Childhood obesity's effects on self-esteem, learning and development

Childhood Obesity and Its Affects on Self-Esteem, Learning and Development

Childhood obesity has reached alarming proportions in developed nations of the world and its prevalence is continuously rising from 1971. In the Scandinavian countries, childhood obesity is less than compared to the Mediterranean countries; yet, the amount of obese children is increasing in both cases. Even though the highest rates of childhood obesity have been seen in developed countries, and at the same time, obesity is increasing in developing countries as well. Childhood obesity is at increased levels in the Middle East and Central and Eastern Europe as well. As an example, in 1998, The World Health Organization project assessing of cardiovascular diseases had showed that Iran was one among the seven countries, which had the highest rates of childhood obesity. (Dehghan; Akhtar-Danesh; Merchant, 2005, p. 1485)

In UK, observations state that there has been a noticeable enhancement in obesity levels, and now among girls, one in five children who were of 9-year of age and one in three children who were of 11 years of age are overweight. There was also the collection of data regarding the measurements of the skin fold levels at the triceps. Considering that there has been an enhancement in the body mass index, these measures were not greatly higher than those expected from the standards of 1975. The explanation was that the 1975 standards were focused on overweight children. (Rudolf; Sahota; Barth; Walker, 2001, p. 1094) Thus there is an increase in body mass index, but no clear facts are available regarding other measures. Thus it may be advisable to take body mass index as an indicator of obesity.

There are many reasons behind the increase in weight, but the basic reason is that the energy input is more than the energy output. Even for children it is the same. All our energy input is in the form of food. There have been quite a few studies, which show that, on average, obese children do not consume more calories in a major way than their other thin children. At the same time, energy output includes the basal metabolic rate and the thermal effect relating to food and activity levels. The thermal effect of food consists of the energy needed to absorb and digest food. Among all the variables, which have an effect on energy consumption, activity is the one, which is the most less affected by genetic inheritance and is hence the one which is most susceptible towards change. When one measures calories and food, it has been seen that 3,500 calories is equal to 1 lb. This makes sure that an excess intake of about 50 to 100 calories daily would lead to a 5-10 lb weight gain during one year. (Moran, 1999, p. 74)

In order to understand the effects of obesity, a study was conducted for 8 years while the children grew up from 4 years to 12 years and the study was among 15% of the total population of the area. The sample that were chronically obese was seen to be around 15% and this number was about three times the generally expected number from the latest of the CDC measures, and the study was conducted in 2003. The population was of white rural youth. There were also changes in obesity among other sections of the population and a group of 7% became obese while passing through primary school age. At the same time, another group of 5% who had been obese earlier became normal during this period. The other interesting point is that chronic obesity is far more prevalent among the poor and less educated families. This probably has some implications with regard to mental health. There are many new methods for the study of data and there has to be development of mental health situations before any firm comments are made. (Jane Costello; Mustillo; Worthman; Erkanli; Keeler; Angold; 2003, p. 858) Only after complete studies are made should there be any final comments on the subject.

Thus Obesity is a feature that exists in all parts of the world and is only related to dietary habits. It is not related to any specific country or any specific method of preparing food, but depends on the relationship to food consumed and physical exercise done. Many parents would prefer to blame their youngster's obesity on medical problems like thyroid, but less than 1% of obese children have a hormonal imbalance or any other medical condition. While there is no proper explanation for obesity, genetics, poor nutrition, bad eating habits and lack of exercise are the likely reasons. (Weight can Damage Self-Esteem) These problems can only be removed through continuous efforts to change habits, which have led to obesity in the first place.

Child obesity and low self-esteem and other psychological and behavioral problems

One of the primary effects of obesity is low self-esteem. This relationship has not been studied using a considerable amount of empirical evaluation making use of strong research methodologies. Thus, it is not fully clear as to whether self-esteem is always linked with obesity, or whether the relationship is total or only related to physical appearance. The variance of the relationship due to demographic variables like age, gender or race or ethnicity, and due to weight variations during the period of weight loss treatment programs is also not clear. (French; Story; Perry, p. 479) Every case of obesity is a research on body image and should examine several outlooks of a child's feelings regarding their physical self. These include the child's overall total satisfaction with that of their body, or their views about various parts of the body. In sum total, researchers have to look at the particular issue of thinness vs. that of fatness, and satisfaction with the shape and figure of one's body affecting self-esteem. (Abell, Steven C; Richards, Maryse H. 1996, p. 61) Children are also individuals and have their own personal opinions and this has to be looked into.

In a study conducted by Pierce and Wardley, low self-esteem was found among children who believed that they are responsible for their overweight as compared to others who attributed their overweight to an external reason. Low self-esteem was also discovered among children who viewed that their high weight harms their social interaction. These provide some significance to the general view that the overweight child is vulnerable to have low self-esteem. (Pierce; Wardle, 1997, p. 645) At the same time there are gender variations in levels of general self-esteem and age variations in physical self-esteem. Girls who were greatly overweight showed even low levels of physical self-esteem in comparison to girls who were more or less moderately overweight. On the other hand, for boys, the opposite feelings are seen. (Strauss, 2002, p. 424)

Some of the problems come from our social systems and behaviors, and that is why some experts like to work with children who are below the age of 7. The reason for this is that age the child grows, the dietary and sedentary habits of the child becomes more and more difficult to change as they get built in. Changes in these habits also have psychosocial factors on the child. The undue focus of the family is on the child's weight, and the children perceive their visits to the doctor for an occasion to be scolded. According to studies, 30% of girls and 24.7% of boys had reported being teased by their peers. On top of this, 28.7% of girls and 16.1% of boys informed being teased by family members. The effect of the teasing by family members was probably worse than the effects of teasing by other boys or girls. Teasing about body weight is connected with feelings of low levels of body satisfaction, reduced self-esteem, high levels of depressive signals, and suicidal tendency and attempts of suicide, even after controls have been developed for body weight. These feelings are the same for both boys and girls, and also for racial and ethnic groups. The main reason that kids become overweight is due to our society structure. Our recreation and transportation is sedentary. Cooking at home is disappearing, and the trend is to eat fast foods full of fat in high amounts. It seems that our society is designed to promote obesity. (Moran, 2003, p. 22)

The problems of children are not constant but keep developing over a period of time. In a particular case, researchers collected data from over 1,500 white, black, and Hispanic children of 10 years of age and followed up with collection of data for four years. The data showed that self-esteem was not different between obese and normal children in a major way at the beginning that is at 10 years of age. But when the children became 14 years old, low self-esteem was noted among obese boys and girls belonging to all races. There are also racial differences and the effect of obesity on self-esteem in white and Hispanic girls was rapidly higher than it was in black girls. Among all teens, low levels of self-esteem were linked with feelings of loneliness, sadness, and nervousness. This often led the obese children to use tobacco and alcohol. Psychiatrists also said that parents who insist on strict diets might be contributing towards a poor self-image as the child may be feeling that he or she is incapable of running his or her life. (Obesity plus Low Self-Esteem May Lead to Risky Behavior in Teens)

There are also differences that are found in different studies of such children, but what we have to note are the common factors. There was a study of 1,000 mostly white children of the ages from nine to 16 living in a rural North Carolina region. This region has childhood obesity at a level three times more than in the entire country. The children under the study were assessed yearly over an eight-year period in order to understand about weight, height, psychiatric disorders, and tendencies towards mental disorders. Chronic childhood obesity was found to be associated with a greater chance of depression in boys and hostile and defiant behavior in both the sections of boys and girls. At the same time, it did not show to enhance the risk of substance abuse, attention deficit disorder, chronic anxiety, or other psychological difficulties. (Mental Illness Common in Childhood Obesity; Defiance, Depression Cited in Study)

Child obesity and learning problems

Studies among boys have shown that intelligence test score and educational level are less for higher levels of obesity. A study conducted by Lissau and Sorensen evaluated as to whether difficulties in the learning are being linked to overweight and obesity. In the year 1974, weight, height and social background were analyzed for Copenhagen boys who were being 987 randomly chosen and for every child, information relating to learning problems, reduced hearing, speech problems, was being collected. (Lissau, I; Sorensen, T.I. 1993, p. 170) This was the basis of the study, but one should note that there are many other factors, which were involved, and on the basis of this study it is difficult to come to a firm decision.

That view is supported by another study, which found an important test score gap in math and reading between the overweight and normal children at baseline and, even in follow up observations as both groups increase similarly over a period of time. The differences, other than for boy's math scores at baseline, are less important when socioeconomic and behavioral variables are being considered. The findings show that overweight is a sign, but not a reason for impacting academic performance. Further race, ethnicity and mother's education are strong causes of test score gains. However, even though the important variations in test scores by means of overweight can be reasoned with other features, like parental education and the environment at home, students more easily observe the characteristics of being overweight than other socioeconomic features, and its link with poor academic performance contributes to the stigma of overweight even in the first years of elementary schooling. (Datar; Sturm; Magnabosco, 2004, p. 58)

Performance in school requires a certain degree of mental peace and that is difficult to achieve when a person is obese. There is a reduced interest in school due to the hopelessness and frustration and anger envelope the child. Often this hopelessness and frustration about weight along with that of anger and hatredness, which is toward those who tease them or those, who pass comments at them, which make them seem small in the student community. Healthy and significant weight loss can bring about hope, self-respect, and better outlook for the future. (Is there a connection between my child's weight and poor performance in school?) The problems of obesity lead to a disturbance of mental peace and these lead to the development of difficulties in concentration. When disturbances take place, it does not remain confined only to the immediate matter of concern, but spreads to all activities, and that is the reason for the effect on studies.

In a study conducted by Richard Strauss on childhood obesity and its consequences for self-esteem a sample of a total of 1520 children who were between 4 and 5 years of age and born to mothers in the National Longitudinal Survey of Youth were being collected. The sample made the survey easier to conduct, and the important matter is that scholastic and global self-esteem were not very different among the obese and other children at the beginning of the study. Then the study continued and during the course of the 4-year period, both white and Hispanic females showed a growing tendency of lower self-esteem. This was in comparison to others who were not obese. The tendency was the same among boys also, but the decreases were not to the same levels. This continued and by the time the group reached 8 to 9 years of age, there were significantly low levels of self-esteem as could be seen in obese boys, obese Hispanic girls, and obese white girls when they were compared with their counterparts with normal builds. (Strauss, Richard S. 2000, p. e15)

This decrease in levels of self-esteem in obese children was combined with highly increased rates of sadness, loneliness, and nervousness. This was particularly noticeable when they were compared with other obese children whose self-esteem increased or remained unchanged. Thus this drop in self-confidence is not a universal phenomenon that occurs for every body, and should be studied in terms of parental characteristics to have been passed on to them. In addition, obese children with decreasing levels of self-esteem over the 4-year period had also more chances to smoke and drink alcohol in comparison to other obese children whose self-esteem enhanced or remained unchanged. (Strauss, Richard S. 2000, p. e15) While these are all interesting results of a study, it should be seen whether the changes came about from family influences or was only due to obesity.

Child obesity and peer group problems

Obesity is a situation causing difficulties for children and every social situation may be embarrassing for the child with excess weight. Overweight children cannot manage their lives very well as the present culture is about being slim. These children generally have low activity levels; they generally do not participate in sports; their social circles tend to be much more restricted than normal; they often view their bodies as being unacceptable to society. They have taken the question of being slim into their hearts. (Is there a connection between my child's weight and depression?) They also have solutions available to them of going into gymnasiums, which are now available in every street corner, but were not available earlier in such profusion. When the child has to appear in gym classes or public swimming pools, and there they have to wear more revealing clothing there is potential for embarrassment. Any obese child deciding to play competitive sports often suffers the humiliation of being considered to be the last one chosen for the team. (Weight can Damage Self-Esteem) In some cases, the direct examples of children can be seen, and let us say, one Kyle is being found outside on the school playground along with other 4-year-old children of the school. He is standing towards one side and watching other children longingly as they try climbing over the wooden ladder, tries to crawl through the tunnels, trying to hang from that of the monkey bars, and tries to glide down through the slide. Then a teacher persuades him and Kyle tries to join in. In spite of his efforts he has problems in trying to keep up with the other children. Then he repeatedly tries to climb the wooden ladder, but does not succeed and at this some of the children laugh. One child yells out, "My brother says you are fat." (Lynn-Garbe; Hoot, 2004, p. 53) This sort of a problem does not have to come from only obesity, but from other defects also, and any physical difficulty will cause a person to be a little afraid and hesitant.

It is clear that overweight and obese primary school-aged children are more likely to be the victims and perpetrators of bullying behaviors than their peers who are of normal weight. As a result, the social and psychological development of overweight and obese youth in the short-term and long-term may be considered to be difficult. (Janssen; Craig; Boyce; Pickett, 2004, p. 1188) The obese children are not capable of fast movement, and this will certainly make them slower than other children and the fright will make them afraid. For this reason acceptance of bullying may seem to them a better alternative.

Certain linkages were found between BMI category and peer victimization. This showed that overweight and obese children had greater chances of being victims of aggression than other children who were of normal weight. Strong and important effects were seen in terms of withdrawing friendship or spreading rumors or lies and even direct forms of effects like name-calling or teasing, kicking, hitting, or pushing. There have not been cases of sexual harassment. It did not matter about gender, but there were no relationships between BMI category and bully perpetrating among the primary-school children. There were cases between BMI category and bullying among 4-year to 5-year-old boys and girls. In these cases, the overweight and obese were more likely to cause bullying in comparison to their classmates who are of normal weight. Associations were seen to form for relational forms of bullying which is found among boys and overt forms of bullying for both genders. (Janssen; Craig; Boyce; Pickett, 2004, p. 1188) This is probably a case of solving psychological problems of bolstering their egos due to the feeling of inferiority that they develop due to their obese physical structure.

The bullying that obese children face probably leads them to becoming bullies, and this was found in a study in Canada, conducted after the study in Britain and U.S.. In this survey there were 5,749 Canadian schoolchildren who were aged 11-16 and the study was carried out between 2001 and 2002. The method was for preteens and teens to report as to how many times they had been bullied at school over the last 2 months and how frequently they had bullied another student at school over the last 2 months. About 12% of the preteens and teens were usually victims of bullies, around 9% bullied their peers, and about 3% were being both victimized by bullies and had bullied others. In a majority of the cases, the greater a child's BMI -- Body Mass Index, the more possibility was the child to be involved in bullying. (Bullying and Overweight and Obese Children) The reaction is quite similar to the reactions of these obese children with others of the same age, but a smaller child is certainly easier to bully, and preferable for the bully.

A study was conducted by University of Michigan behavioral pediatrician and her former colleagues at the Boston University, states that there is an indirect relationship to behavior problems and obesity, and that includes problems with peers. This study was a comprehensive weight, demographic, physical and mental health, behavior, education and socioeconomic look at data from 755 children who were aged between 8 and 11 years old, as well as their mothers. All data was collected through the National Longitudinal Survey of Youth, wherein interviewers are being sent to participants' homes on a regular basis for several years. The findings stress that in the study the majority of the overweight children did not have a significant behavior problem, but there was an important correlation between the two. 21% of the children having behavior difficulties were overweight, as against the 11% of the children without having behavior problems. Thus one can say that there is a likelihood of developing behavioral problems when the person is obese. At the same time, we do not know the reason for obesity and genetics, as well as regarding a family's cultural and home situation, are known to play a significant role for children to become overweight. The researchers are also trying to understand as to how sleep habits, brain chemistry, and home environment influence behavior as well as learning. (Childhood obesity and behavior problems linked) At the same time, any changes in behavior due to bullying take place only later in their growth cycle, and changes in behavior will certainly lead to psychological changes.

For many overweight children, their physical health and well being are not a very important problem. Their reactions are more due to the taunting, teasing and poor treatment they have to receive from other children during school time as well as in the community. To add to this, it's not only how of as to others think of them, but also how they view regarding themselves. A sizable section of overweight kids, especially girl's end up clinically depressed due to their thinking of being overweight. (The Psychological Consequences of Obesity in Children and Teens) Depression may also be connected with their academic performance being inferior to other children, and that also may be a result of their being obese or overweight beyond some limits.

The obese children showed their quality of life as being lower when compared to the young cancer patients due to teasing and weight-linked health problems. This feeling is more of a psychological reaction without much of the prevalence of a physical rationale. Obesity rates in Canadian children have tripled from the 1980s to that of the 1990s and are still growing at the same pace. This is similar to increasing rates in other developed countries as also the United States, where 15% of school-aged children are obese. The data is based on a national survey of Canadian youngsters, aged from 11 to 16, and was conducted in the year 2002. The study found that obese girls were more than five times in comparison to normal-weight girls to physically bully other children at least once in a week. For boys, the chances of being physically aggressive was only little bit enhanced, but they were more than double to make fun of others and to spread lies and rumors in comparison to normal-weight boys. (Study links kid's obesity to bullying risk)

Recommendations and conclusion

The result of excess food intake is seen and a relatively small imbalance between energy input and output and may lead to major weight gains during the course of time. This is what happens in the case of most obese children and they have a slow but consistent weight gain over many years. Children today are considered to be less active than children of former generations and the increase in fatness shows that the total calories which are consumed have not reduced in spite of the decrease in activity. What children eat today should be considered along with the role of soft drinks, fast food and other food items that are consumed for consideration of their risk for obesity. The influence of societal trends on children's diets should also be assessed, and that includes the increase in television viewing which leads to cutting down of activity, enhancing sales of 'snack foods' and 'supersizing'. (Issues and action in childhood obesity)

For solving the problem, what is required is assessing obesity in childhood. The first benefit that it offers is that it is the best possible hope for avoiding disease progression along with the associated morbidities into the stage of adulthood. The second benefit is that they permit consideration of genetic and hormonal causal factors of obesity in children though these situations are rare and often not estimated. Another point is that obesity has a negative influence on the self-esteem of children, and this may have important meanings for their long-term happiness and success later in life. This also can be corrected only if the examination is done. Final benefit is from directed sessions to stress upon healthy eating and exercise routines for children and their own families. These may have lasting long-term impacts on the lifestyle of these patients. (Moran, 1999, p. 74) For any lasting change to take place, it is not enough to think in terms of changing the food habits of the child or adolescent, as most often the food habits come from the entire family and the total culture. Changing this involves changing the mindset of the full family, and not of an individual member.

The question still remains as to who should take responsibility for children's diets and their weight -- whether it is the parents, schools, food industry, government, or children on their own? One of the good things may happen is if the children talk to their parents regarding their eating habits. Then they are less likely to be related to unhealthy behaviors and show less of psychosocial distress. This should lead to participation in collective activities, like sports and club activities. This is also associated with better social ties. And one has to remember that childhood stigmatization could bring about a long-term impact. (Psychological Impact of Obesity on School-aged Children)

Some of the actions have to be taken by parents and these can be outlined as:

1. Respecting the child's appetite. This means that children should not be forced to finish each and every bottle or meal.

2. There should be avoidance of pre-prepared and sugared foods are it is possible.

3. A limitation should exist for the quantity of high-calorie foods, which are kept in the house.

4. The diet provided to children should be healthy, with 32% or less calories from fat.

5. There should be ample fiber in children's diet.

6. There should be replacement of whole milk by skimmed milk at the age of 2.

7. Food should not be treated as a source of comfort or as a form of reward.

8. The reward for finishing a meal should not be sweets.

9. There should be restrictions placed on television viewing.

10. There should be encouragement for active play.

11. There should be regular family activities like ball games, walks, and other outdoor related activities. (1) At the same time, this should not destroy the spirit of independence within the child.

This is not enough and it is essential that obesity be prevented for there is now an improved rise in the occurrence of obesity. All experts accept that obesity prevention has prime importance, but there has been very little research in this area. There are also no accepted methods for obesity prevention. There are not enough documents outlining the success of various intervention techniques. One may even speculate that factors of treatment results, meaning the psychological and social and demographic factors may also serve as obstacles to reach preventive strategies, but this has not been confirmed through investigations. When all facts are taken together, obesity prevention should be a research goal which should have a high priority. There are some obesity prevention programs and initial results are promising. There has to be health promotion and counseling, improved school education as well as social support. (Muller; Mast; Asbeck, I; Langnase, K; Grund, 2001; p: 15) In certain cases, some governments like that in New Zealand where the Ministry of Health research have discovered that 31% of children are obese or having overweight, decided to take action on its own and stated that school children need to do at least one additional hour of physical activity every week for dealing with obesity and sedentary lifestyles. (Physical Activity for Primary School Pupils)

Though all the problems that have been discussed may be viewed as individual problems of an obese child, yet it is also the problem of the development of the society. The problem of childhood obesity has to be addressed and dealt at the community level. The leaders of the community have to be made aware of why and how they should get involved in the efforts of preventing obesity. Schools have to take up the responsibility for offering maximum nutrition and physical activity facilities for all students as also for educating students regarding the real significance of nutrition and physical activity to achieve total health. This brings up an urgent demand for schools to reformulate and revise their policies and programs pertaining to physical activity. Further, community programs have to join with school programs so that children get real opportunities to be physically active, both during and after the hours at school. This type of effort is being followed and implemented in many nations of the world and is likely to result in good results for treating childhood obesity. The other major players in this activity are the parents and they must be ready to accept and make changes in their own lifestyle patterns pertaining to eating and physical activity levels. (Trowbridge; Hill, 1998, p. 573) Only this can help the issue of childhood obesity.

Obesity is not at all a good characteristic for any child, but the development of obesity may be due to different reasons and the sum total of reasons may not be known yet. The results of the same quantity of food on different individuals are not the same, and the total impact of heredity on growth is also not known. It is better that more studies be undertaken to cover these areas.