The self-esteem of children who become overweight or obese is likely to fall, claims a new study that confirms what many heavy children and their parents already know.

To determine if being overweight precedes a low self-esteem among children, or low-self esteem leads to becoming overweight, Australian researchers followed 1,157 children, aged 5 to 10 years at the start of the study, and evaluated their weight and self-esteem in 1997 and again in 2000.

Overweight and obese children had lower self-esteem scores than non-overweight kids at both time points but especially at follow-up, said study author Kylie Hesketh, a researcher at the University of Melbourne & Murdoch Children's Research Institute in Parkville.Her report appears in the October issue of the International Journal of Obesity.

"We don't know exactly why high body mass index [or BMI, a ratio of height to weight] reduces self-esteem," she said. "However, we do know that bigger children get teased about their weight, and this is likely to contribute to the reduced self-esteem noted in our study."

In adults, a BMI below 25 is considered healthy. But in the study, Hesketh said, the children were divided into non-overweight, overweight and obese. "As children are still growing, we need to look at BMI in a different way to how we look at it in adults," she said. "We don't use crude BMI scores of 25, 26, and so on. Instead there are internationally recognized cutoff points specific to a child's age and gender to classify them as overweight and obese."

At the beginning, 937 were not overweight, 174 were overweight, and 46 were obese. At the three-year follow up, 881 were non-overweight, 227 were overweight, and 49 were obese.

"In our study, we found that overweight children tended to have lower self-esteem than non-overweight [children], but that the self-esteem of obese children was considerably lower than that of non-overweight or overweight children."

The relationship of the children's starting weight on later self-esteem was more striking than the self-worth at the beginning and the weight status later, she said. The low self-esteem was evident in overweight and obese children at the start of the study and at the three-year follow-up. However, the relationship was much more stark at follow-up, when nearly half the obese children fell into the lowest 15 percent of self-esteem scores.

The self-esteem scores were computed from parents' completion of a standardized questionnaire.

"These are very important studies to look at the effect of overweight," said Dr. Francine Kaufman, who heads the Center for Diabetes and Endocrinology at Children's Hospital Los Angeles. The findings don't surprise her. "I think it's a causal relationship, but a very complex causal relationship," she said. "In their study, it looks like the overweight precedes the low self-esteem."

What can parents do? The first stop should be the primary-care doctor, Kaufman said. "Track your child's height, weight and BMI. Discuss with the health-care provider whether or not it is associated with health risks."

At home, parents can put into place activity guidelines, Kaufman said. "A child should get one hour of physical activity a day and not more than two hours of 'screen' time," she advised. Screen time includes television viewing and leisure computer use, she said, not counting homework time.

Parents should not underestimate their power as role models, Kaufman added, and be sure to keep their own weight healthy and to get regular physical activity.

Read a PDF report on Child Obesity
"Public Health Crisis, Prevention as a Cure"

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Reference Source 101
September 28, 2004

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