Childhood Obesity and Self-Esteem

DISCUSSION

These data demonstrate a significant relationship between obesity and changes in self-esteem during early adolescence. Obese white and Hispanic girls demonstrated significantly lower levels of self-esteem by 13 to14 years of age compared with nonobese white and Hispanic girls. In addition, childhood obesity had a mild effect on self-esteem in young adolescent boys. Because negative weight perceptions are particularly common among young adolescent white females,^17–21 it is not surprising that young obese adolescent white females show the lowest levels of global self-esteem. Nevertheless, negative perceptions of obesity also exist among adolescent boys;^17–21 it is, therefore, not surprising that obese adolescent boys demonstrate mildly decreased levels of self-esteem.

In this study, obese white and Hispanic girls had similar changes in self-esteem. Unfortunately, no other study has documented the effects of obesity on self-esteem in Hispanic children. However, data from the 1989 Youth Risk Behavior Survey indicate that 37% of white and Hispanic girls consider themselves too fat, compared with only 25% of black girls.¹⁸ Similar weight concerns among Hispanic and white girls also were demonstrated in the Minnesota high school health survey.²² In addition, data from the 1985 National Health Interview Survey also demonstrate similar weight perceptions and dieting patterns among adult white and Hispanic women.²³Data from the San Antonio Heart Study shows that Hispanics' perceptions about weight and obesity is influenced strongly by the degree of acculturation. Hispanic men and women in transitional suburbs demonstrated considerably less weight concerns and dieting behaviors, compared with whites in the same suburbs. In contrast, Hispanic men and women living in affluent Anglo suburbs had very mild differences in health and obesity related behaviors compared with whites.²⁴

These data also demonstrate significant social consequences of decreasing self-esteem in obese children. Obese children with decreasing levels of self-esteem showed significantly elevated levels of loneliness, sadness, and nervousness. Although these effects ere not unique for obese children, they are nevertheless quite important, because nearly 70% of white and Hispanic obese females demonstrated decreasing levels of self-esteem by early adolescence.

Obese children with falling self-esteem are also more likely to engage in high-risk behaviors such as smoking and alcohol consumption. Jackson previously has reported that low levels of self-esteem were correlated with initiation of tobacco and alcohol use among 4th to 6th grade students.²⁵ Similar findings have been reported by Abernathy et al,²⁶ Boptvin et al,²⁷and Murphy et al,²⁸ but not Michell et al.²⁹These findings are particularly important because Ryan and colleagues³⁰ have reported that adolescent girls often use smoking as a means to control their weight. For this reason, the Expert Committee on Childhood Obesity has recommended that smoking cessation needs to be an integral part of childhood obesity treatment.³¹ In addition, up to 50% of obese adolescents who drink alcohol have abnormal liver enzyme levels.³²

In this study, self-esteem in preadolescence (9 to 10 years of age) was not related to obesity. In contrast, global self-esteem by 13 to 14 years of age was related to the presence of obesity. These findings, along with the data from Stunkard and Burt,³³ indicate that early adolescence is a crucial time for the formation of self-worth in obese children. These findings are consistent with the findings of Harter and colleagues,³⁴ which demonstrate that approval from peers is particularly important to the development of self-esteem in adolescence. In contrast, preadolescent self-esteem is more related to family interactions and family support.³⁵

Only one other study has assessed longitudinal changes in self-esteem among obese children.³⁶ Gortmaker and colleagues³⁶ did not demonstrate significant changes in self-esteem over a 7-year period for obese 16- to 24-year-old individuals after adjusting for baseline self-esteem, racial, educational, and socioeconomic factors; however, baseline levels of self-esteem were not reported for the obese and nonobese adolescents. In addition, changes in self-esteem scores were not stratified by race or age. Finally, the Rosenberg self-esteem scale utilized by Gortmaker and colleagues has poorer psychometric qualities and lower internal consistency compared with other measures of self-esteem such as the SPPC.³⁷

Although these data demonstrate an association between the presence of childhood obesity and lower levels of self-esteem in early adolescence, the causal relationship remains speculative. Other factors associated with obesity, such as decreased levels of physical activity, increased levels of depression, or poorer home environments, may contribute to lower self-esteem levels in obese adolescents. In addition, this study does not determine the effects of weight loss or weight gain on self-esteem.

In summary, early adolescence is a critical period for the development of self-esteem among obese boys and girls. These effects are particularly strong among obese Hispanic and white girls. Unfortunately, negative attitudes toward obese children begin quite young and may be difficult to change.³⁸ Additional studies need to focus on whether positive family or social interactions can alleviate the negative psychosocial affects of adolescent obesity. Finally, pediatricians and health professionals need to understand the detrimental psychosocial consequences of childhood and adolescent obesity. Obese adolescents with decreasing self-esteem are likely to report increased levels of loneliness, sadness, and nervousness and are also more likely to smoke and drink alcohol. According to Brownell and Wadden,³⁹ “The professional community is concerned with the medical concomitants of obesity, but the psychological and social perils are at least as important to those afflicted by the problem. The reason is clear; society does not tolerate excess weight. The effects of this overt and covert pressure to be thin can be powerful and permanent.”