Psychology of Learning
Does childhood obesity affect self-esteem?
Observation: Although childhood obesity may have detrimental consequences for childhood self-esteem, the prevalence and magnitude of this problem is controversial (Strauss 2000). In addition, the social and emotional effects of decreased self-esteem in obese children are unknown (Strauss 2000). Several investigators have suggested that psychosocial functioning may be related to the development and maintenance of obesity (Harris 1983; Harris & Smith 1983; Slochower 1983). Overweight youth are believed to be at a high risk for developing low self-esteem (Israel & Ivanova 2002). Over the past two decades there has been a marked increase in the prevalence of overweight and obesity in children worldwide (Janssen, Craig, Boyce, Pickett 2004).
Over the past few years our societal values have been revolved around being thin'. Displayed on television, in magazines, and on billboards are the ultra thin models, including child models. Those who do not fit into the thin' criteria may feel a decrease in self-esteem as a result of not feeling a sense of belonging in the societal norm'. Childhood obesity has been found to be associated with numerous negative social and psychological ramifications (Janssen, Craig, Boyce, Pickett 2004). Children who are overweight or obese find themselves being a target of bullying, tormenting and teasing. Today, a concern of health professionals is to normalize the social and emotional functioning of obese children. There is limited evidence that suggests that overweight girls report lower general self-esteem than boys (Mendelson & White, 1985). According to the Body Mass Index (BMI) a child who is 20% over the average weight for their age is overweight and a child who is 40% over the average weight for their age is clinically obese.
The present study will examine the general, cognitive, social and physical self-esteem in obese children. The study will be conducted within 4 existing summer camps for boys and girls ages 8-14. All participants will have to meet the BMI criteria. Self-esteem has a tendency to fluctuate (Waschull & Kernis, 1996), therefore subjects will be evaluated eight times over the course of the study in order to evaluate and compare the weight and self esteem fluctations and differences firom the different settings. The first group will be a camp designed for overweight children. There, children will be taught how to change their eating habits and how to feel good about themselves. In addition, there will be nutritional counselors who will advise and acknowlwdge the topics of eating disorders. There will be two different summer camps which are designed for normal weight children; for our purposes "group B" and "group C". Group B will be a regular summer camp program designed for normal weight children, however paticipating obese subjects will attend. In this camp, there will be self-esteem workshops which will be offered to the whole camp including the participants of the study. Group C will be a camp designed for the normal weight children but will not have any workshops on self esteem. This study will examine the self-esteem fluctuation among all participants throughout the 6 weeks of camp. Additionally, the research team will also study them two months before and two months after the summer in order to see them in their usual and regular environments. The study it is predicted to show that obese children in general will have a low self-esteem and that the more overweight a child is, the lower their self-esteem will be. It is also predicted that children in the weight loss camp will leave with a higher self-esteem than when they came in, independently of the "self-esteem training". METHOD
Subjects: Participants will include ninety overweight Caucasian children and thirty normal weight Caucasian children. Thirty obese subjects will be enrolled in a weight loss camp and thirty obese subjects will be enrolled in a regular camp with self-esteem workshops. The control group will be matched by age and gender. It will consist of thirty obese subjects and thirty average weights subjects will be in a regular camp without any workshops. Half of the subjects will be male and half female between the ages of 8-14. Subjects will be recruited through letters to pediatricians and school nurses. The overweight subjects will be required to be at least 20% overweight (calculated as 100 x [actual weight-normal weight]/ normal weight is defined as the average weight for age, gender and height). The children and guardians will not know the purpose of the study. The camps, guardians and teachers will be rewarded with money for their compliance. Apparatus: The Perceived Competence Scale for Children will be used. The PCSC (Harter, 1982) is a standardized self-report measure that assesses general and dimensional (cognitive, social, and physical) self-esteem in children and adolescents. The general subscale evaluates perceptions of global self-worth, the social subscale assesses appraisals of interpersonal competencies with peers, the cognitive subscale evaluates views of academic abilities, and the physical subscale assesses perceptions of athletic skills. Responses on each subscale are scored from 1-4, with higher scores reflecting higher levels of self-esteem. The PCSC has been reported to have good psychometric properties (Harter, 1982). This standardized test is specifically made for children ages 8-14. The Research Team's own questionnaire will be used. The questions will address each child's social life at home and in camp. A teacher's report will be used to assess each child's popularity, scholastic abilities and social skills in school (see appendix). A personal profile on each child will be required. It will obtain factual information on the child such as gender, age, religion, placement in family and parental status (see appendix). A consent form, measuring tape and a hidden scale will be used. Procedure: Thirty overweight subjects will be enrolled in a weight loss camp. Another thirty overweight children will be enrolled in a regular camp that will have a once a week workshop that is aiming to enhance the children's self-esteem. These workshops will be identical to the workshops that are normally given at the weight loss camp. Our research team will study the lessons taught in the weight loss camp and our research team will be giving the workshops in the regular camp. Thirty overweight subjects will be in a regular camp with no workshops. Thirty normal weight subjects will be in a regular camp without workshops. All four of the summer camps will commence for 6 weeks. The child and guardians' informed consent will be required along with a personal profile on each child. Two months before camp begins all subjects will fill out the PCSC Questionnaire. Their weight will be obtained using a hidden scale in order to prevent the subjects from knowing the purpose of the study. We will also measure their height. At this time the teachers will be asked to hand in their reports on each child in order to better understand the cause of the child's self-esteem. Once camp begins, the research team will come in weekly to weigh (using a hidden scale) and measure the height of all subjects in the three regular camps. Weight and height of the campers in the weight loss camp will be attained from the staff. Each week all participants will also fill out the PCSC questionnaire. Every week the order of the questions will be rearranged. In order to have 100% compliance, small prizes will be given to the campers. The last week of camp, the subjects will fill out an additional questionnaire from the research team (see appendix). Two months after camp ends all subjects' weight, height and self-esteem will once again be measured. Each child will be identified by a number rather than a name in order to ensure a higher level of confidentiality.
RESULTS AND DISCUSSION
We will first look at all the subjects' weights and its' relationship with time. (GRAPH 1) Then we will look at the subjects' self-esteem and its' relationship with time. (Graph 2) We will look at the self- esteem of the four groups of subjects in each camp and compare it to the subjects' body weight. (Graph 3) Our question will be what is the cause of the different self-esteems in each camp? We will then compare the normal weight children with the obese children in the regular camp without workshops and we expect that the normal weight children will have a higher self-esteem than the obese children in the regular camp. (Table 1) If our prediction is true, we need to know why the normal weight children have a higher self-esteem than the obese children? Did a low self-esteem cause obesity or did obesity cause a low self-esteem? We will compare the self-esteem of the children in the weight lost camp who have maintained their weight loss two months after the summer with campers who have not maintained their weight loss. We predict that the self esteem of the campers who have maintained their weight loss will increase more than the campers who have not maintained their weight loss (Table 2). Two months after the camp has ended, we will compare the self-esteem of the obese children who attended the weight loss camp to the obese children who attended the regular camp without workshops.(Table 3) Why did the self-esteem of the campers in the weight loss camp advance? Is it that the campers in the weight loss camp learned a new attitude or is it that the campers lost weight? First, we will see if learned attitudes can higher self-esteem. We will compare obese children in a regular camp with obese children in a regular camp with self-esteem workshops. We expect that the campers with the self-esteem workshops will have a higher self-esteem. (Table 4) Did the subjects in the weight loss camp leave with a high self-esteem because they lost weight? In order to answer our question, we will compare obese children in a camp with workshops (that attempt to enhance the child's self-esteem) with obese children in a weight loss camp. (Table 5) We expect that that the obese subjects in the weight loss camp will have a higher self-esteem than the obese S in the regular camp with workshops. The obese S in the weight loss camp have not only learned how to raise their self-esteem but they will also have lost weight.
We will also compare the obese children in the weight loss camp with the normal weight children in the regular camp. (Table 6) We expect that the slimmer children in the obese camp will have a similar psychological profile to the normal weight kids in the regular camp since they are both part of the envied "thin" groups.
We will also be comparing the self-esteem in the children in the weight loss camp two months before the summer and two months after the summer. We expect that if they maintained the weight they lost during the summer they will have a higher self-esteem two months after camp than two months before camp. (Table 7) This prediction will support our hypothesis that children that go from obesity to average weight will have a raise in their self-esteem independent of the "self-esteem training". Our results may also find that children may be able to raise their self-esteem by learned attitudes, irrespective of their weight. It is also possible that both losing weight and learned attitudes raise children's self-esteem.
In order to enhance our results we will also be looking at the research team's questionnaire and the teacher's report. For example, we will look at the campers of the weight loss camp and examine if their favorite aspect about camp was their weight loss or if it was that they were the best athletes in camp. We will examine each child's self- report and questionnaire along with his/her weight and self-esteem and see if they have anything in common in which we can draw conclusions.
Israel, A.C., & Ivanova M.Y. (2002). Global and Dimensional Self-Esteem in Preadolescent and Early Adolescent Children Who are Overweight: Age and Gender Differences. Department of Psychology, University at Albany , State University of New York, Albany, New York. Janssen, I., Craig, W.M., Boyce W.F., & Pickett, W. (1992). Associations Between Overweight and Obesity with Bullying Behaviors in School-Aged Children. Pediatrics.Pediatrics, Vol.113, p1187-1194. Klesges, R.C., Haddock, C.K., Stein, R.J., Klesges, L.M., Eck, L.H., & Hanson, C.L. (1992). Relationship Between Psychosocial Functioning and Body Fat in Preschool Children: A Longitudinal Investigation. Journal of Consulting and Clinical Psychology, Vol. 60, p793-796. Strauss, R.S. (2000). Childhood Obesity and Self-Esteem. Division of Pediatric Gastroenterology and Nutrition, University of Medicine and Dentistry of New Jersey, Robert Wood Johnson School of Medicine, New Brunswick, New Jersey. PEDIATRICS Vol. 105 No. 1, p. e15 Waschull, S.B., & Kernis, M.H. (1996). Level and stability of self-esteem as predictors of children's intrinsic motivation and reasons of anger. Personality and Social Psychology Bulletin, 22, 4-13.
The Researcher's Questionnaire- Sample Questions
1.Do you find that other kids bully and tease you?
2.What did you like most about this camp?
3.Did you come to camp with friends?
The Teacher's Report- Sample Evaluations
1.Social Skills- Excellent Average Poor 2.Popularity- (based on a sociogram)Excellent Average Poor 3.Grades-Excellent Average Poor
Personal Profile- Sample Questions
3.Marital Status of Parents- Divorced Widowed Married
4.Number of Children in the Family
6.Placement of Child in the family
These questions will be asked in order to better understand the relationship between self-esteem and obesity. We need to rule out all variables that may affect the child's self-esteem, such as coming to camp with friends, starring in the play or excellent scholastic abilities.