment System for Children). The 10-month PA program included 80 minutes of PA offered 5 days/wk. Regression tree classification was used to model attendance.

RESULTS

Six splits occurred (34% total variance explained). Less anxious subjects attended more often than highly anxious subjects (3 days/wk vs. 1.5 days/wk) did. Subjects with a healthier FI attended more often than those with a less healthy FI (3 days/wk vs. 0.5 days/wk) did. Younger subjects attended more often than older ones (3 days/wk vs. 2.5 days/wk) did. The next two splits were again with anxiety (3.5 days/wk vs. 3 days/wk) and FI (3 days/wk vs. 2.5 days/wk). Finally, subjects with higher levels of self-esteem attended more often than those with lower levels (3.5 days/wk vs. 2 days/wk) did.

DISCUSSION

Subjects who were self-confident, younger, fitter, and less anxious were more likely to participate regularly. This suggests that children who may be more likely to benefit from a PA program are less likely to participate. To enhance participation in PA programs, especially in older African-American girls: 1) psychological concerns should be identified and addressed before enrollment, and 2) programs should be designed to be appealing to children of all fitness levels.

Obesity and risk of low self-esteem: a statewide survey of Australian children

OBJECTIVE

There is variation in the psychological distress associated with child obesity. Low self-esteem, when observed, provides very little information about the nature of the distress and no indication of the proportion of obese children affected. This study used a domain approach to self-competence to evaluate self-esteem in a representative sample of Australian children.

PARTICIPANTS AND METHODS

A total of 2813 children (mean age: 11.3 years) took part in the study. They were recruited from 55 schools and were all in the last 2 years of primary school. Participants completed the Self-perception Profile for Children, a measure of body shape perception, and their height and weight were measured.

RESULTS

Obese children had significantly lower perceived athletic competence, physical appearance, and global self-worth than their normal weight peers. Obese girls scored lower in these domains than obese boys and also had reduced perceived social acceptance. Obese children were 2-4 times more likely than their normal weight peers to have low domain competence. In terms of prevalence, 1 of 3 obese boys and 2 of 3 obese girls had low appearance competence, and 10% and 20%, respectively, had low global self-worth. Body dissatisfaction mediated most of the association between BMI and low competence in boys but not in girls.

CONCLUSIONS

Obesity impacts the self-perception of children entering adolescence, especially in girls, but in selected areas of competence. Obese children are at particular risk of low perceived competence in sports, physical appearance, and peer engagement. Not all obese children are affected, although the reasons for their resilience are unclear. Quantifying risk of psychological distress alongside biomedical risk should help in arguing for more resources in child obesity treatment.

Psychological status and weight-related distress in overweight or at-risk-for-overweight children

OBJECTIVE

To associate psychological status, weight-related distress, and weight status during childhood in overweight or at-risk-for-overweight children.

RESEARCH METHODS AND PROCEDURES

We associated self-report of depression, trait anxiety, and weight-related distress (body size dissatisfaction and weight-related peer teasing after controlling for the effects of weight) in 164 children (black 35%; age 11.9 +/- 2.5 years; girls 51%) who were overweight or at-high-risk-for-overweight and were not seeking weight loss.

RESULTS

Overall, heavier children reported more psychological and weight-related distress. Black children reported more anxiety and body size dissatisfaction than white children, despite equivalent weights. However, psychological distress was not significantly associated with weight in white children. Girls reported more weight-related distress than boys. Depression was associated with weight-related teasing in all predictive models, except in the model using only black subjects. Trait anxiety was associated with report of peer teasing when using all subjects. Depression was also significantly associated with children's report of body size dissatisfaction in models using all subjects, only girls, or white subjects, but not in analyses using only boys or black subjects. For boys peer teasing was associated with body size dissatisfaction. In models including only black children, depression and trait anxiety were not significantly associated with either report of peer teasing or body size dissatisfaction.

DISCUSSION

Regardless of race or sex, increasing weight is associated with emotional and weight-related distress in children. However, associations of psychological status, weight, and weight-related distress differ for girls and boys, and for black and white children.

Associations of adiposity with measured and self-reported academic performance in early adolescence

OBJECTIVE

To examine the associations of adiposity with measured and self-reported academic performance independently of demographics and physical activity among U.S. adolescents.

RESEARCH METHODS AND PROCEDURES

We surveyed 666 students 11 to 14 years old from seven middle schools in Los Angeles, CA. Weight and height were measured. Actual grade point average was obtained from school records. Self-reported school grades and physical activity time were measured by questionnaire. Adiposity measures included BMI, BMI percentile (> or =85th percentile defined as at-risk-of-overweight), and percentage body fat (bioimpedance).

RESULTS

After adjusting for gender, ethnicity, age, and physical activity time, overweight at-risk status, BMI, and percentage body fat were negatively related to only self-reported (p < 0.01) but not measured grades. Level of moderate-to-vigorous physical activity time was negatively related to measured and self-reported grades, independently of adiposity (p < 0.01).

DISCUSSION

To our knowledge, this is the first study to examine both body mass and body fat in relation to measured and self-reported school grades. Adiposity did not relate to actual academic performance in a sample of predominantly Latino and Asian-American adolescents. The use of measured vs. self-reported academic outcomes may represent different constructs and influence study conclusions. Cultural factors may also play a role in our findings, but this requires further study.

Combating the epidemic of obesity and cardiovascular disease: perspectives from school-aged children

This study was designed to assess students' perceptions of the obstacles to positive dietary practices and increased physical activity and to solicit the students' recommendations for addressing and possibly reducing the negative practices that are associated with the rise in obesity and the development of cardiovascular diseases. Data for the study were obtained from the administration of the 2005 Project Health High School Survey (PHHSS) which measured the students' perceptions regarding obstacles to eating more nutritious, healthier foods and obstacles to participating in daily physical activity. The reasons for students' lack of interest in practicing more life-healthy behaviors are ranked and recorded. Some of the students indicated that they usually ate what they liked to eat, and the decision about what to eat was made because of the taste of the food without regard for any health consequence or negative health outcomes. Finding ways to reach these students at their young ages is the key to successfully combating the high prevalence of obesity and the development of other chronic diseases in childhood, as well as in adulthood.

The happy obese child

OBJECTIVE

Firstly, is the negative psychological effect of obesity also present in the whole population of obese and overweight children? Secondly, what tools could be recommended to measure the psychological effects of obesity?

DESIGN

Review.

METHODS

Quality of life or self-esteem is often used in evaluating the psychological effects of obesity. Test instruments used have been instruments for measuring quality of life such as the pediatric quality of life inventory (PedsQL) or the KINDL instrument, and measurements of self-esteem, such as 'ITIA' ('I think I am) and the Self-Perception Profile for Children.

RESULTS

The obese child studied in community samples has better quality of life and self-esteem than obese children from clinical samples.

CONCLUSION

Psychosocial factors seem to be more important than the functional limitations of obesity itself. This means that we might help the obese child better by social support to a minor part of the population than to focus on the child's obesity as a cause of psychological problems. A happy obese child might have greater resources to cope with the problem than previously thought.

'Adventure therapy' combined with cognitive-behavioral treatment for overweight adolescents

OBJECTIVE

Since peers have such an important influence on adolescents, we evaluated the efficacy of adding peer-based 'adventure therapy' to a standard cognitive-behavioral weight control program for overweight adolescents.

METHODS

Adolescents (N = 76) aged 13-16 years and 20 to 80% overweight (M = 60.56%, s.d.=15.17%), were randomly assigned to one of two treatment conditions: cognitive-behavioral group treatment with 'adventure therapy' similar to Outward Bound (cognitive-behavioral treatment with peer-enhanced adventure therapy (CBT + PEAT)) or cognitive-behavioral group treatment with aerobic exercise (CBT+EXER). Anthropometric and psychosocial measures were obtained at baseline, at the end of the 16-week intervention, and at 10 months following randomization.

RESULTS

Adolescents assigned to both treatment conditions demonstrated significant weight loss over time, F = 29.06, df = 2, 53, P < 0.01. Average weight loss did not differ significantly between groups (-5.31 kg for CBT + PEAT and -3.20 kg for CBT + EXER) at the end of treatment. There was a significant difference in the percentage of participants maintaining a minimum 4.5 kg (10 pounds) weight loss (35% in the CBT + PEAT condition vs 12% in the CBT+EXER condition, P = 0.042) 10 months from randomization. We also observed a significant age by treatment group interaction, such that older adolescents randomized to CBT + PEAT demonstrated more than four times the weight loss of older adolescents assigned to CBT + EXER (M = -7.86 kg vs M = -1.72 kg) at the end of treatment.

CONCLUSIONS

Peer-based 'adventure therapy' is a promising adjunct to standard cognitive-behavioral weight control intervention for adolescents, and may be most effective for older adolescents.

Gender, Ethnicity, Psychosocial Factors, and Quality of Life Among Severely Overweight, Treatment-Seeking Adolescents

OBJECTIVE

To examine gender and ethnic differences in psychosocial functioning among 100 (78% African American and 59% girls) treatment-seeking overweight 11- to 18-year-old adolescents. Self-esteem was examined as a potential mediator of the association between weight-related teasing and quality of life (QOL).

METHODS

Adolescents completed measures evaluating self-esteem, dietary habits, teasing, and QOL.

RESULTS

Few racial or gender differences were found. Mean QOL was similar to that reported in another study examining treatment-seeking overweight adolescents and substantially lower than what has been reported for non-treatment-seeking overweight adolescents. Self-esteem partially mediated the association between teasing and QOL.

CONCLUSIONS

Severely overweight adolescents of both genders and diverse ethnicities face significant stigmatization and manifest poor overall psychosocial functioning, which is negatively associated with QOL. Furthermore, self-esteem appears to partially mediate the negative relationship between teasing and QOL.

Overweight adolescent African-American mothers gain weight in spite of intentions to lose weight

OBJECTIVE

This study sought to determine how dietary patterns, self-esteem, depressive symptoms, and intention to lose weight were associated with body size among adolescent African-American mothers 1 year after delivery and with changes in body size over the next year.

DESIGN

Cross-sectional and longitudinal self-reported measures were collected 1 year after delivery. Weight and height were collected 1 and 2 years after delivery.

SUBJECTS

The subjects were 118 low-income, African-American adolescent mothers recruited after the birth of their first child.

STATISTICAL ANALYSES

Multivariate analysis of covariance and multivariate regression analysis were conducted to examine predictors of body size 1 year after delivery and changes in body size over the next year. Analyses were adjusted for maternal age, education, breastfeeding history, and intervention.

RESULTS

One year after delivery, 33.0% of mothers were overweight (body mass index [BMI] > or =95th percentile) and 23.7% were at risk for overweight (BMI > or =85th and <95th percentile). Mothers consumed a daily average of 2,527 kcal and 4.1 high-fat snacks. A total of 11% of normal-weight mothers, 22% of mothers at risk for overweight, and 44% of overweight mothers reported intention to lose weight, chi(2)=10.8, P<.01. Average maternal BMI z score increased 0.13 (3.9 kg) between 1 and 2 years after delivery, P<.01. Dietary patterns, self-esteem, depressive symptoms, and intention to lose weight were not related to body size or increase in body size.

CONCLUSIONS

One year after delivery, overweight among adolescent mothers was common and increased over time. Although nearly half of overweight mothers reported an intention to lose weight, their weight gain did not differ from that of other mothers, suggesting that they lack effective weight-loss behaviors, and may be good candidates for intervention. African-American adolescent mothers have high rates of overweight and snack consumption and may benefit from strategies to identify nutritious, palatable, affordable, and accessible alternatives to high-fat snack food.

Who changes body mass between adolescence and adulthood? Factors predicting change in BMI between 16 year and 30 years in the 1970 British Birth Cohort

OBJECTIVE

To examine whether factors common to obesity prevention programmes in adolescence, namely exercise, sedentary activities, eating behaviours and psychological factors, predict change in BMI in 'free-living' adolescents followed into adulthood.

DESIGN

Longitudinal national birth cohort study.

SUBJECTS

1970 British Birth Cohort: 4461 subjects with data on BMI at 16 years (1986) and 30 years (2000).

MEASUREMENTS AND ANALYSIS

BMI z-score (zBMI) at 16 years (measured) and 30 years (self-reported). Obesity defined as BMI exceeding 95th British centile and 28.5 kg/m2, respectively. Self-report data on exercise, eating behaviours, dieting and measures of psychological function (depression, psychological distress, self-esteem) at 16 years. Models were produced for the regression of zBMI at 30 years on each variable at 16 years, adjusted for socioeconomic status, sex and zBMI at 16 years.

RESULTS

In all, 467 (8.2%) were obese at 16 years and 730 (16.4%) were obese at 30 years. Of those obese at 16 years, 60.7% were also obese at 30 years. Loss of zBMI between 16 and 30 years was predicted by female sex (P=0.01), higher social class (P<0.0001) and higher frequency of playing sport, although this was of borderline significance (P=0.05). Increase in zBMI between 16 and 30 years was predicted by 4 or more hours per day of sedentary activities (P=0.01), eating takeaway meals twice or more per week (P=0.009), consuming two or more carbonated drinks per day (P=0.04) and a history of dieting to lose weight (P=0.04).

CONCLUSION

These data from 'free-living' adolescents followed into adult life support the importance of known risk factors such as reduction of sedentary behaviours and reduction of unhealthy eating patterns (consumption of carbonated drinks and takeaway foods, dieting) in the prevention of the persistence of obesity from childhood into adult life.

Childhood overweight and elementary school outcomes

OBJECTIVE

To examine the link between childhood overweight status and elementary school outcomes.

DESIGN

Prospective study design: multivariate regression models examining the association between changes in overweight status and school outcomes between kindergarten entry and end of third grade, after controlling for various child, family and school characteristics.

SUBJECTS

Nationally representative sample of US children who entered kindergarten in 1998, with longitudinal data on body mass index (BMI) and school outcomes at kindergarten entry and end of third grade.

MEASUREMENTS

Wide range of elementary school outcomes collected in each wave including academic achievement (math and reading standardized test scores); teacher reported internalizing and externalizing behavior problems (BP), social skills (self-control, interpersonal skills) and approaches to learning; school absences; and grade repetition. Measurements of height and weight in each wave were used to compute BMI and indicators of overweight status based on CDC growth charts. A rich set of control variables capturing child, family, and school characteristics.

RESULTS

Moving from not-overweight to overweight between kindergarten entry and end of third grade was significantly associated (P<0.05) with reductions in test scores, and teacher ratings of social-behavioral outcomes and approaches to learning among girls. However, this link was mostly absent among boys, with two exceptions - boys who became overweight had significantly fewer externalizing BPs (P<0.05), but more absences from school compared to boys who remained normal weight. Being always-overweight was associated with more internalizing BP among girls but fewer externalizing BPs among boys.

CONCLUSION

Change in overweight status during the first 4 years in school is a significant risk factor for adverse school outcomes among girls but not boys. Girls who become overweight during the early school years and those who start school being overweight and remain that way may need to be monitored carefully.

Psychosocial correlates of adolescent obesity, 'slimming down' and 'becoming obese'

PURPOSE

(a) To examine how self-reported well-being, weight-related concerns, self-image, peer relationships and psychiatric disorders are associated with obesity at ages 11 and 15 years. (b) To identify and describe those who "slim down" (become nonobese) or "become obese".

METHODS

A cohort of 2127 school pupils was surveyed at ages 11 and 15 years. At each age, those with body mass index above the 95th percentile for age and gender were categorized as obese. Characteristics associated with obesity, "slimming down" and "becoming obese" were examined using ANOVA and chi-square procedures for univariate, and logistic regression for multivariate analyses.

RESULTS

At age 11, 9.6% (males) and 10.5% (females) were obese, compared with 10.5% (males) and 11.6% (females) at age 15. "Slimming down" occurred for 3.5% of the total sample, whereas 4.5% "became obese." Obesity was associated with significant but small differences in low mood (males at 11) and self-esteem (males at 11, females at both ages), and reduced rates of behavior disorders (data on psychiatric disorders available only at age 15). Obesity was associated with weight-related worries, dieting, and poor self-rated appearance, but not most measures of peer relationships, except that obese 11-year-olds experienced greater victimization, partly accounting for their poorer well-being. In comparison with the continuously nonobese, those who "became obese" had lower prior self-esteem and greater victimization, but improvements in well-being and relative reductions in victimization by age 15. "Slimming down" was related to neither prior nor subsequent well-being in comparison with continual obesity, but was associated with better age 15 mood in comparison with continual nonobesity.

CONCLUSIONS

Although overweight was fairly stable, there were shifts in and out of the obese category during adolescence. Obesity during this life-stage, though strongly related to worries about putting on weight and self-report dieting, was associated with only small differences in psychological well-being.

Essverhalten und psychosoziale Anpassung bei Kindern mit Übergewicht

Zusammenfassung. Die Anzahl übergewichtiger Kinder ist in den vergangenen Jahren deutlich angestiegen. Aufgrund der vielfältigen medizinischen und psychosozialen Folgebelastungen des Übergewichts, der hohen Persistenzraten sowie der geringen Effektivität von Gewichtsreduktionsmaßnahmen im Erwachsenenalter besteht ein dringender Handlungsbedarf dahingehend, effektive Interventionsmethoden für übergewichtige Kinder bereitzustellen. Die vorliegende Arbeit soll hierzu einen Beitrag leisten: Über das konkrete Essverhalten der Kinder in Hinblick auf verschiedene Außenbedingungen (Stress, Familie) und die Folgebelastungen des Übergewichts im psychopathologischen und psychosozialen Bereich ist noch sehr wenig bekannt. Daher werden zunächst empirische Ergebnisse aus verschiedenen Studien zu diesen Bereichen vorgestellt. Zusammenfassend lassen sich die Ergebnisse der im Rahmen dieser Arbeit referierten Studien dahingehend interpretieren, dass sich übergewichtige Kinder in wesentlichen Punkten gar nicht so sehr von ihren normalgewichtigen Altersgenossen unterscheiden und dass hinsichtlich verschiedener Ressourcen keine qualitativen Abweichungen nach unten bestehen. Vor dem Hintergrund der Ergebnisse werden Möglichkeiten zur Optimierung von Interventionsmethoden diskutiert.

The unhappy obese child

OBJECTIVE

One of the most painful aspects of obesity may be the emotional suffering it causes. The paper discusses the psychological and social effects of obesity.

METHOD

Current studies examining the psychosocial strains of obese children and adolescents are reported. The report especially focuses on stigmatization, mental health disorders, school performance and health-related quality of life.

DISCUSSION

Research is showing that obesity is associated with poorer psychosocial functioning even compared with other chronic diseases. Future studies should further explicate the risk and protective factors for developing severe psychosocial strain.

Physical Activity, Aerobic Fitness, Self-Perception, and Dietary Intake in At Risk of Overweight and Normal Weight Children

Differences in physical activity, aerobic fitness, self-perception, and dietary intake were examined in a sample of six- to ten-year-olds at risk of overweight, and in normal weight boys and girls. Participants (n=20 at risk of overweight [BMI ≥85th percentile]; n=115 normal weight [BMI <85th percentile]; n=68 boys; n=67 girls) had anthropometric, physical activity, aerobic fitness, self-perception, and dietary intake measurements at zero, three, six, and 12 months. Over the 12-month period, normal weight children were more physically active (F=4.1, p<0.05) and aerobically fit (F=14.3, p<0.001), and possessed higher self-perceptions of social acceptance (F=7.3, p<0.01) than their at risk of overweight peers. Fitness differences between the sexes were not apparent at baseline, but emerged over the long term (F=7.9, p<0.01). Overall, boys consumed more total energy, fat, carbohydrate, and protein than did girls, while the entire sample consumed diets low in vegetables and fruits and meat and alternatives, and high in “other” foods. These observations highlight key disparities in lifestyle-related behaviours and perceptions between groups of children according to overweight status and sex. The findings underscore the importance of longitudinal studies in youth because cross-sectional studies may reflect transient differences.

The impact of obesity on psychological well-being

Children and adolescents with obesity face stigmatization and discrimination in many areas of their lives, and it has been assumed that their psychological well-being will be compromised as a result. This chapter examines the most recent empirical evidence on the relationship between childhood obesity and body dissatisfaction, self-esteem and depression. Studies of clinical samples typically report poorer psychological well-being in treatment seekers when compared with population-based obese and normal weight controls. However, research in community samples suggests that despite moderate levels of body dissatisfaction, few obese children are depressed or have low self-esteem. A number of important moderators and mediators of the association between obesity and well-being have emerged, with females, Caucasians and adolescents being particularly at risk. Implications for treatment and future research priorities are suggested.

Screening and interventions for childhood overweight: a summary of evidence for the US Preventive Services Task Force

BACKGROUND

Childhood and adolescent overweight and obesity are related to health risks, medical conditions, and increased risk of adult obesity, with its attendant effects on morbidity and mortality rates. The prevalence of childhood overweight and obesity has more than doubled in the past 25 years. Purpose. This evidence synthesis examines the evidence for the benefits and harms of screening and early treatment of overweight among children and adolescents in clinical settings.

METHODS

We developed an analytic framework and 7 key questions representing the logical evidence connecting screening and weight control interventions with changes in overweight and behavioral, physiologic, and health outcomes in childhood or adulthood. We searched the Cochrane Library from 1996 to April 2004. We searched Medline, PsycINFO, DARE, and CINAHL from 1966 to April 2004. One reviewer abstracted relevant information from each included article into standardized evidence tables, and a second reviewer checked key elements. Two reviewers quality-graded each article with US Preventive Services Task Force criteria.

RESULTS

Although BMI is a measure of relative weight rather than adiposity, it is recommended widely for use among children and adolescents to determine overweight and is the currently preferred measure. The risk of adult overweight from childhood overweight provides the best available evidence to judge the clinical validity of BMI as an overweight criterion for children and adolescents. BMI measures in childhood track to adulthood moderately or very well, with stronger tracking seen for children with >or=1 obese parent and children who are more overweight or older. The probability of adult obesity (BMI of >30 kg/m(2)) is >or=50% among children >13 years of age whose BMI percentiles meet or exceed the 95th percentile for age and gender. BMI-based overweight categorization for individuals, particularly for racial/ethnic minorities with differences in body composition, may have limited validity because BMI measures cannot differentiate between increased weight for height attributable to relatively greater fat-free mass (muscle, bone, and fluids) and that attributable to greater fat. No trials of screening programs to identify and to treat childhood overweight have been reported. Limited research is available on effective, generalizable interventions for overweight children and adolescents that can be conducted in primary care settings or through primary care referrals.

CONCLUSIONS

BMI measurements of overweight among older adolescents identify those at increased risk of developing adult obesity. Interventions to treat overweight adolescents in clinical settings have not been shown to have clinically significant benefits, and they are not widely available. Screening to categorize overweight among children under age 12 or 13 who are not clearly overweight may not provide reliable risk categorization for adult obesity. Screening in this age group is compromised by the fact that there is little generalizable evidence for primary care interventions. Because existing trials report modest short- to medium-term improvements (approximately 10-20% decrease in percentage of overweight or a few units of change in BMI), however, overweight improvements among children and adolescents seem possible.

Gesundheitsbezogene Lebensqualität bei übergewichtigen Kindern

Zusammenfassung. Die Zahl übergewichtiger Kinder ist in den letzten Jahren stark angestiegen. Gut erforscht sind medizinische und psychosoziale Folgebelastungen des Übergewichts; zur Lebensqualität übergewichtiger Kinder liegen jedoch bislang nur wenige Befunde vor. Die vorliegende Studie befasst sich daher mit der Fragestellung, ob und in welchen Bereichen Unterschiede in der Lebensqualität zwischen übergewichtigen und normalgewichtigen gesunden bzw. chronisch kranken Kindern vorliegen. An der Studie nahmen insgesamt 87 Probanden: 27 übergewichtige, 30 normalgewichtige gesunde, 30 chronisch kranke (18 diabeteskranke und 12 asthmakranke) Kinder teil. Die gesundheitsbezogene Lebensqualität wurde anhand des “Fragebogens zur Erfassung der gesundheitsbezogenen Lebensqualität bei Kindern und Jugendlichen - revidierte Form“ (KINDL®, Ravens-Sieberer & Bullinger, 2000 ) erfasst. Die Ergebnisse deuten auf eine erhebliche Beeinträchtigung der Lebensqualität übergewichtiger Kinder in mehreren Bereichen hin: Die übergewichtigen Kinder schätzten sich hinsichtlich des Bereichs “körperliches Wohlbefinden“ und der gesamten Lebensqualität deutlich schlechter ein als die normalgewichtigen gesunden und die chronisch kranken Kinder. In den Bereichen “psychisches Wohlbefinden“ und “Freunde“ fanden sich Abweichungen nach unten lediglich im Vergleich zu den normalgewichtigen gesunden Kindern. Übergewichtige und chronisch kranke Kinder waren in ihrer Selbsteinschätzung bezüglich dieser Bereiche miteinander vergleichbar. Die Ergebnisse werden in den bisherigen Forschungsstand eingeordnet und kritisch diskutiert. Perspektiven für die zukünftige Adipositasforschung werden abgeleitet.

Eating disorder variables and self image in Italian girls attending a weight control clinic

OBJECTIVE

The aim of this study was to evaluate eating disorder variables and self image in Italian female adolescents asking for a weight control treatment.

METHOD

Eating Disorder Inventory-2 (1991) and Offer Self-Image questionnaire (1989) were administered; 100 subjects (75 outpatients and 25 controls) were enrolled over a period of three months and divided into three study groups (normal, overweight and obese), and one control group.

RESULTS

The relationship between BMI and problematic personality traits tends to be linear and positive. Obese adolescent females describe themselves in more negative terms than non-obese individuals and show a psychological profile similar to individuals with eating disorders, especially for Drive for Thinness and Interoceptive Awareness. Even in the absence of overt mental pathology, obesity can result associated to a psychological distress and it's a risk factor for mental health.

Adipositas im Kindes- und Jugendalter:

Zusammenfassung. Adipöse Kinder und Jugendliche gelten als Risikogruppe für die Entwicklung von psychosozialen Belastungen, den Einsatz von gesundheitsschädigenden Gewichtskontrollmaßnahmen sowie auffällige Essverhaltensweisen. Dennoch ist relativ wenig über das Auftreten von Heißhungerattacken (“binging“) und Binge Eating Disorder (BED) bei dieser Gruppe bekannt. Die folgende Studie untersuchte bei 156 adipösen Kindern und Jugendlichen (im Alter zwischen 11 und 18 Jahren) die selbstberichtete Verbreitung von “binging“ und BED. Im zweiten Schritt wurde untersucht, inwieweit sich “Binger“ von “non-Bingern“ in der Störbarkeit ihres Essverhaltens, ihrem Selbstkonzept, dem Erleben von Hänseleien und dem Umgang damit unterscheiden, wobei eine erhöhte Auffälligkeit der Binger vermutet wurde. Die Kinder beantworteten ein Fragebogenpaket mit folgenden Instrumenten: QEWP-A (essgestörtes Verhalten), POTS (Hänseleien), Auslöser für Essverhalten, Fragebogen zur Problembewältigung und FSK-K (Selbstkonzept). Die Auftretenshäufigkeit der BED lag bei 3.8%. Insgesamt berichteten jedoch 12.8% der Kinder und Jugendlichen (sog. Binger) von Heißhungerattacken. Diese Gruppe unterschied sich von den non-Bingern weder im Alter, noch im BMI oder in der Geschlechtsverteilung. Erwartungsgemäß berichteten die Binger über eine höhere Auslösbarkeit von Essverhalten sowie ein häufigeres Auftreten von gewichtsbezogenen Hänseleien, unter denen sie auch angaben, vermehrt zu leiden. Beim Umgang mit solchen Hänseleien benutzten Binger darüber hinaus häufiger vermeidende Strategien. Keine Gruppenunterschiede wurden im Selbstwert, der erlebten Attraktivität und schulischen Kompetenz gefunden. Vermeidender Bewältigungsstil sowie hohe Störbarkeit des Essverhaltens erwiesen sich als bedeutsam zur Vorhersage der Gruppenzugehörigkeit. Die Ergebnisse wurden in Bezug auf die Bedeutung von Hänseleien und deren Bewältigung diskutiert.

Body dissatisfaction, self-esteem, and overweight among inner-city Hispanic children and adolescents

We examined the associations among self-reported body image, self-esteem, and measured body mass index (BMI) in El-Salvadoran American youth. Higher BMI was associated with body size dissatisfaction, lower peer esteem, and attempts to lose weight. Body size dissatisfaction was also significantly related to self-esteem in these El-Salvadoran American youth.

Overweight, obesity, and health-related quality of life among adolescents: the National Longitudinal Study of Adolescent Health

OBJECTIVE

Childhood and adolescent overweight and obesity have increased substantially in the past 2 decades, raising concerns about the physical and psychosocial consequences of childhood obesity. We investigated the association between obesity and health-related quality of life in a nationally representative sample of adolescents.

METHODS

A cross-sectional analysis was conducted using the 1996 National Longitudinal Study of Adolescent Health, a nationally representative sample of adolescents in grades 7 to 12 during the 1994-1995 school year, and 4743 adolescents with direct measures of height and weight. Using Centers for Disease Control and Prevention growth charts to determine percentiles, we used 5 body mass categories. Underweight was at or below the 5th percentile, normal BMI was between the 5th and 85th percentiles, at risk for overweight was between the 85th and 95th percentiles, overweight was between the 95th and 97th percentiles + 2 BMI units, and obese was at or above the 97th percentile + 2 BMI units. Four dimensions of health-related quality of life were measured: general health (self-reported general health), physical health (absence or presence of functional limitations and illness symptoms), emotional health (the Center for Epidemiologic Studies Depression Scale and Rosenberg's self-esteem scale), and a school and social functioning scale.

RESULTS

We found a statistically significant relationship between BMI and general and physical health but not psychosocial outcomes. Adolescents who were overweight had significantly worse self-reported health (odds ratio [OR]: 2.17; 95% confidence interval [CI]: 1.34-3.51), as did obese adolescents (OR: 4.49; 95% CI: 2.87-7.03). Overweight (OR: 1.81; 95% CI: 1.22-2.68) and obese (OR: 1.91; 95% CI: 1.24-1.95) adolescents were also more likely to have a functional limitation. Only among the youngest adolescents (ages 12-14) did we find a significant deleterious impact of overweight and obesity on depression, self-esteem, and school/social functioning.

CONCLUSIONS

Using a nationally representative sample, we found that obesity in adolescence is linked with poor physical quality of life. However, in the general population, adolescents with above normal body mass did not report poorer emotional, school, or social functioning.

Weight and weight concerns: are they associated with reported depressive symptoms in adolescents?

INTRODUCTION

The primary purpose of this study was to examine the incidence of obesity, perception of weight, and weight management behaviors in a nationwide sample of adolescents. Further, the relationship between these variables and the adolescents' self-reported depressive symptoms was also explored.

METHOD

Cross-sectional data from 16- to 18-year-olds who participated in the 1999 (n=9795) and 2001 (n=8190) Youth Risk Behavioral Surveillance System were used for this secondary analysis.

RESULTS

No relationship was found between depressive symptoms and body mass index. However, perception of weight as either underweight or overweight was related to higher depressive symptoms. The risk profile for reporting depressive symptoms includes use of any weight control strategies, female, and perception of weight.

DISCUSSION

These findings underscore the importance of addressing adolescents' perceptions of weight in relation to their actual body mass index and psychological well-being.

Psychosocial characteristics of obese children/youngsters and their families: implications for preventive and curative interventions

A profile will be given of the psychosocial characteristics of obese children and youngsters, as well as those of their families. Then several attempts of (particularly) preventive interventions will be sketched. Differences found between clinical and non-clinical groups of obese children and youngsters do not permit generalized statements regarding specific psychosocial characteristics. Just as little as there exist a simple and unequivocal image of family functioning with these children. There are great differences between the psychological assumptions and the biological concepts about obesity. Whereas, biological concepts are relevant for the whole obese population, psychosocial characteristics seems to hold mainly for the clinical group of obese persons. The gap between clinical versus non-clinical as well as curative versus preventive approaches will be explained. There are remarkable differences between curative versus preventive intervention goals in terms of the extent to which they focus on life style habits or psychosocial (dys)functioning. Where prevention strategies focus more on enhancing physical activities, curative interventions focus more on changing eating behavior patterns and (depending on chronicity and seriousness of obesity) modifying psychosocial dysfunctioning.

Ethnic differences in the prevalence of overweight among young children in Hawaii

OBJECTIVES

To compare the prevalence of overweight among young children of different ethnic backgrounds and describe the age pattern of overweight in early childhood.

METHODS

Cross-sectional study of 21,911 children, 12 to 59 months old, participating in the Hawaii Special Supplemental Nutrition Program for Women, Infants, and Children in 1997-1998. They were grouped in eight ethnic categories. For 1-year-olds we defined overweight as weight-for-age at the 95th percentile or more and underweight as weight-for-age at less than the 10th percentile. For 2- to 4-year-olds overweight was defined as body mass index (BMI) at the 95th percentile or more, underweight as BMI less than 10th percentile, tall stature as height-for-age at the 95th percentile or more, and short stature as height-for-age at less than the 10th percentile. The National Center for Health Statistics 2000 growth charts were the reference values. The analysis included bivariate and multivariate methods.

RESULTS

Large differences were found among ethnic groups. Among 1-year-olds, Samoans were the heaviest (17.5% overweight) and Filipinos the lightest (30.2% underweight). Among 2- to 4-year-olds, Samoans were the heaviest (27.0% overweight) and the tallest (16.9% tall), whereas Asians were the lightest (12.2% underweight), and Filipinos the shortest (19.0% short). Hawaiians and Asians also had a high percentage of short children (13.6% and 12.2%, respectively). Prevalence of overweight in all 2- to 4-year-olds was more than the expected 5%, especially for Samoans, Filipinos, Hawaiians, and Asians. At age 2 to 4 years, overweight was almost twice as prevalent as at age 1. Multivariate analysis showed that ethnicity (Samoan) had the strongest independent association with weight-for-age percentile, BMI, and overweight in the two age groups, followed by birth weight.

CONCLUSIONS

This is the first study of overweight among children of Asian and Pacific Island backgrounds in Hawaii. It identified important characteristics of growth and will be helpful in the design of appropriate activities to prevent overweight.

Body mass index and parent-reported self-esteem in elementary school children: evidence for a causal relationship

OBJECTIVE

To clarify relationships between body mass index (BMI) and self-esteem in young children at a population level. To assess whether low self-esteem precedes or follows development of overweight/obesity in children.

DESIGN

Prospective cohort study in elementary schools throughout Victoria, Australia. Child BMI and self-esteem were measured in 1997 and 2000.

SUBJECTS

Random sample of 1,157 children who were in the first 4 y of elementary school (aged 5-10 y) at baseline.

MEASURES

BMI was calculated from measured height and weight, then transformed to z-scores. Children were classified as nonoverweight, overweight or obese based on international cut-points. Low child self-esteem was defined as a score below the 15th percentile on the self-esteem subscale of the parent-reported Child Health Questionnaire.

RESULTS

Overweight/obese children had lower median self-esteem scores than nonoverweight children at both timepoints, especially at follow-up. After accounting for baseline self-esteem, higher baseline BMI z-score predicted poorer self-esteem at follow-up (P=0.008). After accounting for baseline BMI z-score, poorer baseline self-esteem did not predict higher BMI z-score at follow-up. While nonoverweight children with low baseline self-esteem were more likely to develop overweight/obesity (OR=2.1, 95% CI=1.2, 3.6), this accounted for only a small proportion of the incidence of overweight.

CONCLUSIONS

Our data show an increasingly strong association between lower self-esteem and higher body mass across the elementary school years. Overweight/obesity precedes low self-esteem in many children, suggesting a causal relationship. This indicates that prevention and management strategies for childhood overweight/obesity need to begin early to minimise the impact on self-esteem.

Gewichtsbezogene Lebensqualität bei Schulkindern:

Zusammenfassung. Gewicht und Figur spielen bereits im Kindes- und Jugendalter eine zentrale Rolle. Das Gewicht stellt einen wichtigen Marker für die soziale Stellung innerhalb der Gruppe und das psychische Wohlbefinden dar. Dementsprechend ist das psychische Wohlbefinden von adipösen Kindern und Jugendlichen im Vergleich zu normalgewichtigen oftmals vermindert; dies gilt vor allem für klinische Stichproben. Gewichtsbezogene Lebensqualitätsinstrumente für Kinder und Jugendliche fehlen größtenteils ebenso wie Angaben darüber, ob für klinische Gruppen entwickelte Messinstrumente sich auch für die Allgemeinbevölkerung eignen. Der folgende Beitrag beschreibt die Validierung eines gewichtsbezogenen Lebensqualitätsinstrumentes für übergewichtige Kinder und Jugendliche (GW-LQ-KJ) in einer populationsbezogenen Stichprobe. 936 Schüler im Alter von 8 bis 18 Jahren füllten neben dem GW-LQ-KJ die deutsche Version des STAI für Kinder, einen Fragenbogen zum Meidungsverhalten auf Grund des Körperbildes (BIAQ) sowie Subskalen des Child Health Questionnaire (CHQ) zur Erhebung der allgemeinen Lebensqualität aus. Die Akzeptanz des Fragebogens ist als gut zu bezeichnen. Hypothesenkonform ergaben sich Unterschiede in der gewichtsbezogenen Lebensqualität zwischen verschiedenen Gewichtsgruppen. Die Ergebnisse dieser Studie deuten darauf hin, dass der GW-LQ-KJ auch in nicht-klinischen Gruppen die gewichtsbezogene Lebensqualität von Kindern und Jugendlichen valide erfassen kann.