Self-esteem and change in body mass index over 3 years in a cohort of adolescents

Differences in weight loss outcomes for males and females on a low-carbohydrate diet: A systematic review

It has been widely demonstrated that there are a broad range of individual responses to all weight management regimens, often masked by reports of the mean. Identifying features of responders and non-responders to weight loss regimens enables a more tailored approach to the provision of weight management advice. Low-carbohydrate diets are currently popular, and anecdote suggests that males are more successful at losing weight using this approach. This is feasible given the physiological and socio-psychological differences between the genders. We analysed the extent and variation in weight change for males and females separately through a systematic search for all low-carbohydrate diet trials published since 1985. Very few studies compared weight loss outcomes by gender and, of those that did, most lacked supporting data. The majority of studies reported no gender difference but when a gender difference was found, males were more frequently reported as losing more weight than females on a low-carbohydrate diet. The lack of gender stratification in weight loss trials is concerning, as there are a range of gender-based factors that affect weight loss outcomes. This study highlights the importance of examining weight change for males and females separately, since as failure to do so may mask any potential differences, which, if detected, could assist with better weight loss outcomes.

Self-Esteem in 60 Seconds: The Six-Item State Self-Esteem Scale (SSES-6)

With 20 items, the State Self-Esteem Scale (SSES) can be cumbersome in settings that demand efficiency. The present research created an efficient six-item version of the SSES that preserves score reliability and validity and its three-dimensional structure: social, appearance, and performance self-esteem. Item response theory and confirmatory factor analyses identified the "best" six items-two from each dimension (Study 1). Participants completed the SSES four times at 2-week intervals (Studies 2 and 3). The six-item SSES' scores showed adequate test-retest reliability, explained substantial variance in trait-relevant measures, and showed convergent validity with related self-esteem measures. Participants completed the SSES and a laboratory experiment where they received negative feedback on an essay they had written and could retaliate against their evaluator by allocating hot sauce for them to consume (Study 4). The six-item SSES interacted with self-esteem instability in expected ways to predict hot sauce allocated.

The association of healthy lifestyle behaviors with mental health indicators among adolescents of different family affluence in Belgium

BACKGROUND

Healthy lifestyles may contribute to better mental health, which is particularly important in adolescence, an age at which half of all mental health problems first occur. This association may be even more relevant in adolescents of low family affluence, who show more mental health problems, as well as more unhealthy lifestyles. This study investigated healthy lifestyle behaviors, namely sufficient sleep and physical activity, daily breakfast intake, low levels of alcohol use or smoking, in relation to mental health and symptoms of mental health problems (feelings of depression, anxiety, stress and self-esteem) among adolescents from different family affluence. Furthermore, the moderating role of family affluence was examined in those relations.

METHODS

Adolescents aged 12-18y were recruited via a random sample of schools in Flanders, Belgium. A total of 1037 adolescents participated (mean age = 15.2, 49.8% female). Independent samples t-tests, Mann Whitney U-tests and χ²-tests determined the differences in healthy lifestyle behaviors and mental health indicators between adolescents of low-medium and high family affluence. Regression analyses assessed the association between healthy lifestyles and mental health outcomes and the moderating role of family affluence.

RESULTS

All healthy lifestyle behaviors were associated with at least one mental health outcome, with the exception of alcohol consumption. Adolescents from low-medium family affluence had lower levels of physical activity, less often took breakfast, had lower levels of alcohol consumption and reported lower self-esteem than adolescents from high family affluence. The results showed no moderating effect of family affluence for the association between healthy lifestyle and mental health.

CONCLUSION

These findings support the value of integrating healthy lifestyle behaviors in interventions for mental health promotion, for both youth of low-medium and high family affluence.

Self-concept, Self-esteem and Body Weight in Adolescent Females

Eighty girls aged 12.8 (0.6) years, completed self-concept, depression and anxiety scales over three years and had their height and weight measured. All nine self-concept domains were lower in the Highest BMI group, compared to the Lower BMI group and this trend was stable over three years. Highest BMI girls were substantially lower than population norms on all nine scales. Over three years, the Physical Appearance and Close Friendship scores of Highest BMI girls decreased compared to Lower BMI girls. This pattern was similar for all of the other self-concept domains. Several aspects of early adolescent girls' self-image may be adversely influenced by a heavy weight status.

A Conceptual Framework for the Expansion of Behavioral Interventions for Youth Obesity: A Family-Based Mindful Eating Approach

BACKGROUND

Currently, over 30% of US youth are overweight and 1 in 6 have metabolic syndrome, making youth obesity one of the major global health challenges of the 21st century. Few enduring treatment strategies have been identified in youth populations, and the majority of standard weight loss programs fail to adequately address the impact of psychological factors on eating behavior and the beneficial contribution of parental involvement in youth behavior change.

METHODS

A critical need exists to expand treatment development efforts beyond traditional education and cognitive-behavioral programs and explore alternative treatment models for youth obesity. Meditation-based mindful eating programs represent a unique and novel scientific approach to the current youth obesity epidemic given that they address key psychological variables affecting weight.

RESULTS

The recent expansion of mindfulness programs to include family relationships shows the immense potential for broadening the customarily individual focus of this intervention to include contextual factors thought to influence youth health outcomes.

CONCLUSIONS

This article provides an overview of how both mindful eating and family systems theory fits within a conceptual framework in order to guide development of a comprehensive family-based mindful eating program for overweight youth.

Life course body mass index and adolescent self-esteem: Evidence from Hong Kong's "Children of 1997" Birth Cohort

OBJECTIVE

Self-esteem is an important determinant of adolescent mental health. Prior adiposity may be a factor in the development of self-esteem. However, the association of adiposity with self-esteem is inconsistent, perhaps because adiposity and self-esteem tend to be socially patterned, making it unclear whether observed associations are biologically based or contextually specific.

METHODS

Multivariable partial least squares regression was used to assess the adjusted association of birth weight and childhood body mass index (BMI) z-score at 3 and 9 months and at 3, 7, 9 and 11 years and changes in BMI z-score with self-esteem at ∼11 years, assessed from the self-reported Culture Free Self-Esteem Inventory in a population-representative Chinese birth cohort, which has little social patterning of adiposity. Whether the associations varied by sex also was assessed.

RESULTS

Self-esteem score was available for 6,520 girls and boys (78.5% follow-up). Birth weight z-score, BMI z-scores at 3 and 9 months and at 3, 7, 9, and 11 years, and successive BMI z-score changes had little association with self-esteem at ∼11 years, adjusted for socio-economic position.

CONCLUSIONS

In a developed, non-Western setting, life course BMI does not appear to be a factor in the development of self-esteem in early adolescence, suggesting that observed associations to date may be contextually specific rather than biologically based.

A school-based comprehensive lifestyle intervention among Chinese kids against Obesity (CLICK-Obesity) in Nanjing City, China: the baseline data

BACKGROUND

urgent development of effective interventions to prevent rapidly rising childhood obesity in China is needed.

METHODS

Between May 2010 and December 2013, a cluster randomized controlled trial was conducted among 4th graders in eight urban primary schools randomly assigned to intervention or control groups in Nanjing, China. A multi-component intervention program was implemented within the treatment group, while students in the control group followed their usual health education curriculum without additional intervention.

RESULTS

At baseline, 638 and 544 students were enrolled in the intervention and control group, respectively. The prevalence of excess body weight was 26.8%, with 27.4% in the intervention group and 26.1% in the control group (p=0.61). The mean (SD) BMI and WC was 18.7 (3.0) and 63.0 (9.2) for participants in intervention schools, and 18.5 (2.9) and 63.6 (8.7) for students in control group, separately (p=0.24 and 0.41, respectively). Compared to those who were not aware of what lifestyle/behavior factors were unhealthy, students who were aware of the unhealthy lifestyle/ behavior factors consumed fewer fried snacks (0.46±0.76 serves/week vs 0.65±0.91 serves/week; p<0.01), soft drinks (160±194 ml/week vs 199±227 ml/week; p<0.01), but larger amount of meat (502±429 g/week vs 449±344 g/week; p=0.03), and reported less screen time (214±232 minutes/week vs 252±264 minutes/week; p<0.01). Moreover, there was no difference within physical activity time between these two groups (257±341 minutes/week vs 218±324 minutes/week; p=0.13).

CONCLUSIONS

Main characteristics of participants were balanced at baseline within intervention and control schools, but a gap existed between healthy lifestyle knowledge and actual healthy behavior in students.

TRIAL REGISTRATION NUMBER

ChiCTR-ERC-11001819.

Myopia, contact lens use and self-esteem

PURPOSE

To evaluate whether contact lens (CL) use was associated with self-esteem in myopic children originally enrolled in the Correction of Myopia Evaluation Trial (COMET), that after 5 years continued as an observational study of myopia progression with CL use permitted.

METHODS

Usable data at the 6-year visit, one year after CL use was allowed (n = 423/469, age 12-17 years), included questions on CL use, refractive error measurements and self-reported self-esteem in several areas (scholastic/athletic competence, physical appearance, social acceptance, behavioural conduct and global self-worth). Self-esteem, scored from 1 (low) to 4 (high), was measured by the Self-Perception Profile for Children in participants under 14 years or the Self-Perception Profile for Adolescents, in those 14 years and older. Multiple regression analyses were used to evaluate associations between self-esteem and relevant factors identified by univariate analyses (e.g., CL use, gender, ethnicity), while adjusting for baseline self-esteem prior to CL use.

RESULTS

Mean (±S.D.) self-esteem scores at the 6-year visit (mean age = 15.3 ± 1.3 years; mean refractive error = -4.6 ± 1.5 D) ranged from 2.74 (± 0.76) on athletic competence to 3.33 (± 0.53) on global self-worth. CL wearers (n = 224) compared to eyeglass wearers (n = 199) were more likely to be female (p < 0.0001). Those who chose to wear CLs had higher social acceptance, athletic competence and behavioural conduct scores (p < 0.05) at baseline compared to eyeglass users. CL users continued to report higher social acceptance scores at the 6-year visit (p = 0.03), after adjusting for baseline scores and other covariates. Ethnicity was also independently associated with social acceptance in the multivariable analyses (p = 0.011); African-Americans had higher scores than Asians, Whites and Hispanics. Age and refractive error were not associated with self-esteem or CL use.

CONCLUSIONS

COMET participants who chose to wear CLs after 5 years of eyeglass use had higher self-esteem compared to those who remained in glasses both preceding and following CL use. This suggests that self-esteem may influence the decision to wear CLs and that CLs in turn are associated with higher self-esteem in individuals most likely to wear them.

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.

The relationships between body mass index and television viewing, internet use and cellular phone use: the moderating effects of socio-demographic characteristics and exercise

OBJECTIVE

This study aimed to examine the relationships between body mass index (BMI) and television viewing, Internet use and cellular phone use and the moderators for these relationships in adolescents.

METHOD

The relationship between BMI and the time spent on three kinds of sedentary activities and the moderators for these relationships were analyzed among 9,278 Taiwanese adolescents. The different relationships between BMI and various Internet and cellular phone-related activities were analyzed.

RESULTS

High television viewing and high Internet use were associated with increased BMI in adolescents. Exercising had a moderating effect on the relationship between BMI and television viewing. Several Internet and cellular phone-related activities were associated with increased BMI.

DISCUSSION

The results support the relationships between adolescent BMI and television viewing and Internet use. The moderating effect of exercise and various Internet and cellular phone-related activities should be considered when developing intervention strategies for overweight adolescents.

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.

Short-term changes in sedentary behaviour during adolescence: Project STIL (Sedentary Teenagers and Inactive Lifestyles)

HYPOTHESIS

Changes in body composition and body image during puberty will impact on sedentary behavioural choices.

AIM

The study aimed to investigate the effects of changes in pubertal status, body composition and body image on changes in time spent being sedentary.

PARTICIPANTS AND METHODS

Eighty-three school students aged 10-15 years were studied at 6-month intervals. BMI and percentage body fat (%BF) were calculated from anthropometric measures. Sedentary behaviour and sleep time were computed for weekday and weekend days using momentary-time-sampling diaries. Body image was measured using the Physical Self-Perception Profile for Children. Pubertal status was assessed from self-reported secondary sexual characteristics.

RESULTS

During weekdays, boys' sedentary behaviour increased by a significantly greater amount for those who increased pubertal level compared with those who did not. No significant correlations were found between changing pubertal status, body composition, and body image for either gender. For girls, but not boys, a significant amount of the variance of the change in weekend day sedentary behaviour was explained by changing %BF, independent of changing pubertal status.

CONCLUSION

Only a part of the hypothesis was supported by these data. Changes in sedentary behaviour were not associated with behavioural choices triggered by body compositional changes.

Psychological and psychiatric aspects of pediatric obesity

A thorough dealing with psychological and psychiatric aspects of obesity requires careful consideration of causal implications. It is nowadays readily comprehensible that obesity can entail psychiatric symptoms, because stigmatization of obese children and adolescents, including teasing and bullying, is a common event. Sources include peers, teachers, parents, and health care providers. It would indeed seem peculiar if this ongoing and intense stigmatization did not affect mental well-being at a very early stage of life.

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.

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.

Personality characteristics in adolescence predict long-term changes in body fatness

Five personality characteristics were assessed in 312 adolescent boys and girls, and investigated in relation to the change in body fat percentage over 22 years of follow up. Boys with low levels of Social Inadequacy and girls with high levels of Recalcitrance showed relatively large gains in body fat percentage.

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.

Overweight, race, and psychological distress in children in the Childhood Asthma Management Program

OBJECTIVE

The purpose of this work was to determine whether overweight in youth with mild-to-moderate asthma occurs with increased frequency and is accompanied by impaired psychological functioning.

PATIENTS AND METHODS

The interrelationships among BMI and demographic and psychological characteristics were examined in 1005 children (aged 5-12 years) enrolled in the Childhood Asthma Management Program and seen for repeated visits over 4 1/2 years.

RESULTS

Baseline rates of overweight (BMI for age: > or = 95th percentile) were comparable, but rates of overweight risk (BMI for age: 85th to < 95th percentile) among children in the Childhood Asthma Management Program were elevated in comparison with the general population of children in the United States. Rates of overweight and overweight risk did not increase over the course of the longitudinal study. Overweight and overweight risk were more frequent among black and Hispanic than white children, although they were not higher relative to same-race groups in the general population. Overweight at baseline was associated with lower IQ, more social withdrawal, and greater internalized psychological distress. As the children became older, the overweight group demonstrated increased evidence of behavior problems and decreased physical activity.

CONCLUSIONS

This study identifies an increase in overweight risk but not overweight in children with mild-to-moderate asthma. Comorbidity between asthma and overweight may be underestimated, because children with severe asthma and those from impoverished backgrounds were not represented in this sample. For the 14% of children who were overweight, some associated psychological difficulties were present in childhood, and additional problems were seen during adolescence. These results suggest a need for programs that encourage greater vigilance and intervention for overweight children with asthma.

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.

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.

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.

A life-course approach in explaining social inequity in obesity among young adult men and women

OBJECTIVE

To examine the cumulative influence of adverse behavioural, social, and psychosocial circumstances from adolescence to young adulthood in explaining social differences in overweight and obesity at age 30 years and if explanations differ by gender.

DESIGN

A 14-year longitudinal study with 96.4% response rate.

SUBJECT

Data from 547 men and 497 women from a town in north Sweden who were baseline examined at age 16 years and prospectively followed up to age 30 years.

MEASUREMENTS

Overweight and obesity were ascertained at ages 16 and 30 years. Occupation and education were used to measure socioeconomic status. The explanatory measurements were: age at menarche, smoking, physical activity, alcohol consumption, TV viewing, home and school environment, social support, social network, and work environment.

RESULTS

No gender or social difference in overweight was observed at age 16 years. At age 30 years, significantly more men than women (odds ratio (OR) = 2.81, 95% confidence interval (CI) 2.14-3.68) were overweight or obese. Educational level was associated with overweight at age 30 years, but not occupational class. Both men (OR = 1.55, 95% CI 1.10-2.19) and women (OR = 1.78, 95% CI 1.16-2.73) with low education (< or =11 years) were at risk of overweight. The factors that explained the educational gradient in overweight among men were low parental support in education during adolescence, and physical inactivity, alcohol consumption, and nonparticipation in any association during young adulthood. The educational gradient in overweight in women was explained mostly by adolescence factors, which include early age at menarche, physical inactivity, parental divorce, not being popular in school, and low school control. Restricted financial resource during young adulthood was an additional explanatory factor for women. All these factors were significantly more common among men and women with low education than with high education.

CONCLUSION

Social inequities in overweight reflect the cumulative influence of multiple adverse circumstances experienced from adolescence to young adulthood. Underlying pathways to social inequity in overweight differ between men and women. Policy implications to reduce social inequity in overweight include reduction of social differences in health behaviours and social circumstances that take place at different life stages, particularly psychosocial circumstances during adolescence.

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.

Being overweight: negative outcomes for African American adolescents

The present study looked at how bodyweight affected African American adolescents their physical characteristics of height and weight, their behavioral characteristics of eating preferences, and their psychological characteristics of self-esteem and locus of control. In the summer of 2002 29 African-American adolescents who were participating in a one month Summer Institute were questioned on the perceptions of their weight and their food practices. They also completed self-esteem and locus of control scales. The Self-esteem scales used were the Rosenberg Self-Esteem scale (RSE), the Rosenberg-Simmons Self-Esteem scale (RSSE), the Rosenberg Depressive Affect scale (RDA), and the Rosenberg Self-Consciousness scale (RSC) The subjects had their height and weight measured and their calculated Body Mass Index (BMI) was divided into high BMI's (124 and above) and low BMI's (123 and below). High BMI's thought they were significantly heavier than low BMI's (p = 0.5), and drank more soft drinks (p = 0.1) than low BMI's. Further, the high BMI group had significantly lower self-esteem than the low BMI group on the RSE scale (p = 0.03) and the RSSE scale (p = 0.02).

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.

Who succeeds in maintaining weight loss? A conceptual review of factors associated with weight loss maintenance and weight regain

Weight loss is difficult to achieve and maintaining the weight loss is an even greater challenge. The identification of factors associated with weight loss maintenance can enhance our understanding for the behaviours and prerequisites that are crucial in sustaining a lowered body weight. In this paper we have reviewed the literature on factors associated with weight loss maintenance and weight regain. We have used a definition of weight maintenance implying intentional weight loss that has subsequently been maintained for at least 6 months. According to our review, successful weight maintenance is associated with more initial weight loss, reaching a self-determined goal weight, having a physically active lifestyle, a regular meal rhythm including breakfast and healthier eating, control of over-eating and self-monitoring of behaviours. Weight maintenance is further associated with an internal motivation to lose weight, social support, better coping strategies and ability to handle life stress, self-efficacy, autonomy, assuming responsibility in life, and overall more psychological strength and stability. Factors that may pose a risk for weight regain include a history of weight cycling, disinhibited eating, binge eating, more hunger, eating in response to negative emotions and stress, and more passive reactions to problems.

Chronic administration of leptin in Asian Blue Quail

It is well known that leptin has the capacity to reduce food intake, cause body weight loss, and increase energy expenditure in several vertebrate species. In this study, we investigated the effects of chronically elevated leptin levels on behavior and physiology of Asian Blue Quail (Coturnix chinensis). Fifteen male quail were treated with chicken leptin dissolved in phosphate-buffered saline (PBS) via subcutaneously inserted osmotic pumps that released approximately 1 microg/g body weight/day during a 14-day period. Another 15 males acted as controls and their pumps released PBS only. All males were housed together with two females. We observed a decrease in body weight and feeding behavior in leptin-treated birds, but not in control birds, after 2 days of treatment. Thereafter, all birds increased in weight. Males treated with leptin were more active and more likely to preen the day after the beginning of the treatment. Plasma cholesterol levels in leptin birds decreased during the first week of treatment and plasma triglycerides tended to remain lower compared to the controls during the whole 2-week period of treatment. Glucose levels appeared stable during the observation period. Leptin-treated males remained closer to accompanying females than did control males, and females together with leptin males took longer to lay their first egg compared to females together with control males. This is the first article showing the effect of leptin on cholesterol and triglyceride levels in birds. We also observed a change in the activity and male-female interaction pattern in tested quail.

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.

Role of the physician in childhood obesity

OBJECTIVE

To suggest the role of the practicing physician in examining and treating childhood obesity. How should obesity be determined at clinical examination? Is there an obesity epidemic? What is the likely influence of obesity upon current and future health? What are the causes of obesity, and what does this imply for prevention and treatment?

DATA SOURCES

Relevant articles in Medline and personal files.

DATA SYNTHESIS

The 80th and 95th percentiles of body mass index and skinfold readings provide the most commonly accepted indices of overweight and obesity in the child. Over the last 20 years, the proportions of overweight and obese children have increased in both indigenous populations and most developed societies. Current methods of assessing physical activity and diet during childhood lack the precision to establish the primary cause of the obesity epidemic, but correlational analysis shows a close relationship between body fat content and a decline in daily energy expenditures. Immediate consequences of childhood obesity include an increased prevalence of atherosclerotic plaques, hypertension, and an adverse lipid profile, with a poor self-image that limits participation in physical activity. Tracking is such that many obese children become obese adults, and in consequence, the long-term risks of cardiovascular and all-cause deaths are increased. The prevention of obesity is easier than its cure. A combination of increased lifestyle activities, less sedentary behavior, and dietary modification seems the most effective approach. This should be supported by the use of behavioral modification techniques and changes in the urban environment that encourage an active lifestyle.

CONCLUSIONS

The pediatric physician can contribute to the control of obesity by monitoring body mass index and skinfold thicknesses in all patients. Children above the 50th percentile of body fat need dietary modification and a greater amount of moderate physical activity. Physicians should also advocate quality daily physical education and an environment that encourages adoption of an active lifestyle.

Effect of physical and mental activity on blood pressure

OBJECTIVES

The authors measured and recorded the physical (outdoor playing) and mental (home study) activity behavior and blood pressure amongst school going children and observed their association with the blood pressure levels.

METHOD

It was a cross sectional school-based study from 12 primary schools; selected by stratified random sampling. Participants included 2250 children aged 10 years and above. Explanatory variables were age, sex, outdoor playing (hours/ day) and home-study (hours/ day). Outcome variables were mean and standard deviation (SD) of systolic and diastolic blood pressures in various activity groups. Statistical tools used were proportions, correlation co-efficient (r), coefficient of determination (r2) and Regression analysis.

RESULTS

47.8% boys and 2.5 % girls were engaged in outdoor playing for more than two hours. No trend was observed for systolic blood pressure (SBP) in both the sexes in various activity groups of outdoor playing. Both mean diagnostic blood pressure (DBP) and mean BMI showed decreasing trend in boys. Mean BMI had an inverse relationship with outdoor playing in girls. Correlation of age and weight with both SBP and DBP was highly significant in both the sexes and in all the age groups except that of the 15-year age. Both SBP and DBP were not associated with home study in all sex and age groups except the age group of 10 and 12 years. Both SBP and DBP were significantly associated with the outdoor playing taking the whole sample as one group, but not in different sex or age groups; except that the SBP was significantly correlated with outdoor playing in 10 to 13 years age groups in boys.

CONCLUSION

Boys spent twice the time in outdoor playing than girls. They were spending more time on outdoor playing than on home study. Conversely girls spent more time in home study. A weak negative correlation was observed between outdoor playing and blood pressures. Less time spent in physical activities by the girls may have contributed to their higher BMI. They need behavior change communication for involvement in physical activities.

Weight satisfaction and self-esteem among teenagers in Helsinki, Moscow and Tallinn

OBJECTIVE

Information on weight satisfaction in Eastern Europe is limited. This study compares relative weight, weight satisfaction and self-esteem of teenagers living in two post-Soviet capitals, Moscow and Tallinn, and a western capital Helsinki.

METHOD

Classroom surveys including data about weight and height, weight satisfaction and self-4 esteem among 15-18-year-old girls (n = 911) and boys (n = 650) collected in 1994-95.

RESULTS

Body mass index and self-esteem were highest in Helsinki. Nevertheless, feelings of over-weight were most common among Tallinn girls and feelings of over- and underweight among Muscovite girls. Boys were mostly satisfied with their current weight with no differences between cities. Low self-esteem was associated with feelings of overweight among girls and underweight among boys.

DISCUSSION

Somewhat unexpectedly, girls grown in non-western cultures were more dissatisfied with their weight than girls in Helsinki. These findings may partly be attributable to rapid economic and cultural transformations that were occurring in these countries during the study period.

The spectrum of eating disorders: prevalence in an area of Northeast Italy

This study aims at exploring the prevalence of eating disorders in a sample of adolescents living in a community in Northeast Italy. It takes into account age and gender differences in a mixed male-female sample of 1000 school-aged adolescents corresponding to 10% of the young population aged 15-19 years of the district. The study was based on self-reported questionnaires, including the Eating Attitudes Test (EAT), the Bulimic Investigatory Test of Edinburgh (BITE), and the Body Attitudes Test (BAT). The cases at risk were identified on the basis of the suggested validated cutoff for a clinically relevant syndrome. Females scored higher than males at all ages, body mass index levels, and socio-economic status levels. We found 100 females (15.8%) and 8 males (2.8%) scoring higher than the suggested cutoff for caseness on the EAT (cutoff=30); 26 females (4.1%) and 1 male (0.3%) scoring higher than the suggested cutoff for caseness on the BITE (cutoff=20); 287 females (45.5%) and 24 males (8.6%) scoring higher than the suggested cutoff for caseness on the BAT (cutoff=36). We did not find any gradient between age and socioeconomic status and the scores on the eating disorder inventories. BAT scores predicted with sharp precision the presence of an abnormal psychometric pattern on the EAT and the BITE. The prevalence of psychometric patterns that indicate an eating disorder seems in our adolescent sample higher than those reported in previous similar studies carried out in the North of Italy. The use of self-report inventories is a limitation in drawing definitive conclusions on the rates of eating disorder in this area; however, bodily dissatisfaction seems to be psychologically linked to abnormal eating patterns.

Children's weight-loss camps: psychological benefit or jeopardy?

OBJECTIVES

To investigate the change in body image, self-esteem, and worries in obese adolescents attending a residential, weight-loss camp.

DESIGN

A longitudinal intervention study, with a nonintervention comparison group of lean adolescents.

PARTICIPANTS

A total of 57 obese adolescents (age: 13,11; BMI: 32.6 kg/m(2)) and 38 normal weight comparison adolescents.

MEASURES

Self-esteem, salience of weight-related issues, body shape preference, weight and height at the start, and end of the weight-loss camp (mean stay: 4 weeks).

RESULTS

The obese adolescents lost 5.6 kg, reduced their BMI by 2.1 kg/m(2), and BMI s.d. score by 0.28 while comparison children gained weight. Body shape dissatisfaction significantly decreased and self-esteem increased on measures of global self-worth, athletic competence, and physical appearance, in the camp attendees. This improvement took place without any exacerbation of existing worries about appearance or weight.

CONCLUSIONS

While obese adolescents had lower self-worth and greater body dissatisfaction relative to the comparison children at the start of the camp, the intervention improved their psychological state. Greater weight loss was associated with greater psychological improvement, indicating the value of the intervention and the relevance of psychological change in effective treatment.

Are obese adolescents and young adults at higher risk for mental disorders? A community survey

OBJECTIVE

Associations between body mass index (BMI) and mental disorders meeting Axis-I diagnoses according to the Diagnostic and Statistical Manual for Mental Disorders IV (DSM-IV) were investigated in The Early Developmental Stages of Psychopathology Study in a large population-based sample, which included adolescents and young adults of both genders for the first time.

RESEARCH METHODS AND PROCEDURES

A total of 3021 German subjects ranging from 14 to 24 years of age were assessed for specific DSM-IV diagnoses derived from a modified version of the standardized Composite International Diagnostic Interview, and general psychological disturbances, using the Symptom Checklist-90-Revised. BMI percentiles for age and gender were calculated to avoid systematic bias in the BMI distribution resulting from the young age range represented in the sample. Additionally, subjects with a lifetime diagnosis of any eating disorder were excluded from statistical analysis to control the confounding effect of body weight-related eating disorders on associations between BMI and psychopathology.

RESULTS

The results based on logistic regression analyses and MANOVAs demonstrate that the BMI is not associated with mental disorders or general psychopathologies. There were no significant associations between BMI and mood, anxiety, substance, and somatoform disorders, a result that contrasts with almost all previous clinical studies. Additionally, in contrast to clinical investigations and most epidemiological studies, neither obesity nor underweight was significantly associated with any kind of general psychopathology.

DISCUSSION

The overall finding that obesity is not significantly related to marked psychopathology in the general German population of adolescents and young adults has important clinical implications.

Rates of psychiatric disorders in a clinical study group of adolescents with extreme obesity and in obese adolescents ascertained via a population based study

OBJECTIVE

To compare rates of DSM-IV psychiatric disorders between (1) a clinical study group of extremely obese adolescents and young adults, (2) gender-matched population-based obese controls and (3) a population-based control group of the same age range.

DESIGN

Rates of psychiatric disorders were assessed in (1) the clinical study group of obese adolescents and (2) the population based sample of obese adolescents, and compared to (3) a large population-based control group using a standardized psychiatric interview.

SUBJECTS

(1) Clinical study group: 30 female and 17 male extremely obese adolescents and young adults (age range: 15-21 y; mean BMI:42.4 kg/m2). (2) Thirty females and 17 males with the highest BMI (age range 15-21 y; mean BMI: 29.8 kg/m2) of a population-based control group encompassing 1655 (805 males) adolescents and young adults. (3) The population based control group excluding the 30 females and 17 males with the highest BMI (n = 1608; 788 males).

MEASUREMENTS

Munich-Composite International Diagnostic Interview (M-CIDI) allowing for DSM-IV diagnoses.

RESULTS

High rates of mood, anxiety, somatoform and eating disorders were detected in the clinical sample of obese adolescents which exceeded those observed in population controls (all P-values < 0.01). Rates between population-based obese adolescents and young adults and population controls did not differ. In most patients the psychiatric disorders set in after onset of obesity. 57% and 35% of the female and male patients, respectively, reported eating binges with lack of control. However, less than one-half of these patients qualified for a DSM-IV diagnosis of an eating disorder.

CONCLUSIONS

Extremely obese adolescents and young adults who seek long-term inpatient treatment have a high lifetime prevalence for affective, anxiety, somatoform and eating disorders. Because the mean BMI of the clinical study group was considerably higher than that of the obese population controls, we were not able to clarify whether the high rate of psychopathology in the study group was related to the extreme obesity or to their treatment-seeking behavior.

Prevalence of marked overweight and obesity in a multiethnic pediatric population: findings from the Child and Adolescent Trial for Cardiovascular Health (CATCH) study

OBJECTIVE

Determine the prevalence of marked overweight and obesity among children in the Child and Adolescent Trial for Cardiovascular Health (CATCH), identify high risk groups, and compare findings to other recent studies.

DESIGN

Cohort study.

SUBJECTS/SETTING

Five thousand one hundred-six school children who were participants in CATCH at baseline (age approximately 9 years) during 1991 and 4,019 of those children who had follow-up data from 1994 (age approximately 1 years) available.

METHODS

Body mass index (BMI), triceps and subscapular skinfolds, subscapular to triceps skinfold (S/T) ratio, and an estimate of body fat distribution from skinfolds was calculated. Findings were compared to population-based reference data from the First National Health and Nutrition Examination Survey, 1971 to 1973 (NHANES I), to data from the Bogalusa Heart Study, and to data from the Third National Health and Nutrition Examination Survey, 1988 to 1994 (NHANES III).

RESULTS

Children in CATCH were markedly heavier and fatter than the NHANES I population and more comparable to the NHANES III population, especially those in the upper percentiles. The prevalence of obesity based on BMI and triceps skinfolds >95th percentile among CATCH children was higher in boys than in girls at both baseline (boys 9.1%, girls 8.6%) and follow-up (boys 11.7%, girls 7.2%). It was higher among African-Americans and Hispanics than whites for both sexes. S/T ratios did not differ appreciably from those observed in the NHANES I reference population, suggesting that body fat distribution was more stable over time than BMI and skinfolds.

APPLICATIONS

Our findings support other recent reports that American children, especially African-American and Hispanic children, are becoming heavier and fatter. Preventive measures are warranted, especially for high-risk youth.

Assault, PTSD, family substance use, and depression as risk factors for cigarette use in youth: findings from the National Survey of Adolescents

A national household probability sample of 4,023 adolescents aged 12 to 17 years was surveyed by telephone via structured clinical interview to determine the impact of familial substance use, sexual and physical assault, witnessed violence, depression and posttraumatic stress disorder (PTSD) on risk of smoking. Results indicated that familial substance use increased risk of smoking only for boys and sexual assault or depression increased risk of smoking only for girls. Age, Caucasian ethnicity, and experiencing physical assault or witnessing violence elevated risk of current cigarette use for both genders. By contrast, PTSD per se was not associated with increased risk of smoking, after the effects of other variables were controlled.

Psychosocial differences associated with body weight among female adolescents: the importance of body image

PURPOSE

To determine whether overweight female adolescents differ from normal and underweight female adolescents with respect to a set of psychosocial factors, while controlling for body image.

METHODS

Female participants of the National Longitudinal Study of Adolescent Health (n = 3197) were selected for analysis. Multivariate Analysis of Variance (MANOVA) was used to test whether overweight subjects differed from normal and underweight subjects with respect to measures of depression, self-esteem, trouble in school, school connectedness, family connectedness, sense of community, autonomy, protective factors, and grades. Stepdown F-tests and discriminant function coefficients provided information regarding the strength of specific factors in contributing to overall differences.

RESULTS

MANOVA revealed significant differences between groups on the combined set of psychosocial factors. Self-esteem defined the difference in a positive direction while grades defined the difference inversely. When controlling for body image, multidimensional group differences were still evident; however, self-esteem was no longer a significant contributing variable.

CONCLUSIONS

While overweight female adolescents seem to suffer from low self-esteem, it may be explained by body image. Efforts should be directed toward encouraging and supporting healthy eating patterns and physical activity while encouraging students to recognize personal strengths not related to physique.

Family functioning and psychosocial adjustment in overweight youngsters

OBJECTIVE

To analyze the relationship between family functioning and psychosocial adjustment in Dutch overweight children and adolescents.

METHOD

Seventy-three overweight (weight-for-height >P90) and 70 normal-weight youngsters between the ages of 10 and 16 years were recruited by school physicians during routine medical screening. The Family Dimension Scale, the Child Behavior Checklist, the Teacher Report Form, the Self-Perceived Competence Scale, and the Body-Esteem Scale were filled out, as well as a specific weight-related questionnaire.

RESULTS

Both parents and teachers report more behavior problems in overweight children, particularly in the younger than 13 age group. Lower body-esteem was found in older overweight girls, whereas in older overweight boys higher levels of body-esteem were found. More significant relationships were found with the weight-related Parental Concern Scale than with the Family Dimension Scale.

DISCUSSION

The results suggest that a developmental psychological approach reveals important age and sex differences. Weight-related instruments may be more useful than general questionnaires.

Eating disorder symptoms in a cohort of 11 to 16-year-old black and white girls: the NHLBI growth and health study

OBJECTIVE

This study sought to provide reference data for the Eating Disorder Inventory (EDI) with use of young adolescent black and white girls. Moreover, the study examined the relationship between race, age, socioeconomic status, and adiposity and each of the eight EDI scales.

METHOD

To achieve these aims, data were used that had been collected in Years 3, 5, and 7 as part of the National Heart, Lung, and Blood Institute Growth and Health Study, a longitudinal cohort study of risk factors for obesity in black and white girls. For the present report, data were available from 2,228 girls in Year 3, 2,056 girls in Year 5, and 1,902 girls in Year 7.

RESULTS

EDI scores were found to vary by race, age, socioeonomic status, and body weight of respondents. Black girls scored different from white girls on all EDI subscales. Scores on all but two subscales (Body Dissatisfaction, Drive for Thinness) decreased significantly with increasing age. Significant inverse associations were found between maximum parental education and all EDI subscales except Body Dissatisfaction and Perfectionism. Elevated body weight was associated significantly with Body Dissatisfaction, Drive for Thinness, Bulimia, Interoceptive Awareness, and Ineffectiveness.

DISCUSSION

Our results illustrate the importance of taking into consideration the potentially confounding role of demographic characteristics and body weight when comparing different race or ethnic groups on the EDI.

Changes in self-esteem in black and white girls between the ages of 9 and 14 years. The NHLBI Growth and Health Study

PURPOSE

We examined changes in self-esteem and feelings of competence with physical appearance and social acceptance over approximately 5 years in 1166 white and 1213 black girls, aged 9 and 10 years at baseline.

METHODS

Maturation stage and body mass index (BMI) were assessed annually. Biennially girls completed Harter's Self-Perception Profile for children. Changes were analyzed in the context of race, sexual maturation, BMI, and household income. Longitudinal regression models were used to compare trends with age in global self-worth, physical appearance, and social acceptance.

RESULTS

Mean global self-worth showed little change over ages 9-14 years in blacks (p = 0.09) but decreased in whites (p < 0.001). Mean physical appearance scores for both races declined between ages 9 and 14 years (blacks, p < 0.001; whites, p < 0.001). Mean social acceptance scores increased for both races between ages 9 and 14 years (blacks, p < 0.001; whites, p < 0.001). For all three scores, these changes differed between blacks and whites (all three p values, < or = 0.002). Adjustment for maturation stage, BMI, and household income did not alter the significance or direction of racial differences in the changes with age in global self-worth and physical appearance scores. Self-worth, physical appearance, and social acceptance scores decreased with increasing BMI. Decreases in physical appearance and social acceptance scores with increasing BMI were smaller in blacks than in whites (p < 0.05). After adjustment for maturation stage and household income, racial differences in social acceptance scores depended on BMI (p < 0.05) but not on age (p = 0.008).

CONCLUSIONS

This article reports the first data on self-esteem scores by age for a large population of black girls aged 9 and 14 years and concludes that self-esteem does not follow the same developmental pattern in black as in white girls. A reason for black girls' higher and more stable self-worth and their greater satisfaction with their physical appearance compared to white girls may be racial differences in attitudes toward physical appearance and obesity.

Pediatric obesity. An overview of etiology and treatment

Pediatric obesity is a chronic and growing problem for which new ideas about the biologic basis of obesity offer hope for effective solutions. Prevalence of pediatric and adult obesity is increasing despite a bewildering array of treatment programs and severe psychosocial and economic costs. The definition of obesity as an increase in fat mass, not just an increase in body weight, has profound influence on the understanding and treatment of obesity. In principle, body weight is determined by a balance between energy expenditure and energy intake, but this observation does not by itself explain obesity. There is surprisingly little evidence that the obese overeat and only some evidence that the obese are more sedentary. Understanding of the biologic basis of obesity has grown rapidly in the last few years, especially with the identification of a novel endocrine pathway involving the adipose tissue secreted hormone leptin and the leptin receptor that is expressed in the hypothalamus. Plasma leptin levels are strongly correlated with body fat mass and are regulated by feeding and fasting, insulin, glucocorticoids, and other factors, consistent with the hypothesis that leptin is involved in body weight regulation and may even be a satiety factor (Fig. 2, Table 1). Leptin injections have been shown to reduce body weight of primates, although human clinical trials will not be reported until summer 1997. So many peptides influencing feeding have been described that one or more may have therapeutic potential (Fig. 2, Table 1). Although the complexity of pathways regulating body weight homeostasis slowed the pace of understanding underlying mechanisms, these complexities now offer many possibilities for novel therapeutic interventions (Fig. 2). Obesity is a major risk factor for insulin resistance and diabetes, hypertension, cancer, gallbladder disease, and atherosclerosis. In particular, adults who were obese as children have increased mortality independent of adult weight. Thus, prevention programs for children and adolescents will have long-term benefits. Treatment programs focus on modification of energy intake and expenditure through decreased calorie intake and exercise programs. Behavior-modification programs have been developed to increase effectiveness of these intake and exercise programs. These programs can produce short-term weight loss. Long-term losses are more modest but achieved more successfully in children than in adults. Several drug therapies for obesity treatment recently have been approved for adults that produce sustained 5% to 10% weight losses but experience with their use in children is limited. Identification of the biochemical pathways causing obesity by genetic approaches could provide the theoretic foundation for novel, safe, and effective obesity treatments. The cloning of leptin in 1994 has already led to testing the efficacy of leptin in clinical trials that are now underway. Although novel treatments of obesity are being developed as a result of the new biology of obesity, prevention of obesity remains an important goal.