Obesity Plus Low Self-Esteem May Lead to Risky Behavior in Teens

From the WebMD Archives

Jan. 14, 2000 (Atlanta) -- Obese boys and girls have significantly lower self-esteem than their nonobese peers at age 14, according to a report in the January issue of Pediatrics. The researchers also found that obese adolescents with esteem difficulties are more likely to engage in such risky behaviors as smoking and drinking alcohol. Doctors say effective weight control should focus on lifestyle issues rather than strict diets and calorie counts.

Researchers collected data from over 1,500 white, black, and Hispanic children at age 10 and followed them for four years. Self-esteem was measured using a standard psychological tool, body mass was calculated from height and weight, and tobacco/alcohol use was reported via questionnaire.

The data showed that self-esteem was not significantly different between obese and nonobese children at 10 years of age. But by age 14, significantly lower self-esteem was observed among obese boys and girls of all races. But the effect of obesity on self-esteem in white and Hispanic girls was significantly greater than it was in black girls. In all of the teens, low self-esteem was associated with feelings of sadness, loneliness, and nervousness. Additionally, the obese children were more likely to use tobacco and alcohol.

The chief investigator says the findings have implications for psychological well-being. "Our findings and [those of] others indicate that early adolescence is a critical time for obese children," says Richard Strauss, MD, director of the Childhood Weight Control Program and assistant professor of pediatrics at the University of Medicine and Dentistry of New Jersey. "Because this is when they're developing their sense of self-worth."

"The focus should be on healthy food choices and eating right rather than strict calorie counts," says Strauss. "Increasing physical activity and watching less television is equally important. Also, this and other research suggest that teen-age girls smoke cigarettes to control their weight. That's why an expert committee has recommended that smoking cessation be an integral part of childhood obesity treatment."

Psychiatrists say parents who enforce strict diets may actually be contributing to a poor self-image. "Enforcing a strict diet informs children that parents are in charge," says Robert Begtrup, MD, a child psychiatrist and associate clinical professor of psychiatry at Vanderbilt University in Nashville. "This denies children a sense of control and reinforces their low self-esteem. It's also probably too soon to panic about obesity in early adolescence. At 14, kids still have a lot of growing to do." Begtrup tells WebMD that allowing adolescents to guide obesity treatment is a good approach.

"Parents should make an appointment with the pediatrician and let their child take charge during the visit. That way, a safe and effective plan of treatment can be developed that the child buys into," says Begtrup, who was not involved in the study "Parents also need to look in the cupboards and make adjustments in order to support their child's efforts."

"Our findings demonstrate an association between childhood obesity and low self-esteem, but a true causal relationship is only speculative," says Strauss. "Depression, weight gain, and home environment are additional factors in need of study. Investigation in these areas may help identify interventions to improve self-concept."

Vital Information:

  • Obese teens have significantly lower self-esteem at age 14, compared to nonobese teens.
  • Effective weight control programs should focus on eating healthy foods and increasing physical activity, not counting calories.
  • Parents of obese children should allow them to guide their own treatment.