Abstract
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 1157 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.
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References
Dietz WH . Health consequences of obesity in youth: childhood predictors of adult disease. Pediatrics 1998; 101: 518–525.
World Health Organisation. Obesity: preventing and managing the global epidemic. WHO: Geneva; 1998.
Stunkard AJ, Wadden TA . Psychological aspects of severe obesity. Am J Clin Nutr 1992; 55 (Suppl 2): 524S–532S.
Stunkard AJ, Mendelson M . Obesity and the body image. 1. Characteristics of disturbances in the body image of some obese persons. Am J Psychiatry 1967; 123: 1300.
Strauss RS . Childhood obesity and self-esteem. Pediatrics 2000; 105: e15.
French SA, Story M, Perry CL . Self-esteem and obesity in children and adolescents: a literature review. Obes Res 1995; 3: 479–490.
Mellin LM, Slinkard LA, Irwin CE . Adolescent obesity intervention: validation of the SHAPEDOWN program. JAMA 1987; 87: 333–338.
Kolody B, Sallis JF . A prospective study of ponderosity, body image, self-concept, and psychological variables in children. J Dev Behav Pediatr 1995; 16: 1–5.
Brown KM, McMahon RP, Biro FM, Crawford P, Schreiber GB, Similo SL, Waclawiw M, Striegel-Moore R . Changes in self-esteem in black and white girls between the ages of 9 and 14 years: the NHLBI Growth and Health Study. J Adolesc Health 1998; 23: 7–19.
Braet C, Mervielde I, Vandereycken W . Psychological aspects of childhood obesity: a controlled study in a clinical and nonclinical sample. J Pediatr Psychol 1997; 22: 59–71.
Lazarus R, Wake M, Hesketh K, Waters E . Change in body mass index in Australian primary school children, 1985–1997. Int J Obes Relat Metab Disord 2000; 24: 679–684.
Wake M, Salmon L, Waters E, Wright M, Hesketh K . Parent-reported health status of overweight and obese Australian primary school children: a cross-sectional population survey. Int J Obes Relat Metab Disord 2002; 26: 717–724.
Waters E, Salmon L, Wake M, Hesketh K, Wright M . The Child Health Questionnaire in Australia: reliability, validity and population means. Aust NZ J Public Health 2000; 24: 207–210.
Cole TJ, Bellizzi MC, Flegal KM, Dietz WH . Establishing a standard definition for child overweight and obesity worldwide: international survey. BMJ 2000; 320: 1240–1243.
Cole TJ, Green PJ . Smoothing reference centile curves: the LMS method and penalized likelihood. Stat Med 1992; 11: 1305–1319.
Kuczmarski RJ, Ogden CL, Grummer-Strawn LM, Flegal KM, Guo SS, Wei R, Mei Z, Curtin LR, Roche AF, Johnson CL . CDC growth charts: United States. Adv Data 2000; 314: 1–27.
Waters E, Salmon L, Wake M . The parent-form Child Health Questionnaire in Australia: comparison of reliability, validity, structure and norms. J Pediatr Psychol. 2000; 25: 381–391.
Wake M, Hesketh K, Cameron F . The Child Health Questionnaire in children with diabetes: cross- sectional survey of parent and adolescent-reported functional health status. Diabet Med 2000; 17: 700–707.
Waters EB, Wake MA, Hesketh KD, Ashley DM, Smibert E . Health-related quality of life of children with acute lymphoblastic leukaemia: comparisons and correlations between parent and clinician reports. Int J Cancer 2003; 103: 514–518.
Landgraf JM, Abetz L, Ware JE . The Child Health Questionnaire (CHQ): A user's manual. The Health Institute: Boston; 1996.
Baughcum AE, Chamberlin LA, Deeks CM, Powers SW, Whitaker RC . Maternal perceptions of overweight preschool children. Pediatrics 2000; 106: 1380–1386.
Waters E, Salmon L, Wake M, Wright M, Hesketh K . The interpretation guide for the Australian authorised Adaptation of the Child Health Questionnaire: Adolescent/self report form: CHQ CF-80 & CF-50, Centre for Community Child Health. Melbourne, Victoria, May 2001.
Waters E, Salmon L, Wake M, Wright M, Hesketh K . The interpretation guide for the Australian Authorised Adaptation of the Child Health Questionnaire: Parent/proxy form: CHQ PF-50 and PF-28, Centre for Community Child Health. Melbourne, Victoria July 1999.
Acknowledgements
This study was supported by grants from the National Heart Foundation, Financial Markets for Children, and Murdoch Childrens Research Institute. KH is supported by a National Health and Medical Research Council Public Health Postgraduate Scholarship. We acknowledge the contribution to data collection of Bibi Gerner, Louisa Salmon, Naomi Paine, Susan Gallagher, Jennifer van Gemert, Sarah Barker and Winnie Lau.
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Hesketh, K., Wake, M. & Waters, E. Body mass index and parent-reported self-esteem in elementary school children: evidence for a causal relationship. Int J Obes 28, 1233–1237 (2004). https://doi.org/10.1038/sj.ijo.0802624
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DOI: https://doi.org/10.1038/sj.ijo.0802624
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